Exploring the Prescribing Process of Domperidone for Low Milk Supply: A Qualitative Study Among Mothers, IBCLCs, and Family Doctors

Abstract

Background When mothers are confronted with milk supply problems, taking domperidone is regularly suggested. However, domperidone has been associated with sudden cardiac death and caution in prescribing is advised. In 2016, a multidisciplinary group of authors from a tertiary academic hospital (Erasmus MC) published a clinical protocol in a leading Dutch physicians’ journal to support Dutch family physicians in prescribing domperidone to stimulate lactation. Research aim To explore consumer and health care provider perspectives and experiences regarding the prescribing of domperidone for lactation insufficiency following publication of a national clinical protocol. Methods A cross-sectional qualitative study was performed using semi-structured interviews ( N = 40) based on a topic list covering the prescribing process. Participants were mothers ( n = 18) who had been advised to try domperidone to boost their milk supply between November 2016 and May 2018, their International Board Certified Lactation Consultants ( n = 9), and their family physicians ( n = 15). Another group of participants (mothers; n = 6) answered short questionnaires. All interviews were recorded, transcribed and analyzed using ATLAS.ti software. The resulting list of codes was organized according to the topics. Results In the process leading to domperidone use to stimulate lactation, participant family physicians relied on the IBCLC, pharmacist, or mother to guide the prescription of domperidone, often citing the published national clinical protocol as back up. The medical safeguards incorporated in the protocol (e.g., taking medical history, physical exam, performing electrocardiograms, limiting dosage) were usually not implemented. Conclusions Though the availability of a national clinical protocol in which the prescribing of domperidone for lactation is supported appeared to increase the willingness of participant family physicians to prescribe, gaps were identified between clinical practice and this clinical protocol for prescribing domperidone.

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

“…This suggests either a communication gap between recommendations/information about galactagogues like domperidone that misinforms practices of use, inconsistency around how the risk is presented or explained, and, a moral burden on women which upholds practices that may be risky to themselves as unimportant vis-à-vis their responsibility to baby. Few women in our study reported active discussions with prescribers regarding potential risks of domperidone use, representing a similar finding to that of Tauritz Bakker et al [28].…”

“…The issues around practices of use that involve selfmanaged dosing and long-term use was also observed in interviews conducted by Tauritz Bakker et al with women who took domperidone for lactation insufficiency in the Netherlands [28]. Such practices may be influenced by the lack of agreement by healthcare practitioners around the criteria for use, including no consensus on the safest and optimal dosing and the duration of use.…”

“…The practices of extended use based around a "fear of stopping" and self-directed dose adjustments provides evidence of unsupported/unsupportive practices associated with the use of domperidone. While practices of women initiating both increases in dosage and extension of therapy have been previously noted by Tauritz Bakker et al, [28] reasons for such behaviours have not been well explored. In the context of our study, these practices illustrate how some women navigate the perception of risk and responsibility in the context of breastfeeding challenges, perceiving the risk of baby not having access to breast milk as greater than engaging in unsupported practices that affect their bodies.…”

“…In addition, GPs may benefit from further training in the best way to support lactating women including the uptake of practice guidelines. This is particularly pertinent given interviews conducted by Tauritz Bakker et al observed that GPs prescribing domperidone often did so under direction from women themselves and they often relied on the woman's definition of milk supply problems, rather than assessing the situation themselves [28]. This indicates that more collaborative work needs to be done to ensure women are continually supported whilst ensuring medications are promoted, prescribed and used safely.…”

“…In addition, unlike herbal galactagogues, which have been frequently studied [23][24][25][26][27], there has been few studies that have provided an in-depth exploration of the ways in which women are using domperidone during lactation. A recent qualitative study from the Netherlands interviewed 18 mothers and aimed to explore consumer perspectives and experiences regarding the prescribing of domperidone in lactation following the publication of a national clinical practice guidelines [28]. This study identified numerous gaps between what occurred in clinical practice and what the guidelines recommended.…”