Abstract
BackgroundDomperidone is the most frequently prescribed medicine used to increase breast milk supply. There is considerable controversy surrounding the use of domperidone in lactation, due to limited evidence about efficacy and concerns about rare but life-threatening side-effects. Despite this, in many high-income settings such as Australia, use of domperidone among breastfeeding mothers appears to be increasing. The aim of this paper was to explore women’s experiences of using domperidone during breastfeeding.MethodsSemi-structured interviews were conducted in 2019 with 15 women in Australia who reported using domperidone as a galactagogue during breastfeeding. Interviews were recorded, transcribed and analysed thematically.ResultsWomen reported a wide variety of practices concerning the timing of initiation of domperidone use, including prophylactic use, as well as the dose and duration of use. Prolonged periods of use and unsupervised dosing were commonly reported, these practices were sometimes associated with a fear of the consequences of stopping, insufficient provision of information about the drug or feeling dismissed by health professionals. Some women indicated that when doctors refused to prescribe domperidone they responded by doctor shopping and seeking anecdotal information about benefits and risks online, leading to unsupervised practices. Women often reported high expectations surrounding the effectiveness of domperidone, and most used the medication in conjunction with food/herbal galactagogues and non-galactagogue support. Positive outcomes following domperidone use included having greater confidence in breastfeeding and pride at achieving breastfeeding goals.ConclusionsThis study identified a variety of practices concerning domperidone use, including potentially unsafe practices, linked in some cases to inconsistent advice from health professionals and a reliance on online, anecdotal information sources. These findings emphasise the urgent need for development of clinical practice guidelines and a greater focus on translating existing evidence concerning domperidone into clinical practice, including clinical support that is tailored to women’s needs.
Highlights
Domperidone is the most frequently prescribed medicine used to increase breast milk supply
The novel findings reported in this study present some previously unreported insight into women’s experiences when using domperidone to support their breast milk supply
We argue that one way of ensuring more supportive and tailored support that can factor in goals, decision making processes and aspects of maternal identity is a shared decision-making approach as a facet of lactation support delivered by International Board-Certified Lactation Consultants (IBCLC) and other breastfeeding specialists
Summary
Domperidone is the most frequently prescribed medicine used to increase breast milk supply. In many high-income settings such as Australia, use of domperidone among breastfeeding mothers appears to be increasing. Current and agreed upon advice promotes exclusive breastfeeding until six months and continued breastfeeding (combined with solid food sources) up to two years or longer [1]. Many studies indicate that women are well-informed about the importance of breastfeeding, the rates indicate a high initiation but low continuation (by six months) in high income countries [2]. In order to support supply, either to initiate, maintain or boost lactation, women often turn to breastfeeding support and the use of galactagogues which can be certain foods, herbs or medications. Increasing in mainstream use [8] there is currently insufficient evidence supporting the efficacy of galactagogues [4]
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