These are questions with different answers in virtually every jurisdiction
represented on Lactnet.  If I were practicing in the US I would be abiding
by the rules governing my practice as whatever kind of licensed professional
I am there.  As an IBCLC I would be extremely cognizant of my lack of any
license for that particular function, in most places.  I'm not sure how such
an awareness would play out in my approach to practice, however.

I live in a country where we can't get domperidone at all, and our national
breastfeeding coordinating body spouts the FDA line verbatim, while saying
women can try Reglan, but only for a few weeks because of concerns about
side effects in the babies.  Yes, that's what they say.  Then again we don't
have any tradition of using medications to treat low supply and induced
lactation is extremely rare, possibly because sustained lactation is a norm.
Adoptive breastfeeding is also very rare. 

However, it is perfectly legal here to bring up to a three month supply of
drugs purchased legally elsewhere, into the country for your own use.  So
Norwegians can, if so inclined, pop down to the Netherlands and stock up on
domperidone which is available without prescription.  

I've never worked with a mother who was taking domperidone so I don't have
any experience with it but have seen many testimonials on Lactnet, and
besides, Jack Newman recommends it, which is good enough for me.  I don't
have any qualms about telling women where they can find info about
domperidone, nor about what I think the reason is behind the FDA stance
(politics, pure and simple).  I have serious qualms about urging anyone to
take it, given that I do not have prescriptive authority anyway, and it is
not a licensed drug here.

Frankly I think it is preferable that people whose main preparation to work
with breastfeeding mothers is attendance at a course after which the
organizers of the course award them a certification of their own making, be
wary of any such things.  Would you really want someone with a five day prep
course, advising your sister or your friend to take this or that herb or
drug?  I would rather the course instructors simply emphasized the need to
know one's limits but it's probably not a realistic expectation considering
they think it's fine to 'certify' people after a course lasting less than a
week.

Rachel Myr
Kristiansand, Norway, where you can only purchase twenty paracetamol
(acetaminophen in the US) tablets at a time on your own, because it is
considered unsafe to dispense it in larger amounts without a prescription.

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