Just wanted to add a few comments to this issue, since we adoptive moms have
alot of experience.  I personally did not have the opportunity to use
domperidone while I was nursing my kids, the last of whom weaned six years
ago.  However, I have since had contact with many, many moms who have used
it.

There were a few years there, where a large percentage of adoptive moms
tried metoclopramide.  This was also a question I asked on a survey for some
research I started, around 1995.  Nearly everyone who had taken it had had
some side-effects.  Many felt that it did increase their milk production to
some extent, but not anything earth-shattering.  Most had gotten off of it
quickly, after the depression and/or anxiety and/or sedation had started.  A
few were able to take it for weeks without seeing adverse effects, but many
saw them right away.  A few also seemed to be fine on it, only to have the
side-effects hit with a vengeance, when they quit taking it.  I was an
example of that.  I used it for three weeks.  When I quit taking it, I spent
nearly a week feeling like I was a totally unfit mother and wanting to give
the baby I'd had to fight tooth and nail to get out of foster care to
someone else.  There were a couple of other times that I tried to take a
lower dose of metoclopramide, hoping I could get by with it, but the
side-effects started soon after.

We have seen negative effects in both women with histories of clinical
depression, and those who have never had a problem with it before.  In fact,
one of the most severe cases was in a woman in her 40s who had never had any
trouble before.  She became severely depressed, after several months of
metoclopramide.  Her doctor referred her to a psychiatrist, who diagnosed
her with severe, chemically induced clinical depression.  When she got off
the metoclopramide, she immediately started having severe anxiety attacks.
It took her six months, under the care of the psychiatrist, to get back to
feeling like herself and being able to enjoy her children.

The most frightening case I know of was in a woman who did have a history of
clinical depression.  She had started feeling badly when she first started
taking it, but had been assured that it couldn't be the meds that caused it,
because no one got depressed from metoclopramide until they had been on it
for at least two months.  Things had gotten worse until she ended up in the
psych ward of a hospital, in such a deep depression that she was suicidal.
Instead of spending happy hours nurturing her adopted baby at her breast,
which is the primary goal of breastfeeding an adopted baby, the baby was
being bottle fed by others of her relatives, while she was in the hospital,
trying to find the will to live.  She told me that, by this point, she
wished she had never heard of the notion of nursing an adopted baby.

I think domperidone is both safer and more effective.  Its effectiveness
varies, of course.  Some women only have a small increase, but there is a
percentage (which I can only very roughly estimate at around 20%) of
adoptive mothers who can provide all the milk their babies need, within six
weeks or less of starting domperidone and pumping or nursing.  There doesn't
appear to be any way to predict who will respond in what manner.  There have
been several cases of ladies who have been pumping for up to a couple
months, without seeing so much as a drop of milk, then been producing enough
to sustain a newborn, after just a few weeks of adding domperidone to the
same pumping routine that had previously produced nothing.  There are also
many moms who have pumped and taken domperidone, in advance of placement,
who still need some supplementation when the baby gets there, but can use
their own previously frozen milk in a supplementer.

Darillyn


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