I know I'm probably delusional, but I hope this doesn't cause a mommy war post. I always though Reglan was a common BFing drug--isn't it prescribed for adoptive Moms who want to BF?
Breastfeeding Pills’ Risky Results by Eliza Shapiro Aug 7, 2012 4:45 AM EDT Nursing moms are taking drugs to help them produce more milk. But doctors say there’s no evidence the pills—which can pose serious health risks—actually work. Eliza Shapiro on extreme breastfeeding.
New moms across the country are popping pills meant to alleviate gastrointestinal distress—not because their stomachs hurt, but because they want more breast milk.
The drugs are typically prescribed by lactation consultants—specialists who help women cope with breastfeeding issues—who say the pills can increase prolactin, the hormone responsible for breast-milk production. But a growing chorus of doctors says there is little if any evidence that the drugs—one of which has not been approved by the FDA—are actually effective at boosting prolactin. More troubling, they say, the drugs can pose serious health risks to women who use them.
The two most popular drugs, according to medical and lactation experts, are Reglan, which has been found in rare cases to cause an irreversible facial muscle-spasm condition, and Domperidone, which is not FDA-approved and mostly found via Canadian online pharmacies. One of Reglan’s side effects, according to the FDA, is depression—a condition some new mothers are already at risk of.
While the exact number of women using the drugs is difficult to determine, the topic is hotly discussed at breastfeeding support groups like La Leche League and in online new-mother forums. On the Fertile Thoughts blog, for example, commenters have referred to Domperidone as a “wonder drug” and traded tips on where to find it. One site, BigMountainDrugs.com, was recently listing 1,000 capsules for $118, alongside advertisements for discounted Viagra.
“It was better to take the drug so our kids were getting breast milk,” said Kelli Davis, a schoolteacher in Toronto. In an interview, Davis said she took Domperidone for two years after struggling to nurse her first child, and said she had no side effects. The drug is approved in Canada, but only for its gastrointestinal use.
On the online mothering forum Baby Center, one new mom taking Domperidone posted that she “gained quite a bit of weight” and didn’t know if the drug “actually is doing anything,” but added, “I still take it as an insurance policy.” Another mother wrote that she’d been taking the medication for four months and didn’t notice much of a difference.
The off-label usage of GI drugs is one of the more extreme measures nursing mothers are taking when they can’t or won’t use formula. Some are using breast pumps in the middle of the night to build up their supplies. Others are getting donated milk from human “milk banks” or guzzling foul-tasting fenugreek tea. It comes at a time when the pressure to breastfeed is intensifying. In New York City, Mayor Michael Bloomberg’s new Latch On NYC program aims to spread the gospel of breast milk through subway advertisements showing happy moms nursing their presumably happy babies. The program also bans distributing free formula samples in maternity wards. “We don’t give free McDonald’s to our cardiac patients,” said Allison Walsh, manager of parent education and lactation services at Beth Israel Hospital in Manhattan.
The “breast is best” camp, including some lactation consultants and pediatricians, have applauded the move, citing research that the nutrients in breast milk help prevent infections and illnesses for infants, and can even increase IQ.
But critics say campaigns like these are fueling an unintended side effect: making new mothers more stressed out than ever.
The off-label usage of GI drugs is one of the more extreme measures nursing mothers are taking when they can’t or won’t use formula. “Breastfeeding has gone from being an ideal option for new mothers to a mandatory prerequisite for ‘good’ parenthood,” wrote Gayle Tzemach Lemmon in a recent article in The Atlantic about Bloomberg’s New York campaign.
In reality, some women have difficulty breastfeeding, or have babies who struggle with latching on properly. Others worry they don’t have enough milk, or are told by pediatricians that their milk is too “thin.” Desperate, and feeling guilty or ashamed for using baby formula, some seek any help they can find to squeeze out a few extra drops of milk.
“We have to get a reality check here,” said Jacques Moritz, medical director of Beth Israel Hospital’s gynecology department. Moritz said he gets requests “every day” for the GI drugs, but refuses to prescribe them. “You get an ‘A’ for effort for breastfeeding. This cannot be an obsession. You can’t take the risk of your life.”
In 2004, the FDA issued a warning about Domperidone, advising women not to take it to increase breast milk production and alerting FDA officials to watch for attempts to import the drug through other countries. An intravenous form of the drug aggravated cardiac problems and, in a few rare cases, caused sudden death. Reglan, the commercial name for metoclopramide, is FDA-approved only for GI-related use. In 2009, the FDA issued a warning about the drug’s possible side effect, a potentially permanent movement disorder called tardive dyskinesia, which can resemble Tourette’s Syndrome or Parkinson’s disease.
“If you’ve ever seen tardive dyskinesia, you’ll never use the medicine again. This is a black-box warning,” Moritz said, referring to the requirement that a special warning be included on the drug’s packaging. “It’s not like you’ll have a little headache or some stomach pains. We’re going to give that to somebody?”
Not all new mothers are scrambling to get hold of the medicine. “Both drugs just seemed to be a bridge too far,” one New York mom told The Daily Beast. “I was willing to do the herbs and the brewer’s yeast and all the other things that any lactation consultant will tell you to do, but to cross the threshold into taking a non-FDA approved drug … it seemed to not be a good choice.”
While there is anecdotal evidence that the drugs appear to help some women make more milk, a 2011 report released by the American Academy of Breastfeeding Medicine found no conclusive evidence of “correlation between baseline prolactin levels and rates or milk synthesis or measured volumes of milk production.” The study also found that previous studies on the effectiveness of the drugs in increasing milk supply have “generally been of poor quality,” lacking randomization and having small sample sizes for testing. “The case for using pharmaceutical galactogogues [substances used to increase lactation] has grown weaker,” the report found.
Grace Lau, a gynecologist at NYU-Langone Hospital, said the lack of placebo testing and randomization in studies about Reglan and Domperidone are not “adequate for me to prove that they work.”
Still, lactation consultants—most of whom are not medical doctors and can only recommend getting a prescription from a doctor—say they’ve seen an uptick in the number of clients asking about Domperidone and Reglan. Freda Rosenfeld, a much sought-after lactation consultant based in Brooklyn, said that in her own experience, the two drugs “do work for most people, and helps them tremendously.”
For others, formula will suffice. "I formula-fed my daughter, starting from the first hour of her life,” wrote Amy Sullivan in the New Republic, last week. “I loved it. And I would do it again. Do you hear me, Mayor Bloomberg?"
Reglan was prescribed to me as an anti-emitic for chemo. It actually worked better than some of my other meds (like zofran) but I took it judiciously because it freaked me out. As for other methods to increase production - fenugreek isn't gross at all - it's pretty tasty. And oatmeal, lots of water, and other methods certainly are not onerous or dangerous.
I agree that the pressure to breastfeed can be intense, but not as intense as it is made out to be. Having a LC recommend measures to improve production increases the number of measures a newly nursing mom can try to take to make BFing easier. Nothing wrong with that so long as it doesn't lead to the outcome voodoo had.
Some LCs are awful, but many are great. As always, it is neither black nor white, and no one answer is uniformly best.
I couldn't take Reglan because its side effect is depression, and I was coming off a high-risk pregnancy which correlates with higher risks of depression as it stands, and I have a history of depression. It was a risk I wouldn't take. So instead I saw a lactation consultant who made me more depressed than Reglan ever could have.
lol!
I do find prescribing medication for nursing purposes as taking it way too far. There are other options that don't require off-label use of actual prescription drugs.
Purely anecdotal here, but the two moms I know who've taken Reglan have not gotten it via prescription, but rather online or from friends. One of them acquired Domperidone through a friend also (the friend had a stash she hadn't completely used up and shared it). And neither of these women were willing to tell their doctors that they were taking the drugs.
I don't judge them for their decision, but I did worry about their health at the time. And I found it hard to understand them being leery of fenugreek (because it's an herb) or beer (because they didn't want to accidentally feed alcohol to the baby), but being okay with what are essentially black market drugs. I've never had a hard time producing enough milk, though, so I don't really know what it's like to feel pressured to BF and feel like you're somehow failing because it's not working out. I'm sure it can turn a new mom into an emotional wreck.
I inquired about both those drugs when I had my son. My OB would have prescribed at least Reglan (and my sister would have sent me Domperidone) but my son's neonatologist nixed both. I wish I could remember exactly why since she was all over me to give him breastmilk.
And the pressure on me to pump was intense. It made me more depressed than anything - especially since my body simply was not cooperating.
this article is very timely for me as I have spent the last month trying all the herbal supplements and different tricks to improve my horrible supply and none of them have made a significant difference. The most my daughter gets at a feeding from me is half an ounce, and I can't even pump a full ounce in a day. I am not willing to take Reglan as I suffer from depression and am in a good place right now thanks to Zoloft. I am very leery to buy Domperidone from Canada when it is not an FDA approved drug. I know many LCs and LLL members tout it as a miracle drug, but I am just not comfortable with it.
I want to be able to say I tried everything...but I'm not willing to try those drugs, and had some anxiety that some would think I truly hadn't tried everything. I do think there is a lot of pressure to BF. I am not as torn up about our need to supplement with and likely switch over to formula as i see many new moms on the bump are, but it is stressful. I see moms on the bump having total breakdowns over their inability to EBF, seeing formula as poison, and taking risks with their health to keep BFing.
I am really glad there is good formula out there for those that need it. I never expected to have a late term preemie or to need formula to feed her.
I took domperidone with DD. It was prescribed by our pedi (who is also a LC). I had a very low supply with both DS and DD.
With DS, I used a LC, took fenugreek, goat's rue, brewer's yeast, and oatmeal, and pumped after every feeding, and still did not produce enough BM that we didn't have to supplement. I was exhausted (b/c DS was up every 2 hours all night, and I would spend 45 minutes BFing then pumping at every feeding) and getting more and more frustrated and stressed. I kept getting less and less with pumping until I finally gave up at 4 weeks.
With DD, I decided that I would do everything except pumping, b/c I hated it, and just try to give DD as much as I could and make it a more enjoyable experience. I still did all of the natural supplements, and after my LC and DD's pedi mentioned that they had had women use domperidone with success, I tried it. I did see a slight increase in BM production, though still not enough that I could EBF, but it was enough that I could handle about half of what she needed, at least for 8 weeks.
I really didn't have a problem with it being an off-label use, but that is probably b/c I suffer from chronic migraines and have taken a number of medications for migraine prevention for which that is an off-label use. I tried beta-blockers, blood pressure meds, and anti-depressants before finding an anti-seizure drug that stopped years of debilitating migraines.
ETA- I would not have taken domperidone (or Reglan) if my doctor had not been willing to prescribe it for me. Getting medication from friends or online pharmacies from other countries makes me nervous. The fact that the article kept stating that LCs prescribe it also sounded weird- my LC couldn't prescribe anything (my pedi, who also happens to be a LC did).
I am just grateful I have shead the guilt associated with bfing. I ebf now but have zero issues with giving formula to suppliment. It just makes balancing life once I go back to work so much easier. I can not imagine taking a perscription drug and potentially putting myself in harm's way to get a couple extra ounces each day.
Timely. I have an unfilled script for Reglan. I ultimately decided that I'm more comfortable with compromising my BFing goals (6 months instead of a year, for example) and supplementing as we are now instead of taking the risk with the drug (which was recommended by two of my LCs after 3 weeks of unrelenting home visits and support).
That said, its a lose lose. BFing really sucks (har har) and the pressure to do it is unforgiving.
I struggled with supply from the start & the only things I didn't try were domperidone & reglan. I did ask my OB, but his opinion was that the risks wouldn't be worth it in my particular case. I kind of wondered if he was being overly cautious since it seemed to be a common thing on the boards, but after reading this I'm glad I followed his advice.
I hate that we've swung back to the extreme that formula is evil and women would rather take black market drugs (referencing batsteph's post) to up their supply.
Reglan was prescribed to me as an anti-emitic for chemo. It actually worked better than some of my other meds (like zofran) but I took it judiciously because it freaked me out. As for other methods to increase production - fenugreek isn't gross at all - it's pretty tasty. And oatmeal, lots of water, and other methods certainly are not onerous or dangerous.
I agree that the pressure to breastfeed can be intense, but not as intense as it is made out to be. Having a LC recommend measures to improve production increases the number of measures a newly nursing mom can try to take to make BFing easier. Nothing wrong with that so long as it doesn't lead to the outcome voodoo had.
Some LCs are awful, but many are great. As always, it is neither black nor white, and no one answer is uniformly best.
It's not black or white for sure but I will say I found the pressure to BF to be far greater than I expected it to be---and it was bullshit because it was repeated to me over and over and over again that if I just tried hard enough, kept at it long enough, and took enough pills and supplements (I took reglan, fenugreek and drank several cups of mothers milk tea with my oatmeal every morning.) that I WOULD succeed. But nothing did anything to help my non-existent supply and and It's a bit shitty that I was prescribed something potentially harmful at a time where researching side effects and making informed, logic based decisions was not on my radar at all.
I don't think this article makes bfing look or feel sinister, but I do feel that many times even well meaning LC's and others do have a very negative affect on women who are really struggling to BF. the common refrain is that "every mother CAN BF". But every mother can't. And for those of us that tried so hard and still couldn't produce, it was depressing to be told that you are failing at your first and at the time, most important task of motherhood.
I had to start supplementing nearly from the get-go (as I've mentioned in the past). I worked with two LCs, felt like I was chained to my pump, and tried just about every herb, fenugreek, tea and cookie out there to up my supply. Nothing worked. I couldn't get more than an ounce or two per day.
During all that hot mess, my second LC suggested domperidone and/or reglan . Her husband is an OB in my practice (although he wasn't my doctor), so she said the script would obviously, be pretty easy to get if I wanted. Had a couple soul-searching conversations with H and my mom, and eventually, I made the decision not to try the drugs. Guess it's a good thing I didn't.
And pixy, I'm with you. The stress of BF and my lack of supply made me miserable. I felt like such a failure and a terrible mother. I had tears running down my cheeks as I gave my son his first bit of formula--formula ordered by his pediatrician because his jaundice was getting worse and he was dropping weight quickly. I still, 15 months after my son's birth, have guilty pangs, especially when I see a mom breastfeeding or one of my friends (a new mom who has turned into a BFing crusader since the birth of her child 3 months ago) posts on FB about the beauty of breastfeeding.
Breastfeeding is one of the best things you can do for your child if it works. But no mother should feel terrible about giving her child something he or she needs, and for some babies, yes, that means formula, whether as a supplement or as a sole food supply. And no mother should have to turn to drugs that may or may not be safe just to breastfeed. The pendulum has gone way, way, way too far.
Im pretty big into breastfeeding. Still go to monthly mtgs, etc. And I cant see going to black market drugs to make it work... if all the (legal) and natural ways to boost production - oats, fenugreek, water, beer, and lots and lots of nursing were not enough, then Id rather supplement over taking drugs like this. I EBFd but I mean, formula is SURELY better than black market illegal drugs!
Im pretty big into breastfeeding. Still go to monthly mtgs, etc. And I cant see going to black market drugs to make it work... if all the (legal) and natural ways to boost production - oats, fenugreek, water, beer, and lots and lots of nursing were not enough, then Id rather supplement over taking drugs like this. I EBFd but I mean, formula is SURELY better than black market illegal drugs!
Meg how did I miss you were expecting!!!!!! Congrats!
During all that hot mess, my second LC suggested domperidone and/or reglan . Her husband is an OB in my practice (although he wasn't my doctor), so she said the script would obviously, be pretty easy to get if I wanted. Had a couple soul-searching conversations with H and my mom, and eventually, I made the decision not to try the drugs. Guess it's a good thing I didn't.
I am actually pretty bothered that they were considering doing this.
When I was struggling with my supply with DS, I was shocked by the number of women on the BFing board on the Bump who recommended I order Dom from Canada.
Sorry, but I don't like to take drugs that have to be ordered internationally b/c they are not FDA approved off-label and without any Rx/oversight.
I'm gonna go ahead and say it, at some point, you have to consider how much of a benefit you're really getting from all the work.
Breastfeeding is faboo when it goes well.
I think the responses in this thread sum up rather well why I'm so opposed to anti formula initiatives in the hospital. They aren't addressing the real difficulties with breastfeeding or giving meaningful help except to remind you that formula is inferior.
I was rx'ed reglan with nary a warning or a discussion. I only knew that it was to attempt to help my supply. It was given to me 3 days after MPT was born at my first LC appt. it was only later that I realized it was something that could be potential harmful for me.
I was rx'ed reglan with nary a warning or a discussion. I only knew that it was to attempt to help my supply. It was given to me 3 days after MPT was born at my first LC appt. it was only later that I realized it was something that could be potential harmful for me.
I'm gonna go ahead and say it, at some point, you have to consider how much of a benefit you're really getting from all the work.
Breastfeeding is faboo when it goes well.
I think the responses in this thread sum up rather well why I'm so opposed to anti formula initiatives in the hospital. They aren't addressing the real difficulties with breastfeeding or giving meaningful help except to remind you that formula is inferior.
This is really how I feel. Taking away the formula doesn't really help at all.
I had a lot of guilt over BFing not working for me with Jackson, but the best advice I received was from my mom - and that was if BFing works for both you and your baby, do it. Enjoy it. But if it doesn't, don't feel guilty or feel like you're feeding your baby wrong. Because in the end - you are FEEDING your baby and that is what is important. (FTR, my mom was an extended BFer)
I had a lot of support to BF. There was really nothing in my way besides my own body, and 6 years later I can honestly say I feel no guilt. But at the time, it was a really ugly place for me. When I got pregnant, there was no question in my mind I would BF. And let my kid self wean. And that BFing was far superior to FF. I learned a pretty harsh lesson within the first 2 weeks of having Jackson, but it was one of the best parenting lessons I ever did learn. I think I was lucky in the sense that I didn't have ANY breast milk, so the decision wasn't to supplement and try and up my supply. It was - this isn't happening, you're formula feeding.
Post by laurenpetro on Aug 7, 2012 13:25:30 GMT -5
every time there's a BFing post there are a ton of stories from you guys about how horribly people made you feel when you stopped and it crazy to me. not that i don't believe you, but holy shit.
am i the only one whose doctors didn't guilt the shit out of me for stopping pumping at 6/8 weeks? i never once got a guilt trip from anyone about stopping. even my mom, who was pretty heavily pro-BFing, never said a word about it. she was never one to hold her tounge so it must not have bothered her at all.