Taking drugs to keep breastfeeding

Most breastfeeding mothers can afford to be vague about when they’re going to stop breastfeeding.

Their decision may depend on cultural expectations (“She’s walking and talking and you are still nursing her?!”) or personal comfort (“I just can’t deal with the biting anymore!”) or parenting philosophy (“He’ll wean when he’s ready.”)

But there are others, like me, who need to take a more pragmatic approach. The question of how long we’ll breastfeed goes hand in hand with another question: how long can we afford to take domperidone?

Domperidone is a drug normally prescribed for nausea but has the side-effect of increasing prolactin levels. In a breastfeeding mother this can noticeably increase her milk supply.

I first read about it in a kellymom.com article on low milk supply but when the lactation consultant who was helping us mentioned it, I asked the GP who was doing Talitha’s 6-week check to prescribe it.

I started taking it because although the tongue-tie cut greatly improved her latch and suck, she was hardly swallowing and still wasn’t gaining weight.

I was pumping after feeds, doing breast compressions while she fed and making sure the latch was correct every time. Yet there was hardly any milk and my tiny baby was never happy and hardly sleeping day or night.

Within 24 hours of starting domperidone (and it was a LOW dose of 30mg a day) my breasts suddenly had the feeling of fullness they had never had. Like Liska yesterday described happened to her, my baby was staying on the breast longer and was happier.

I ended up taking 90mg a day because the initial effect couldn’t be maintained on such a low dose. This is the starting dosage that breastfeeding expert Dr Jack Newman recommends for this purpose. However, my GP refused to prescribe it in that amount as she was unfamiliar with domperidone being used this way. I ended up getting the extra pills by other means.

In fact, she eventually stopped prescribing it for me altogether and instead prescribed a drug called metoclopramide (known as Reglan in the US) which is known for causing depression in postnatal mothers.

With a history of depression, I wasn’t taking any chances so refused to take it, did some research and took it to the GP, pleading with her to seek further advice on prescribing domperidone.

In the meantime I had three weeks without taking domperidone and had very little milk. I had my Supplemental Nursing System ready for every feed which was disheartening after getting to a point where I’d only needed to supplement with a couple of ounces of formula a day.

After speaking to the infant feeding midwife at the hospital, my GP agreed to prescribe the domperidone but only at 30mg a day. This hardly did anything to help.

When I finally started taking domperidone at 90mg it didn’t make much of a difference because of the time I’d spent off it. Then, without me even noticing, it suddenly kicked in. And Talitha began feeding better (I attribute this partly to the work done to her jaw in cranial osteopathy).

In fact, the scales showed she was gaining weight too quickly. So I began cutting out the formula supplements until it became apparent that she didn’t need them at all.

She could be exclusively breastfed. She turns six months this Saturday and we’ve finally got here.

Now this presents the conundrum. I’d initially said I’d stop taking domperidone when Talitha reached six months, feeling that was a more than reasonable stretch.

If the drugs weren’t working or had a minimal effect that would be one thing but I’m convinced that I need them in order to breastfeed my daughter and I’m just not ready to stop doing so.

On one hand I wonder whether I should be taking medication to produce breast milk. It’s somewhat artificial. On the other, formula is artificial. Breast milk is a live substance. Formula is not.

And it’s not just about the nutrition. Breastfeeding is so comforting to Talitha and so much a part of our relationship that I feel stopping suddenly would force me to rethink a lot of how I mother her.

On the health side of things, the amount of domperidone that enters breast milk is considered negligible and mothers have taken it up to eighteen months without adverse side effects.

I don’t think this is one of those questions whether there is a right or a wrong answer. Whichever decision I make will be the right one for us. Either way, I have already breastfed her for much longer than I imagined I’d be able to.

So tell me, when and how did you decide to stop breastfeeding? If you stopped around the six-month mark, was that enough?

Image: m-generic.net

This week is Baby Feeding Week on Circus Queen. I’m celebrating having made it to six months of breast and bottle feeding my daughter through LOTS of difficulty. Look out for tomorrow’s Baby Feeding Week post: “The best bottle for a breastfed baby.”