FAQ: Domperidone (Motilium) - Page 18

[pdxmomazon]

Originally Posted by Blessed_Mom

Hi,

At 4 months I am seeing a dip in my supply. I ordered Dom from the NZ pharmacy a week back...but am scared stiff about taking it. Actually my supply behaves erratically. Most days it is fine but some off days - I can tell my daughter is not getting 100% and she fusses.

A Mama's supply tends to even out around three months, so you might be experiencing that. Have you done some weigh-feed-weighs? If I were you I would make sure my baby wasn't getting enough before starting Dom or using a lact-aid.

As far as what is the "lesser evil" I suppose it's a personal decision and needs to be made as such. I've been using Dom since my daughter was two months old. I've noticed no side effects for her, and I've been happy not to have my period! I had to supplement with formula, so obviously I don't think it's evil, but being able to nurse my baby with the help of Dom is one of the greatest gifts I've ever received.

[NicoleS]

Originally Posted by Blessed_Mom

Hi,

At 4 months I am seeing a dip in my supply. I ordered Dom from the NZ pharmacy a week back...but am scared stiff about taking it. Actually my supply behaves erratically. Most days it is fine but some off days - I can tell my daughter is not getting 100% and she fusses.

I take fenugreek, MMplus and oatmeal.

I also ordered lact-aid which we should receive today. After reading this thread and some of the side effects (QTs, will reach baby and may affect her heart arrythmia (if it affects me in large doses- then what's to say it won't affect my baby's teeny heart?), not making me ovulate (meaning messing with my hormones) and also drug dependence(my supply may tank if I wean from it).....not to mention weight gain...
After reading all these - I am wondering why formula supplementing via lact-aid isn't the lesser evil?

Can someone please elaborate?

I wanted to add, even though I haven't taken Dom...4 months is also a prime growth spurt time and development spurt time. So that could be contributing to your "dip" and/or her fussiness. I second the PP about doing the weigh-feed-weigh to see how much she is actually getting.

BFing in general will "mess with your hormones" - hence why some lucky women (wish I could count myself among them!) won't get a period while they are still BFing, regardless of whether they are using a galactalogue or not. Fenugreek and Reglan can do the same thing if they increase your supply enough.

I can't speak to the other side effects.

As far as formula being the lesser evil - I think that is 100% a personal decision. For us, formula ends up becoming a necessary evil - I've tried all the supplements and it doesn't boost my supply enough and my kids lose weight. I'm still debating whether or not to give Dom a try this time around or to just try and nurse while we can and try my best not to feel guilty when we can't.

[LilMomma83]

My supply always fluctuates right before I get my period too...could be that... formula is a personal decision. We are doing formula and donor milk and I'm taking dom...but am only taking it at the recommendation of my LC because I don't get much nipple stimulation from baby sense I am gone 10-12 hours per day 7 days a week...I've never supplemented when I've been with him, but, he does nurse VERY frequently. My older sun fussed at he breast a lot because of gas and because of OVER supply/over active letdown....so that is a possibility. One thing you can do is try to squeeze milk out of your nipple after baby nurses to see if you have more I also weigh my baby before and after a feed with the same diaper every so often and that tells you how much they are getting - though different babies take different amounts.

[Megan73]

Hi Erica,
It really sounds like dom could do the trick for you. Check out Dr. Jack Newman's FAQ on starting dom and make sure you're taking enough. Most moms should start with three 10 mg tablets three times a day.
I would also eliminate the bottles. Have you tried supplementing with a Lact-Aid? Bottles can never help supply. Using an at-the-breast supplementer will prevent your baby from developing flow preference and keep him at the breast longer. I can't recommend it highly enough.
Good luck, mama!

Originally Posted by egmaranian

Hi ladies,

I'm new to this forum and also a FTM to my 9 wk old son, Nickolas. I have read through this entire thread and I have found the discussion so informative and helpful. Thank you so very much for all the great discussion. Here's my story...

I have been BFingmy baby since birth and didn't find out that I have supply issues until he was 5 wks old. He became a very fussy baby as soon as his mild jaundice cleared up and DH and I just figured he was a high-needs baby and were committed to giving him the love and attention he needed. When he was a month old, my mom commented on his stool being green in color and told me that that was not normal for a BF baby. I started researching green stool and realized that it could be caused by a foremilk/hindmilk imbalance. That, coupled with the fact that my baby wanted to nurse all the time for 1-1 1/2 hrs, but still always seemed hungry led me to call his ped. The doc had me bring him in right away and immediately diagnosed reflux and gave us a script for Prevacid. Thankfully, he also referred me to a local breastfeeding resrouce center. After three weeks of working with two different IBCLCs, I am now being referred to a different pediatrician who specializes in more complicated BF issues. I have already been told that she will probably prescribe dom for me based on my consistent low supply. My baby typically gets 1.5-2 oz per feeding at the breast and I have been supplementing anywhere from 2-8oz of expressed breastmilk per day in a bottle.

Finding this discussion has been so helpful to me because it has let me know that I am definitely not alone in my struggles with low supply AND it has seriously raised my comfort level witht he idea of using a drug to increase my supply. I've been taking Fenugreek and Lactation Blend capsules plus eating lots of oatmeal but I just haven't seen the kind of results I would like. I'm also pumping 4-5 times per day after feedings and I get anywhere from a few drops to 2 oz. It's just so inconsistent. My son is ALWAYS hungry and I get so sad everytime he finally feels satisfied with a bottle after being so frustrated with me. I have a very small supply stashed in the freezer, but it won't last much longer and I want to avoid more formula if possible (I had to supplement with formula for about two weeks). I desparately want a long-term BF relationship with my son and I really hope dom will help me get that.

Erica

[Megan73]

The only way to really know if you have low supply is if your babe isn't gaining enough. Check out kellymom.com for how much she should be gaining a week at her age. I think it still should be 5-8 oz a week at four months.
That said, dom has been used by thousands of lactating women without a problem. I've been taking it for 14 months and I haven't gained weight - I weigh less than before I got pregnant. I think getting my son the most BM possible is worth any tiny risk. I took 90 mg a day for 10 months then weaned down to 60 mg without noticing any decrease in supply but plan to stay on my current dose for the forseeable future. I can't see any harm in having higher prolactin levels - lots of women don't menstruate into their nurslings toddlerhood.
I also supplement at the breast with a Lact-Aid (less than when my son was younger) because even with dom I was only making about 2/3 to 3/4 of what he needed. I used formula (about 8 oz a day) until my son was nine months then switched to cow's milk at my LC's suggestion. Since I returned to work at one year, I use the BM I pump at work and he has cow's milk at daycare.
Neither dom or supplementing to me is "evil" - I did what I needed to do to breastfeed my babe. He's still going strong at 14 months!

Originally Posted by Blessed_Mom

Hi,

At 4 months I am seeing a dip in my supply. I ordered Dom from the NZ pharmacy a week back...but am scared stiff about taking it. Actually my supply behaves erratically. Most days it is fine but some off days - I can tell my daughter is not getting 100% and she fusses.

I take fenugreek, MMplus and oatmeal.

I also ordered lact-aid which we should receive today. After reading this thread and some of the side effects (QTs, will reach baby and may affect her heart arrythmia (if it affects me in large doses- then what's to say it won't affect my baby's teeny heart?), not making me ovulate (meaning messing with my hormones) and also drug dependence(my supply may tank if I wean from it).....not to mention weight gain...
After reading all these - I am wondering why formula supplementing via lact-aid isn't the lesser evil?

Can someone please elaborate?

[mambera]

I felt a lot better about the dom after I found out that the dose the baby gets in the breastmilk is only 1/10,000 of the maternal dose.

http://www.ncbi.nlm.nih.gov/pubmed/18507654

Dom's been used for babies with GI issues in the past also. A baby whose mother is taking dom will get much less dom than a baby who is taking the medicine directly.

Also dom doesn't cross the blood-brain barrier, which makes me feel it is safer than Reglan. I would be pretty worried about chronic dopamine blockade in a developing brain, even at low doses.

My feeling on the 'lesser evil' question is that if baby is very young and has never had formula, and dom can help keep the 'virgin gut,' then that is a good trade. On the other hand if baby is older and can handle formula better, or if it is just about getting from, say, a 50% supply to 75%, I'm not sure I would think that was worth it. I feel like the difference between 'no formula' and 'some formula' is a lot bigger than the difference between 'some formula' and 'some more formula.'

[guestmama9920]

many babies I know in the UK take this for reflux, if you think that many FF babies have reflux to begin with, well your better off taking the dom yourself

[Clay]

Hello ladies!

I hope you dont mind a guy responding to your discussion, but I have a couple of quick questions for you.

First, a little background. My wife had our first son in early 06, and had supply issues as well as my son having latching issues. Dom was a god send for us then. We used it from probably 4 weeks until 1 year of age, and it kept him with plenty of milk. My wife had to pump ALL of it (yes, she is a GREAT woman) due to his latching issues.

Anyway, we now have our 2nd child, a beautiful baby girl who is 2 weeks old today, and is quite the great little eater. Our problem is my wife had excellent supply in both breasts the first week, and now has one breast which is lacking a bit. We are considering DOM (and fenugreek) again, so here are my quick questions:

1) Where to buy? Seems 'inhousepharmacy' is highly recommended, is this still the case?

2) Does anyone have some they want to sell? I know it takes a couple of weeks for internet/overseas orders. It would be nice to get some ahead of time to head the low producing breast off at the pass, so to speak.

Thanks for the wonderful thread!

Clay

[Megan73]

Congratulations on your new babe, Clay!
I can't advise you on how to get dom because I'm in Canada where it's just a prescription drug like any other.
But is there any reason to think you're wife's supply is low this time around? You say your baby is a great nurser, is she not gaining weight? Because many women with normal supply have one breast that produces more than the other.

[spughy]

Clay, my first guess would be that your little one's latch is good on one side, but not the other. It's more common than you think. It's also not always a problem - one breast can usually easily supply a baby with all it needs, but your wife will likely end up lopsided.

It sounds like you will probably be able to give the domperidone a miss this time around, but I would go see a good LC to get the latch evaluated on both sides. Also, encourage your wife to try a different position on the side that doesn't seem to be producing as well.

And the pp is quite right in that the only real measure you need worry about with respect to supply is weight gain, and adequate pees and poops. (6-8 wet diapers per day and at least one poop until 6 weeks, at which point poops can become less frequent, but you still need the 6-8 good wet diapers. Pour 1/4 cup of water into a clean dry dipe to see what it should feel like.)

[Clay]

thanks for the replys everyone.

The only reason we know the supply is "low" on one side is the wife started pumping right away this go around. Nurse the baby, then pump. In the beginning after feeding the baby the wife would get 2 or 3 ounces per side. Now she gets around 1 if she is lucky on the left side. She has had a sore and a yeast infection on the right side, which suprises me that the left side is the one with reduced volume.

I think we will hold off for a bit on the dom. The wife is working with a LC so I would like to see how that works out first.

[spughy]

Clay, if she's only pumping *after* nursing, and she's getting less, it probably means your baby is eating more. And, if the baby is maybe a little turned off by whatever's going on in the other breast - and if it's candida (thrush) she needs to be treating both breasts AND the baby - then she's probably taking less from that breast in favour of the non-affected one.

The ONLY time you need to worry about supply is if there's a problem with "output" from the baby. Otherwise, if your wee one is gaining steadily and peeing and pooping normally, AND your wife can pump an ounce on each side after nursing, you definitely don't have a supply problem.

(And I think it's awesome that you're obviously so involved and supportive of your wife, kudos to you!!! )

[XiansMommy]

Hi Everyone,
I've been reading this thread non-stop since discovering it and am feeling hopeful for the first time since my son was born.
I am a first time mom with a almost 8 week old son who was born at 36 weeks and 1 day. We initially had latching issues because his mouth was so small and nursing issues because he was so tired and would fall asleep only minutes after nursing. My LC recommended a nipple shield which seemed to be helpful but significantly held back my milk supply.
3 days after birth my son was admitted to the PICU due to high jaundice levels, low blood sugar, decreasing weight and dehydration. He was placed on fluids and we were forced to supplement with formula. After returning home he would nurse from the nipple shield until he fell asleep then I would wake him and feed him a formula bottle of an ounce to two ounces.
Around 4 weeks old I weaned him from the nipple shield and had an abundant milk supply, or so I thought. He was always having 7-9 wet diapers a day but would frequently go days without having a bowel movement but I was told this was normal with breast fed babies.
Although he had gained weight then lost, at his two month check up he weighed exactly the same as he did at his one month. It was if all at once he stopped being a good eater regardless of whether it was breastfeeding or bottle feeding, was fussy surrounding feedings and was suffering badly from his acid reflux that he had earlier been diagnosed with. Because he hadn't been eating well, my milk supply, which was difficult to get in and barely adequate at best, regardless of eating oatmeal for nearly every meal, taking max doses of Fenugreek, approval from a LC that his latch was perfect, continuous pumping and frequent feedings had decreased.
His pediatrician sent us straight from his appointment to the ER where we were admitted for "failure to thrive." We've been in the children's hospital since Friday where his feedings have been closely monitored, all from bottle. I've been pumping with a hospital grade pump religiously ever 2.5 hours and never getting more than 1.5 ounces. I've been putting him to the nipple regardless of doctors recommendations for nothing more than to just pacify him and to keep that connection as well as doing skin-to-skin but my milk supply is dropping steadily.
The doctors have told me that he will never be a solely breast-fed baby and it may be in his best interest to not breastfeed. I've not met with my LC since being admitted but she also agreed that he may always be a partial breast-feeder. I'm awaiting a call back from the hospital LC but discovered dpd through research. After spending the night reading your threads, I've already placed an order through clickremedy.com. My husbands in the military so we don't have tons of extra funds but breastfeeding is so important to me that I can't justify not making the investment in our bond and relationship.
Before hearing of dpd, I was in complete despair, feelings as if everyone had given up on breastfeeding but me, including my husband, family and my son. This is truly my last resort.
My son is weighing in at 7lbs 14ounces today at 7 weeks 6 days old so he is still significantly below the growth chart expectations. He has been supplementing with 2-4 ounces every 3 hours, with the doctors saying the majority of his eating and growth has been consiered "catch-up eating and growth." I was wondering if this situation sounds familiar to anyone and if so, how it turned out. Also, if there's any suggestions of what I could do to encourage breastfeeding in the mean time while I await my shipment, seeing as he is completely disinterested after receiving the bottle.
Any information/assistance that could be offered would be greatly appreciated. I want nothing more than to breastfeed and am so disheartened and feel as if I've failed my little man.
Thanks,
Melissa
Married to my hero and loving being a first time Mom to Xian 9/15/09 6lbs 3ounces 19 inches

[Megan73]

Originally Posted by 2Babies

I have several questions:
1. Does anyone have some that they would be willing to sell me? I can send funds by paypal.
2. What, if anything, should I say to my pediatrician who is not overly supportive of taking this medication?
3. Who is a good company that is reasonably priced and can get it to me quickly?

Anyway, thanks to all, and I eagerly await your responses.

Erin

Hi Erin, I'm sorry I can't help you with getting dom (I'm in Canada where you just have to get a prescription) but I'd tell you to not worry about what your ped says –*many lactating women have been taking it safely for years. You can also Google Dr. Jack Newman's response to the FDA.

[Megan73]

Originally Posted by XiansMommy

Any information/assistance that could be offered would be greatly appreciated. I want nothing more than to breastfeed and am so disheartened and feel as if I've failed my little man.

I'm sorry you're struggling with this, mama.
I really hope the dom helps. You can find some great advice about starting taking it at Dr. Jack Newman's site.
The main other thing I'd suggest is eliminating the bottles. Has your LC talked to you about supplementing at the breast with a Medela SNS or Lact-Aid? That way your LO won't lose interest in the breast or suffer flow preference ("nipple confusion") and will get all his food while breastfeeding – even if some it has to be formula at the moment.

[XiansMommy]

Originally Posted by Megan73

I'm sorry you're struggling with this, mama.
The main other thing I'd suggest is eliminating the bottles. Has your LC talked to you about supplementing at the breast with a Medela SNS or Lact-Aid? That way your LO won't lose interest in the breast or suffer flow preference ("nipple confusion") and will get all his food while breastfeeding – even if some it has to be formula at the moment.

The hospitalist that we've been seeing in the children's hospital says she doesn't recommend them because they are so cumbersome... If it is what I'm thinking, where the catheter feeds at the nipple the formula... Otherwise, no, I haven't been informed as to what a Medela SNS is or Lact-Aid. He is doing okay switching back and forth but definitely gets frustrated with the effort it requires to breastfeed compared to bottle-feeding, which is making what is an amazing experience difficult for the both of us. I would be willing to put any effort into something that would keep him at the breast and interested so when there is a milk supply, he'll still be fighting for this with me.

Married to my hero and loving being a first time Mom to Xian 9/15/09 6lbs 3ounces 19 inches

[Blessed_Mom]

Originally Posted by XiansMommy

The hospitalist that we've been seeing in the children's hospital says she doesn't recommend them because they are so cumbersome... If it is what I'm thinking, where the catheter feeds at the nipple the formula... Otherwise, no, I haven't been informed as to what a Medela SNS is or Lact-Aid. He is doing okay switching back and forth but definitely gets frustrated with the effort it requires to breastfeed compared to bottle-feeding, which is making what is an amazing experience difficult for the both of us. I would be willing to put any effort into something that would keep him at the breast and interested so when there is a milk supply, he'll still be fighting for this with me.

If that is the case then Lact-aid is very much your solution. Yes it is a bit cumbersome, but well worth the effort.

[Megan73]

Originally Posted by XiansMommy

The hospitalist that we've been seeing in the children's hospital says she doesn't recommend them because they are so cumbersome... If it is what I'm thinking, where the catheter feeds at the nipple the formula... Otherwise, no, I haven't been informed as to what a Medela SNS is or Lact-Aid. He is doing okay switching back and forth but definitely gets frustrated with the effort it requires to breastfeed compared to bottle-feeding, which is making what is an amazing experience difficult for the both of us. I would be willing to put any effort into something that would keep him at the breast and interested so when there is a milk supply, he'll still be fighting for this with me.

Yes, a supplemental nursing system is a bag or bottle you fill with formula or EBM with a small tube that you put in the baby's mouth along with the nipple.
I'm just SHOCKED that a medical professional doesn't recommend supplemental nursing systems because they're too "cumbersome."
Many, many nursing mothers with low supply – including dozens on this site alone – not to mention women nursing after breast surgery or breastfeeding adoped babies use them. I'm frankly shocked to hear that she has so little confidence in the women she serves. That makes me SO angry that she discouraged you from doing something that may well save your nursing relationship.
YES a supplemental nursing system is the way to go for exactly the reason you mention. I much prefer the Lact-Aid – which is available to buy online www.lact-aid.com – but some women have luck with the Medela SNS which (where I am anyway) can be purchased at some pharmacies and through LCs.
I would start the dom, get an SNS, eliminate all bottles and pump after feeds to boost supply. You can use any pumped milk to supplement.
Good luck, mama.

[svmaine]

2babies and xiansMommy, first!!! Second...if you have time look through this thread, it's loaded with great info. I also had babies that needed supplementation, mine were barely getting an oz from me per feeding, due to IGT and tubular breasts. Anyways the good news is that there are tons of stuff out there! I'd check out www.motherlove.com , they have great info and supplements that you can get quickly while waiting for Dom, which I used with all 3 of my kids for a total of about 3 years and the only side affect was an increased appetite, not a big deal considering what it might do for you. Also there is Shatavari which is a natural form of Dom from India, you can get it online in the states. I had great luck with Goat's Rue from Motherlove, oh and I did use a SNS for my first 2 babes and despite the frustrating tubing, it was worth it.

Hang in there and absolutely ignore what the "medical professionals" say, they are full of !

[XiansMommy]

I had a hard time believing that she would advise me against something so simple or so it sounded. If doing a "cumbersome" activity was possibly going to save my milk supply then it should be my choice whether I wanted to pursue it. After she made her "ruling" she made it difficult for me by making to resources available to get the supplies much less learn how to do it.
My son had a gastric bypass test to determine his ability to empty his stomach. Those tests results aren't back yet but he had an upper GI yesterday which showed he had severe acid reflux that could potentially be aspirating into his lungs. The doctor also told me that she didn't think he had acid reflux, that all the symptoms we noticed were because he was malnourished. I fought with her saying that something changed drastically because he was eating and gaining then all of a sudden eating in general became what appeared to be a painful experience so he refused to do it and started losing weight quickly. She relented and order the test only to be eating her words now.
I also met with the hospitals main LC who is also an RN. Within a few minutes she had a multitude of suggestions. She started off by saying that the hospital was wrong to send us home the day after delivery when he was just barely over 36 weeks. She said that my pump, The First Years "Mi Pump" isn't a quality pump so when I'm pumping at home I'm not really having a drastic impact, I was pumping incorrectly with the hospital grade pumps that no one have ever shown me how to use, that I wasn't taking enough Fenugreek and it should be combined with Blessed Thistle which I knew but was unable to find until she provided it today and that my son had a "tied tongue" in the sense that it was short, preventing him from getting a proper suction which all other previous doctors and LC had missed.
She said that her diagnosis for me is the same as what she would tell an adoptive mom who was starting from square one because at this point thats basically where were at and even at that, shes only giving me about a 50% chance of being able to go back to solely breastfeeding him. She is starting me on an SNS tomorrow morning. She provided the Blessed Thistle and upped my dose of Fenugreek. She also wrote a prescription of Raglan to sustain me until the DPD arrives. She wants me to rent a hospital pump for $120/month and pump 8-10 a day for 20 minutes in addition to keeping him at the breast with the SNS.
For my son, she says to work with him by encouraging him to stretch his tongue farther out. She says shes going to recommend a specialist who might have better stretches but if that doesn't work they might want to perform some surgical procedure on it that she said we would discuss when we got there.
I was able to justify the cost of the DPD because it would hopefully pay for itself in saving the cost of formula. Luckily we have excellent insurance that will cover the Reglan, but the cost of renting the pump is almost making this unaffordable which is such an awful reason to hit as a road block and so disheartening to run into something that may end up being out of my control. I realize though that my pump will be better than nothing so if it turns out to be too expensive I can continue using that. I sm unfortunately preparing to literally move cross-country in less than a month and am leaving Sunday for a house-hunting trip. The LC said that the SNS will be extremely difficult for me to use while traveling and that that difficulty decreases my chances of success as well.
I am worried sick about taking Raglan. I've read through the thread and heard all the stories about depression. I have no history of depression in my family and have had no signs of PPD after birth. I also understand that if you stop taking Raglan, the depression goes away within a few hours so that's a tolerable side effect. What I'm worried about is that I was told Raglan would cause life-long tremors for my son and QT. I don't know what "QT" is and tremors for life definitely are not worth it for any cost. The LC says shes never seen these results but I wonder if shes telling me this because she has invested interest in the drug. She assures me though that if I chose not to take Raglan while I wait for the DPD I will most likely have dried up and have no chance.
I've read through this entire thread and it has helped me TREMENDOUSLY. All the questions I knew to ask and my ability to make educated activism for my son and myself has come from the knowledge you all have so freely shared. I just feel like theres no light at the end of the tunnel but also don't feel that if I were to stop, I'd feel as if I tried everything within my power in the end.
Again, ANY advice, stories, resources, etc you all have to offer is greatly appreciated. I'm checking the thread religiously just because its been so helpful.
THANK YOU all SO much!

Married to my hero and loving being a first time Mom to Xian 9/15/09 6lbs 3ounces 19 inches