While this substance is sold without a prescription in many neighboring
countries it is not on the Norwegian national formulary at all and so it is
not included in any official procedures concerning breastfeeding here.  It
seems that the Norwegian agency that determines such things has simply
adopted the US opinion on its appropriateness for use, though I do not
believe it has been categorized as an illicit drug, unlike khat or cocaine
or cannabis.  The only such drug that is used is metoclopramide, and it is
very rarely used too.

The rules here on legal medications are that one may carry into the country
up to a three month supply for oneself when returning to Norway from a place
where the medication is obtainable.  Since it is sold for motion sickness in
many airports from which there are direct flights to Norway, I would be
surprised if someone were ever subject to legal sanctions for having
purchased it in good faith. I do not suggest its use, but if someone asks me
what I know about it, I tell them what I know.

I've only run across one woman who told me she used it, and she got it on
her own, long before I met her, while under the care of IBCLCs in a country
where it was not restricted.  In her case, none of the usual things were
sufficient to help her produce all the milk her baby needed so if I
practiced in a setting where pharmaceutical galactogogues were common I
might well have suggested them for her too.  But in the vast majority of
cases of low milk supply that I see, increased stimulation by feeding or
expressing milk more often for a time is enough to do the trick, usually
after correcting whatever underlying problem it was that led to the
understimulation in the first place. This is just plain appropriate
management of any health problem: start with the simplest things, and work
through to the more complicated ones only when necessary. 

In the case that sparked the current discussion about domperidone here,
there were plenty of simple things to do at the outset, and in these
desperate situations, the most important thing is often to prioritize,
generally placing the mother-baby relationship at the top. In my experience,
an overwhelmed, distraught mother who is terrified of losing her supply
needs more than anything to connect with her baby. You can make brilliant
plans that are no more complex than 'feed the baby, protect the supply, and
every moment that isn't spent feeding the baby or expressing milk, should be
spent in skin-to-skin contact with the baby, in a bed'.  I strongly advise
keeping interventions SIMPLE and DOABLE, and preferably PLEASURABLE, and
only adding new ones if the simple ones don't meet the goals.  What has
really strengthened my trust in this approach is my experience with mothers
who have ended up exclusively breastfeeding after up to several months of
supplementation.  When they get to the point where the baby prefers coming
to the breast over being fed some other way, you know you are on the home
stretch AND you know they are going to enjoy the rest of the 'work' they
have to do because they are pumping and supplementing less, and basking with
their babies at their breasts a lot more.

In recent years many midwives here have taken a short course in 'midwifery
acupuncture'. The courses are offered by acupuncturists trained for years in
traditional Chinese acupuncture, and give a rudimentary understanding of the
theories underlying its use, while emphasizing that these midwives are not
acupuncturists, they are midwives who know a few points, for analgesia, as
well as nausea in the first trimester, musculoskeletal pain from pelvic
softening, hemorrhoids, and cervical ripening, as well as engorgement and
low milk supply.  It is disturbing to me to see midwives going for their
needles on day two or three postpartum before helping a woman understand
that the most important factors in avoiding both conditions are effective,
early, frequent milk removal, preferably by a baby who is with her all the
time. Makes me wonder whether the midwives themselves understand this!  I
don't put much store by the anecdotes about women who on day three hardly
have any milk and are very engorged, and thanks to one acupuncture
treatment, they have plenty of milk and less engorgement on day four. Not a
sensational triumph for acupuncture, to my mind.  But for women with
persistent difficulty in establishing milk supply, it's nice to have one
more thing to try.

Rachel Myr
Kristiansand, Norway

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