There is the right to do something ... and then there is the price of doing
something.  Sometimes if the boss says Don't Talk About This, you have to
respect that order (as a condition of your employment) ... until and unless
you have an opportunity to change the minds of the powers that be.

The IBLCE Scope of Practice for IBCLCs is clear: we have a DUTY to provide
evidence based information and support to mothers so they can make informed
decisions about breastfeeding-related matters affecting them, and their
children.  We do the informing; the mothers do the deciding (often in
conjunction with a separate discussion with the primary health care
provider, the pediatrician and/or the midwife/OB).

I personally, do not have a problem providing **accurate information** (as
an IBCLC) to mothers about domperidone.  We are an international credential
... there are plenty of countries where domperidone use is not problematic.
 Here in the USA, by the way, that **accurate information** is going to have
to include discussion of that that that domperidone is not FDA approved.

Domperidone is a very hot political hot potato.  Unlike other areas of
practice of lactation care where we run into lots of blow-back (think tongue
tie, or early use of hormonal birth control, or use of the "warmer" vs.
skin-to-skin), domperidone is a drug.  Drugs are highly regulated.  Those
who can prescribe drugs are licensed, and carefully monitored.

One of the fastest, easiest ways to give a doctor or midwife heartburn
(perhaps requiring a round of Motilium?) is to suggest that she has
illegally prescribed a drug ... or prescribed a drug that is illegal.
 Licensing boards, hospitals and physician practices do not mess around with
this sort of stuff ... and can make the professional life of the
practitioner pretty miserable, if they allege the practitioner has
overstepped her bounds.  And that is a good thing.  We WANT practitioners
who prescribe medicines to be very watchful about what they do, and we WANT
to know that there are authorities who are looking out for us as patients
and consumers.

It was news to me, reading recent posts, to learn that domperidone has
*never* been approved for any use in the USA by the FDA.  I had to poke
around the FDA website to confirm it.  Yup.  It's true.

Which means it is a little more prickly from the compounding standpoint.
 Customarily, the FDA will *not* step into the traditionally-revered privacy
of the doctor-patient-druggist relationship.  If, for example, a doctor and
her patient decide that Reglan, a traditional heartburn medicine, should be
tried to see if it boosts mom's supply, that use will be allowed, and the
druggist can make up the prescription -- even though it is off-label use --
because this doctor and this patient have agreed to this course of
therapeutic action, having weighed all risks and benefits.

The reason?  Reglan has been reviewed and approved by FDA, albeit for
another use.  Domperidone has never been approved by the FDA.

Yes, I know:  some pharmacies compound it.  Some doctors prescribe it.  Go
back to the fifth paragraph of this post.  In some areas, practitioners and
druggists find they do not incur the wrath of the regulators when they do
this.  In other areas, practitioners and druggists have been raked over some
pretty hot coals.

Bottom line:  IBCLCs are a lot "safer" because we do not (as IBCLCs) have
prescribing powers in our scope of practice ... and providing information is
always acceptable and correct.  Whether or not Our Bosses understand that we
are "just" providing information is another matter altogether.  We each have
to weigh our own professional settings, and ask:  what is the price of
providing this information, even though I have been ordered not to?

-- 
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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