I don't want to breastfeed: how do you stop your milk coming in?

Colostrum production begins from birth, or even towards the end of pregnancy. It is a thick, yellow liquid, very rich in micronutrients. It will meet your baby's needs before your milk supply is established. The milk coming in is the transition from colostrum to more mature, richer milk — high in lactose — which signals the start of lactation. It is a physiological process, occurring between the second and fifth day after your baby's birth.

This milk let-down is caused by the drop in oestrogen and progesterone levels after birth. This triggers the production of another hormone, prolactin, which enables lactation. It can be accompanied by breasts that feel hard, swollen and sore. Milk coming in will happen even if you have decided not to breastfeed your baby, because — just like the delivery of the placenta — it is a physiological process that occurs in the postpartum period for all mothers.

According to the French National College of Gynaecologists and Obstetricians, given their potential side effects, pharmacological treatments for the inhibition of lactation should not be offered routinely to women who do not wish to breastfeed.

Cabergoline

Cabergoline, marketed under the name Dostinex, has a powerful and prolonged inhibitory effect on prolactin secretion. Cabergoline can be used to stop milk coming in.

This medicine, long used as a routine treatment, is certainly effective but carries a risk of numerous serious side effects: nausea, vomiting, abdominal pain, constipation, headaches, dizziness, vertigo, fatigue, orthostatic hypotension with or without fainting episodes. Less commonly: breast tenderness, hot flushes, postpartum depression, tingling in the extremities [1].

Cabergoline has been shown to have fewer side effects than bromocriptine [2].

Cabergoline has a long duration of action, with a half-life of 63 to 69 hours. For this reason, mothers are advised to express and discard their breast milk for approximately 5 days after using cabergoline [3]. Therefore, avoid taking cabergoline for weaning purposes, as you will no longer be able to give milk to your baby.

Lisuride

Arolac, a medicine containing lisuride, can be used to stop milk coming in, primarily for medical reasons (for example, intrauterine foetal death or medical termination of pregnancy). It may also be used in cases of inhibition of milk let-down, cessation of lactation, breast engorgement, or inflammatory breast symptoms.

After childbirth, Arolac is not recommended for women with psychiatric disorders or a history of psychiatric conditions. Careful monitoring is required in cases of smoking, high blood pressure, obesity, vascular disease, or treatment with vasoconstrictive medicines [4].

Breastfeeding must not take place alongside the use of Arolac!

Bromocriptine

Bromocriptine was marketed under the names Parlodel and Bromocriptine Zentiva. It was used because it inhibits prolactin secretion.

Bromocriptine is not recommended for the routine inhibition of lactation or for the relief of postpartum pain or breast engorgement, which can be effectively managed through non-pharmacological means. However, it may be prescribed when there is a medical reason (intrauterine death, etc.).  

This follows the fact that the French national medicines safety agency issued an opinion in 2013 on bromocriptine: "The Committee for monitoring the benefit-risk ratio of health products, after deliberation, unanimously considers that the benefit-risk ratio of bromocriptine-based medicines is unfavourable for the indication 'prevention or inhibition of physiological lactation for medical reasons in the immediate postpartum period (ablactation) and in the late postpartum period (weaning)'" [5].

Indeed, bromocriptine causes side effects: hypertension, myocardial infarction, seizures, stroke, and psychiatric disorders have been reported in women treated with bromocriptine for the inhibition of lactation in the postpartum period [6].

The contraceptive pill

The contraceptive pill is sometimes recommended to stop milk coming in. Oestrogens have a negative effect on lactation, reducing milk production. They can be administered in the form of a combined contraceptive pill, once a day for one week, then stopped. The mother should notice a reduction in her milk production after 5 to 7 days [7]. 
Please note: oestrogen treatment increases the risk of thromboembolism in the mother, particularly if prescribed before 4 weeks postpartum.

Several plants are recommended for their effect on reducing milk production in cases of oversupply or when weaning is desired [8]. These are peppermint, sage, parsley and chaste tree. 

We avoid all galactagogue foods such as fennel, fenugreek, caraway, moringa, etc. that are classically found in a breastfeeding supplement. 

It is sometimes recommended, as a traditional home remedy, to use some green cabbage to reduce engorgement. To do this, simply apply cabbage leaves (straight from the fridge or at room temperature) to your chest. 
Indeed, some studies show that cabbage compresses significantly reduce breast hardness [13] as well as pain [14]. This effect of cabbage has even been found to be more effective than the application of cold [15].

Jasmine petals [16] (Jasminum officinale) are highly fragrant and have long been used to freshen rooms and cool the body. They have been used for centuries to treat post-partum engorgement, particularly when the mother is not going to breastfeed. The petals and essential oils are known to reduce prolactin levels and are effective at reducing milk production. 

If you have the opportunity, try a soft clay paste and apply it in a thick layer (half a centimetre) over the breast. Hold it in place with cling film and make sure to change the poultice before it dries out. Rinse off in the shower and repeat as often as you feel the need to have softer, more comfortable breasts.

In order to stop milk coming in and reduce the associated discomfort, there are several guidelines to follow during the first few days after giving birth.

First of all, you may wish to seek support from an IBCLC lactation consultant. They are the experts in breastfeeding, and it goes without saying that they are also there to support you in situations such as stopping milk from coming in or weaning, and to help you avoid any potential complications.

Breast binding means wrapping the breasts firmly. It has been used throughout history to help women stop producing breast milk.

In a study conducted in 2003 on post-partum women who were not breastfeeding, the effects of breast binding were compared to those of wearing a supportive bra [17].

Although engorgement symptoms in both groups did not differ significantly over the first 10 days, the group who wore binding experienced more pain and leakage overall. Consequently, the researchers do not recommend breast binding.

A supportive bra provides better support for sensitive breasts during movement and helps reduce discomfort.

If you need help stopping your milk from coming in, do not hesitate to consult an IBCLC who will be there to support and guide you through the process.

Although medications to suppress milk production are still sometimes prescribed, they are not recommended unless there is a medical reason to do so.

There are, however, natural alternatives to help reduce milk production: consuming sage, parsley or chaste tree, or applying cabbage leaf compresses to your breasts!