Take the Right Drugs

Now that the baby had turned head down the only issue to solve before we could relax and wait for the big day was trying to get the Domperidone prescription to enable me to increase my breastmilk once the baby is born.

I had been to see the GP a while ago to ask for the prescription and you'd think I had asked for his life savings! The conversation went something a little like this...

K_: I would like a prescription for Domperidone please
Dr: What do you want that for?
K_: To increase my breast milk once my baby is born please. I had a breast reduction 10 years ago and I had low milk supply with my first baby, which was dramatically increased by using Domperidone.
Dr: I don't know anything about that, you need to ask your obstetrician
K_: Um....what obstetrician?
Dr: The one you usually see.
K_: I haven't seen an obstetrician, I have midwife led care
Dr: There will be an obstetrician where you usually go to clinic
K_: I've only ever been to this surgery for the midwife clinic...
Dr: The hospital where you are having the baby...
K_: I'm having the baby at home and only see midwives.
Dr: Well I don't know anything about it so I'll have to speak to the obstetrician and get back to you.

So off I go, hopeful that I will get a satisfactory resolution soon...

2 weeks go by and I don't hear anything so I phone to be told that the Dr has gone on holiday and that I should phone the following week. So I phone back and cannot get hold of him. When he finally returns my call I am at work, very busy and a bit flustered. Without referring to the fact that I had asked him for Domperidone, he announces that he has spoken to the obstetrician who has recommended Metoclopramide and I can pick my prescription up at the desk. This drug rang an alarm bell in my head but without any of my research with me I was unable to respond to this and just said I would take a look at what it was.

Once I got home and checked the fact I realised that my gut feeling of alarm bells was certainly justified. On the face of it Metoclopramide is a similar drug to Domperidone, it is a dopamine receptor antagonist stomach drug which although unlicenced for this usage does have a side effect of increasing lactation. That is where the similarity ends. Whereas Domperidone has a very low side effect profile with headache and dry mouth being the most common, Metoclopramide is a very nasty drug indeed. Although it is prescribed to increase breast milk this is generally very short term (2 weeks or less) usage in mother of premature babies to get their milk established. The main difference between Metoclopramide and Domperidone is that Metoclopramide crosses the blood-brain barrier and has documented Central Nervous System (CNS) side effects including anxiety, depression and even suicidal thoughts. Then incidence of negative CNS rises if Metoclopramide is used for more than 4 weeks. Metoclopramide is not recommended for those with a history of anxiety and depression.

I had NO intention of taking Metoclopramide as I have a history of anxiety and depression. Although drpression would not necessarily be recorded on my medical records as I have avoided being prescribed antidepressants, my medical history includes treatment for arthritis caused by extreme nightime teeth grinding and use of sleeping pills to manage ongoing insomnia. It wouldn't take a genius to work out that I may not be a great candidate forMetoclopramide at the best of times, but the danger of postnatal depression makes it even less of a brilliant plan.

There was also the concern that Metoclopramide is for very short term use, due the the side effect profile. Quite what the GP expected I would do after the 2-4 weeks maximum usage was up I am not sure.

M_, the midwife, and I discussed things and I emailed her some of the evidence I have collected on the use of Domperidone to increase breast milk supply. She was also not happy for me to take Metoclopramide got on the case and spent several days trying to get hold of the GP. We had been hoping that he might be willing to learn more and discuss the relative merits of the drugs but once she finally got to speak to him he wouldn't even discuss the evidence with her and told her to just take it up with the obstetrician. I'm note sure if he has even bothered to read my notes or find out about either drug. I didn't expect him to be an expert on increasing lactation but I did at leats expect him to be willing to find out more and to discuss clinical evidence with another medical professional.

M_ has been brilliant and got straight on to the obstetrician who works out of the local hospital. He was happy for me to switch to Domperidone and is arranging for a prescription to be available for me to pick up at the hospital. Once I have this I will then be able to request repeat prescriptions from the GP surgery.

Success at last and big thanks to M_ for her efforts in sorting this out for me.