“Fear of stopping” vs “wanting to get off the medication”: exploring women’s experiences of using domperidone as a galactagogue - a qualitative study

Abstract

Background Domperidone is the most frequently prescribed medicine used to increase breast milk supply. There is considerable controversy surrounding the use of domperidone in lactation, due to limited evidence about efficacy and concerns about rare but life-threatening side-effects. Despite this, in many high-income settings such as Australia, use of domperidone among breastfeeding mothers appears to be increasing. The aim of this paper was to explore women’s experiences of using domperidone during breastfeeding. Methods Semi-structured interviews were conducted in 2019 with 15 women in Australia who reported using domperidone as a galactagogue during breastfeeding. Interviews were recorded, transcribed and analysed thematically. Results Women reported a wide variety of practices concerning the timing of initiation of domperidone use, including prophylactic use, as well as the dose and duration of use. Prolonged periods of use and unsupervised dosing were commonly reported, these practices were sometimes associated with a fear of the consequences of stopping, insufficient provision of information about the drug or feeling dismissed by health professionals. Some women indicated that when doctors refused to prescribe domperidone they responded by doctor shopping and seeking anecdotal information about benefits and risks online, leading to unsupervised practices. Women often reported high expectations surrounding the effectiveness of domperidone, and most used the medication in conjunction with food/herbal galactagogues and non-galactagogue support. Positive outcomes following domperidone use included having greater confidence in breastfeeding and pride at achieving breastfeeding goals. Conclusions This study identified a variety of practices concerning domperidone use, including potentially unsafe practices, linked in some cases to inconsistent advice from health professionals and a reliance on online, anecdotal information sources. These findings emphasise the urgent need for development of clinical practice guidelines and a greater focus on translating existing evidence concerning domperidone into clinical practice, including clinical support that is tailored to women’s needs.

Knowledge of Galactagogue Use During Breastfeeding in Australia: A Cross Sectional Online Survey

“…In contrast, participants perceived GPs as the most unhelpful sources of information regarding galactagogues. This finding is consistent with that of other researchers, where GPs were observed to have less current knowledge and specific training in breastfeeding support in general (Cramer et al, 2021; Holtzman & Usherwood, 2018), or related to the use of specific galactagogues (e.g., domperidone; Zizzo, Rumbold et al, 2021). A perceived lack of helpfulness may be related to breastfeeding support in general, a lack of information provided about the use of specific galactagogues, receipt of conflicting advice, or the provision of advice considered too generalized or inappropriate for an individual’s situation.…”

Women’s experiences with using domperidone as a galactagogue to increase breast milk supply: an Australian cross-sectional survey

“…Even with these concerns about potential cardiac side effects, domperidone was still largely perceived as safe by women in this survey, which may demonstrate that these concerns for cardiac safety are not being communicated or that the perceived benefits outweigh the risks. This is supported by evidence from a qualitative study on a subset of women from this survey which found that galactagogue use is often underpinned by a strong determination to breastfeed, often resulting in women preferencing the potential benefits to their infant over potential risks to themselves [22,24].…”

“…This is reflected in the most recent guidelines from the Academy of Breastfeeding Medicine that, while stating domperidone may increase breast milk supply, do not provide any direct practice recommendations regarding optimal dosing regimens and treatment approaches [10]. This may lead to inconsistent prescribing practices and broad variations in dosing and duration of use [10,22].…”

Advancing breastfeeding promotion: leveraging integrative natural galactagogues and unveiling their potential roles—Insights from a 19-year Taiwan nationwide registry to address lactation insufficiency in postpartum women

“…However, the potential side effects and contraindications associated with pharmacological galactagogues have raised concerns among healthcare professionals and patients. These issues include possible central nervous system side effects, cardiac arrhythmias, and drug interactions, posing risks to both the mother and infant (18,19). Therefore, there is a growing need to explore alternative solutions, particularly herbal galactagogues, which are considered safer and more natural options for promoting lactation (20,21).…”