Weaning

With my return to work date looming, one of the things I have to do is start weaning Savanna.  Ever since she quit drinking from the bottle at 3 months of age, she has been exclusively breastfed.  For the past 6 months, we’ve been in a very comfortable routine of nursing 4 times a day, while I take the maximum dosage of domperidone.

This week, I stopped taking domperidone, and reduced the feeding to 3 times a day. Later this week will be 2 times a day, then next week onward just keeping one feed a day. Savanna is a pretty good eater, so I’m not worried about her missing vital nutrients.  I can tell right away that my milk production has reduced greatly once I stopped the medication.  Thank goodness for the meds, or I would never be able to breastfeed exclusively!

This afternoon while I was nursing her, I had her cradled in my arm, with a warm fuzzy blanket covering both of us.  The afternoon sunlight was streaming in from our window, shining beautifully projected streaks on Savanna’s face.  She looked up at me with her bright eyes, while scratching my neck with one hand.  It made me a little sad to think that 10 days from now I’ll be sitting in my office, churning out tax work, rather than being with my baby.  I’ve had a much better experience with breastfeeding this time around, and I am really going to miss all this bonding time I’ve had with her.

A year is a long time, and a short time.  It’s long because you sleep little, you’re chasing after a toddler while trying to care for a baby, and you’re cranky because your toddler is growing a personality.  A year is short because your baby is still just a baby, barely taking a few steps, and barely saying a few words.

Weaning Savanna is harder for me than it is for her.  I feel like I need to be weaned off my attachment to her, and all the sweet and luxurious amount of time I got to spend with her.

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.

The never ending battle of breastfeeding

I wrote a number of posts on breastfeeding during Joshua’s first year of life.  Most of the posts were about the stress of trying to figure out how to produce an extra ounce of milk to feed my baby.  I took the maximum dosage of domperidone, and was also taking fenugreek seed and blessed thistle.  But for whatever reason, I physically cannot produce enough to exclusively breastfeed, so I’ve always had to supplement with formula.  It was something I really struggled with, because there was no correlation between my efforts and the result.

Domperidone

Now, the battle continues.  This time around with Savanna, I expected that I wouldn’t produce enough.  What I did not expect was that while I was still in the hospital, my doctor told me she would no longer prescribe domperidone because of a Health Canada black box warning.  For certain demographic, it raises the risks of cardiac arrest.

No domperidone?  Are you kidding me?  If I can’t be on that drug, I would have no hope of breastfeeding.

Domperidone is a drug often prescribed to women to help increase lactation, although the original intend of the drug was for something else.  I had taken the maximum dosage of domperidone when I was breastfeeding Joshua during his first year, but that was before the black box warning came out.

Luckily for me, the obstetrician on rotation that night at Women’s had no problem giving me the prescription for a 2-month supply of domperidone.  I filled the prescription, against my doctor’s advice.  I felt that I do not fit in the demographic of the people having issues with domperidone, and that I had no problems with it when I was on the drug the last time.  I’ve decided to take the medication.

Vancouver Breastfeeding Clinic

Still, even with the medication, I do not produce enough milk, just like the last time around. And even though I already knew this was going to happen, it does not make me feel any better about it happening again.

My doctor referred me to the Vancouver Breastfeeding Clinic. I was a little reluctant to go, because I felt that I’ve seen my fair share of lactation consultants and nurses specialize in lactation issues.  I remember going to numerous appointments and putting Joshua on scale after scale to figure out how much milk he was getting.  At the end I wasn’t really sure how much those appointments really helped.  I don’t really want to waste time going to another appointment when I can enjoy some time at home with Savanna.  But at the end, I agreed to go, in the hopes of learning something new that may help me.

Last week we had our first appointment to see Dr. Stringer.  She came across very clinical, straight forward, and no none-sense.  She gave me some tips on how to help Savanna latch on better for more efficient drinking, and gave me a plan of reducing nursing time but include pumping after each feed.  The plan is supposed to make my body produce milk more efficiently without being tied to a nursing chair 24/7.  But that also means pumping and washing all the pump parts 8 or 9 times a day.

I followed the “plan” for an entire week, and went to the follow-up appointment today with Dr. LIvingstone.  She’s apparently the authority figure on breastfeeding in Vancouver.  Anyway, she’s another interesting character.  She told me to stop the pumping because it’s not really helping much, and actually told me to cut my domperidone dosage by half because she doesn’t think the drug is actually helping me much.  She felt that I was just born physically incapable of producing enough milk.  I have no idea how she came to that conclusion, but I would tend to agree.  My mom didn’t produce enough milk to breastfeed me, so it seems like it’s partly genetics that I just don’t produce enough for my kiddos.

Now what?

So we’re sort of back to sqaure one.  I don’t produce enough milk, and there’s not a heck of a lot we can do about that.  I can still breastfeed, but would just need to supplement with formula so that my baby will put on weight properly.  I am frustrated.  I’ve spent so much energy and effort into this issue with Joshua, but I’m no further ahead with Savanna.  I don’t know why I can just accept this as a fact of life and move on.  There’s just something about this issue that I struggle with, and I couldn’t quite put my finger on it.

I am slowly working through how I feel about all this.  I think at the end of the day, I need to come to terms with my physical limitations and focus my energy on other more important things.  It’s probably easy to say that than to really achieve it.  I’m defintely not there yet, but I’m working on it.