Sharing milk

Burnaby-20130330-00025It has been an amazing journey with breastfeeding Savanna.  We started off with me crying like a mad woman in the hospital because I wasn’t producing any, progressed to breastfeeding and supplementing with formula for 3 months, and then eventually Savanna decided she no longer needed to be supplemented.  She has been exclusively breastfed for the last 2 months.  Oh, the freedom from bottles is so sweet!

Not only that, she has been sleeping longer at night.  We put her down around 7 or 7:30 pm, and she wakes up around 3 am to feed.  Before I go to bed (usually around midnight), I would pump out the milk that has been accumulating since 7 pm.  I freeze the milk, thinking that we might need it one day.  But our use of the frozen milk is very limited, because even though Savanna will drink it from a cup, she doesn’t drink very much from it.  She just really prefers the boob, and would rather wait for me to get home.  I had about a litre of frozen milk just accumulating in our freezer.

I didn’t want the milk to go to waste, so I talked to a friend who could use it.  A few nights ago, I delivered the little bags of frozen milk in a cooler bag to her.  I snapped a picture of the cooler bag content, and I’m saving the photo for Savanna.  I want her to know one day that she was sharing at a very young age.

p.s. I struggled a bit on whether I should have written this post.  Sharing breast milk may sound weird to you.  The first time I heard of donor breast milk I was weirded out too.  But I think if you are in good health, free of diseases and infections, why not donate extra milk to others who can use it?

Research on domperidone

I thought I’d write this post in case someone else is taking domperidone for breastfeeding, and have concerns about the safety of the drug.

I was spending some time this week doing research on Domperidone, the prescription drug that helps me produce more milk to breastfeed my baby.  Dr. Livingstone at the Vancouver Breastfeeding Centre is dead set against the drug.  My own doctor is a bit on the fence.  And my public health nurse thinks I should just keep taking it if it is helping me breastfeed.  With all the conflicting advice, basically I need to make up my own mind about it.

If you were to do any research on breastfeeding, Dr. Jack Newman is a name that will come up everywhere.  He has a lot of very useful information and videos on his website about breastfeeding.  He is the authority in this area.  I would certainly consider whatever he has to say about the drug.  When Health Canada issued the black box warning about the drug, Dr. Newman issued the following statement:

Based on a study that was published in Belgium which looked at over 1000 cases of sudden death and found that some of the people who died suddenly were taking domperidone, Health Canada has put out a warning about possible concerns about treating with domperidone. This is a bit of an overreaction on the part of Health Canada. Well, a big overreaction given the data.

Note that in the study, the youngest person who died was 55 and the average age of those who died was 75 years. What has this to do with breastfeeding mothers who are rarely older than 45 years and are usually in reasonably good health? Furthermore, this information came from a data base with no clinical information. It simply has information that so and so died  suddenly and was taking such and such a drug. The thing is that domperidone in these patients was used for reflux and we know that heart disease is frequently misdiagnosed as reflux; severe pain at the top of the abdomen or lower part of the chest is typical of both reflux and cardiac pain.

Misdiagnosis is particularly possible in Europe where domperidone is available in countries like the United Kingdom, Belgium and the Netherlands without a prescription and it is likely that many people are self-diagnosing and self-medicating.

So that’s it and it does not mean that domperidone kills. I will continue to prescribe domperidone at our doses which are based on many years of clinical experience. I have treated many thousands of women with it with only minor side effects. I believe this article from Belgium proves nothing and does not require us to stop prescribing it.

It would be a pity that mothers and babies not benefit from domperidone when used in conjunction with our Protocol to manage breastmilk intake.

Dr. Newman is also a part of the consensus statement issued by a number of breastfeeding doctors.  It is a very good read, giving a lot more information on the articles/studies that Health Canada based its warning on.

I know Health Canada has to issue these warnings when there is a possibility that a drug could have harmful effects.  But it would seem to me that it has over reacted here, especially the statistics came with no clinical information.  I have yet to find any articles or research on the harmful effects of the drug, other than potentially giving you an upset stomach.

I still haven’t decided if I am going to decrease the domperidone dosage and track Savanna’s formula intake, based on Dr. Livingstone’s advice.  But either way, at least I feel more at ease about taking the drug if I need it.

Does domperidone make a difference?

A few weeks ago at the Vancouver Breastfeeding Clinic, Dr. Livingstone advised me to cut my domperidone dosage in half (from 80 mg to 40 mg a day) because she doesn’t believe the lack of prolactin is my problem for the lack of milk supply.  I did take her advice, and then 3 days later I believe that my milk supply dropped because I was pumping out less than what I normally would.  I had put myself back on 80 mg a day, and cursed Dr. Livingstone under my breath. 

The interesting thing is, when I went back for the follow-up appointment, I was ready to tell her she was wrong to give me that advice.  When I told her that dropping the domperidone dosage also dropped my milk supply, she was pretty quick to tell me that my method of measurement is not accurate.  She said just because I pumped less it doesn’t mean my supply dropped.  And just when I was about to argue with her, she gave me a chart to use for a month.  This chart basically tracks my domperidone dosage and the amount of formula Savanna takes in over a month’s time.  If dropping the domperidone dosage has no impact on the amount of formula she takes, then it means the drug has no effect on me and I should stop taking it.  She went on and on about the scary things domperidone can do to me and baby, and strongly encouraged me to get rid of it if I can.  So now I’m supposed to slowly cut my domperidone dosage and keep track of Savanna’s formula intake for the next month.

Even though I went in to the appointment ready to tell her she was very wrong, I came out thinking maybe I should try this tracking chart, slowly drop my dosage, and just see what happens.  If I don’t have to be on medication, I’m all for that, as long as I can still breastfeed Savanna the same way.  I already use an iPhone app to keep track of Savanna’s feeds anyway, so it really isn’t any more work than I usually have to do to complete this chart.  And if Savanna really takes more formula because my milk supply dropped due to the dropped domperidone dosage, I’ll just get back on the high dosage without being any worse off.  It’ll be a bit of an experiment, but I don’t see the harm in it.

I am feeling a lot more at peace with the breastfeeding issues now.  It makes my life so much easier when I just accept my limitations and move on.  I find that it gives me more energy and freedom to enjoy my very precious time with Savanna and Joshua.  I am still doing the best I can to breastfeed and give Savanna the best possible start in life.  Whatever the outcome is with this experiment, I have decided that not to waste anymore time fretting over everything.

I won and you lost!

With all the issues I’ve had with breastfeeding Joshua, our doctor and I both felt that weaning Joshua off at 3 or 4 months is good enough.  Then somehow I found the energy to continue with breastfeeding.  I figured, ok, I’ll stop at 6 months.  So when Joshua was 6 months old, I stopped taking domperidone.  But without the medication, I was still producing some milk, so I kept feeding Joshua twice a day.  It became a comfortable routine, and I didn’t really feel the need to stop.  This continued for the next 5 1/2 months.

Now I only have 2 weeks left of maternity leave, I definitely need to wean Joshua off before I go back to work.  I started skipping a feed each day last week, so now I only breastfeed him just before bed.  In a few more days I’ll start skipping the evening feed too.

I keep expecting this major emotional turmoil for me, but so far I’m feeling quite relaxed about the whole thing.  Maybe it’s because I know that I’ve already done the best I can, even exceeding our doctor’s expectations.

Actually, I’m quite proud of myself.  I remember how stressed out I was about producing one extra ounce of milk, and how desperate I felt for not being able to exclusively breastfeed.  Looking back at the battles I’ve fought in order to keep breastfeeding, I feel a sense of pride and victory.

It makes me want to say to my breasts: I won and you lost!