Brenda, I live in a state where the attorney general decided to warn a couple of physicians and compounding pharmacies not to prescribe, compound or mention Domperidone.  The warned physicians were required to sign an "Assurance of Compliance" (see http://www.nebraska.gov/LISSearch/actions/79619.pdf for an example).  In the breastfeeding clinic where I worked, we were worried that not being able to use Domperidone would have a huge impact on our ability to help mothers.  In the end, it pushed us to go back to the basics, focus on ways to optimize milk production without a pill.  We constantly talked about the need for frequent milk removal, the relationship of supply and demand.  There is a tendency for some mothers to seek a simple solution when a non-pharmacological approach (which may require more effort) can do wonders.  I think that if you hope to keep a good working relationship with the physicians who have asked you not to discuss Domperidone, you should honor their request.



Being able to share information now about the importance of the mother taking an active role in milk removal even when pumping (focusing on hands-on pumping rather than passive pumping), using Dr. Jane Morton's helpful website http://newborns.stanford.edu/Breastfeeding/MaxProduction.html has been very useful.  I know mothers obtain Domperidone from other sources and I share information with them, such as that which Jake Marcus has mentioned (that Domperidone is not FDA  approved and could be seized at the border if they are having it shipped from Canada, Mexico, New Zealand or somewhere else outside the US).



I think the most important thing to remember is that we are not left without options for helping moms even when we cannot encourage them to obtain Domperidone.



Sara Dodder Furr, MA, IBCLC

Quality Improvement Specialist

Office of Research, Policy & Quality Improvement

Health Licensure & Investigations Unit, DHHS Division of Public Health 

P.O. Box 95206

Lincoln NE 68509-5026

Phone:  (402) 471-4973 FAX:  (402) 471-0383

[log in to unmask] 

Website: http://www.dhhs.ne.gov/crl/crlindex.htm 



AND



Former LC and current Facebook administrator at MilkWorks 

www.milkworks.org

http://www.facebook.com/MilkWorks



"creating a healthier community by helping mothers breastfeed their babies...." 

----------------------------------------------------------------------



Date:    Tue, 13 Sep 2011 16:08:03 -0700

From:    Brenda Phipps <[log in to unmask]>

Subject: Continued questions on ethics and the domperidone discussion



 ...



I guess my real question at this point is - how do I, as an LC, ethically discuss this with my patients? What exactly should I be telling the physicians? I know that domperidone is safer in terms of side effects, but I also know it is NOT FDA approved at this moment in time, and that the physicians are not all super comfortable with me sending patients their way for prescriptions. Do I immediately conform to their requests, and discontinue my practice of offering this as a suggestion for moms with dwindling milk supplies who are desparate to continue breastfeeding?



             ***********************************************



Archives: http://community.lsoft.com/archives/LACTNET.html

To reach list owners: [log in to unmask]

Mail all list management commands to: [log in to unmask]

COMMANDS:

1. To temporarily stop your subscription write in the body of an email: set lactnet nomail

2. To start it again: set lactnet mail

3. To unsubscribe: unsubscribe lactnet

4. To get a comprehensive list of rules and directions: get lactnet welcome