Pam mentioned Cytotec.  I have seen the Very Scary warning letter sent to
all practicing obstetricians in the US about how they are totally out on
their very own flimsy teensy weensy limb, with a chain saw lurking in the
background, if they use this drug on a pregnant woman.  Period.  Given how
skittish obstetrics is as a field it is mind-boggling that the drug is still
in widespread use, but it sure is.  Why should domperidone be any different?

OTOH as an IBCLC you are usually not authorized to prescribe medications in
most countries.  I am not aware of any exceptions.  This has been discussed
before on LN.  It takes a different kind of credential to prescribe, and if
you don't have one, you are out of your domain when recommending drugs.  If
you are fortunate enough to have a collaboration with an understanding
person with the right credentials, great.  It doesn't really matter if the
drug is approved elsewhere.  As a professional practicing in one
jurisdiction, you are expected to play by the rules there, and it doesn't
usually help in court to say 'yeah, but you can buy it in a candy store in
Farawayland (and they just happen to take credit card orders on line)!'  We
all agree that OTC sale of (dumped) broad-spectrum antibiotics in developing
countries is a Bad Thing.  But the availability of domperidone serves our
purpose, which admittedly is a noble one, so we don't protest so loudly
about that.

In my opinion it is up to the person taking a drug imported by unorthodox
means to do the footwork, and you as an LC are probably on very thin ice if
you are handing out phone numbers to pharmacies in other countries and
telling them to go for it, because you as a professional have a
responsibility to respect the laws where you practice.  You are probably on
thinner ice as an IBCLC than as a peer counselor, in fact.  We all know an
internist isn't necessarily qualified to give breastfeeding advice or help a
mother improve a latch.  The law doesn't prohibit the internist or anyone
else from trying to practice as an LC, because our profession lacks the
legal status in most jurisdictions to protect its 'monopoly'.  Not so
medicine, which is a very powerful guild, almost as powerful as midwifery
where I live (had to get that in!).

Within the legal framework in which I work, I would feel uncomfortable doing
any more than informing a woman that a particular drug is used elsewhere,
but that it is not available in our country except by special arrangement.
If she needs more than that to get started on her own search, I don't want
to be a part of it.  I would be happy to discuss it with her doctor, AFTER
she gets the doc to contact me, after doing her homework herself.

I reiterate: there is very likely a strong connection between the
manufacturers of formula and of domperidone/motilium.  This thing stinks, no
doubt about it, but let that not drive us over the line into indictable
behavior.

Rachel Myr
Kristiansand, Norway

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