Herbs and
Breastfeeding
Sheila I. Humphrey, BSc,
RN, IBCLC
Dennis J. McKenna, PhD
from Breastfeeding Abstracts,
November 1997, Volume 17, Number 2, pp. 11-12.
Medicinal herbs can be defined
as plants used to prevent or remedy illness. As our understanding of
plant chemistry expands, drawing clear boundaries between food and herbs
becomes increasingly difficult. Cultural attitudes toward herbs are
currently undergoing rapid change, in part because new discoveries about
old remedies are becoming known to scientists and the public. While
much of the commonly encountered information about herbs does not meet
scientific standards, a large body of research literature about medicinal
plants does exist.1-8 However, scientific
information about herb use during lactation, particularly recent studies,
is comparatively sparse. 9-12
Nonprofit educational organizations,
such as the American Botanical Council (ABC)27
and the Herb Research Foundation (HRF),28
maintain large collections of current scientific articles and books,
as well as provide other resources such as Web sites and publications
such as Herbalgram. Chemical and pharmacological data on thousands
of plant constituents can also be found in textbooks, 3,4
on the Web, and through specialized computer databases, most notably
Napralert, maintained by the Program for Collaborative Research in the
Pharmaceutical Sciences at the University of Illinois at Chicago. While
reliable predictions about safety during lactation cannot be made for
all situations, pharmacological data can certainly help assess relative
risk for the majority of herbs widely available for sale in the USA.
Some recent texts1,2,6 and monographs13,14
focus on plants about which there is scientific evidence regarding efficacy
and safety, and this information can help put the reader on firm ground.
Herbs differ from medications
in that they frequently contain a large number of physiologically active
constituents in very small amounts. It is logical to assume that each
of these chemical constituents enter human milk following the same chemical
principles that govern medications. Following the rule of thumb that
approximately 1 percent of a chemical consumed by the mother will enter
her milk,9 it is logical to conclude that
overall extremely small amounts of any one plant constituent will be
present in breast milk. This is not to say that adverse effects could
not occur.
It is important to distinguish
between safety issues in herbal medicine versus safety issues related
to a particular herb. Side effects and toxic reactions to herbs are
considered rare.15,16,17 Toxic effects of
herbs are often not the fault of the herb itself, but are caused by
products containing misidentified plants or contaminants such as bacteria,
heavy metals, or even prescription drugs. Allergic reactions to herbs
can occur, as with any other plant material. Problems associated with
particular plants or product types are documented.2,5
Some plants are inherently dangerous, containing naturally occurring
toxins, often with cytotoxic or carcinogenic effects. While the identities
of the more common toxic plants are generally known, at least to plant
chemists, older herbal texts may not reflect this knowledge.16
There have been occasional
reports in the medical literature of adverse effects in infants from
maternal use of herbs. Review of these cases has generally revealed
either the use of misidentified plants, as in the infamous "hairy
baby" story,18-21 or the inappropriate
or mistaken use of dangerous herbs.22 Even
though these cases were exceptional, involving non-medicinal plants
or dangerous medicinal herbs, it should be kept in mind that some plant
species have been or could be responsible for adverse reactions in the
nursing child.
Some medicinal herbs contain
phytochemicals that have strong effects on the body as part of their
therapeutic action, i.e., purgatives.1 Highly
purified or isolated extracts of plants, such as essential oils or other
concentrated isolates may have markedly different effects on the body
or may even be quite toxic compared to less refined extracts of the
same herb.7, 23 A familiar example would be
fennel oil compared to fennel tea. The German Commission E report considers
fennel seed tea, when prepared using the dose guidelines given, to be
useful for indigestion, whereas the internal use of fennel oil can cause
serious neurological effects.2, 14 Similarly,
the use of essential oils or other strong preparations on nipples where
the child would directly ingest them is a potentially dangerous practice.
Maternal use of strong-acting herbs or herbal preparations should also
be considered a possible risk to the child during lactation, and milder
alternatives sought. Dose-related toxicity is of particular concern
with any potent herb. As with all medications, following the recommended
dose guidelines included with all herb products would be a first line
of defense against overdose.
Referenced herb textbooks
can be very useful and sound sources of information about herbs. However,
their authors are not necessarily knowledgeable about lactation, a fact
that must be kept in mind in reading their recommendations for lactation,
which are usually rather broad. Statements such as "avoid excessive
intake" or "avoid using amounts greater than used as food"
present vague dose guidelines, while the statement "avoid while
breastfeeding" may seem unnecessarily constrictive. Choosing to
err on the side of caution, some authors state that lactating women
should not use herbs at all.1,6
Current thinking about the
risks of chemical substances in human milk, whether they be medications,
plant chemicals, or even chemical contaminants, takes into account the
significant benefits of continued breastfeeding to the baby and the
mother.24 In balancing the risks and benefits
in a given situation, a medication is not considered absolutely contraindicated
unless it is logical to assume harm, or evidence of harm has been documented.9,
25 The analysis of risk and benefits also takes into account
the varied nature of lactation: newborns face different risks than older
babies or toddlers because of immaturity; infants consume varying amounts
of human milk; mothers may be looking forward to years of lactation
yet need or desire the benefits of medicinals.25, 26
Although health care practitioners may wish otherwise, some mothers
may refuse prescription drugs and insist on using herbal alternatives
for a number of reasons. While these mothers may perceive herbs as "safer,"
there are both risks and benefits. As with medications mothers need
knowledgeable individual assessment of their unique situation.
Current science-based writings
on herbs may or may not mention the folkloric or traditional information
available about the use of herbs as an aid to lactation. Ethnobotanical
information stands separate from knowledge gained through application
of the scientific method, but it may still be valid. While little research
has been conducted on the use of herbs as lactation modulators, it would
seem prudent to include these ethnobotanical considerations in any description
of herb use. Practitioners working with breastfeeding women need to
know that herbs such as sage, for example, may decrease milk supply,
even though no lactation studies have been done to verify this. Despite
an otherwise conservative stance on lactation, Newall et al.6
do not cite ethnobotanical information about using sage for weaning
in their recommendations for lactation, although they describe sage's
folkloric use as a treatment for galactorrhea in another section. Other
texts likewise mention sage's reputation as a lactation suppressant,
yet fail to highlight this information when considering use during lactation.2
Careful reading of all the information about an herb is required to
glean lactation-related information. Reliance on a single text for information
pertaining to lactation may be inadequate, all the more so if the ethnobotanical
information has been ignored.
Future investigations of
herbs in lactation are needed, and not just to clarify safety issues,
although these concerns are paramount. Research into the current clinical
uses of herbs as aids in breastfeeding difficulties is also needed,
to put the practice on a rational basis. In addition, research into
the relative risks and benefits of herbal versus medical therapies in
such areas as postpartum depression and thrush would be beneficial.
Investigations of traditional plant use have long been an important
part of drug discovery and the study of human physiology. It is reasonable
to expect that systemic interdisciplinary study of plants with lactation-modulating
reputations would reveal new therapies and provide research tools for
a deeper understanding of human lactation.
Sheila I. Humphrey is
a La Leche League Leader who majored in botany in college. Her husband,
Dennis McKenna, is an ethnopharmacologist in private practice, a Fellow
of the Linnean Society, and an Advisory Member of the American Botanical
Council.
References
- Tyler; V. E. Herbs
of Choice: The Therapeutic Use of Phytomedicinals. Binghamton,
New York: Pharmaceutical Products Press, 1994.
- Wichtl, M. Herbal Drugs
and Phytopharmaceuticals: A Handbook for Practice on a Scientific
Basis. English language edition ed. N. G. Bisset. Boca Raton,
LA: RC Press, 1994. (This volume includes selected extracts from the
German Commission E Monographs for Human Medicine, Section of Phytotherapy.)
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Biologically Active Phytochemicals and Their Activities. Boca
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Page last edited Sun Oct 14 09:32:42 UTC 2007.
