Hi everyone,

This is my first post to Lactnet, though I've enjoyed 'dipping' into the amazing wealth of knowledge shared here!  I am a private LC in Brisbane, Australia.  I have a question about the use of domperidone early post-partum.

I've recently seen a mother who was prescribed domperidone and fenugreek on day 2, on leaving the hospital with the birth of her 3rd child.  Had breastfed her two older children - 1st for 2 years (breastfed through pregnancy), 2nd for 11 months.  Mother said she had many problems with her first child with cracked nipples, painful feeding for first few months, and supply issues.  No supply or breastfeeding problems with her second child.  I do wonder if the low supply was more as a result of the formula supplements the first bub was receiving.  But with this third pregnancy, mother developed gestational diabetes, had induced birth at 38 weeks, much more intervention than with her previous births, and seemed anxious about her supply.  Had expressed colostrum prenatally, which wasn't needed - bub fed well in first 24 hours; glucose levels fine.  Mum asked me to see her at home, day 3, due to nipple pain and concern about supply.  I was a bit shocked that domperidone was prescribed before her milk came in (evidence of milk coming in day 3, breasts were 'feeling hot', baby fed well, nipple pain probably mostly due to evident candida; corrected positioning & attachment with BLA).  And given mother's history, I was concerned that she has been made to doubt her supply even before it was in, when she's been able to produce plenty of milk with her second child (mother said the only problems with second child were a fast flow!).

So, my questions are:
- how common is it for domperidone to be prescribed in early post-natal period, and in what circumstances?  I found this article http://www.ijgo.org/article/S0020-7292%2811%2900593-5/abstract  but have yet to get the full article.  Caesarean wasn't the issue in this case, though.
- is gestational diabetes on its own a justification for use of galactogogues before lactogenesis II?  I know my views on this, but interested in hearing from those with more experience!

Thanks for your ideas and input.  I realise practices vary a lot across countries, hospitals, etc.  This is the first I'd come across this early use of domperidone.

Cheers,

Irene Francisco IBCLC
Brisbane, Australia

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