For women who have trouble achieving an appropriate volume of breast-milk, a medicine which is commonly prescribed is domperidone. This medication, which has a long medical history, is prescribed principally for nausea and vomiting. In certain women, it can provide a useful increase in milk supply.
There has been recent discussion about the safety of domperidone following the restriction of its use in Europe by the European Medicines Agency. This restriction was brought about by the finding that in people over the age of 60 years, and particularly for men, there was an increased mortality from cardiac events and, in particular, arrhythmias. There has been no evidence published to suggest that these cardiac risks applied to young, fit women.
If your care provider has prescribed domperidone to assist your breast milk volume, I would regard this as a reasonable thing to do. While I rarely prescribe domperidone myself I would never attempt to discourage a woman where it had been prescribed by another doctor.
In my practice the strategies for increasing milk supply include the following:
- recognising that lactation is an energy expensive time.
- that a woman’s energy utilisation increases by between 50 and 100% while she is breastfeeding.
- eating three meals per day and possibly adding snacks assists in meeting this requirement of an additional 2000 to 3000 cal per day.
- I find it highly effective to encourage the consumption of between 1 and 1½ litres of full cream milk in any format that the mother likes. This can include yoghurt, custard, ice cream, milkshakes and any combination of these. For those women who are lactose intolerant then there are multiple soy choices available.
- it is important to recognise that while domperidone may increase breast milk volume it has no impact upon breast-milk energy density.
- some women will produce low energy density milk (skimmer) and other women will provide high energy density milk (full cream). These differences in energy density are genetically determined and we are unable to alter that by any medical intervention.
- achieving an appropriate sleep routine for the child and returning a mother to appropriate day and night routines which emphasises her ability to eat, drink and rest are clear and have obvious benefits to lactation.
- I tend to encourage that a woman use both breasts at each feed while also noting that in some women their milk supply is very generous and a baby will be satisfied after one breast.
- As you know I also recommend top-up bottles of either expressed breast milk or formula if a woman feels that her milk supply at a particular time of day is decreased. This will occur most commonly between about 4pm and 8pm.
To conclude about domperidone:
In some women it can provide a useful increase in her milk supply. The dose given varies between 20 and up to 60 mg per day. Once an appropriate milk volume is achieved it is recommended that the medication be slowly reduced.
Best wishes
Sleep well
Dr Brian Symon
The Babysleep Doctor
