Generally speaking, the lactation literature seems to be cautious about the
use of traditional and herbal remedies, even as many colleagues seem to use
them frequently. Stephanie George makes an appealing case for the safety of
remedies used over centuries by peoples who had sought the advice and
knowledge of traditional tribal elders and medicine men.

I have been cautious about the use of non-prescription drugs and remedies,
including herbal and traditional remedies ever since I attended a 3-day
workshop in 1989 in Harare, Zimbabwe convened by WHO and Health Action
International.  That's a long time ago, but many of the concerns outlined
at that time can be applied to our practice today.

Traditional remedies recommended by n'angas (traditional healers, medicine
men) in African societies are frequently used in place of western medicine
if they can't afford it, or sometimes as well as western medicine, or even
in preference to western medicine if there is a strong belief system in its
efficacy. Nevertheless, I recall a study which showed that the single
largest cause of poisoning in Zimbabwe was the use of traditional "muti" as
this type of treatment is called.

A South African report at
http://journals.lww.com/jpgn/Fulltext/2003/02000/Death_Due_to_Use_of_Traditional_Medicines_in.28.aspx
 reported that  60% to 80% of the population use traditional medicines (
*muti*), some of which are toxic. In an analysis on patients admitted to
hospitals in Johannesburg over one year, 66% were less than one year old
(median 8 m). The authors went on to say that the clinical features
attributable to herbal intoxication may be superimposed on the symptoms of
the pre-existing disease. The overall in-hospital mortality was 33%, with
the malnourished patients showing a similar percentage to the remainder.
The contribution of traditional medicine has not been addressed in most
studies of infant mortality. Children are especially vulnerable to
*muti* intoxication,
possibly due to the difficulties in adjusting doses. The mortality rate of
one third in their patients was much higher than the overall in-hospital
mortality for this age group, which is less than 5%. They believed that the
possible contribution of traditional medicines to deaths that follow their
administration should be notified in mortality statistics that are
collected in African countries.

A very recent literature review at
https://www.hindawi.com/journals/jt/2016/8789624/
Tagiwireyi et al, Lit Review, Pattern & epidemiology of poisoning in E
African region, J Toxicology 2016, includes the research I remember hearing
about (O. M. J. Kasilo and C. F. B. Nhachi, “The pattern of poisoning from
traditional medicines in urban Zimbabwe,” South African Medical Journal,
vol. 82, no. 3, pp. 187–188, 1992). which contained a subanalysis of a
total of 1456 cases of traditional medicine poisoning from their 10-year
retrospective study of all poisonings. They reported that poisoning from
traditional medicines represented 23% (the biggest single group) of all
poisoning cases. Almost two-thirds (67%) of the patients were male and most
of the admitted patients were under 5 years of age (53%). Of the
traditional medicine poisoning cases, 61% were associated with treatment of
an ailment. The authors reported a case fatality rate of 6% from their
study. They found that the main reasons for seeking treatment with
traditional medicines were for depressed fontanelle and fever in children.

My view is that until individual herbal and traditional remedies are
researched and shown to be safe for mothers and/or babies that we need to
be cautious about their use.  It's also a given that recommending them is
out of our mandate.

Pamela Morrison IBCLC
Rustington, England

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