Auft NZ J Obstet Gynaecol

1988; 28: 68

Suppression of Puerperal Lactation Using Jasmine Flowers

(Jasminum Sambac)
Pankaj Shrivastav,’ Korula George,2 N. Balasubramaniam’ M. Padmini Jasper: Molly Thomas4 and
A.S. Kanagasabhapathy’

Christian Medical College Hospital, Vellore, India

EDITORIAL COMMENT: Zt is unlikely that the use of jasmine flowers for

suppression of lactation will become the rage but we thought that readers would
be interested in this safe and simple method. We rapectfuUrly disagree that it would
be unethical to have included a placebo treated control group in the study (read
on for remon). Twenty years ago (2), when the association between oestrogen
therapy and venous thromboembolism was reported ( I ) , our managemenf of
suppression of lactation changed abruptly from stilboestrol 5 mg tds for 5 days,
to avoidance of breast stimulation, the use of a good supporting brassiere, and
aspirin for pain if engorgement occurred - we were surprised to see how little
difference there was and how few patients required analgesic drugs. Provoked by
this paper, discussion with 12 charge skters of postnatal wards disclosed that about
20% of patients who elect to suppress lactation are prescribed brornocriptine - in
most cases prophylactically rather than as treatment of severe engorgement. This
miniaudit revealed that the nursing staff were not in favour of bromocriptine
therapy except when engorgement was severe, because of nausea and rebound
lactation (often after the patient had gone home) - interestingly in one postnatal
ward in Melbourne, the charge sister used cabbage leaves to treat engorged breasts
and claimed that the method was successful! Routine therapy can become a crutch
you can afford to throw away.

Summary: The efficacy of jasmine flowers (Jasminum Sambac) applied to the

breasts to suppress puerperal lactation was compared that of Bromocriptine. Effec-
tiveness of both regimens was monitored by serum prolactin levels, clinical evalu-
ation of the degree of breast engorgement and milk production and the analgesic
intake. While both bromocriptine and jasmine flowers brought about a significant
reduction in serum prolactin, the decrease was significantly greater with bromo-
criptine. However, clinical parameters such as breast engorgement, milk production
and analgesic intake showed the 2 modes of therapy to be equally effective. The
failure rates of the 2 regimens to suppress lactation were similar; however, rebound
lactation occurred in a small proportion of women treated with bromocriptine.
Jasmine flowers seem to be an effective and inexpensive method of suppressing
puerperal lactation and can be used as an alternative in situations where cost and
nonavailability restrict the use of bromocriptine.

Most South Indian mothers elect to breast-feed
their babies. However, suppression of puerperal lac-
tation is required when a stillbirth or a neonatal death
occurs. The currently available methods of suppress-
1.4 Daniel DG,Campbell H, Turnbull AC. Puerperal throm-
boembolism and suppression of Lactation. Lancet 1967; 2:287
289.
2.4 Quoted in above paper.
1. Lecturer, Department of Obstetrics & Gynaecology.
2. Readers, Department of Obstetrics & Gynaecology.
3. Professor, Department of Obstetrics & Gynaecology.
4. Professor, Department of Clinical Pharmacology.
5. Professor, Department of Clinical Biochemistry.
ing puerperal lactation are unsuitable for use in third
world countries because of either high cost, poor
efficacy or unacceptable side-effects.
Traditional methods of suppressing lactation such
as avoidance of breast stimulation and breast binding
have an unacceptable level of side-effects such as
breast engorgement, tenderness and continued lac-
tation (1). Diuretics and fluid restriction have also
been found to be ineffective (2). Oestrogens, either
alone or in combination with androgens, have been
widely used for this purpose. Their use seems illog-
ical, since oestrogens cause an elevation of serum
prolactin levels, thus causing a rebound lactation on
 PANKAJ
SHRIVASTAV
withdrawal of the hormones in about 40% of patients
(3,4). Also alarming is the increased risk of associated
thromboembolism (5). Pyridoxine in high doses has
been tried but the results have been largely disap-
pointing (6). Bromocriptine has been found to be
very effective in suppressing lactation and its use is
associated with few and infrequent side-effects (7,8).
However, its high cost restricts its use in third world
countries.
Fresh jasmine flowers (Jasminum sambac) stringed
onto cotton thread are used by Indian women for
hair adornment. These flowers applied directly to the
breast are also traditionally used in South India to
suppress puerperal lactation. No human clinical trials
have been conducted to evaluate their efficacy. Stud-
ies on lactating mice have shown inhibition of milk
production, regressive changes in breast parenchyma
and accumulation of eosinophilic material in the lac-
totrophes of the anterior pituitary following the use
of these flowers (9). The present study was under-
taken to evaluate the efficacy of jasmine flowers in
the suppression of puerperal lactation and to compare
it with that of bromocriptine.
MATERIALS AND METHODS
Sixty women who had delivered at the Department
of Obstetrics at the Christian Medical College Hos-
pital, Vellore, and who required suppression of puer-
peral lactation following a fresh stillbirth or an early
neonatal death (within 24 hours of birth) were se-
lected for this study. These women were randomly
divided into 2 groups of 30 each after being stratified
for age and parity. Each pregnancy had progressed
beyond 30 weeks’ gestation. A sample of blood was
taken for serum prolactin estimation (RIA Kit by
Sereno Diagnostic, Rome, Italy), 24 6 hours after
delivery. At this time the breasts were examined and
the degree of milk production and breast engorge-
ment evaluated as follows.
Milk production was evaluated by manual pressure
on the nipple and observations recorded on a Cpoint
scale (8).
0 - absent secretions
1 - few drops on pressure
2 - moderate secretion on pressure
3 - abundant spontaneous secretion
Breast engorgement was rated on a 4-point scale
(8).
0 - no engorgement
1 - slight engorgement
2 - moderate engorgement, no analgesics
3 - severe pain, analgesics required.
The 2 were combined to give a lactation score
(range 0-6). Therapy was then started. Group I was
given bromocriptine mesylate 2.5 mg (Proctinal, Bid-
dle Sawyer Pvt. Ltd., Bombay, India) 8-hourly for
5 days. Patients in Group I1 were treated with jasmine
ET AI 69
Figure 1. Jasmine flowers applied to the breasts.
flowers. Each breast had 50 cm of stringed flowers
bought from the same vendor, applied on to it. The
flowers were kept in place by means of a loosely
applied surgical adhesive as shown in figure 1. The
women were asked to wear loose blouses (without a
brassiere) over the flowers. The flowers were replaced
every 24 hours for 5 days, at which time the breasts
were examined for engorgement. Paracetamol was
given for relief of breast pain as required.
Seventy two hours after the initiation of therapy
a second sample of blood was taken for serum pro-
lactin estimation. The breasts were examined and the
lactation score assessed. The total number of para-
cetamol tablets required for breast pain relief by the
end of 72 hours was recorded. If the breasts showed
no evidence of milk production or engorgement, ther-
apy was continued for a further 2 days by the patient
herself on an outpatient basis. When the lactation
score at the end of 72 hours of therapy was 4 or
higher, therapy was considered to have been unsuc-
cessful. In such patients from Group I, bromocriptine
and analgesics were continued for a further week. In
women from Group I1 with unsuccessful suppression
of puerperal lactation, bromocriptine 2.5 mg 8-hourly
was given for 1 week.
Patients were asked to report at the end of 2 weeks
if engorgement or milk production returned.
In view of the high incidence of breast engorge-
ment, discomfort and excessive lactation reported
with the use of a placebo, the use of a placebo was
considered unethical and no placebo control was used
(10, 11). Statistical analysis was done using the stu-
dent’s test (mean difference test and paired test).
RESULTS
The distribution as regards age, gravidity and ges-
tational age at delivery was similar in the 2 groups
(table 1). The interval between delivery and the com-
mencement of therapy was also similar.
70 AUST.AND N.Z. JOURNAL OF OFJSTETRICS
AND GYNAECOLOGY

Tabh! 1. Patient Pmfii in #be 2 Groups
Group I Group I1
(Ekomocriptine) (Jasmine flowers)
Age (years) 25.9 (4.4) 26.2 (5.9)
Gravidity 3.2 (2.2) 2.5 (1.8)
Gestational age
(weeks) 35.5 (3.2) 35.4 (4.4)
Delivery therapy
interval (hours) 23.5 (4.3) 24.4 (3.7)
Results are means (SD)
The serum prolactin levels and the lactation scores
prior to commencement of therapy were not signifi-
cantly different in the 2 groups (table 2). After 72
hours of therapy while there was a significant fall
@<O 0.001) in the serum prolactin levels in both
groups, the fall was significantly greater in women
treated with bromocriptine compared to those treated
with jasmine flowers Ip< 0.01). However, the lac-
tation scores after 72 hours of therapy, were similar
in the 2 groups.
Jasmine flowers failed to suppress lactation in 2
women and bromocriptine was unsuccessful in 1. This
difference was not found to be statistically signifi-
cant. Analgesic consumption in the 2 groups was also
similar. Two women treated with bromocriptine were
found to have rebound lactation at follow-up 2 weeks
later.
Serum prolactin levels were not found to correlate
well with the lactation scores. In the 3 women in
whom suppression of lactation was unsuccessful,
serum prolactin levels were 1.09 nmols/l, 4.35
nmols/l and 0.28 nmols/l respectively. Likewise, other
women who were clinically asymptomatic with lac-
tation scores of less than 4 after 72 hours of therapy,
had serum prolactin levels as high as 13.04 nmols/l.
DISCUSSION
A variety of modes of therapy to suppress puer-
peral lactation are available. Most of them are as-
sociated with poor efficacy or unacceptable side-
effects or both. Bromocriptine, though an excellent
suppressor of serum prolactin and puerperal lacta-
tion, is limited in usefulness due to its high cost, I t ,
has been shown that in rats, jasmine flowers can
suppress puerperal lactation (9). They found the ef-
fect to be maximal when the flowers were applied
directly to the breast. Though the smell of jasmine
flowers was also found to decrease lactational activ-
ity, the effect was not as marked as when the flowers
were in direct contact with the breasts. They con-
cluded that in rats both tactile and olfactory stimuli
were responsible for the inhibitory action.
In the present study, on clinical evaluation jasmine
flowers were found to be as effective as bromocriptine
in the suppression of puerperal lactation. There was
good patient acceptance, no side-effects and the cost
of treatment was modest (A.$0.5). Continued lac-
tation and engorgement occurred in 2 women (6.7%)
which was not significantly different from the failure
rate with bromocriptine (3.3%). There was no re-
bound lactation observed on discontinuation of treat-
ment with jasmine flowers, whereas 2 women (6.7%)
treated with bromocriptine were found to have re-
bound lactation at follow-up after 2 weeks. This was
not significantly different from the rate reported us-
ing bromocriptine for 14 days (8). The abbreviated
bromocriptine regimen used in this study seemed to
be as effective in suppressing puerperal lactation as
the 14-day regimen recommended by most authors.
Bromocriptine seemed to be more efficient in sup-
pressing serum prolactin than jasmine flowers.
Though jasmine flowers brought about a significant
(p< 0.001) reduction in the serum prolactin levels,
these levels 72 hours after beginning therapy were
significantly higher than those in women treated with
bromocriptine (p < 0.01). However, serum prolactin
levels in the puerperium did not seem to correlate
very well with the degree of lactation. Women with
appreciable breast engorgement and milk production
(lactation score of 4 or higher), were found to have
normal or only moderately elevated levels of serum
prolactin. Also, women with high levels of serum
prolactin at completion of therapy were found to
have no symptoms of breast engorgement or mitk
production.
The mechanism of action of jasmine flowers can
only be hypothesized. it has been postulated that the
tactile and olfactory stimuli of the flowers were re-
sponsible for the suppression of lactation (9). The
olfactory route if responsible for the inhibitory effect,
would probably be mediated through a suppression

Tnbk 2. Serum Prolactin Levels and Lactation Scores in the 2 Groups

Croup I Group I1
(Bromocriptine) (Jasmine flowers)
Serum prolactin Lactation score Serum prolactin Lactation score
Before therapy 6.81 (0.46) 0.23 (0.57) 6.69 (5.25) 0.23 (0.43)
After therapy (72 Hours) 0.56 (0.72) 0.90 (1.06) 3.45 (3.27)*** 1.07 (1.34)
Before - after (difference) 6.25 (4.52) 3.157 (4.06)**
Results are mean (SD)
Prolactin expressed in S I Units (nmolsfl)
bb = (p<0.01)
*** = (p<O.Ool)
 PANKAJ SHRlVASTAVET AL
of serum prolactin. Though a reduction of prolactin
levels was obtained with the flowers, it was not as
marked as that obtained with bromocriptine. This
would suggest that the olfactory route may not be
the major mediator of the suppressant effect. A local
action, as suggested in rats, may be the major mech-
anism responsible for the suppression of puerperal
lactation (9).
Jasmine flowers seem to be a clinically effective
and inexpensive method of suppression of puerperal
lactation with good patient acceptance. In the third
world, where monetary restraints limit the use of
bromocriptine, jasmine flowers can be used as an
alternative.
Acknowledgments
This report is based on a project funded by the
Christian Medical College Fluid Research Grant. The
authors also wish to thank Mrs. Geetha SriKrishna
(Department of Clinical Biochemistry) for her help
in the estimation of serum prolactin levels.
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