Hey All,
We may be correct in our belief that this warning is politically motivated
but that does not release us from the professional responsibility to search
the literature and review the original documents that the FDA cites as
showing risk.  I am guessing that we will find that it is as safe as we
expected but until that work is done and references in hand we haven't
anything to protest.

We also do not have any proof that domperidone is an effective
galactogogue, I personally have had many mothers who feel that it does
increase their supply but an equal or greater number who feel that it
didn't help at all.  Randomized control trials would be difficult as each
mother infant dyad has their own unique circumstances making it impossible
to compare groups.  BFAR moms seem to me to be the most promising group for
such trials, has anyone done this? Tom Hale questions efficacy of
domperidone and says that there is no mechanism by which it should work.
This leaves us with a drug of questionable efficacy and potential risk.  To
dismiss this warning out of hand is dangerous and unprofessional.

I think that most of us were breastfeeding advocates first and lactation
professionals second.  In cases like these our advocate hats are firmly in
place making it difficult to draw on our professional experience.  We then
come off to the media and the public as unprofessional fanatics.
Presenting ourselves as rational professionals able to analyze the
situation without bias is critically important to our status as
professionals and to our ability to promote, support and protect
breastfeeding.

Janie Akerlund RN IBCLC
Nurse-Midwifery Birth Center
Eugene, OR USA

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