Low Milk Supply – Is Domperidone the Answer?
When I first went on my pregnancy and beyond journey there were definitely some natural nerves I encountered about what my breastfeeding journey would be like. Would I have enough milk? Would my baby latch properly? Would it be painful? Would it be enjoyable? So many questions ran through my head, but I took a deep breath, trusted my body’s amazing ability and put steps into place to help nurture and support the whole process.
Setting the Scene for Milk to Flow
When we are pregnant, our estrogen and progesterone increase significantly. In fact, just before birth estrogen increases 1000 times and progesterone 10-18 times. This sets the scene for our labour and birth to progress, but once bubs is out, there is another big hormonal shift that takes place for breastfeeding to occur. Estrogen and progesterone drop dramatically (which is why some new mamas can experience the baby blues for a few days) to make way for oxytocin and prolactin to come through. These two hormones are responsible for helping mama and baby bond and for lactation to occur.
Prior to this however, lactogenesis takes place, which is the process of developing the ability to secrete milk. It takes place in two stages: secretory initiation and secretory activation. These are influenced by placental efficiency during pregnancy, and then removal after birth, as well as copious milk production, more commonly known as ‘milk coming in.’ Our milk coming in is primarily influenced by suckling at the breast by the infant, which further stimulates the hormone production mentioned earlier. So if perhaps we had issues with our placental efficiency (HELLP Syndrome, preeclampsia or incomplete removal of the placenta) during pregnancy or our birth did not go according to plan, this can impact our breastfeeding journey right from the start.
My Breastfeeding Diaries
I vividly remember those first few days after Breya was born and I was waiting for my milk to come in. She was constantly suckling and receiving the all important colostrum that comes out initially (which is the best thing to do to help encourage the milk to come through) but my nipples were not having a good time and I remember thinking “If this is how painful breastfeeding is going to be, I am not looking forward to it!” And that’s real talk. Thankfully, I reached out to my mama tribe who had gone before me and they reassured me that it was normal and that things would ease as the milk flowed. And that’s exactly what happened.
Factors That Can Impact Milk Supply
- Pregnancy & birth experience – as mentioned above, if you have issues with your placental efficiency or a traumatic pregnancy or birth experience that ends up resulting in intervention that you weren’t ready for, the stress of it can make it challenging for the natural flow of breastfeeding hormones to come through;
- Poor latch – my advice to clients and friends is to get a lactation consultant right from the get go to give themselves the best chance of early success. Sometimes if babies have tongue or lip ties or a shallow pallet, it can impact how they latch on and remove milk from the breast. A lactation consultant will be able to pick this up early and suggest options to rectify it if necessary. It could also mean the difference between an enjoyable and painful breastfeeding experience. Efficient and regular removal of the milk is one of the best ways to ensure a healthy supply. The tips and tricks, reassurance and encouragement I received was so helpful – I only wish I’d done it right at the start.
- Not enough feeding – as mentioned above, the best way to promote a healthy supply is the constant draining of the breast that happens when baby drinks. Feeding on demand in those early weeks is paramount to establishing your supply and meeting baby’s changing needs. Trying to develop a routine right from the get go, especially with feeding, may actually hamper your efforts to have a healthy supply. Go with the flow and know that baby suckling after they have finished drinking is also a good way to keep that milk coming.
- Stress – the production of our breastfeeding hormones begins in the brain, or the hypothalamus to be exact. This is also the starting point for our stress response, and when cortisol starts to dominate and get over secreted, it can down regulate the production of oxytocin and prolactin. It is normal to have new levels of stress when navigating motherhood for the first time, but when this is coupled with other factors like lack of nourishment and poor sleep, it can lead to further issues.
- Lack of nourishment-l it is important to note that caloric intake first and foremost is very important. New mothers do not have to be getting every single meal they consume perfectly balanced from a macro and micronutrient perspective, but supporting the extra depletion that takes place when we feed our little ones must be considered. We as mamas can burn up to 500 extra calories a day whilst breastfeeding but instead of viewing this as an opportunity to ‘lose the baby fat’ we should use it as a reason to justify getting some extra calories into our day. It can be easy to reach for ‘quick energy fixes’ when we are sleep deprived and navigating motherhood for the first time, and that’s why it’s so important to have a postpartum support game plan that includes pre-made meals and snacks that provide nutrition and much needed calories. Prolactin itself is actually made up of 199 amino acids so we must be consuming foods that contain amino acids (like good quality animal protein) to help promote healthy lactation. Other foods that promote a healthy milk supply, known as galactagogues, include steel cut oats, flaxseeds, fenugreek, fennel seeds, black tahini, alfalfa, salmon and foods containing electrolytes such as sweet potato. Check out our delicious Black Tahini Cookie recipe here.
- Unclear Expectations – women need to be more informed so they know what to expect in those early days. We are resilient beings whose bodies were designed for birthing and breastfeeding. Even when things are tough and challenging, they can always be shaped in an empowering way and the language being used is of utmost importance. If women knew that it could take up to four4 days for their milk to come in, that the initial nourishment for baby was predominantly colostrum, and that the continuous suckling would help the milk to flow, I believe their resilience would be much higher. Conversations I’ve had with friends and clients recently have included them being offered formula for their bubs in the first few days when their milk was still coming in. This has resulted in them having issues getting baby used to suckling on the breast because they were being exposed to a bottle so early in the journey.
Another consideration is the use of domperidone, which we will explore further to follow. Considering the above, I do wonder how many new mamas are being offered non pharmaceutical strategies to help with their milk supply before medication is suggested. Let’s take a closer look.
What is Domperidone?
Domperidone is actually traditionally used as an anti nausea medication but is also being prescribed to boost milk supply too. It is referred to as a dopamine antagonist, which means that it blocks dopamine in an effort to boost oxytocin and prolactin. Dopamine usually inhibits prolactin production so by blocking it, prolactin can increase, which should have a positive impact on milk supply. It should also be noted that it has been removed from the FDA in America because of safety concerns, especially in relation to cardiovascular side effects.
My issue with this is that nothing in our beautiful bodies works in isolation, so if we are blocking or inhibiting something, it is going to have a knock on effect somewhere else. Simply put, dopamine is a brain chemical that is associated with feelings of motivation, arousal, reinforcement and pleasure. All things that are very important for new mamas to be experiencing. It makes sense to assume that blocking it could down regulate these feelings, which is concerning when a new mama is already navigating the stress of new motherhood and low milk supply. Thoughts of issues with bonding and the baby blues are what spring to mind. Common side effects include dizziness, dry mouth, restlessness, heart palpitations and headaches. Based purely on the role of dopamine in the body, I would also add low mood and low motivation to that list.
A Backwards System Does Not Promote Success
If medication that was primarily created for something completely different is being offered as one of the first solutions to women struggling with their supply, then I believe the system is failing. Whilst I can appreciate that domperidone might provide a short term solution, it is definitely not a deficiency of this drug that caused the issue in the first place. Our system needs to support women better and provide them with natural and long-term solutions that aim to support their journey in a more holistic way.
Tips for a Successful Breastfeeding Journey
Truth be told, I had a very smooth breastfeeding journey with Breya. She was however on the small side so I did have moments where I thought she might not have been getting enough milk. With Harlan however, it was very challenging at the start and shocked me a bit after my easy journey with Breya. I was lazy with his latch and my nipples were very sore in those early weeks. Thankfully I was very determined to succeed and so I put up with the pain (and awkwardness of a nipple shield). They eventually healed and we continued on with a great journey. Things that really helped:
- Employing a lactation consultant right from the start to establish good habits and effective ways to feed.
- Keeping my nourishment status up even when I didn’t feel much like eating – warming foods like slow cooks, bone broths and warm porridges were my go-to’s. I made sure I had a plan in place so these foods were pre-prepped in my third trimester or part of the food delivery service I employed after baby came.
- Having nipple relief strategies when they were really sore – cold compresses, coconut oil and short term use of a nipple shield helped!
- Having a resilient mindset and attitude-there were definitely moments when I didn’t want to or look forward to feeding because of the discomfort I was in, but I knew I had to keep getting him onto my breast so he could drain the milk and continue to support the establishment of a healthy supply.
- Having a regular self care practice to help combat stress – this looked like a warm bath or short guided meditation for me, but doing whatever vibes with you will be the best option for you. Other options include getting out in nature, having a nap, or getting a postpartum massage.
To any mamas out there reading this who may have had (or are still having) domperidone, I do not judge your choices at all. I can appreciate that you wanted to do whatever you could to continue feeding your baby that liquid gold and for that, I applaud you. My hope is that the information that women are receiving informs them of what they can do alongside the medication (such as the points mentioned above) in an effort to boost their supply naturally and help their body do what it is designed to do.
If you would like more information on how to support yourself and your growing baby in those precious postpartum weeks please reach out to me. I would love to support you.
Dewey KG. Maternal and fetal stress are associated with impaired lactogenesis in humans. J Nutr. 2001;131(11):3012S-5S. doi:10.1093/jn/131.11.3012S
Neville MC, Morton J, Umemura S. Lactogenesis. The transition from pregnancy to lactation. Pediatr Clin North Am. 2001;48(1):35-52. doi:10.1016/s0031-3955(05)70284-4
Grzeskowiak LE, Amir LH. Use of domperidone to increase breast milk supply: further consideration of the benefit-risk ratio is required. J Hum Lact. 2015;31(2):315-316. doi:10.1177/0890334414567895
Sewell CA, Chang CY, Chehab MM, Nguyen CP. Domperidone for Lactation. Obstetrics & Gynecology: 2017;129 (6): 1054-1058 doi: 10.1097/AOG.0000000000002033