There's research that domperidone works, and only one preliminary, 
uncontrolled study showing an effect from fenugreek, and no research at 
all on the other herbs. Germany's Commission E assures us that the ones 
we use most are usually safe, but there is little data about efficacy.
No drug will work in the absence of good management, but if mom is doing 
everything else without full results, domperidone is a reasonable and 
low risk intervention. I do encourage my clients to speak with their 
physician or see our local breastfeeding medicine doc before taking any 
pharmaceutical, just to review their health history and ensure that this 
is the correct intervention for them and that they have no personal 
contraindications. That said, this drug is considered safe enough to be 
sold over the counter in most nations.
In the absence of universal access to banked human milk, our choices are 
often domperidone or formula. There's lots of research on the risks of 
formula.
Catherine Watson Genna, IBCLC NYC

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