Medication For Breast Milk Production – The first few weeks of breastfeeding are not easy for many women. It’s not uncommon for a new mother, a raw pacifier exposed to the cackling of a hungry baby in the dark of the night, to want a magic pill that makes everything easier. It wasn’t until after her second baby was born that she learned that the pill actually existed. Available by prescription, the generic name is domperidone.
Prescribed to me by the midwife in low doses of 10 milligrams three times a day, these glorious little white pills promised to ease the worries that plagued me around the clock until my heart felt raw too. Enough milk to feed my baby? Or is time marching the two of us through another sleepless night filled with howling, herd feeding, empty chests like sacks, and enough salty tears to drown us both? The worry started the moment I woke up in the morning and grew worse as time went on, taking away my already low energy. To combat this, I filled my day with self-imposed strategies to stay in supply. I drank endless amounts of milk-based herbal teas and liters of water while popping fenugreek and blessed thistle supplements. I also ate a ton of carbs (no science to back this up, but I’m pretty sure I added it to more milk).
Medication For Breast Milk Production
All I longed for was a safety net that I could rely on my body to produce the milk my son needed. He was gaining a lot of weight, but my experiences with his first child raised concerns. Her constant phasing and cluster feeding left me unsure if my body was producing enough. It is constant feeding or slow weight gain in the baby that prompts the regimen for many mothers.
Relactation: Restarting Breastfeeding After A Gap
After receiving the prescription, it took only a few days to realize there was a problem with the supply. Every time I took a pill, I felt like I was biting into an Alice in Wonderland “Eat me” cake. It was as if I was fueling some kind of milk-making magic that turned my breasts from an unreliable pair of instruments into a complete and unmistakable series of instruments. . A machine that produces the required yield. Eating three eggs a day was the most bothersome thing. But just like that, my attention was bent and I was able to devote my remaining energy to handling the mountain of work as a non-worrying business owner and mother of two children under the age of three.
While I was frantically popping her pills, another Toronto mother, Eve Falkovich, was tearing up her domperidone prescription for fear that it might kill her. It took me a day and a half to get her meds. Exactly the same low daily dose I was prescribed. For the first time, my mother felt a non-stop “spooky pain” in her chest below her ribcage. “It was like she couldn’t breathe, like something heavy was sitting on her chest,” she said. Falkovich was aware that she had a cardiac arrhythmia, but when she was prescribed domperidone, it did not appear. When she went to see a doctor about her pain, she learned that the condition could be dangerous and even life-threatening to take medication for. According to Health Canada, domperidone can increase the risk of serious abnormal heart rhythm and sudden death, so it should be prescribed with caution in patients at high risk of developing an abnormal heart rhythm. Falkovich soon stopped taking her medication.
She stopped taking the medication and after about a day the symptoms went away. But she was devastated. Falkovich had breast reduction surgery before her birth and she knew that breastfeeding was not only difficult, but long term. Her doctors warned her that she might not be able to produce milk properly due to possible damage to her nerves and milk ducts during her surgery. But she is determined to do whatever it takes to breastfeed her. Her determination led Falkovich to see three lactation consultants and several doctors, and received three prescriptions for domperidone. Breastfeeding her daughter seemed her only hope. But Falkovich says she’s never seen an expert commenting on the life-threatening risks associated with drugs, and she only remembers the potential side effects of headaches and nausea. “I was desperate to make it work. When I couldn’t give my child her breast milk, it was like letting her down,” she says. “Now I know what nonsense it was. Having my heart stop is probably the biggest failure.” In retrospect, Falcovich, now pregnant with her second child, is furious at the unknown risks she faced while taking her Domperidone. “People need to know. They need to know more about it before they just take it,” she says. “It’s not a conversation about risk.”
One country has the danger of domperidone in its crosshairs. This pill is not approved for use in any condition in the United States. Domperidone is still used in more than 100 countries around the world, including Canada. About 2,000,000 prescriptions are written here each year, many of them for the purpose of increasing breast milk.
Causes Of A Decreasing Breast Milk Supply
But that’s not what drugs are for. When licensed, domperidone is indicated to help with stomach problems. However, this drug also stimulates the pituitary gland to increase prolactin. Jack Newman, one of Canada’s first doctors to specialize in breastfeeding, calls it “the lactogenic hormone.” Doctors have been prescribing off-label in Canada for 30 years because giving domperidone to breastfeeding women usually increases milk supply. Few studies have been able to quantify its effects, but a study of 1,000 mothers last year at Toronto’s Hospital for Sick Children at Newman’s Clinic found that domperidone increased milk supply by 28%.
He has been prescribing off-label since domperidone first became available in Canada in 1985. Some patients are prescribed medication on their first visit to his clinic, the International Center for Breastfeeding, while others are given other strategies to try first. “Sometimes we just wait and see,” says Newman, who prefers to evaluate each mother and baby individually to determine whether breastfeeding problems can be resolved without medication. First, Newman and his team teach mothers how to hold their babies correctly. “The better the latch, the more milk the baby can get from the mother,” he says. They also teach mothers how to recognize when their baby is sucking from the breast. There are ways to check if your baby’s mouth is filling up by looking at the chin and neck area. They instruct mothers to use breast compression to end one breast and offer the other to increase milk flow. Eliminating milk completely signals your body to make more milk.
Nevertheless, if supply still seems to be in short supply (Newman says short supply is very common), domperidone may be prescribed. Some doctors advocate blood tests to measure prolactin levels before prescribing, but Newman says testing can be problematic (prolactin levels change all the time, so the timing of the test can affect results). Most mothers feel an increase in supply within 2 to 3 days of starting the drug, but it may take 1 week to 10 days for others.
Newman said that about 10% of mothers who take domperidone experience a common side effect, a temporary mild headache. In rare cases, women with migraine headaches need to be treated for migraines or stop taking domperidone. For everyone else, says Newman, “Use as much as you need.” He recommends that women take domperidone until their baby is well accustomed to solid food, so that any reduction in milk supply that occurs when the drug is discontinued can be compensated with additional food. Although there are few studies on domperidone’s excretion in human milk, it is presumed safe for babies because of the low levels detected in breast milk.
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Newman’s off-label use of domperidone reflects an unofficial standard widely accepted among physicians who use clinical judgment to prescribe medications they believe may be helpful in a given case. In 2012, more than 2.2 million prescriptions for domperidone were filled each year in Canada. It’s unclear how many of these medications are for breastfeeding women, but a recent British Columbia study found that domperidone is the most commonly prescribed medication for mothers during the first six months of life. Between January 2002 and December 2011, use of domperidone for new mothers doubled, with 20% of full-term mothers in BC receiving a prescription for domperidone in 2011, and 1 in 3 mothers who had previously given birth was prescribed domperidone.
