Dying to breastfeed

intensive care unit monitoring system

The following is a guest post from the doctor who wrote A cardiologist’s experience with a “baby friendly” hospital warning women about the off label use of domperidone (a drug typically used to suppress nausea) to improve milk supply in breastfeeding mothers. This message could save your life:

Domperidone is a non-FDA approved drug which is often touted to breastfeeding mothers as a remedy for low supply. It’s available over the counter in many European countries, and can easily be obtained from internet pharmacies.

As a cardiologist, I’m very concerned about this drug, and the European Drug safety agency agrees. Here’s why:

1. Domperidone prolongs the QT interval. This means that it alters the speed and duration of certain electrical currents in cardiac muscle cells, making them very susceptible to a dangerous arrhythmia called torsades de pointes. If this occurs, the heart stops beating and the patient will die unless she is shocked with a defibrillator within seconds. Survivors often suffer from HIE.

2. QT prolonging drugs are silent killers. The first symptom that anything is amiss is that the patient literally drops dead from a malignant arrhythmia. The only (imperfect) way to screen for it would be to do serial ECG’s before and after starting the drug in a hospital environment with full resuscitation equipment nearby. Obviously this is not going to happen with an off-label drug bought off the internet.

3. When a woman is taking this drug on her own initiative from an internet pharmacy, she probably won’t mention it to her doctor. If she is prescribed another drug with QT prolonging effects on top of the domperidone, eg a quinolone antibiotic for postpartum UTI, or antidepressant for PPD, she is at an extremely high risk for arrhythmias. The list of QT prolonging meds is very long and keeps growing, so ideally a doctor should consult it for every new prescription to a patient taking domperidone.

4. Advising a woman to risk her life with this dangerous drug only to be able to breastfeed, is so fundamentally unethical it makes my blood boil. The only excuse these lactation consultants and midwives have is that they don’t have the knowledge to understand what they are doing. Someone who hasn’t been to medical school really has no business playing with this stuff.

5. If the risk to the mother isn’t enough, there’s a risk to the baby too. Domperidone is transferred in breastmilk (LC’s often deny this!) and infants are exquisitely sensitive to its effect. How many ‘SIDS’ cases out there are in fact sudden cardiac deaths from arrythmias caused by maternal domperidone use?

6. Breastfeeding support organisations bear a shattering responsibility here. Where is the big lettered warning on the La Leche League website? Where is their official position statement forbidding their leaders to endorse this drug? They have blood on their hands.

My bottom line is: it isn’t worth it. If you need domperidone to keep your supply, throw it out and start supplementing. You risk death or permanent disability, not only for yourself but for your baby too. I know firsthand how heartwrenching it is to want to breastfeed your baby, and not be able to. The feelings of guilt, fear and inadequacy combined with postpartum emotional vulnerability are completely overwhelming. It’s enough to make the most levelheaded woman look into these harebrained methods. Please don’t make yourself a victim.

Editor’s note: The recommendation to use domperidone off label to increase breastmilk supply shines a light on the essential hypocrisy of the natural childbirth and homebirth movements. The same people who are shocked about the off label use of Cytotec, and imply that off label means illegal, seem to have no problem with the off label use of domperidone. What’s the difference? Modern obstetrics is “bad” and the off label use Cytotec “proves it.” But breastfeeding is “good” so anything, even the off label use of a drug that might kill the mother, must be “good.”

195 Responses to “Dying to breastfeed”

  1. Darlene Henderson
    October 1, 2015 at 5:53 pm #

    Thank you Sarah, Asley and JS for being knowledgable and having common sense. Colbalt, anonymous cadiologist, do your research, then you can come out of the closet.
    LLL Leaders CANNOT discuss medication, IBCLCs CANNOT prescribe medications,I’m both. We’d lose our registration!! We can advise that taking antibiotics does NOT mean you have to wean, that any treatment for thrush has to be given to both mother and infant. We DO discuss the ingredients of formula a drug)and it’s risk factors.
    Thank you skepicalob for entertaining me again with your NON evidenced-based facts and NO references. Your opinions are lethal.

    • Fallow
      November 4, 2015 at 7:08 pm #

      Do you think prescribing massive doses of fenugreek doesn’t count as “discussing” medication? Because it sure as hell does. And that happened to me, from a fucking IBCLC just like your dumb ass.

      And fenugreek is not necessarily harmless. My LC didn’t ask about my own medical state. She didn’t discuss any contraindications, like the fact that I have asthma. She did not worry at all that my pre-eclampsia had organ involvement before she told me to take megadoses of an unregulated, unproven supplement.

      I am also acquainted with a woman who was advised by her LC to get illegal domperidone, and she did it. Don’t you dare lie and tell us this doesn’t happen. A lot of us have SEEN it happen.

  2. Darlene Henderson
    October 1, 2015 at 5:10 pm #

    FYI!! Lactation Consultants and Midwives CANNOT prescribe any medications. hehehe It’s only those with “medical” training who can, the same medically trained “professionals”, who don’t know anything about breastfeeding, the contents of breastmilk, the life saving properties to mother and child. IF, they did, they would not need to prescribe Dom,peridone, as most breastfeeding problems are due to “poor management, and support. Oh, and formula kills, ever heard of Nestle, the “Baby Killers” campaigne/boycott??

    • Dr Kitty
      October 1, 2015 at 5:35 pm #

      Darlene, while stream of consciousness was effective for Keruoac, it works less well as a comment on a blog.
      Could you try and maybe post this as something more coherent?


      A breastfeeding mother who is also a doctor, who supports all safe methods of feeding babies and who doesn’t prescribe Domperidone for lactactional problems.

  3. August 17, 2015 at 3:14 pm #

    Cytotec can indirectly rupture a uterus by causing ridiculously strong contractions, especially risky in a uterus belonging to a woman with a previous c-section scar. That’s why natural childbirth advocates have a problem with it. Don’t leave out that part because it just makes you look dishonest.

    Thank you for the information about domperidone though. And you know who’s using it? Adoptive mothers. It’s even worse than you thought.

    • yentavegan
      August 17, 2015 at 3:40 pm #

      I recently read an article about a parent who was born male but transitioned to being a woman and took domperidone to stimulate lactation. Oh, the infant ended up in the ER with dehydration. Go figure.

      • Young CC Prof
        August 17, 2015 at 4:53 pm #

        Um. Was she actually operating on the assumption that she was producing adequate milk, without external confirmation? That seems… overly optimistic.

        I know some adoptive mothers successfully stimulate lactation, but getting a full supply that way is probably less common than for gestational mothers, and for a transgendered woman the probability of success would most likely be even lower.

        And it’s going to take a lot more than domperidone to stimulate lactation without birth, you need very specific adjustments to hormone therapy as well.

  4. Zen
    April 16, 2015 at 12:50 am #

    As a pharmacist-in-training, I was a bit shaken when I learned how little “gold-standard” evidence is available for the use of drugs in pregnancy and lactation. Use of basically every single drug available is definitely a risk-benefit situation that only a health care provider can assess. Were I in this situation personally, it would be a very hard sell to convince me to take domperidone or metoclopramide to increase supply instead of just giving my kid formula. I am more aware than the average Joe of what these drugs can do, and in my mind the formula is the much safer of the two options with very little downside (for an at-term, otherwise healthy baby, anyway.) Taking on a risk, however small, to your baby by using medications for selfish reasons when there are other safer options available is to me completely incomprehensible.

    • Darlene Henderson
      October 1, 2015 at 5:26 pm #

      Formula safer?? NOT!! Very little downside?? OMG!! What about obesity, hypertension, diabestes, heart, lung, kidney disease, cancers, immune defiency diseases such as Lupus, M.S. As a pharmacist you SHOULD read the ingredients, and then compare to what is in breast milk
      Breastfeeding is NOT selfish. It is the only natural, optimum nutrition — to ALL mammals. You are NOT more aware than the average Joe, much less from what I just read.
      Domperidone is not needed, understanding the breastfeeding process (which is much more than nutrition: love, immunity, security, warmth, pain and stress relief) and how to support breastfeeding and breastfeeding families intelligently is what is needed.

      • Zen
        November 4, 2015 at 5:22 pm #

        Please present me one well-designed study that concludes formula is responsible for any of those things, or else I have no choice but to completely disregard your post as unfounded drivel.

      • Roadstergal
        November 4, 2015 at 5:57 pm #

        “obesity, hypertension, diabestes, heart, lung, kidney disease, cancers, immune defiency diseases such as Lupus, M.S”

        All the things that the best-controlled studies of formula vs BM have shown to be unrelated to BM vs formula? Those conditions that have been massively on the wane in the US since the ’70s, as breastfeeding rates have consistently and substantially risen from that nadir here? Oh, except they haven’t.

        “love, immunity, security, warmth, pain and stress relief”

        You seem to be saying that these cannot be adequately provided by bottle-feeding moms, by adoptive parents, and by non-gestational parents, including fathers. That’s the magic duo of inaccurate and offensive.

  5. Ashley
    April 15, 2015 at 10:32 pm #

    Oh wow.. This website just keeps getting worse. Talk about a rant with zero evidence to back it. Here in canada, there has not been a single report to health canada since 1965 of adverse cardiac events while a breastfeeding mom has used domperidone. Stop scaring people, for no reason.

    • Cobalt
      April 16, 2015 at 12:01 am #

      The reason is called “informed consent”.

      Stop trying to deny mothers information because it’s inconvenient for you.

    • VanessaB
      December 19, 2018 at 5:09 pm #

      The irony. Maybe breastfeeding advocates like you need to still ssscarpingscarring wen about the made up “risk of formula.”

  6. Sarah
    March 14, 2015 at 9:28 am #

    References???? Everything I’ve read on Dom usually has many references unless it is a personal experience from a mother. I don’t see any references here. Or any case by case examples. Seems very opinionated.

    • Cobalt
      April 16, 2015 at 12:00 am #

      It’s the expert opinion of a cardiologist.

  7. Nope
    December 1, 2014 at 2:37 am #

    I am just wondering, what is the name of the cardiologist?

  8. JS
    October 16, 2013 at 8:03 pm #

    LLLI, nor it’s Leaders, ever give medical advice. Advising on domperidone is considered medical advice. This fact in the article is false.

    • yentavegan
      October 16, 2013 at 8:19 pm #

      what rock are you living under? LLL Leaders do talk about domperidone and do ask struggling mothers if they would consider going to a health care provider that can write a script for it.

    • momofone
      March 14, 2015 at 11:00 am #

      They certainly aren’t supposed to, but I know of many cases in which they have done exactly that, in pursuit of breastfeeding at any cost.

  9. yentavegan
    March 27, 2013 at 11:21 pm #

    i was discussing the use of domperidone with an IBCLC. I was defending my decision to advise against the use of this drug . The IBCLC’s position was that the potential placebo affect of the drug outweighed the risks. This was just one more example bolstering my choice not to become IBCLC certified lactation consultant. The money it costs to train and sit for the exam becomes an incentive to throw everything at a mother with lactation issues just to see which one sticks,

  10. Liv
    March 27, 2013 at 12:06 am #

    I’m completely shocked that domperidone is touted as a breastfeeding cure, one women’s hospital here in Australia even has info on their website about it’s use ‘if you’re having trouble’… It’s not approved for breastfeeding women, there is evidence that it is excreted in breastmilk and, dammit, there are no large, well controlled RCTs providing reliable data on safety and efficacy. Why on earth would you take it?

    • Ashley
      April 15, 2015 at 10:34 pm #

      Because the documented and real risks of formula use are greater.

      • Cobalt
        April 15, 2015 at 11:58 pm #

        Actual scientific documentation? And before you start posting studies, check to see if confounders like parents’ education level, socio-economic status, family medical history, etc. are addressed in the study.

      • VanessaB
        December 19, 2018 at 5:05 pm #

        Nonsense. “Risk of formula” is mostly all lactivist propaganda. Formula is perfectly safe and nutritious. I have two formula fed babies who thrived and are in perfect health.

  11. Tim
    March 24, 2013 at 1:14 pm #

    Considering that 1 in 100 babies born in the US have some kind of CHD, and many of them go undiagnosed for a time, it would seem to me that any amount of a QT prolonging drug being passed through milk would be an unacceptable risk to a baby who hasn’t been screened by a pediatric cardiologist.

    • KoryO
      October 3, 2013 at 10:33 pm #

      Actually, I have a child with a CHD. While she was in for corrective heart surgery, a lactation consultant recommended that I get some to augment my breastmilk supply.

      Fortunately, nothing happened to me or my child. I thought that it was ok, because the LC was a hospital staffer, and she said lots of CHD mothers had used it with no bad effects.

  12. lulubee
    March 23, 2013 at 3:58 am #

    This is a rather sensationalist article, given the facts on this matter from what has been published in the literature. While I don’t advocate over the counter or uncontrolled access to drugs, if prescribed by a health professional and with due care to preexisting heart conditions, it seems pretty safe and the alarming stuff stated here is much more theory than fact. On the contrary, the risks of not breastfeeding, to both mother and child are very well evidenced. the evidence doesnt seem to show a high risk of sudden cardiac death with domperidone at all. Even with the widespread uncontrolled use of this stuff over decades there has never been a reported case of sudden cardiac death in a breastfeeding woman taking domperidone. The american academy of paediatrics still considers it “mostly compatible with breastfeeding”, and a whole panel of about 22 medical specialists who work with babies and lactating women recently endorsed the use of it to increase milk supply in healthy women with no preexisting medical conditions. the actual studies which suggested a possible risk (there are only a handful of studies I think 2 or 3) were not with young lactating women, but with elderly. The youngest person who died sudden cardiac death while on domperidone was 55 years old, the average age was 75. I would be worried if you hadn’t given up on breastfeeding by then…. and also there was no causative link established.

    • anonymouscardiologist
      March 23, 2013 at 10:58 pm #

      I’ll bite one more time: there is nothing sensationalist or fear-mongering going on here. Let’s look at the naked facts:

      – The FDA issued a warning NOT to use domperidone as a galactagogue because of cardiac concerns in 2004.
      – AN EMA investigation has been opened recently because of an alarming amount of cardiac events being reported. This will lead to the end of OTC sale of domperidone in Europe in the near future.

      Shouldn’t these two facts cause reasonable doubt regarding domeridone’s safety profile? Why would these things be happening if the risk isn’t there? Were there any (adult) cardiologists in the AAP panel endorsing domperidone?
      Women who take domperidone often do so on the advice of someone who isn’t a doctor (eg lactation consultants, midwives). Even when the drug is prescribed by a physician, they don’t receive ECG checks before and after. This is the standard of care when starting treatment with other QTC prolonging gastroprokinetics such as cisapride. Lactating women do not deseve anything less.

      From an ethical perspective taking risks with a woman’s health to get enough milk for exclusive breastfeeding as opposed to combo feeding is unacceptable. The benefit to the baby doesn’t jusify the risk.

      • Ashley
        April 15, 2015 at 10:43 pm #

        If you read the black box warning, Health Canada has only endorsed the companies own warning. The FDA has issued their statement based on high-dose IV administration… What would happen if we used IV to deliver unusually high doses of say, tylenol? It would certainly have adverse effects – the risk of tylenol are documented. Would it be taken off the market due to this unusual usage? No. Of course not. Cytotec is another great example of an actual dangerous off label use of meds. Domperidone as a dopamine antagonist, according to the available reports, is far less risky than the alternative – not breastfeeding on mom, and formula exposure to baby.

    • Box of Salt
      March 23, 2013 at 11:52 pm #

      lulubee “the risks of not breastfeeding, to both mother and child are very well evidenced”

      Really? Do tell.

      Please be sure that those risks apply to mothers and children who might actually have ready access to this drug – in other words, in developed countries with an adequate clean water supply.

      In your haste to write your statement supporting the use of this drug via prescription, did you miss the part where the author mentioned “It’s available over the counter in many European countries, and can easily be obtained from internet pharmacies”?

      If there are legitimate concerns over the safe use of this drug, why don’t you want them investigated before more women and babies risk using it?

  13. Amy
    March 22, 2013 at 2:15 pm #

    Oh my word!!!! I have read about sooooo many women using this on breastfeeding boards, and NEVER knew that it was so dangerous! How scary!! Are there any stats on deaths caused by using this drug?

  14. CanDoc
    March 22, 2013 at 6:20 am #

    I have to respond with some real science, rather that conjecture:
    1. Head-to-head studies of domperidone and placebo or metoclopramide for increasing milk supply confirm increases in lactation, in varying populations and to varying degrees.
    2. Metoclopramide (aka Reglan or Maxeran) is used routinely in North America for nausea and vomiting in spite of having a more worrisome side effect profile than domperidone, including tardive dyskenesia, but has historically been used for lactogenesis, nausesa and vomiting in (and outside of) pregnancy without the same derision.
    3. The only known cases of adverse events related to domperidone use with respect to QT prolongation have been in the elderly with intravenous (ie higher dose) administration.

    SO, although I am suspicious of domperidone use for lactogenesis, I think this blog contribution smacks of EXACTLY the same fear-mongering that the NCB crowd uses to warn to the “dangers” of epidurals, cesarean sections, and other interventions.

    • anonymouscardiologist
      March 22, 2013 at 7:46 am #

      Your opinion of the safety profile of domperidone seems based on wishful thinking rather than real science. Are BOTH the FDA and the EMA fear-mongering along with me? The last time I looked, they didn’t have any warnings out on epidurals or cesareans, nor were they preparing to pull them off the market. I’ll refute your points one by one:

      1. The issue at hand is not whether domperidone is an effective galactagogue. Even if it makes women produce gallons a day, it simply isn’t worth the risk.

      2. The fact that the only alternative for domperidone (reglan) has an even more horrid risk profile doesn’t make domperidone a safe drug. It only illustrates how little effort is being put into pharmaceutical research to benefit breastfeeding mothers.

      3. Everything that I have written, and the recent EMA investigation, are about the ORAL domperidone. The iv form has been off the market for over 20 years. The fatalities in the recent literature are also on the ORAL form. Let me point you towards this large review from the Netherlands with 10 sudden cardiac deaths in patients taking as little as 30 mg a day ORALLY. Pubmed nr 20925438

      (sorry, no link, disqus won’t let me)

      • CanDoc
        March 22, 2013 at 10:06 pm #

        Fair point about the increased risk in sudden cardiac death even with oral domperidone, BUT again, the average age in BOTH studies that have evaluated this was well over 70 (72.5 and 79 years of age), and there were significant limitations in both of these retrospective studies.
        (References: Johannes CB, Varas-Lorenzo C, McQuay LJ, Midkiff KD, Fife D. Risk of serious ventricular arrhythmia and sudden cardiac death in a cohort of users of domperidone: a nested case-control study. Pharmacoepidemiol Drug Saf 2010;19(9):881-8.
        Van Noord C, Dieleman JP, van Herpen G, Verhamme K, Sturkenboom MC. Domperidone and ventricular arrhythmia or sudden cardiac death: a population-based case-control study in the Netherlands. Drug Saf 2010;33(11):1003-14.)
        The Canadian think-tank for medications in pregnancy and breastfeeding, Motherisk, operating on evaluation of the evidence (rather than taking FDA/Health Canada warnings as gospel – which they are NOT – note black box warnings on warfarin, methylphenidate and fluroquinolones), clearly recommends considering domperidone in healthy young women as a galactogogue, while being aware of QT prolongation and discriminating in its use. The Motherisk position can be found at:

        “A recent systematic review and meta-analysis by Motherisk demonstrated a statistically significant increase of 74.7% (95% CI 54.6 to 94.9, P < .001) in daily milk production following treatment with domperidone and found no maternal safety issues when compared with placebo. 5 At present, some intervention trials are under way to define the appropriate dose in specific populations (eg, mothers of preterm infants). Only minimal amounts of domperidone are excreted into breast milk (less than 0.1% of the maternal weight-adjusted dose), and side effects in breastfed infants have not been reported. Therefore, when nonpharmacologic treatments fail or are inadequate, domperidone might be an option."
        So although I think BFI needs to be buried once and for all, I go out of my way to support my formula-feeding patients against a tide of lactavist vitriol, and I'm not a big fan of prescribing domperidone under most circumstances, I think that it should remain a reasonable, evidence-based option for consenting women in certain circumstances. And if we're going to stop using as a galactogogue, then we need to stop using it for diabetic gastroparesis or IBS, especially given that diabetics are a MUCH higher risk cardiac population.

        • anonymouscardiologist
          March 23, 2013 at 4:27 am #

          I’m not advocating taking domperidone completely off the market. It’s use should be reserved for those cases where the benefits outweigh the risks, the drug is started with appropriate cautionary measures, and the patient gives informed consent. Those requirements aren’t fulfilled in the current situation:

          – When a lactating woman is put on domperidone, she runs a risk. The benefits, however, are not to her, but to another person (her baby). Even if you don’t doubt the quality of the evidence on the benefits of breastfeeding, is this fundamentally ethical?

          – Do you do an ECG for every patient before and after starting the drug?

          – Does every patient give fully informed consent for domperidone treatment?

  15. March 22, 2013 at 4:34 am #

    My understanding is Reglan is even more dangerous than domperidone and Reglan also crosses the blood brain barrier. I was under the impression domperidone is actually pretty safe! I have so many friends who have taken Reglan to increase their milk supply!

  16. Starling
    March 22, 2013 at 1:00 am #

    Ugh. And another crowd favorite, Reglan, can cause tardive dyskinesia when taken in large doses or for an extended period.

    Formula is just not all that bad, people.

  17. notahomebirthlactivist
    March 21, 2013 at 7:47 pm #

    Hmm when I had a premature baby almost six years ago I used this drug to breastfeed for a short time. It is not OTC in aus as far as I know. My obstetrician and the paed both recommended it. No mention of a sids risk. On the other hand the sids and kids council recommends breastfeeding, as a protective practice against SIDS. So on the one hand you have a theoretical link to SIDS which is kind of scary, but on the other hand you have a research organisation dedicated to reducing SIDS who advise mothers to breastfeed where possible. I know I certainly did not have a dying to breastfeed attitude. Neither did the doctors who put me on this medication. I only breastfed for a few months.

    • CanDoc
      March 22, 2013 at 10:16 pm #

      Motherisk remains supportive of careful use of domperidone – requiring a prescription and counselling, not “black market” domperidone from the internet… http://www.motherisk.org/prof/updatesDetail.jsp?content_id=981. Most (but not all) Canadian maternity care providers continue to use it in *select* circumstances, especially for moms with a sick preemie/micro-preemie. (Disclosure: I took it myself for about 6 weeks with my first child, but was feeling a little gun-shy given the recent Health Canada warnings with my second and so didn’t, since the Motherisk review wasn’t out yet at that point in time.)

  18. Not My Normal Nym
    March 21, 2013 at 2:34 pm #

    Let’s put aside the safety concerns about domperidone for a moment and list all of the other things we don’t know about this drug:

    * What percentage of lactating mothers who take domperidone see an increase in milk production?

    * How big an increase is typical on domperidone?

    * How long do mothers typically have to keep taking domperidone to sustain breastfeeding?

    * What is the effective dose of domperidone for nursing mothers?

    * What percentage of lactating mothers are able to EBF while on domperidone?

    * Of those mothers who have to supplement with formula even after taking domperidone, how much supplementation is taking place?

    * Does domperidone significantly increase the duration of breastfeeding? By how much? Is it a matter of weeks? Months?

    Even if domperidone were perfectly safe, it isn’t cheap. If it turns out not to be all that effective at enabling mothers to EBF, then why not spare mothers the expense and bother of taking an ineffective drug?

    • CanDoc
      March 22, 2013 at 10:12 pm #

      The answers for many of these can be found through Motherisk (Canadian publicly funded think-tank devoted to evaluating medication safety in pregnancy and breastfeeding) at http://www.motherisk.org/prof/updatesDetail.jsp?content_id=981.

      I think the main area where we will continue to see domperidone in research and use is for women with premature babies in the NICU, where there is in fact excellent evidence for the benefits of breastmilk (and now resulting in increasing donor-milk banks providing for sick prems, to decrease risk of necrotizing enterocolitis), and given that the amount of medication transferred to the newborn is 0.1% of the maternal weight-adjusted dose. It is widely but not universally used in Canada but requires careful evaluation and discussion, not just a woman who says, “I feel like I don’t have enough milk.”

  19. Lena
    March 21, 2013 at 9:19 am #

    My cousin who just had a baby had intended to exclusively breastfeed for six months, but after only two wet diapers in two days she started supplementing with formula in the hospital. She’s been nursing, pumping, and supplementing since, usually doing two formula feeds a day because otherwise the baby’s constantly hungry, her back is killing her, and she has flat nipples which makes nursing even more of a pain in the ass. She went to the pediatrician for the first time a couple of days ago, and the ped insisted that she not supplement at all and just keep her at the breast all day until she gets the hang of things. So now her husband–who’s usually the kindest, most supportive man I know–is pressuring her about it because of what the doctor said, but the baby literally will stay latched on all day without supplements and scream as soon she’s taken off the breast.

    I told my cousin to find a new pediatrician.

    • anonomom_LLLL_IBCLC
      March 21, 2013 at 10:02 am #

      Is it possible the ped interpreted the mother’s frustration about the situation as her wanting breastfeeding to work, rather than her real plea for advice on feeding her baby more sanely? It’s entirely possible that the ped is fine with partial or full FF, but misinterpreted what the mother wanted to hear. Or the mother misinterpreted what he said.

      If you’re right, I think finding a new ped is a good idea, but also making clear to her husband that there is more to being a good mom than sitting on the couch 24/7 with a leech attached to your nipples. He needs to support her mental health and her relationship with her baby more than he needs to push a particular feeding choice.

      • Lena
        March 21, 2013 at 10:15 am #

        She didn’t even ask for advice, really, since she first gave formula at the hospital staff’s insistence. She simply told her she was supplementing with formula and why, and the doctor took it from there. It’s possible she misinterpreted, but my cousin is soooo not the type to get hung up on the natural stuff, so I think it’s unlikely. And considering the circumstances under which formula was started, I have to question the judgement of a doctor who tells a woman to just keep the baby on her breast round the clock.

        • anonomom_LLLL_IBCLC
          March 21, 2013 at 10:18 am #

          Me too. It seems a recipe for FTT. And PPD for that matter.

  20. anonymouscardiologist
    March 21, 2013 at 2:53 am #

    I’m the author of the post. I’m going to react to a couple of comments but will do it here so it comes on top.

    1. I’m shocked by the number of women who have needed this drug for extended periods of time. It’s time for the dogma “Everyone Can Breastfeed” to come down. Women and babies deserve much better than breastfeeding organisations that publicly deny the existence of lactation failure, while at the same time encouraging them to secretly solve that problem with shady, dangerous drugs off the internet.

    2. ” Is the problem serious enough to warrant such a post?” In my opinion: yes. Back in 2004, the FDA gave out a warning NOT to use domperidone for the purpose of improving milk supply. 9 years later, LC’s on both sides of the pond are still handing it out like candy, and every breastfeeding forum has threads on domperidone use. The reason that EMA has opened an investigation now is that studies on sudden cardiac death and domperidone were appearing with alarming frequency.

    3. “There are no case reports of lactating women on domperidone who died”. There ARE several case reports and at least one large retrospective review documenting sudden cardiac deaths in people who took the drug as an antiemetic. The breastfeeding dosing is in the same range. Why would breastfeeding women be safe on a dosage that kills people with nausea?

    4. “Domperidone is being used for gastroparesis in infants, therefore it’s safe for babies”. I found a study where domperidone was being administered to babies with stomach trouble whith serial ECG checks. 4.4% of them had serious QTc prolongation (all boys, for some reason). If a pediatrician judges that for a particular baby, the benefits of domperidone outweigh the risks, and the drug is started with appropriate ECG checks, that is fine with me. But in what world does that situation compare to feeding an unknown number of healthy babies breastmilk laced with this med without any kind of medical supervision?

    • Guestll
      March 21, 2013 at 9:48 am #

      I don’t know where you’re from, but you might want to check out the breastfeeding culture in Canada. Domperidone is easy to access here via one’s GP, and it’s regularly touted as being the solution to supply issues. I can name at least two dozen women I know here in Canada who’ve obtained Domperidone from their GP. A good friend of mine is a pharmacist who owns two drugstores; Domperidone is one of the more popular drugs she dispenses to women.

      Point being, it’s not just breastfeeding organizations who are pushing Domperidone from the interwebs.

      • March 21, 2013 at 10:29 am #


      • CanDoc
        March 22, 2013 at 10:27 pm #

        I know this is my 4th post of this link, but I PROMISE it’s my last!
        The reason why domperidone is used, albeit more cautiously in recent years than previously, is related to a full review by Motherisk.
        Motherisk is the publicly-funded national think-tank out of Sick Kids Hospital in Toronto whose mandate is to evaluate, with evidence, the safety of medications taking during pregnancy and lactation. Last fall they came out with a clear statement supporting careful consideration of domperidone use in certain circumstances. There continues to be ongoing research and I think standard dosing has decreased from the 20 mg 4x/day of yesteryear to 10 mg 3x/day, and many physicians have become more cautious in their use and indications for treatment. Their statement is clearly written, takes into account the concerns about sudden cardiac death (in patients with mean ages of 72 and 79 in the series reviewed), and confirms that weight-adjusted maternal transfer of the drug to baby is 0.1%.
        So, for a woman faced with objectively proven supply problems, I think that formula supplementation, pumping to increase supply, and domperidone are all legitimate options – depends on what the woman wants to do and underlying medical conditions that would contraindicate domperidone.

    • Disgusted
      March 22, 2013 at 7:04 pm #

      Very interesting…
      I had an ekg where I was told i had a “long QT interval” and 1st degree block, bradycardia and “marked sinus arrythmia” but Im guessing it isn’t very serious? Because they didn’t give me anything and I seem to be fine (this was over a year ago after my doctor found a heart murmur). I’ve had the bradycardia my whole life. I hope I don’t die, haha

  21. Alenushka
    March 20, 2013 at 11:37 pm #

    I had no idea. I am re-posting it everywhere .

  22. Scared in WV
    March 20, 2013 at 10:59 pm #

    Oh crap. I used this for about 12-14 months because I lost my milk. I still had to supplement. I was taking about 100mg per day. I haven’t taken it in like a year and a half. Am I going to die??? Should I get an EKG?

    • Therese
      March 20, 2013 at 11:29 pm #

      Not a health professional but I’m almost certain the effects only last while it is being taken.

    • GiddyUpGo123
      March 21, 2013 at 12:03 am #

      Yeah, me too. I used it for months, with three different babies. If I had even heard a whisper of a possible connection with SIDS, I wouldn’t have taken it. SIDS terrified me.

      I expressed concerns about the safety of this drug to both an IBCLC and the nurse practitioner at my pediatrician’s office, and both of them poo-pooed any claims that the drug might not be safe. They reassured me that the drug was actually prescribed to babies with acid reflux in much larger doses than what was passed on in breastmilk. As for cardiac concerns for Mom, they also reassured me that all studies that showed a connection with heart problems had to do with IV administered domperidone, not the oral tablets.

      If what is written in this blog post is true, then it’s really awful that so many lactivists advocate the use of this stuff just in the name of avoiding the “evils” of formula. I swear if I had only seen this blog back when I had my first baby, I wouldn’t have gone through all the hell of trying to breastfeed and the HUGE expense (and, evidently, danger) of taking domperidone to keep up my milk supply.

      I’d also like the answer to your question: what about the long-term effects of this stuff after you’ve stopped taking it? Is there permanent damage or are we just talking about risks that occur while you are on the drug?

      • Becky05
        March 21, 2013 at 8:29 am #

        The link to SIDS is just conjecture.

        • anonymouscardiologist
          March 21, 2013 at 9:58 am #

          Actually, it’s an educated guess.

          J Pediatr. 2008 Nov;153(5):663-6. doi: 10.1016/j.jpeds.2008.05.013. Epub 2008 Jun 27.
          (Disqus still won’t let me post links.)
          This study shows a significant association between oral domperidone therapy and QTc prolongation in babies. It advises giving domperidone only with serial ECG follow-up.

          We don’t know the dose at which even the most sensitive baby is absolutely safe from domperidone induced QT prolongation. Then how can we be 100% sure that what a baby ingests with breastmilk is insignificant? What if the baby is exposed to other QTc prolonging drugs at the same time (Nizoral for thrush would be a definite winner)?

          I’m not claiming that I have absolute proof that there is a risk to babies. I’m only trying to point out that we cannot be sure that there is NO risk.

    • anonomom_LLLL_IBCLC
      March 21, 2013 at 7:23 am #

      I believe Dr Newman has used it up to 90 mg/day. Not saying that’s a good idea though. Maybe you should print out some of the links on this blog and show it to your GP. Can I ask why you decided to take 100 mg?

      • Guestll
        March 21, 2013 at 9:50 am #

        Newman recommends going as high as 160 mgs per day. It’s on his website.

  23. Lisa the Raptor
    March 20, 2013 at 10:19 pm #

    I had a chronically low supply with my second child, leading to her being Dxed FTT at nine months. Neither my personal PA nor my pediatrician suggested any drugs. I had never even heard of it. All I can say is that I am glad I was trusting the advice of my doctors instead of heading towards the internet because I might have tried such a thing back then.

  24. Therese
    March 20, 2013 at 8:05 pm #

    So are the QT altering antibiotics only prescribed as a last resort kind of thing or are they commonly prescribed for infections? Are you typically warned of these risks before receiving them? This is just scary.

    • Sarah, PharmD, RPh
      March 22, 2013 at 11:42 pm #

      They are commonly prescribed in situations where it is presumed that the benefit of the medication outweighs the risk of potential QT prolongation.

  25. Amy Tuteur, MD
    March 20, 2013 at 7:31 pm #

    OT: It’s difficult to believe that there are people this stupid, but apparently there are. From BabyCenter:


    “It’s just a question of having the right attitude. Trust birth. Trust your body. Tell yourself that you will have a good birth and you will have a good birth. It really is that simple.

    The women whose babies died at homebirths did not have their child die because they birthed in an improper environment with poorly trained attendents. They died because they didn’t trust their bodies enough.

    Those babies would have died in the hospital, also, too.”

    Maybe she’s just being sarcastic. We can only hope.

  26. auntbea
    March 20, 2013 at 4:43 pm #

    Completely OT: The Senate just passed an amendment to prohibit NSF funding of most quantitative political science (think Nate Silver), on the grounds that it is not relevant to American security or economic interests. Though certainly of greatest immediate interest to those of us who rely on that funding, it raises a huge red flag by setting a precedent in which Congress, rather than the scientific community, gets to decide what constitutes important knowledge. It is not obvious why defunding would stop at political science, and not ultimately affect research into, say, public health. But it *is* obvious that the identity of the majority party, now and in the future, may have something to do with what types of research topics are considered worthwhile.

    • The Bofa on the Sofa
      March 20, 2013 at 4:54 pm #

      The Senate just passed an amendment to prohibit NSF funding of most quantitative political science (think Nate Silver), on the grounds that it is not relevant to American security or economic interests.

      That’s pretty ugly. Since when has NSF funding ever had to be relevant to American security (actually, DHS or DOD should be funding that, not the NSF) and who is the Senate to determine whether research is relevant to economic interests?

      Then again, I’ve never had to explain why my NSF funded research is relevant to either. We have to justify IMPACT, but not economic interests.

      Of course, the joke to be made is, “So quantitative poly sci is not relevant to American security or economic interests. Meanwhile, non-quantitative poly sci is not relevant to anything else, either”

      Does this mean that the Senate has passed an NSF budget? To be fair, the poly sci component of the NSF is pretty small, and if that is what it takes to approve a budget, it’s better that than holding up the other 99% of it. I don’t like it, though.

      • auntbea
        March 20, 2013 at 6:17 pm #

        Nope. They just voted on the amendments. I have no idea what agreement was made in exchange for its passage, or if this amendment is related to whether the bill passes. Coburn — who has been trying to cut political science funding for several years — also put forward a number of other strange penny-pinching amendments, so presumably people had to pick their battles.

  27. mimi
    March 20, 2013 at 4:41 pm #

    OMG, Just use formula! I have a lingering cardiac arrythmia from a virus, and I wouldn’t wish it on anyone, ever. Don’t even risk this.

  28. Guestll
    March 20, 2013 at 3:55 pm #

    “Someone who hasn’t been to medical school really has no business playing with this stuff.” My former GP went to medical school, and he wrote a scrip, no problem. No mention of any issues at all. I took Domperidone for 14 months due to prolactin levels plummeting with the advent of my period at 10 weeks postpartum. Without Domperidone, I could not produce enough milk.
    I was never encouraged to supplement with formula — just the opposite. Formula is not nearly as good as breastmilk. Breast is best, you’re doing just fine, let’s start you off on this dose and build up if we need to, it’s very safe and you might get a headache at first (I didn’t) but you should be just fine, come back and see me in a week, you can use it for as long as you need…
    It was covered by insurance, easy to access, no discernible negative side effects (other than I couldn’t lose the last 10 lbs of pregnancy weight until I stopped taking it, but that could also be related to weaning) and it worked well. No potential downside was ever discussed. Jack Newman approves, and so do I!
    It’s not just midwives and LCs who are irresponsible. I get the bias here, I really do, but there are some pretty lousy physicians out there as well.

    • grenouille
      March 21, 2013 at 3:13 pm #

      I am in Canada too, and I was really pressure to take Domperidone when nursing didn’t go well. It was odd to me that no one was suggesting that I supplement with some formula. And don’t even get me started about Jack Newman. He reared his ugly head again when my third had digestive issues and poor weight gain. Did you know that babies don’t really have milk protein intolerance? They just need Dr Jack’s magic compression technique! *eyeroll*

      It disturbs me that my doctor was so eager to have me take Domperidone. I had PIH that did not resolve with delivery and became chronic hypertension. My sister died at age 32 after a massive rhythm disturbance. I doubt I was a great candidate for the drug.

  29. theadequatemother
    March 20, 2013 at 2:53 pm #


    this is a nice review about drug associated prolongation of the QT interval. It gives you an idea of the magnitude of the problem, the clinical, laboratory and cardiac evaluation that should occur prior and highlightes the major drug and pathophysiological interactions of concern.

  30. Amy Tuteur, MD
    March 20, 2013 at 1:59 pm #

    Oops. I forgot the link to the European Medicines Agency. I’ve put it back in.


  31. thankfulmom
    March 20, 2013 at 1:58 pm #

    I’m skimming the replies and I see a lot of comments about the transfer rate to the baby being very low. What about the MOTHER? Isn’t the mother at risk here? I thought about taking this because as an older mother I truly had a low milk supply for my preemie. However, since I take a beta blocker I wasn’t comfortable using this.

  32. Nina
    March 20, 2013 at 1:39 pm #

    I took domperidone, which was recommend not by an LC, but by my daughter’s pediatrician. She even offered to write a prescription so that I could get it from a compounding pharmacy (although I just bought from NZ). She recommended a fairly minimal dose and I took it for several months without incident. I also told my OB and she didn’t have a problem with it. Neither the pediatrician nor my OB would prescribe Reglan because of the risk of PPD. When I talked to her about the research, she mentioned the IV study, but that was at very high doses and taken intravenously. I think there needs to be more evidence that taking this drug in pill form is dangerous before we declare it so. I also think that there needs to be more evidence that it actually works for increasing milk supply (although I do believe it was helpful for me. I saw an increase in a couple of weeks).

    • ratiomom
      March 20, 2013 at 1:49 pm #

      It’s the other way around, actually. They need to prove that a drug is SAFE before it can be marketed.
      If the FDA and EMA are both concerned, that’s good enough for me.

  33. Dr Kitty
    March 20, 2013 at 1:08 pm #

    Respectfully, some of this is somewhat overstating the case (not that I prescribe Domperidone for that indication, or would encourage anyone to use it OTC for that reason).

    From my BNF:
    Indications  nausea and vomiting, dyspepsia, gastro-oesophageal reflux
    Cautions  children; cardiac conduction abnormalities including QT-interval prolongation; electrolyte disturbances; cardiac disease; interactions: Appendix 1 (domperidone)

    Contra-indications: prolactinoma; if increased gastro-intestinal motility harmful
    Hepatic impairment: avoid
    Renal impairment :reduce dose
    Pregnancy : use only if potential benefit outweighs risk
    Side-effects: rarely gastro-intestinal disturbances (including cramps), galactorrhoea, gynaecomastia, amenorrhoea, hyperprolactinaemia; very rarely ventricular arrhythmias, agitation, drowsiness, nervousness, seizures, extrapyramidal effects, headache; also reported QT-interval prolongation, sudden cardiac death

    Breastfeeding: amount too small to be harmful.

    • I don't have a creative name
      March 20, 2013 at 1:46 pm #

      I agree. I was disturbed by the conjecture of a connection to SIDS. From what I’ve read, domperidone either is or has in the past been safely used to treat infants with gastric issues.

      • Sue
        March 20, 2013 at 7:28 pm #

        True, creative name, but the only case reports I’ve seen of cardiac toxicity are in infants. In general, domperidone is used for vomiting and gastric motility, and preferred to metacploramide where extra-pyramidal effects are a concern.

        Amy’s point stands, though, NCB only requires “natural” when it suits their purposes.

        • I don't have a creative name
          March 20, 2013 at 8:18 pm #

          I don’t disagree with that point at all. NCBism is a case study in hypocrisy from start to finish. And all drugs have potential side effects, but I’m just not convinced that all the maybe’s are worth getting worked up about. If there was a good study that showed domperidone is quite likely to be dangerous, I would definitely withdraw my support of this drug. As it is, though, it worked like a charm 3 times in helping me to breastfeed at all. I’m obviously no NCB’er, but I do really love breastfeeding and am grateful to this drug that helped me do it.

          • Box of Salt
            March 21, 2013 at 11:11 am #

            IDHCN: ” If there was a good study that showed domperidone is quite likely to be dangerous”

            But is there a good study that shows it is actually beneficial? That is does significantly improve milk production for the majority of users?

            How would one even conduct such a study in a controlled manner?

          • Box of Salt
            March 21, 2013 at 12:00 pm #

            I will note that the meta-analysis Becky cited consists of all of 78 women, 37 domperidone vs 41 placebo. And big surprise: no adverse effects in those 37 women and babies.

          • I don't have a creative name
            March 21, 2013 at 12:38 pm #

            I really don’t know how one would conduct a study like that. I isn’t so science-y. All I know is that it worked for me, with varying degrees of success each time. For my oldest, I had almost completely dried up, was only producing about an ounce a day (by now I was pumping every 3 hours, as he was refusing). This went on for about 2 weeks while I waited for the domperidone to come in. And after less than 48 hrs on the domperidone had close to a full supply back. With the subsequent babies, I tried each time without it and each time just was not keeping up.

            Second son, once I went on the domperidone, my supply increased about 50%. I later relactated with it after weaning when we found out he would need surgery, as he would have to starve from midnight the night before, but as breastmilk it considered a “clear liquid”, he could have it 3? 4? hours before the surgery. I can’t remember. I was completely dried up but went back on the dom. for a week to pump and have some bottles ready to take to the hospital with us. Crazy, sure, but I was so upset at the thought of him being so hungry.

            Baby girl, not as much success. Horrible latch, yet she would become enraged if not offered the boob before the bottle. I tried to wean at 4 months because I was so tired of it, and she went insane. After a week or two, I gave in and went back on the dom. and did get a lot of milk back, enough for about 50% of her feedings. So this isn’t data for others, perhaps, but it’s my story of how it worked for me and why I believe it works so well. We’re done with having kids, but if we have an ooops, I would do the same thing – I would try to feed them with what I could, and if it was low supply, I would use the dom.

    • Durango
      March 20, 2013 at 2:23 pm #

      I wonder about the whole risk/benefit aspect though…given that the benefits of breastfeeding are so small compared to formula, what level of risk is acceptable to (potentially? marginally?) boost supply? That argument is put forward all the time wrt chiropractic neck manipulation and vertebral artery dissection–the odds of a potentially fatal/paralyzing manipulation are very very low, but the only benefit is a placebo, so that’s enough reason to avoid chiro neck manipulation.

    • theadequatemother
      March 20, 2013 at 2:45 pm #

      I agree. There are many other drugs that prolong the QT interval to a similar extent as domperidone that do not have an FDA black box warning. This comes up in anesthesia all the time. Droperidol for example, is highly effective for PONV but has the same black box as domperidone wrt QT prolongation…but ondansetron/ zofran, which also prolongs the QT, does NOT have a black box warning.

      Domperidone is available in Canada and used to relieve feelings of bloating and GERD in diabetics and other patients with gastroparesis and I see a fair number of patients on it.

      If a woman is going to take domperidone to increase milk supply then informed consent for treatment, including mention of arrhythmia, and review of other meds for potential interactions, is required and this may not occur if the drug is being procured off the internet on the advice of an LLC or DEM.

  34. Renee Martin
    March 20, 2013 at 1:02 pm #

    Moms that use Methadone NEED to know this, as methadone increases the QT interval as well. I had to get an EKG in order to take a dose over 100mg (standard dose for many things, including MMT). Taking them together would be very dangerous.

  35. Jessica
    March 20, 2013 at 12:28 pm #

    I generally liked my LC, who had wonderful advice about getting baby to the breast and ways to improve his latch, but at my first appointment, five days postpartum, she suggested that I take fenugreek and domperidone or Reglan. Then she thought about it and said just the fenugreek and that she would reevaluate the need for domperidone or Reglan later. I was really uncomfortable with her advice to take drugs or supplements to increase my supply. At that time I was already pumping more than baby was eating at each feeding, and my milk had only been in for 48 hours. So I didn’t bother taking any medication or supplements; I just nursed and pumped every 2-3 hours around the clock until he was no longer accepting a supplemental bottle, then I switched to exclusive nursing until I returned to work. I’ve not had to supplement formula since he was three days old, and I have about 100+ oz. in the freezer.

    Reading this post makes me feel like I dodged a bullet.

  36. anonomom_LLLL_IBCLC
    March 20, 2013 at 12:24 pm #

    I’d love the author’s response to the characterization of domperidone as dangerous for babies, when according to Wan et al (2008), concentrations in breastmilk at a maternal dose of 30 mg/day were only 0.012%. I’m not a cardiologist, so I don’t know if even such a small dose could have an impact on the baby, but if this is indeed a stretch, it makes me question the need to panic about the potential maternal risk.

    • ontheotherhand
      March 20, 2013 at 12:29 pm #

      anonomom, you make a lot of sense.

    • anonymouscardiologist
      March 20, 2013 at 12:58 pm #

      My answer is 3 words long: we don’t know.
      In order to determine a safe dose of domperidone for infants in regard to QTc prolongation, we’d have to administer increasing doses to a large group of babies while doing serial ECG’s.
      Domperidone is contraindicated in babies: it has neurological side effects because their blood-brain barrier isn’t developed yet. No ethics committee would ever allow a clinical trial with domperidone in neonates.
      So what IS a safe dose of domperidone for a baby? I don’t know. Nobody knows. I’m sure as hell not going to test it on my kid, and I believe that every mother deserves to know these things before she decides to take the drug.

      • anonomom_LLLL_IBCLC
        March 20, 2013 at 1:24 pm #

        Just to be devil’s advocate, isnt this also true of Reglan, plus the risk of extrapyramidal effects? And Reglan is often given to preemies for GERD?

        • anonymouscardiologist
          March 20, 2013 at 1:46 pm #

          As I said in the post: the list of QTc prolonging drugs is a mile long. I’m NOT saying that all these drugs shouldn’t be given to babies.

          What I am saying is that a drug with such potentially devaststing side effects should not be available off the internet to be taken long-term, in high doses.

          And I am saying that it is extremely unethical for breastfeeding associations such as LLL to promote, endorse or even allow the use of this drug.

          • anonomom_LLLL_IBCLC
            March 20, 2013 at 1:49 pm #

            Totally agree. All drugs should be taken under the care of a physician, both for the safety of patients, and so adverse effects can be monitored for the purpose of research.

          • Lisa the Raptor
            March 20, 2013 at 10:28 pm #

            And herbs as well. Natural does not mean harmless.

    • AllieFoyle
      March 21, 2013 at 11:25 am #

      You have to also consider that while that concentration may not pose a risk for most healthy babies, there will probably be a subset of babies who are especially vulnerable to cardiac side effects for various medical reasons that their parents and doctors may not even be aware of at that point in their lives.

  37. Mrs. W
    March 20, 2013 at 12:20 pm #

    I get why women use domperidone – when everywhere you turn it’s breast is best (even on packages of formula), formula is regarded as ‘poison’, and there’s tremendous pressure to ‘do everything’ before giving up being your child’s primary source of nutrition – a little domperidone seems like a reasonable alternative to abandoning breastfeeding….it might even be better than turning to donor milk but this risk needs to be explored further. Where I live (Canada) use of domperidone is widespread – however I also live in a place where HBAC is seen as being reasonable under some circumstances and the minister of health encourages Homebirth…

  38. Erin
    March 20, 2013 at 11:39 am #

    Wow. In my part of Canada, Domperidone prescriptions are handed out to just about any woman that asks for one – Lactation consultants thorough the regional health authority and public health nurses that visit postpartum recommend that new mom’s ask for a script “just in case.” Women in my new mother’s groups share the pills back and forth and I know several women that have taken Domperidone for over 2 years so they can continue to breastfeed their toddler.

    This is terrifying. I’m going to share this all over my pages and get blasted. But if the risks really are this serious, then I feel obligated to do so.

  39. Amy Tuteur, MD
    March 20, 2013 at 11:13 am #

    Here’s a question for those who like to pretend that a C-section isn’t a “real” birth”:

    Is it “real” breastfeeding if you have to take a chemical (and pass that chemical to your baby) to do it?

    • The Bofa on the Sofa
      March 20, 2013 at 11:17 am #

      I am more wondering, if breastfeeding is so natural and everyone can do it, why are so many needing drugs to increase their supply?

      • Kirsten
        March 20, 2013 at 11:53 am #

        Me too!!! Here in Canada we are apparently a bunch of poor producers as every second woman I talk to had to take domperidone. I’ve just accepted my body can’t do anything right in terms of reproduction.

        • Anka
          March 21, 2013 at 8:34 am #

          Sorry if this has been covered elsewhere, but is domperidone prescribed as a matter of course in mainstream hospitals (and not just woo-filled outfits) in Canada? I’m going to give birth (knock on wood) at a large hospital in Toronto in a few months, and what with the likely medically indicated c-section and my desire to try to breastfeed (though I’m not going to torture myself if I can’t), I’m concerned that they’ll try to get me to take it. The hospital is apparently making the transition to “baby-friendly” status, so I’m worried.

          • Kirsten
            March 21, 2013 at 10:50 am #

            Most of the time this is something discussed after a few weeks if your supply is still low. It was something my Dr and I discussed when my section incision got infected. If you don’t want to take it just say no, although I doubt the hospital will bring it up.

          • CarolynTheRed
            March 21, 2013 at 12:24 pm #

            I’m in Toronto, gave birth at NYG four months ago – nobody I know has been prescribed Domperidone. Not women who went to the bf clinics and struggled with supply, no women taking fenugreek and a beer a day.

          • Anka
            March 21, 2013 at 4:52 pm #

            Kirsten and CarolynTheRed–thanks, that’s very good to know! I was envisioning a scenario when I’m groggy immediately post c-section and they push this drug really hard so I can accomplish my (or their) breastfeeding goals. Glad to know it’s not like that.

      • ontheotherhand
        March 20, 2013 at 11:55 am #

        in my case, my daughter couldn’t latch really at all. I was bleeding on both sides and she was losing weight precipitously after my c-section. i supplemented with formula in the hospital when she lost 16% of her birth weight. But no one told me to start pumping to get my supply established…in fact, I was told NOT to, b/c I might get oversupply. so i didn’t get the right advice until almost 9 days after her birth, by which time many of my prolactin receptors had dried up. hence i now have permanent low supply and need help increasing it.

        • ejohns313
          March 20, 2013 at 6:42 pm #

          Sort of the same thing happened to me. No milk came in for 6 days, and my baby had jaundice. So they had me give some formula with the SNS boob tube thing to flush out the toxins. But no one said I might also need to pump to establish supply. I read two breastfeeding books and took a breastfeeding class; of course they don’t tell you how fragile production is in the early days, or that pumping might be necessary. “Trust your body” blah blah blah. The supply problem wasn’t discovered until day 10 (she had diapers, but the LC said they looked like dehydration, and it turned out she was underweight). I tried a bunch of crazy pumping and Reglan and herbs and everything else (no Domperidone, though). Never got close to what the kid needed.

          It was such b.s. I’m afraid to have another kid and possibly put myself through all the self-hate again. It’s been more than 2 months since my supply totally dried up, and I honestly don’t know if I’m ever going to get over this breastfeeding failure.

          • anonomom_LLLL_IBCLC
            March 20, 2013 at 7:12 pm #

            It was not your fault. And i have a feeling your baby is happy and healthy despite the fact that she only got a little breastmilk. If you want to try again, you’ll be better prepared, and hopefully you can see in your baby that formula is just fine.

          • Sue
            March 20, 2013 at 7:31 pm #

            ejohns313 – I hope you can come to terms with the fact that your baby’s health and well-being doesn’t just depend on how you fed them. BF is only one of a range of factors that affect infant health and, in our society, its influence isn’t major and does not appear to be long-lasting. Either combo feeding or formula produces perfectly acceptable nutrition.

      • Jessica
        March 20, 2013 at 12:29 pm #

        It’s the C-sections! And the lack of skin-to-skin after birth! And the epidurals! And the pacifiers! And the relief bottle offered by a well-meaning husband at 2 AM!

        • ontheotherhand
          March 20, 2013 at 12:36 pm #

          you’re being sarcastic, but i’d imagine the c-sections and relief bottles do have an effect. i was in so much pain after my c-section that it was hard to hold my daughter to try to breastfeed. and if baby isn’t hungry and doesn’t go to mom’s breast, the milk doesn’t come in…

          • Jessica
            March 20, 2013 at 12:44 pm #

            I was being sarcastic, but I do agree with you that removing the milk – either with a baby or with a pump – is crucial in the early days to build supply. But I do think many women avoid many interventions to make breastfeeding work and to their great disappointment, still end up with supply issues.

          • Sunandstarshinemommy
            March 20, 2013 at 1:25 pm #

            That sounds like a pain management issue, not a csection issue. I have noticed huge discrepancy amongst hospitals in my area as to how pain is managed. I was fortunate with my sections to have wonderful pain management so nursing and moving in general was much easier.

          • Wren
            March 20, 2013 at 1:40 pm #

            I would agree that sounds like a pain management issue, and I know there are women in a whole lot of pain after some vaginal births too. I had one midwife who refused to manage my pain appropriately (refusing to give what the anaesthetist had prescribed while simultaneously “forgetting” to get a doctor who could change it to talk to me–evil witch) and I did have a hard time for the shift she was on.

        • Sunandstarshinemommy
          March 20, 2013 at 1:22 pm #

          No. It’s the hats.

      • March 21, 2013 at 9:20 pm #

        If you look at old medical books and womens’ diaries … lots of women couldn’t do it. That’s why the had wetn urses and foster mothers. And baby feeding equipment.

    • take7steps
      March 21, 2013 at 7:54 am #

      Dr. Amy, we both know that C-section babies aren’t “born” they are extracted. This is beneficial to the child later in life, such as in the teenage years when some may lament “I wish I was never born!” The mother who had a c-section can simply reply “You were not born! Problem solved. You were extracted.”

      • Spiderpigmom
        March 25, 2013 at 4:55 pm #

        Reminds me of Macbeth.

      • Ruth
        April 2, 2013 at 10:54 am #

        Shove off. I have never read of or spoken with another woman who actively tells their child that they were “extracted”.

        When I talk about the birth of my daughter, she was “born by cesarean” or “delivered by cesarean” – the language may be passive, but she was still born. I, on the other hand, did not actively participate in that birth. I was literally given too much epidural (and an anti-anxiety medicine without being informed) and passed out about 2 seconds after I was transferred to the operating table. She was born, but I did not give birth.

        • take7steps
          April 2, 2013 at 11:59 am #

          I’m sorry you have bad feelings about your daughter’s birth but rest assured that I do not. My kids have heard their birth stories and think it’s quite neat that they were extracted and I enjoyed welcoming them into the world. I loved my c-sections and I wouldn’t trade that experience for anything.

          I know this is hard to understand, but not everyone has the same experience you do, nor does everyone have children as fragile as glass.

  40. Amy Tuteur, MD
    March 20, 2013 at 11:07 am #

    Don’t forget: domperidone is

    a drug
    manufactured by Big Pharma
    never tested for safety in breastfeeding mothers.

    Proving yet again that NCB and homebirth advocates are hypocrites and utterly inconsistent in their claims.

    • Captain Obvious
      March 20, 2013 at 3:56 pm #

      I have heard that fenugreek isn’t recommended anymore as a galactagogue. But I think that is more because of the inability to guarantee the “dose” you are getting from brand or batch. Side effects can be gastrointestinal such as diarrhea and flatulence. Allergic reactions, exacerbation of asthma, and a 14% decrease in serum potassium have been reported. Cross-reactions with chickpeas, peanuts, and other legumes are possible. Dosages typically used to increase milk supply are 1 to 6 grams daily; in dosages of about 25 grams or more daily, fenugreek may cause lowering of cholesterol and blood sugar. Caution should be used in giving high dosages to women with diabetes mellitus.
      Reglan (metoclopramide) is mentioned below. I have prescribed a taper dose over 10 days to jump start lactation. No QT prolongation but tardive dyskinesia worries me if prolonged use. How much gets into breast milk?

    • Anthropologist Underground
      March 20, 2013 at 6:57 pm #

      Yes, but…. they can self-ascribe mommy status by self-prescribing a dangerous medication! They are “educated” mavericks who know better than their doctors and the FDA! They gain status and power among their peers by risking themselves and/or their children’s lives. The shaming and pressure from hospital LCs is nothing compared to the guilt and social shunning of other dogmatic mamas. It’s similar to the other litmus tests of the subculture: homebirth, vaccine rejection, etc etc.

  41. The Bofa on the Sofa
    March 20, 2013 at 10:56 am #

    The recommendation to use domperidone off label to increase breastmilk supply shines a light on the essential hypocrisy of the natural childbirth and homebirth movements. The same people who are shocked about the off label use of Cytotec, and imply that off label means illegal, seem to have no problem with the off label use of domperidone.

    Of course. Remember, Cytotec requires prescription, and therefore can only be given by doctors. Domperidone is over the counter, and so midwives can give it.

    What else do you need to know?

  42. March 20, 2013 at 10:53 am #

    Out of curiosity I checked how it is where I live.

    In Sweden they tell you NOT to use this if breastfeeding since it’s transfered into the milk and they havent deduced if it can harm the baby

  43. ontheotherhand
    March 20, 2013 at 10:52 am #

    How many cases are there where a woman has died from off label use of domperidone? My understanding was zero documented cases…

    just saying…

    • Kirsten
      March 20, 2013 at 10:58 am #

      Indeed!! I live in Canada where the use of this medication for increasing supply is HUGE. I personally have about 7 friends who used it over 8 babies. Plus myself. I realize that is anecdotal, but I would really, really be interested in a large study–because women and babies are not dying from this in Canada as far as the doctors are aware. This medication was prescribed by our primary care doctors, the heart risks were discussed but described as minimal.
      If women and babies are dying from this medication I would be very interested in knowing about it, especially since I’m still on it!!

      After infertility requiring medical intervention, then a c-section for breech, it meant a lot to me to be able to breastfeed. Currently at a year old I have a wonderful breastfeeding relationship with my son. If I stop the domperidone I dry up, so I’m on the lowest dose that is effective.

      I understand theoretical risk, I just wish there was data on this…which would be readily available in this country if it was collected.

      • March 20, 2013 at 11:02 am #

        I posted this above, but wanted to make sure you saw it: the EU’s EMA has been gathering reports of adverse cardiac events from more than just IV form for years and are starting an in-depth investigation into its safety. (The link is in my comment above)

        • Kirsten
          March 20, 2013 at 11:18 am #

          I am unable to read the article as I’m not a member. As of March 2012 “Health Canada also said it has not received any adverse reaction reports of serious heart-related problems “in relation to the use of domperidone used to stimulate milk production in breastfeeding women”

          I’ve got to say, it is a huge sample size here. And women aren’t hiding that they are on domperidone as it is freely prescribed by Drs. According to Health Canada they were looking into domperidone safety as of March 2012 based on the FDA’s warning on it, as of yet nothing new that I could find has been released.

          • March 20, 2013 at 11:34 am #

            I wonder if its a geography thing. I know I’m not a member but I was able to open it straight from the google results page.

          • LukesCook
            March 20, 2013 at 1:24 pm #

            It’s not really a sample if they aren’t making any effort to collect the data, is it? There’s a difference between actively collecting data and waiting for someone to send you data.

          • DiomedesV
            March 20, 2013 at 4:07 pm #

            “I’ve got to say, it is a huge sample size here.”

            How so? Is it a study? Or are they just assuming that the sample size is the patient population? It’s not, and that’s a really stupid thing to assume.

            Do you think the FDA refers to its adverse reaction reports as a “study”?

          • Kirsten
            March 20, 2013 at 4:28 pm #

            My point was that there would be a large sample size should someone choose to do a study–which they likely won’t, the drug is generic. However, my choice of words it technically incorrect, but my point remains–many, many women use it here and Health Canada is reporting zero adverse events.

          • DiomedesV
            March 20, 2013 at 4:58 pm #

            Fair enough. I suspect they’re not looking for it, though.

          • Kirsten
            March 20, 2013 at 4:59 pm #

            They are, Health Canada started looking into Domperidone use for milk production increase in March of 2012. As of last posting they have reported 0 adverse effects.

          • Amy Tuteur, MD
            March 20, 2013 at 5:29 pm #

            The author of the post sent me this link that includes reported deaths:


          • anonomom_LLLL_IBCLC
            March 20, 2013 at 6:09 pm #

            God I wish I had the skills to interpret this. And I wonder how it compares to the risk of aspirin, such as cerebral microbleeds, and yet it’s still sold OTC. Of course just because one unsafe drug is sold doesnt mean another one should; I’m just curious how they compare.

    • Amy Tuteur, MD
      March 20, 2013 at 11:02 am #

      There are no reported cases in which a woman who was using domperidone off label died. That does not mean that there were no cases. When someone dies of sudden cardiac death, the cause is often unidentified. If no one but the woman herself knows that she is using domperidone, no one will connect the two.

      Of course this begs the larger question. Why is it okay to risk maternal sudden cardiac death for the sake of breastfeeding, which only has trivial benefits?

      • LovleAnjel
        March 20, 2013 at 11:46 am #

        Add to that, if the mother dies, the baby is no longer breastfed and thus doesn’t get the oh-so-important benefits anymore.

      • ontheotherhand
        March 20, 2013 at 12:12 pm #

        i agree with you – IF, and only if, there were really women dying of this. but i’m wondering. use of domperidone by rx is widespread in canada…and we are not hearing about scores of women suddenly dropping dead. i’m not even aware of any case reports in the literature (and i would expect there to be some if women were in fact dying).

        • nohika
          March 20, 2013 at 2:32 pm #

          They’re not saying that scores of women are going to start dropping dead. They’re saying that it increases the risk of something happening. There are several heart issues that the only signs that something is wrong is – well, death. Or have symptoms that someone (especially a pregnant woman) might brush off as something else. It’s an increase in the risk.

        • theadequatemother
          March 20, 2013 at 2:55 pm #

          there also aren’t scores of diabetics dropping dead from arrhythmias and they are commonly prescribed domperidone for gastroparesis by their physicians.

        • suchende
          March 20, 2013 at 11:16 pm #

          I already have a cardiac risk factor that prevents me from taking, for example, hormonal birth control. If I took domperidone, would my death be deemed the consequence of the medication, or rather my underlying condition? Risk factors are cumulative.

    • anonymouscardiologist
      March 20, 2013 at 5:28 pm #

      Disqus won’t let me post a link, but here’s a study from The Netherlands with 10 sudden cardiac deaths in patients using domperidone. They were taking it as an antiemetic instead of a lactation enhancer but I don’t think their cardiac musce cells were aware of that.

      Van Noord C.Drug safety 2010, pubmed nr 20925438

  44. anonomom_LLLL_IBCLC
    March 20, 2013 at 10:29 am #

    This is extremely concerning. I have shared information about Domperidone with patients, based on Dr. Hale (a PhD pharmacologist) who rates it as an L1 (safest) drug for breastfeeding moms/babies. He says with regard to arrhythmias: “These claims were derived by data many years old where domperidone was used intravenously… These patients were undergoing extensive chemotherapy, were extremely ill, and hypokalemic to begin with. In addition, intravenous domperidone produces plasma levels many times higher than oral use.” Dr. Ruth Lawrence, MD, cites a study showing that the infant dose for 60 mg maternal dose is 0.009%. The AAP rates it as “usually compatible with breastfeeding.”

    So I am confused and deeply troubled by this post. Is domperidone truly a “dangerous drug,” or is there a bias here about mothers taking an “unneeded” medication “just to breastfeed”? I’m especially confused about the alleged danger to infants; is a 0.009% transfer into milk truly a risk for infants? How does this compare to risks of other drugs commonly prescribed to infants?

    • PH Student
      March 20, 2013 at 10:33 am #

      Me too. I never recommended domperidone because I was a LLL leader and not an IBCLC, but if women asked I always told them to ask their physicians, who I assume were also using Hale to gauge its safety.

      • anonomom_LLLL_IBCLC
        March 20, 2013 at 11:23 am #

        IBCLCs should not recommend medications either since they are not physicians. But that certainly doesnt stop some of them.

        • Sarah, PharmD, RPh
          March 21, 2013 at 12:54 am #

          I’ve found (in both my personal and professional experience), that LC frequently recommend medications and/or recommend discontinuation of medications they deem incompatible with breastfeeding. Not “check with your physician,” but “You should stop taking __________.” Many/most (all?) of them lack the training and credentials to do this. I even had one want to argue with me about medication issues, and I’m a pharmacist/professor of pharmacology. Frustrating and dangerous, in my opinion.

    • Amy Tuteur, MD
      March 20, 2013 at 10:54 am #

      Breastfeeding Inc. of Canada thinks that the benefits of breastfeeding outweigh the risk of maternal death (!). Interestingly, among the many individuals listed as endorsing the statement, not a single one is a cardiologist.

      • ontheotherhand
        March 20, 2013 at 10:56 am #

        again, how many maternal deaths have there been? Any?

      • anonomom_LLLL_IBCLC
        March 20, 2013 at 11:12 am #

        Presumably this is what Dr Amy is referring to:


        I will definitely be copying this very detailed report and sharing with patients, as well as recommending they talk to their doctors before considering taking it. As we know, many women are going to order it off the internet, and they need to be aware of this.

      • quadrophenic
        March 20, 2013 at 12:05 pm #

        This is my problem with lactivists. They’re not advocating informed decisions. I’m not just talking about disclosing the risks of these types of drugs to increase supply or discussing the risks of other medications while breastfeeding – I’m talking about a comparison of the “risks” to formula feeding – you can’t be informed unless you compare the risks and benefits if both sides.

        When I was discussing with my doctor and pediatrician about the risks of using my medication while breastfeeding I was simply told that they don’t know it’s effect so they advised against it. Some women on the same drug are advised that there’s no evidence of adverse effects in the limited data so it’s ok. Dr. Hale’s book suggests its ok and many women use it while breastfeeding – so there were really two opinions on the subject. What was missing from that conversation was the flip side: the well established safety of formula. When I thought about it that way, “probably safe” or “maybe safe” just wasn’t enough – I know much more about what potential “risks” I’m taking with formula and its use on millions of babies.

        • The Bofa on the Sofa
          March 20, 2013 at 4:26 pm #

          Also, part of informed consent would be, how many women end up using this drug to increase supply?

          As I noted earlier, if usage of this is extensive, it calls into question the whole, “All women can breastfeed” claims. If anyone can do it, why would so many need drugs to increase their supply?

          • OnMon
            March 20, 2013 at 6:53 pm #

            I think The Bofa on the Sofa is getting to the biggest silent question surrounding breastfeeding research: why do ANY women EVER have problems breastfeeding? We have quotes from breastfeeding promoters saying that 90-95% should be able to breastfeed easy-peasy which is getting pretty close to the best U.S. initiation rates by state, yet adherence goes down especially for exclusive breastfeeding and probably the most frequent reason given is “low milk supply.” Is this because not enough women are exposed to Baby Friendly practices that (allegedly) encourage the positive feedback loop to get breasts making more milk? Or are we actually seeing a problem society wide that has a yet-undiscovered cause, or perhaps a known one like longer maternity leaves for working mothers? Either way I’m tired of research tying breastfeeding possibly-maybe-maybe-not to ending obesity, and wanting more research that actually looks at WHY women stop breastfeeding (e.g. low milk supply), and whether their problems CAN be addressed, especially outside of known parameters of “supply and demand” (since I’m sure any feeding/pumping/non-sleeping/crying mom is sick to death of hearing about how she should be “trying harder” to build her supply).

          • Jessica
            March 20, 2013 at 8:00 pm #

            I don’t think the problem is really BFHI protocols and practices. Among my friends, the failure to breastfeed are thus: (1) A had insufficient glandular tissue. Despite perfect latch, pumping, SNS, etc., she never produced milk. (2) C had sleepy babies who quickly lost weight; she appeared to have milk (engorgement and spraying in the shower) but didn’t respond to the consumer grade pump she had and did not pump religiously in the first few weeks. (3) L had latching difficulties, didn’t understand cluster feeding and newborn nursing behaviors, and didn’t pump after each supplemented/bottle feeding. A probably would never be able to breastfeed because her breast tissue didn’t really develop during puberty. C might have been able to breastfeed if she’d had access to a hospital grade pump and wanted to nurse, bottlefeed, pump every 2-3 hours around the clock until the sleepy newborn period ended, but she was perfectly happy to switch to formula. L suffered postpartum depression, regretted not breastfeeding, and has been exclusively BFing her second child for more than eight months with no issues.

            Clearly there’s a number of reasons women can’t breastfeed or have low milk supply. For some, it is structural or hormonal. For some, it is a matter of education as to supply and demand not just in the beginning, but over time (especially for mothers pumping outside the home). Lactivists want to pretend that the former situations are probably much rarer than they really are.

          • OnMon
            March 21, 2013 at 7:45 pm #

            Your last sentence goes back to the question I feel breastfeeding researchers are NOT asking: Why are we not looking at problem women before they encounter problems with breastfeeding? Why are we not looking at the breastfeeding problems women self-report and starting from there, working to overcome breastfeeding difficulties for all women who choose to breastfeed (to the ability possible)? Better education would help all women, but especially those with known hormonal or structural issues, and as primapara ages get older, those hormonal issues are going to keep increasing. Way better to be counseled before birth with an individually tailored counsel than after! High initiation rates indicate women are interested in breastfeeding – we don’t need to keep shaming them as a society when they stop. At this point we need to start asking “why”, and if there is anything that could be different, that would have helped them continue. If we have freaking “birth trauma” qualitative research, I want “breastfeeding trauma” research. Stories of bloody nipples and sad moms who had to give up breastfeeding (like your friend L) make me way sadder than the mom who felt alienated by her doctors during her emergent C-section. While both may involve loss-of-control that can contribute to stress, PPD, and even PTSD, the horrific breastfeeding stories tend to go on for weeks and weeks, and may involve guilt over underfeeding, prolonged periods of physical pain (over WEEKS, mind you!), inability to bond with baby, and doctor-shaming from the public health sector and possibly your own pediatrician. Breastfeeding trauma usually doesn’t involve actual death or dismemberment (at least, I’ve never heard of such a thing), but if birth trauma doesn’t have to involve it to be labeled traumatic (the trauma is in the eye of the beholder, after all), then I’m certain such a thing exists – and that if such women knew ahead of time that they were high risk for certain problems (lowered expectations allowing women to let go of BF as a personal ideal) combined with information on how to overcome those problems (to the extent that it is possible – education is empowering), these sad stories wouldn’t be so frequent. Focusing on the extent that such measures might help high-risk women would help all women who want to breastfeed, which to my estimate is around 90-95% of primaparas. MORE QUALITATIVE BREASTFEEDING RESEARCH PLEASE. With a dash of studies on modern prevalence of PCOS, hormone imbalances, structural breast/infant problems (I’d including things that are not a barrier to exclusive BF, such as flat nipples, but that frequently end BF relationships anyway because of a lack of education), and other contributors with a mind to educating docs & nurses on what to look out for before a problem hits.

          • Amy M
            March 20, 2013 at 8:33 pm #

            That supply and demand thing did not work for me. I was pumping every 3-4hrs, for 30-45 minutes and I didn’t get enough to feed one baby let alone twins. There could be a number of reasons:
            2)anemia from PPH
            3)pumping exclusively, maybe not responsive enough to the pump
            4)Constant plugged ducts. I’d massage one out and 3hrs later there would be another, sometimes on both sides. Eventually this led to mastitis, which was caught early, luckily.

            After 4wks, my mom could see that it wasn’t working out so well and she suggested I stop. I had to agree with her, since1)I was never that committed to breastfeeding, since I had twins, and had to go back to work 12wk postpartum and 2)I was spending more time with the damn pump and less time either with my babies or sleeping, both of which were more valuable than breastmilk.

            I always expected to use some formula, and my boys were/are fine. Maybe my issues could have been addressed, but it didn’t matter enough to me, to sacrifice time better spent with my children or sleeping. I wasn’t willing to take drugs I’d have to get from the internet and I was already on the road to PPD..I think if I had tried harder to BF, I’d have ended up with full blown PPD. My mental health is worth more (to me and my children) than breastmilk. I live in America. Formula is safe and adequately nutritious, therefore a perfectly reasonable feeding choice.

    • March 20, 2013 at 11:01 am #

      The argument that the QT prolongation was only observed in IV admin would appear to be a valid reason to investigate further the risks. But that doesn’t mean its safe to use orally until that time. Additionally I found a very recent article online explaining that the EU’s EMA has been gathering reports of adverse cardiac events from po admin and are therefore starting an investigation into its safety.


      “The US Food and Drug Administration (FDA) has not approved domperidone for any indication. In 2004, the FDA warned clinicians and breast-feeding mothers not to use domperidone to boost milk production because of the risk for adverse events. The agency cited reports of cardiac arrhythmias, cardiac arrest, and sudden death in patients receiving an intravenous form of domperidone that has been discontinued in several countries. However, the European Medicines Agency (EMA) continued to receive reports of these adverse events with other forms of the drug.”

      • anonomom_LLLL_IBCLC
        March 20, 2013 at 11:19 am #

        As of 2011, the FDA has declared domperidone to have orphan drug status “treatment of hypoprolactinemia in breastfeeding mothers, and in some hypoprolactinemic conditions follwing the use of cabergoline or bromocriptine in mothers who wish to return to breastfeeding.”
        “treatment of hypoprolactinemia in breastfeeding mothers, and in some hypoprolactinemic conditions follwing the use of cabergoline or bromocriptine in mothers who wish to return to breastfeeding.”

        • March 20, 2013 at 11:24 am #


        • Sarah
          March 21, 2013 at 12:31 am #

          It’s not going to be available in the US any time soon. They’ll still have to go through the (lengthy) NDA process, safety/efficacy studies, etc. before the FDA decides whether to approve it.

          Interestingly, you can obtain domperidone from certain US compounding pharmacies. The raw drug can be obtained from chemical suppliers and is compounded into capsules of varying doses. Most patients I have seen have been taking it for GI indications. While still not an FDA approved product, getting from a US compounding pharmacy is probably safer than getting it off the internet. Many internet pharmacies are not licensed and are basically unregulated. Who knows what you’re getting when you buy from an internet pharmacy!

        • Sarah, PharmD, RPh
          March 21, 2013 at 12:37 am #

          It’s not going to be available in the US any time soon. They’ll still have to go through the (lengthy) NDA process, safety/efficacy studies, etc. before the FDA decides whether to approve it.

          Interestingly, you can obtain domperidone from certain US compounding pharmacies. The raw drug can be obtained from chemical suppliers and is compounded into capsules of varying doses. Most patients I have seen have been taking it for GI indications. While still not an FDA approved product, getting domperidone from a US compounding pharmacy is probably safer than getting it off the internet. Many internet pharmacies are not licensed and are basically unregulated. Who knows what you’re getting when you buy from an internet pharmacy!?

      • Susan
        March 20, 2013 at 12:43 pm #

        To Dave Hale- just curious, I sort of looked around because even though you have posted before I never put it together. Your name is familiar because the most common reference about drugs and breastfeeding is written by a Dr. Hale. But I just looked and that’s Dr. Thomas Hale, I believe. But then I saw that if you search your name there is a Dr. Dave Hale that has put together an online database about meds. Is that you?

        • March 20, 2013 at 1:46 pm #

          I wish I was famous. Dave Hale is too common a name (which I guess will make it good if future employers try to dig up dirt on me before hiring, and can’t find me) I’m just a lowly 1st year pharmacy student.

          • Susan
            March 20, 2013 at 3:52 pm #

            Just a coincidence! Thanks. It appears many Hale’s discuss meds and breastfeeding.

          • Lisa the Raptor
            March 20, 2013 at 10:27 pm #

            Dr. Hale’s book has been a life saver for a mother like myself on a plethora of chronic condition meds and nursing. I’m sure you’ll make a great pharmacist Dave 🙂

          • suchende
            March 20, 2013 at 11:24 pm #

            Glad to see more medical professionals find this blog. It’s nice to have educated commenters.

          • March 21, 2013 at 10:17 am #

            I found this blog a couple years ago (between baby 2 and 3) when my wife read about placenta encapsulation and thought about trying it for her PPD, if we had another kid. This blog has been very helpful.

    • Becky05
      March 20, 2013 at 11:37 am #

      The data I’ve seen all show that milk transfer is very low. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492930/

      There’s decent evidence that it works, but groups aren’t really large enough for firm data on safety: http://www.hindawi.com/journals/ogi/2012/642893/

      Also found this consensus statement, which is interesting: http://kindercarepediatrics.ca/wp-content/uploads/Domperidone-Consensus-Statement-Final-May-11-2012.pdf

      On the other hand, some of the data being put out by cardiovascular research is pretty negative.

    • Becky05
      March 20, 2013 at 12:40 pm #

      Here’s Motherrisk’s response: http://www.motherisk.org/prof/updatesDetail.jsp?content_id=981

  45. FresnoJenny
    March 20, 2013 at 10:19 am #

    Can you get a similar article posted on Reglan (metoclopramide)? Seems like it would have all the same risks plus tardive dyskenesia in mom and baby.

    • FresnoJenny
      March 20, 2013 at 10:21 am #

      Plus blocking dopamine seems like a pretty bad idea in a population already at risk for depression.

      • EmbraceYourInnerCrone
        March 20, 2013 at 12:58 pm #

        Plus I’m not sure I would have (as an already exhausted new mother) wanted to take something that has these as common side affects:

        Common side effects of REGLAN include:

        feeling restless, sleepy, tired, dizzy, or exhausted
        trouble sleeping


        I guess I’m glad I just decided to formula feed since breastfeeding didn’t work out for me, despite the lovely Lamaze teacher who inferred you would be a failure if you didn’t breastfeed and the LC in the hospital whose idea of “helping” was to grab my breast and shove it in the baby’s mouth without asking.

  46. MH
    March 20, 2013 at 9:42 am #

    What about the use of Zofran? I read recently there has been concern about it prolonging the QT interval. I’m 8 weeks pregnant and have been taking 16mg Zofran/day for 2 weeks.

    • Sue
      March 20, 2013 at 7:37 pm #

      MH – medication for early pregnancy vomiting (hyperemesis) is a balance of risk and benefit. Very few drugs are now cleared as completely safe in early pregnancy because, ethically, the studies can;t be done any more. However, if the choice is between a prescribed medication or severe dehydration or electrolyte imbalance and kidney failure, safety generally favours the medication.

  47. Yet another
    March 20, 2013 at 9:26 am #

    OT: yet another water birth story in a free standing birth center where the 10 lb baby ends up in the NICU on antibiotics and the mother is oblivious about the cause. http://www.becomingmamas.com/introducing-eleanor-a-birth-story/

    • Amy Tuteur, MD
      March 20, 2013 at 10:10 am #

      I can beat that. How about this story:


      “I woke in the ICU. I had been given 5 units of blood, I felt like I had
      been beaten, and I had the hardest time focusing on anything. My fiancé
      was there. God, he was mad at me. I had scared him too much. He was
      pale, and shaking. I asked if we had really had a girl. I couldn’t
      remember for sure. He showed he to me, and was hustled out of the room
      for me to rest…

      When I was finally released from the hospital my iron levels were still
      dangerously low, and I was unable to walk without assistance, and
      someone to spot me in case I wavered.

      It took more than a month for me to feel like the effects from the blood
      loss were over, and I was fairly normal again. All that and I still am
      most thankful for Spirit’s birth. Even with the recovery, her birth was
      by far the most healing choice I could have made, after the C-sections. I
      would do it all over again just to feel the wonder of the way my body
      took charge and did everything. Yes, you read that right. I would still
      choose the same. It would be wonderful to do it minus the placenta
      retention and hemorrhage (or at least without the doctors telling me
      what a stupid thing I did), but even with the ICU trip it was better
      than the surgeries that left me feeling hollow and empty.

      11 months later, I feel the same way. Spirit’s birth was truly what I needed to heal from the boys’ un-births.”

      • T.
        March 20, 2013 at 10:20 am #

        I am an horrible person, but all I can think about are the resource wasted on this woman. Yes, wasted. She may be a wonderful person and a wonderful mother and a wonderful what-you-have, but lady, if you choose something, you choose the conseguences of it as well!

      • Josephine
        March 20, 2013 at 10:35 am #

        Pardon my ineloquence (and I should be inured to these kinds of stories by now) but HOLY SHIT. She labored for three days and still complained about a section? Did she WANT a fistula or what? I also love how she complains that no one else held her son the whole time, when you know she would have been raging had anyone else been holding him when she came to. Perhaps that’s presumptive of me to say, but considering how much it’s all about her, maybe not.

        “I couldn’t breath (sic).” Maybe if she had done a few minutes of research on spinals/epidurals she would have known that it’s a common side effect instead of freaking out and punishing herself for…having a baby safely? Ugh. But I forgot, those were her UNBIRTHS and she didn’t deserve to “breath”.

        Her crowning achievement is, of course, doing the stupidest fucking thing she could have done in terms of safety for her and her child, followed by almost leaving her four children motherless and her fiance a single parent. And heaven forbid she actually call the father of the child to be present for his daughter’s birth. She put her partner through hell for her selfish wants.

        And over what? Did she have some super traumatic classical incision emergency c-section all three times and get some massive infections with each? Not from what she’s said. She had three medically-indicated surgical births. The worst that happened is that her son ended up in the NICU – probably for observation since he was born at 36 weeks. She didn’t say anything about any other problems. Maybe she’s leaving out his issues for some reason, but it doesn’t seem likely.

        And I know I’m not saying anything we all don’t already know, but the selfishness is breathtaking.

      • I don't have a creative name
        March 20, 2013 at 10:50 am #

        Un-births. UN-births. How stupid and asinine.

        How heartbreaking it is that her boys will always be second class citizens in her world because they didn’t know how to be born the “right” way.

        • crabby appleseed
          March 20, 2013 at 1:50 pm #

          And SHE’S the one who refers to them as being “surigcally removed” from her body, as if they were tumors. That entire blog entry is appalling. I feel sorry for her children. I feel a bit of pity for her fiance, but only a little bit, since presumably he chooses to be with her.

        • Captain Obvious
          March 20, 2013 at 2:50 pm #

          Un-birth? You mean non vaginal delivery you idiot. Babies are born or gave birth or delivered vaginally or abdominally. Unbirth sounds like the baby is still in her uterus.

          • Bombshellrisa
            March 20, 2013 at 3:08 pm #

            Un-birth to me is when you get all excited thinking you are going to the hospital in labor and you get your bag and call everyone and then it turns out to be false labor and you go home.

          • An Actual Attorney
            March 20, 2013 at 8:30 pm #

            Un-birth sounds like someone shoving my 2 year old back up my vagina. And it doesn’t sound good.

          • The Bofa on the Sofa
            March 21, 2013 at 10:28 am #

            No, that’s anti-birth, not un-birth.

      • nohika
        March 20, 2013 at 10:52 am #

        ” “That’s not what you need to be concerned about right now” was the reply I got, and I knew that he wouldn’t help me.”

        Oh geez. Not like he’s…yanno, busy trying to save your LIFE or anything. Holy hell.

        I agree, as harsh as it is. Resources could go other places and be FAR more useful. I fear for her children.

        • Bombshellrisa
          March 20, 2013 at 3:06 pm #

          Her children are “ghost hunters” she has a blog about it.

      • GuestB
        March 20, 2013 at 10:57 am #

        “Un-births?” Really?
        I used to get fired up reading these stories. Now I just feel really really sad for these women. Sad that they have to attach meaning to the most inconsequential shit (ie vaginal birth) and then spend the rest of their lives trying to “make up for it”. It is so sad.

      • LukesCook
        March 20, 2013 at 1:19 pm #

        Note that she wouldn’t really have minded the placenta retention and hemorrhage if it weren’t for the doctors telling her what a stupid thing she did. Priorities.

        • Eddie
          March 20, 2013 at 11:34 pm #

          Yeah, that was what I noticed also. Apparently, the doctors should have given her a high-five. Stunningly backwards priorities.

      • Mrs. W
        March 20, 2013 at 1:35 pm #

        “Un-birth”, what an awful way to describe the arrival of your child – traumatic or not, cesarean or vaginal, the arrival of your child should always be their birth. I dislike the way in which my daughter arrived – I found it traumatic, but I will celebrate her birth (her arrival into my life, not the way she was born) and who she is for all the years I am blessed to share with her. Her birth was a blessing in my life, even though the circumstances of the delivery were nothing short of awful.

      • Susan
        March 20, 2013 at 1:38 pm #

        That may win the stunt birth olympics. Too bad there are so many contestants.

    • attitude devant
      March 20, 2013 at 10:31 am #

      Oh Jeez—who would have ever guessed that post-dates plus active-phase arrest might wind up with a shoulder dystocia and a post-partum hemorrhage. Way to miss the obvious, midwives!! Oh and mom, glad you got the intervention-free birth you wanted, oh except for the 3 day NICU stay, the pitocin for post-partum “gushing,” and the maneuvers for shoulder dystocia. Better luck next time, right?

      • Courtney84
        March 20, 2013 at 3:20 pm #

        My nephew was born via stat c-section, he had meconium aspiration. My sister says that THE WORST part of the whole thing was small amount of time before when they could no longer detect his heartbeat, and when the surgery started (truly, 5 min or less, they’d already suspected things were going south). She does not say the worst part was that she didn’t hold him for over 24 hrs, that he was not allowed to be fed for 2 days, that it took 3 1/2 days to get him off the oxygen completely, or that he spent 5 days on IV antibiotics. She does not say that the Christmas she spent with her newborn, days after sending off his re-tests to the state metabolic screen to determine if he had one of the metabolic conditions was the worst part. [His original screen was a false positive, but we didn’t know that on Christmas] She does not say the worst part was the ugly incision that took longer than typical to heal, the mild skin infection, or the staples were the worst part. The worst part was the brief time of uncertainty. SO – How is it this mother thinks that needing to get out of the tub with her baby half delivered and experiencing shoulder dystocia “could have been scary”? WTF is wrong with these women? Are they really that much more concerned with the experience than the baby? Or are they just unbelievably smug to think that they are immune to complications of delivery?

    • Jessica
      March 20, 2013 at 12:40 pm #

      Oh my God, I recognize that woman from The Bump.

    • Captain Obvious
      March 20, 2013 at 2:44 pm #

      I generally don’t sweep the membranes on positive GBBS patients. Just have the worry of propelling GBBS up the cervix into the uterus onto the membranes. Protracted active phase is a worry for a larger baby and anticipating that much may have had her out of the tub for the delivery so SD maneuvers could be initiated quicker. And maybe it wasn’t that the baby’s grunting was because she couldn’t get all the lung secretions up but rather because she swallowed or breathed too much hyponatremic tub water during the birth. In addition, you mean she couldn’t dim the lights in the hospital room with her first birth?

  48. Courtney84
    March 20, 2013 at 9:24 am #

    Is there any data out there on the frequency which QT prolonging drugs, or domperidone in particular, have these severe side effects?

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