Lactation suppression

Pharmacological lactation suppression prevents lactogenesis II, preventing engorgement and the associated pain. It may also decrease chest growth related to lactogenesis II. Pharmacological lactation suppression should not be used for clients who are undecided about bodyfeeding.  

Cabergoline is a dopamine receptor blocker that inhibits prolactin secretion, preventing lactogenesis from occurring [2,3]. It is given as a one-time dose in the first 2-3 postpartum days but is most effective on the first day postpartum. Common adverse effects include headache, fatigue, dizziness, nausea, and orthostatic hypotension.

For more information, see Immediate Suppression of Lactation Following Birth.

Cabergoline is approved by Health Canada for the prevention of lactation in the postpartum period and is on the BC Hospital Formulary (BC Women’s Hospital + Health Centre, 2023). Due to the time sensitive nature of cabergoline, checking availability at your hospital prior to the client’s birth is recommended.  

There is no known interaction between cabergoline and testosterone (UpToDate, 2023).  

When using non-pharmacological methods, the body will undergo lactogenesis II and the milk will ‘come in.’ By not removing milk, the body will gradually cease milk production. Strategies focus on comfort and management of engorgement.

For an in-depth review of engorgement and mastitis, see the Academy of Breastfeeding Medicine’s Clinical Protocol #36: The Mastitis Spectrum.

Detailed client resource (uses gendered language) from the Academy of Breastfeeding Medicine: Mastitis in Breastfeeding.

General recommendations

• Binding Wearing compression garments or using other methods to flatten the chest. the chest lightly may be helpful, but tightly binding may lead to pain, inflammation, and mastitis.  
• Expressing small amounts of milk, just to comfort.  
• Cool clothes, ice packs, and cold compresses can be used for comfort and to decrease pain. Cold cabbage leaves may decrease engorgement pain more effectively than cold compresses, but the evidence is of low quality [4].  
• Pain can be managed using over the counter analgesics and anti-inflammatory medications, if not contraindicated.  
• If a client is suppressing lactation after establishing their milk supply, they should gradually reduce the frequency of milk expression, dropping one feeding or pumping session every 2-3 days.  

Herbal remedies to support lactation suppression

Most herbs used for lactation suppression are based in traditional ways of knowing and have not undergone rigorous testing (e.g., randomized control trials). We recommend consulting a herbalist or naturopath if you want more information about herbal remedies for lactation suppression.