Well, here in Spain we can get domperidone over the counter, without a prescription, and just know I am facing a dilema.  I have a mother who gave birth three weeks ago to a baby boy after 32 weeks of gestation.  She was not allowed to touch her baby for the first two weeks (I can hear yours ahh and oohs...but that is common practice in a very big hospital in Madrid, as it is not the first case I hear about).  She's been pumping every three hours, day and night, but the most she's been able to express in 24 hours is 80ml.  The baby has been given 60 ml. of formula every three hours for the last week, and given the amount the mother has been able to express, he has been given only one bottle of breast milk a day.  Yesterday, for the first time, she was allowed to put him to her breast.  He latched on beautifully according to the mom, but after five strong sucks, the nurse told her to stop, because nursing could tire the baby too much, and he would not be able to drink his formula.  He is at 1.900 grs. now and the mom will take him home next Wednesday.  In the meantime she or her husband (not both, that means that if he goes in, she cannot) are allowed to see (not always hold) the baby for one hour every three, from 9 am to 10 pm.

I have assured her that once at home, with her baby at the breast all day, she'll start producing enough milk.  I 've also told her that at the beginning she might have to continue with the supplements but that she does not have to use artificial nipples (explained other methods).  I've also suggested getting a more efficient breast pump, increase the pumping time to 15 minutes every two hours around the clock, visualizing the baby, etc.  She is more than willing to try, specially since I seem to be the only person that has treated her with empathy and respect.  She trusts me and has been calling me daily for the last three days.  At this point, and seeing how little she has been able to express, the nurses, the pediatrician and now her husband are telling her that she is just being stubborn, that sometimes breastfeeding does not work, and that by insisting so much, she might jeopardize the well being of the baby.

I am a LLL leader, and as such, I would not even dream about suggesting any kind of medication, let alone prescribe anything.  But I am tempted to tell her to coment with her doctors the possible use of domperidone, without telling her the name of the medication under which the formula is commercialized in Spain.

I know most of you will be outraged with the procedures of this Hospital, but this mother is in no position to change them at this very moment.  I am working towards that, but it might take years, which I am willing to spend in the fight, but in the meantime...could I just mention the domperidone?

Thanks a lot,

Lavinia (LLL Madrid)

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