If you’ve come to this blog post, you’re likely experiencing issues with breastfeeding and if you’re researching domperidone or low milk supply, you’re also likely at your wit’s end. To you I say, “I’m so sorry, and no matter what, it will be okay.”
I found myself in this position at 9 weeks postpartum when my pediatrician confirmed my suspicion that my son wasn’t gaining enough weight. Everett had fallen from the 41st percentile at birth to the 3rd percentile at 9 weeks of age. Dropping percentiles isn’t always a huge deal and pediatricians use a curve to evaluate growth – but my son had fallen off of his curve.
I was so excited that breastfeeding had apparently been going so well for the first few weeks of his life. He achieved his birth weight at 5 days postpartum (10 days to 2 weeks is normal) and had an excellent latch. Breastfeeding had also been a great source of bonding in the midst of severe colic and my postpartum depression.
“Be thankful formula is available. Back in the day, these babies would have required women in the village to feed them or cow’s milk which isn’t nutritionally optimal for an infant,” my pediatrician said. He was right, but I didn’t feel thankful at all; I was devastated and hanging on by a thread as it was. I was not ready to give up on breastfeeding, and anyone who knows me well will tell you that I rarely accept no as an answer.
Panic set in as I left the pediatrician’s office. I immediately called the lactation consultant (IBCLC) whom I’d met in the hospital after delivering my son. Yes, I do realize the irony of a lactation consultant needing the help of another lactation consultant, but I was clearly not in a rational state of mind to be helping myself. Also, I’m very new in my own lactation consultant training. I have not yet obtained my IBCLC designation (I am a CLC) but it is in the process! We will call my IBCLC “V” for anonymity. V is a highly experienced lactation consultant, and she was honestly a godsend.
Disclaimer: If you are considering domperidone and you have not yet seen a lactation consultant, stop reading this right now! This is step number one and it is absolutely critical. The vast majority of breastfeeding issues can be resolved without the use of domperidone.
Disclaimer #2: I in no way condone or recommend the use of domperidone to anyone who is not my patient. This blog post is exclusively intended to be informational in nature and should not be interpreted as medical advice.
V observed Everett nursing and weighed him pre- and post-feed. She assessed his latch (excellent) and monitored for signs that he was swallowing. He transferred less than 1 ounce in nearly 30 minutes, which was not great! He was evaluated for tongue/lip/cheek ties and had none. The issue did not lie anywhere with Everett.
I was sent home with a hospital grade pump and spent the weekend power pumping (10 minutes on, 10 minutes off) for one hour, every three hours, in addition to nursing and supplementing Everett’s feeds with frozen pumped milk. I began taking supplements such as fenugreek, blessed thistle, nettle and fennel. I ate loads of oatmeal, chocked full of flax seed and drank plenty of water. None of this seemed to have any effect on milk output, at least not noticeably so.
After one week of power pumping, nursing and supplements, my supply seemed to be dwindling even more. Around this time, I had my thyroid and prolactin levels tested to ensure there was no underlying thyroid disease causing my sudden drop in milk supply. My prolactin was low for a breastfeeding mother at 10 weeks postpartum. Of note, prolactin levels are finicky and can be difficult to use diagnostically, but it nonetheless seemed low for an exclusively breastfeeding mother.
I was running out of frozen milk, so we began incorporating formula into Everett’s bottles. The first time I watched my husband feed Everett a bottle I sobbed so hard I couldn’t breathe. I realize now how irrational this was and how much added stress I put on myself. In the moment, coupled with colic and PPD it truly felt like the end of the world.
Eventually, he was almost exclusively bottlefed, nursing only for comfort. I also briefly used a supplemental nursing system (SNS) which was quite cumbersome and impractical for my own use. As each day passed, I panicked more at the thought of our breastfeeding journey already being over. My son was only 10 weeks old, and I had planned to nurse him until one year of age. He was becoming fussier at the breast, and I was losing my one good way to console and bond with my colicky baby. The thought that he would soon lose interest in nursing altogether was unbearable.
Around this time, V and I had been texting back and forth as we had been for several weeks. She mentioned domperidone and metoclopramide, and I vaguely recalled learning about them in lactation training. She recommended I research Dr. Jack Newman, a Canadian physician who works exclusively in breastfeeding medicine.
As I mentioned in the top of the blog, I exhaustively researched the literature that does exist. I did not take the risks lightly and considered the innumerable benefits to be gained by continuing with breastfeeding.
Procuring domperidone can be challenging. Many physicians are not familiar with the medication and do not prescribe it. If they do, it must be ordered from a pharmacy outside of the US or from a compounding pharmacy, which can be expensive. It is important to discuss the risks and benefits with your own physician if you are considering domperidone.
I followed Dr. Newman’s protocol and saw an increase in my milk supply within two days. By one week, I was almost exclusively breastfeeding again, supplementing with only 6 ounces of formula per day and milk pumped overnight.
For 10 months I woke up every three hours at night to pump, and I nursed Everett throughout the day. I gradually began weaning off of the medication and dropping nighttime pumping sessions simply because I was exhausted and wanted to sleep. I am still very proud of my experience with breastfeeding and feel grateful to have made it as far as I did.
Here’s some information that I gathered about domperidone in my own research. This constitutes medical education, not advice. Please seek guidance of a qualified healthcare professional for any specific medical questions.
What is domperidone?
Domperidone is a medication that leads to increased stomach motility, so it empties more quickly. Because of this effect, it is prescribed in various countries to treat several conditions, including nausea/vomiting (not in pregnancy), acid reflux and gastroparesis, a condition in which the stomach empties much more slowly than it should. It is also used to treat certain gastrointestinal side effects of drugs used to treat Parkinson’s disease. Domperidone works by blocking dopamine receptors outside of the brain (it does not cross the blood-brain barrier).
Domperidone is also used “off-label” in some countries to stimulate lactation, by indirectly increasing the secretion of prolactin, the hormone responsible for milk production that is produced by the pituitary gland. The medication is not FDA approved for any of the above uses and must be obtained by prescription from pharmacies outside of the United States or from a compounding pharmacy in the US.
Is there another medication like this?
I emphasized that domperidone works exclusively on the dopamine receptors located peripherally (outside of the brain) versus centrally (within the brain) because this is an important feature when comparing domperidone to metoclopramide, a medication available in the US that also blocks dopamine receptors, but does cross over into the brain. Medications like metoclopramide that block dopamine receptors within the brain can also increase prolactin levels, however there is a risk of some specific unwanted side effects – things like tremor, slurred speech, muscle spasms, rigidity, jerky movements and restlessness. The likelihood of experiencing these side effects increases with duration of use, particularly greater than 3 months.
Because domperidone is not able to enter the brain and is not associated with any of these particular side effects, it was a more attractive medication to me.
Why isn’t domperidone available in the US?
The FDA does not approve the use of domperidone in the US for any indication because of concerns of cardiac arrhythmias (abnormal heart rhythms).
Why did I take domperidone anyway?
I exhaustively reviewed the literature (or lack thereof) for several weeks during my own breastfeeding struggles and personally believe that the studies showing a link between the use of domperidone and cardiac arrhythmias are not applicable to the general population. The average age of the patient in the study was 72, and the majority had underlying cardiac risk factors such as high blood pressure, congestive heart failure or cardiovascular disease. I am a young, healthy woman with no cardiac risk factors, and I take no other medications that are associated with abnormal heart rhythms (QT-prolonging drugs, for anyone who cares).
I do not have history of long qt syndrome and I take no other medications associated with qt prolongation.