Domperidone/ low supply problems

[hopsalong]

A brief history of unsuccessful breastfeeding… I have a lovely 16 week old DS who is currently mix fed (about 500ml of breast milk a day, as far as I can reckon, and 350-400 ml of formula). I wanted to EBF, but he lost more than 10% of birthweight by two weeks and so we were referred back to the hospital. Carried on for another two weeks EBF and trying everything, nursing vacations where I spent whole days in bed, pumping after every day time feed (only got tiny amounts!), Mother's Milk capsules etc. But although he had started gaining weight the increase was very slow and he was 'crashing' through the percentiles. He had been big at birth (9.10) and at the 95th percentile (also born late), but by four weeks was down to the 25th! I felt terrible about starving him (though also worried that adding formula would be beginning of the end) and so decided that I would follow advice and top up with formula and expressed milk (where possible) after every feed, and am still more or less doing that now. (Actually I give him a fairly fixed amount of formula a day and so sometimes do three full bottles rather than tiny amounts 8 times a day, which was driving me a bit mad. He also has one small bottle a day of expressed milk.)

Saw a lactation consultant as well as going repeatedly to local breastfeeding clinic. Everyone who has checked thinks his latch etc all good problem with me. It may be a case of insufficient glandular tissue, apparently I have very small widely spaced breasts. But could also be linked to an emergency c-section where I lost a lot of blood and needed a transfusion. Having said that, we did get breast-feeding started quite quickly.

She also recommended maybe trying domperidone to increase supply, but my GP has been reluctant to prescribe. Does anyone think this would help or know how I could get hold of it? Am based in North London and would consider going to a private GP if necessary.

Sorry about long message! Just to finish, I would be happy to limp on like this (though am very sad I couldn't exclusively breastfeed) but am due back at work in seven weeks, and am pretty sure that any extended absence will completely put an end to breastfeeding unless I can improve my supply. So thought if I could take this drug to improve supply I might be able to carry on longer.

[tiktok]

What a difficult time :(

Post partum haemorrage is known to have an effect on the establishment of breastmilk production.

Insufficient glandular tissue sounds as if it might be a factor in your case.

Both of these conditions raise the bar and really work against breastmilk supply :(

I can understand the reluctance of your GP to prescribe domperidone. It's not something to be done without careful thought.

This might help you decide:

www.breastfeedingnetwork.org.uk/wp-content/dibm/BfN%20statement%20on%20domperidone%20as%20a%20galactogogue.pdf

The fact is that breastmilk supply is normally effectively increased by more frequent removal of breastmilk - and this is described in that link. However, you have clearly tried that, and it did not work well enough. I can't see from your post how often you are expressing/feeding direct....but can totally understand your frustration and exhaustion :(

Maybe talk again with your doctor, and take that statement?

[BookSnark]

Domperidone is a tickly one.

Under very similar circumstances - I used it. I got a round on prescription from my GP (rubber stamped by a paediatrician) - and once that had run out (having picked up that GP wouldn't be happy about it as a long term thing) - I bought my own under the 'Motilium' brand name.

Motilium is now no more. It was originally marketed as an anti-nausea/gastric drug. I don't know the details off the top of my head, but iirc, a few too many people developed (serious) heart problems on it. Again recalling off the top of my head (don't quote me) - I think the withdrawal was controversial - since the heart problems related to high dose, long term use by sick people.

I'm pregnant again now - and if the same sequence of problems recurs (relatively likely, since I have more than one previous baby, and in each case all the non-pharmaceutical help in the world didn't manage to get sustained weight-gain) - I'm honestly not sure what I'd do. Firstly - since I don't know if its even available on prescription any more - secondly because presumably there must have been enough contraindications to withdraw it.

Of the herbals - best one IMO is More Milk Plus by Motherlove co.

[BookSnark]

(also - 16 weeks was when the wheels fell off the waggon with DS1. It is a notorious growth spurt. Rightly or wrongly (but with paed support) - we took the choice that it was better for DS to being forward solids, rather than to increase formula. This was because we strongly suspected he was sensitive to cows milk protein.

And I should obviously mention that he is now a fit and healthy teenager - so the story had a happy ending - though it was grim at the time! )

[PenguinPoser]

I would suggest having a read of that link tictok posted and decide if you would be happy to take domperidone. Then go armed with that info to your GP (maybe a different GP?) and have a reasoned discussion. It's the prescribers decision ultimately but they are more likely to prescribe if you're fully informed of the risks and benefits - I speak from experience

Sorry you're going through this it sounds like you're doing a great job.

[hopsalong]

Thank you tiktok for the helpful link and to all of you for 'getting' it! I am from a family of happy untroubled breastfeeders but will go mad if mother or sister tell me one more time to 'just relax' and it will sort itself out. I was pretty relaxed at the beginning until the weight loss and bad weight gain. Currently am feeding directly 7-8 times a day and expressing after all the daytime feeds at home so probably 3-4 times a day. But I don't get very much maybe 30ml at best, usually less. (Over course of day I aim to get 100ml of expressed milk.) We bought a baby scale so we could monitor weight gain at home and I have tried weighing him before and after a direct feed to see how much he takes seems usually to be about 50ml, 60 at best (when breasts feeling quite full beforehand). So think must just not be able to store much. I always feed on both sides now, though didn't always in first couple of weeks. Regret this now. Was told in hospital it was more important for him to finish the first side, to get the fatty hindmilk, but this advice for someone with much more milk than me!

I have to say that after reading the link I am now feeling a bit more cautious about whether taking domperidone would even be right. I have a history of mild heart arrhythmias and feel anxious about the potential side effects. But I will go back to GP and discuss again. Just wish it could have worked out better naturally. Sigh. Has really been quite a blight on these otherwise wonderful/knackering early months.