> Agreed about studies, but what about "advising" a mom to use Fenugreek to
> increase her milk supply?
> Is that prescribing, or is it within my scope of practice and knowledge
> base?  There are many sticky wickets out there, and we need to think
> carefully sometimes.
> Patricia Ellis

We discussed whether this is "prescribing" or "advising" as part of our
normal practice. Research the Archives for details. I believe one of the
MDs on this list (Newman?) said, "fenugreek is a food"!

In capsule form it is more concentrated than when one uses it in cooking or
as flavoring in artificial maple syrup. Are we to tell her never to use
herbs and spices in cooking? We do have occasional moms who say their
supply is down after Thanksgiving. Could be true. Could be Gramma used LOTS
of sage in the stuffing! The Thanksgiving reduced supply is recoverable.

Some of us suggest sage as a remedy for oversupply in the same manner as we
suggest fenugreek as a remedy for undersupply. (Remember the song,
"Parsley, Sage, Rosemary & Thyme"? All herbs that can help reduce supply.)

Are we never allowed to tell her to make a tea of any kind, to eat oatmeal,
to plaster cabbage on her breasts, or anything else with a FOOD that may
help increase or decrease her supply? One caveat: if she is using it in a
concentrated form, i.e.capsules, she should tell her doctor if she is in
for an exam, just in case there's a possible interaction with some
medication the doctor may prescribe. Sometimes it happens. Same thing for
vitamins, aspirin, other OTCs we consume for self-medication.

Suggest only what you know. If not sure, don't. When in doubt, refer mom to
an herbal specialist or consult with one yourself. It is always wise to
suggest the bottle be marked "standardized" to be sure there's the same
concentration of herb in each capsule. There are also two US government
marks but I forgot what they are. Participation in this govt assessment is
voluntary by the herbal manufacturer. That they do seek this designation
leads one to have a bit more confidence in that company. Can herbal
specialists out there tell us what these agency letters are?

We do sometimes make an assessment that mom's high caffiene intake is
affecting her supply or baby's behavior, or that the form of iron in her
vitamins is affecting baby, and make suggestions accordingly... We talk to
her all the time about food in relation to BFing.

--- Phyllis Adamson, IBCLC
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