Here in New Zealand, there are no issues with obtaining domperidone prescriptions.  It can even be prescribed by midwives in the first 6 weeks postpartum as midwives have prescribing rights for childbirth related conditions (approx 80% of women have a midwife for their maternity care and ALL women have a midwife for their postnatal care).

The use of domperidone has "saved the day" in many circumstances, mainly when there has been an interruption to the normal establishment of lactation (e.g. sick or prem baby, unwell mother), or later when a baby is admitted to hospital and milk supply decreases due to reduced feeding by the baby (during illness) and the stress of a hospital admission.  Pumps are expensive to buy or hire here and beyond the means of many family incomes.  Other galatogogues (e.g. herbal) are also very expensive for most families but a prescription of domperidone is manageable.

It has also very useful for identified low milk supply issues (where any feeding problems have been corrected) and the use of this medication has enabled many mothers to breastfeed longer or better than they would have otherwise.  But I do not need to convince most of you about this!  It really is very effective in certain circumstances, and without all the side effects that maxalon often caused.

HOWEVER, it is also over used here and is often dished out like lollies (candy, sweeties, whatever) at the recommendation of feeding and sleep "experts" who tell mothers their milk supply is the reason why their baby does not sleep, settle etc.  I find this very distressing as it is encourages "a pill for everything" mentality in our society and some mothers feel they cannot lactate without it!  It is a case of educating GP's about the appropriate use of this drug, as against the popular use for all the wrong reasons. 

So, in essence, in USA you cannot get it when you need it and here we get it when we don't need it.  How back to front is that!

Karen Palmer
Midwife and IBCLC

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