Wednesday, December 25, 2013

On induced lactation

Claire, Michelle, Rebecca, Pam, Josey, Meg, Sloper (OMG, how did I miss out on your second pregnancy?!?!), thank you so much for your inputs.

I started reading up on induced lactation. Reglan is a no-no because it can cross the blood-brain barrier, and has one potential really scary side effect, tardive dyskinesia. My brother actually had that as a child.

Domperidone appears to be safer. Still, it can have cardiac effects---it can prolong something called the QT interval, and hence cause arrhythmia, which could potentially cause your heart to stop(!!). Here is a blogpost on the subject on the Skeptical OB blog, though I would say, this post does not seem to be wholly objective. The truth most likely is that this drug is safe in the majority of women, and would be dangerous for a smaller subset. Obviously it is more dangerous if you are mixing it with other medications that also prolong the QT interval, or you have underlying conditions that you are unaware of. The evidence for both intravenous and oral Domperidone causing arrhythmia comes from studies they did in people over 70 years of age.

But what genuinely scares me about this drug is the fact that the baby may get a tiny bit of it through breast milk, and if the baby has any underlying cardiac issues (one unverified source mentioned that 1 in 100 babies born have some sort of cardiac issue), this could be a bad combination. It is probably safe for 99 out of the 100 babies, but what if you are the 100th one?

So...if you are taking it, exercise caution with respect to dosage, be aware of your other medications, and I would suggest talking to your doctor too. I was also a little freaked out by Claire mentioning that her liver enzymes were elevated. So all in all, I'm going to give induced lactation a pass.

Human milk banking exists in Mumbai. However, the milk is pasteurized, which destroys most of the good stuff. I AM going to try to use the milk bank to find a wet nurse though, and if all else fails, supplement the goat milk formula with banked milk.

But all this is a ways away. I want to start doing stuff, but there is no way I will before I get to the "safe zone" of beyond 28 weeks, which I feel I am crawling towards one slow inch at a time. I'm sad to say that I'm not somebody who stops to smell the roses and celebrates what I have today, instead of thinking about tomorrow. I can't celebrate that the J has completed 22 weeks of pregnancy today...all I can think of is how much more time has to pass before we are in the relatively safer zone of 28 weeks and beyond.

But this is folly, because once you decide to have a child, there is no safe zone anymore. After birth, you worry about SIDS and diphtheria and the flu. You worry about Autism. Then one day you worry about your child being bullied at school. You worry about predators----it never ends.  Somebody described parenthood as having your heart walking outside of you, unprotected and vulnerable, for the rest of your life. And here we all are, eagerly signing up for all this.

Merry Christmas everybody. I'm so very happy for everybody who has gotten what they wanted for so long this year. For the ones who are still waiting or have had their hearts badly damaged, all I can say is that I am thinking about you. There are no words to make it better.

8 comments:

  1. Merry Christmas Jay! Please keep in mind that MANY babies get only formula and do just fine. Yes, breastmilk is preferred, but only if you are 100% sure there are no disease risks/etc. And, you are so right, the fears and risks continue after the baby is born. As I think you know, my perfectly healthy 13 month old nearly died of an out-of-the blue E coli infection, and she will face lifelong kidney problems as a result. And my "perfectly healthy" (in utero) 2nd daughter was born with hearing loss. And right now both my older daughter and I are dealing with some health scares. We truly do not have control. We can try to prevent every problem and live with the heavy weight of needing to be in control, or we can use reasonable caution and understand the universe will deliver what it will. I just have to say I am really bothered when people say "as long as the baby is health..." (and I used to say it myself) because an "unhealthy" baby is just as valuable and loved. I now know in my deepest heart that every child is perfect.

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    1. I've found my own attitudes on this (the emphasis on health) shifting as we've moved through this pregnancy, and I have not even been the one carrying the baby. I believe it will change all the more once this becomes far more real. Parenthood is...something else.

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  2. The first six months when baby is receiving all of her nutrition from milk goes by so fast. It is a short blip in a lifetime. Breast milk is great, but even if you delivered your baby yourself, there's no guarantee you wouldn't have to supplement with formula. It's amazing formula exists! And aren't we lucky we can afford it ? It pains me to think about mothers who are unable to feed their infants at all.

    I researched domperidone and spoke to my doctor and felt confident it was a healthy choice for me. But you need to choose what's best for you and your baby, and if inducing lactation adds to your anxiety then you're right to move on.

    I hope you have a wonderful Christmas. Next year it will look very different, won't it?

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  3. I personally know of people who have used formula milk for their babies and they have done fine. If induced lactation has risks, please avoid it. The thought of that affecting the baby is scary indeed and it is wise not to take such risks.

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  4. You could not be more right when you say "because once you decide to have a child, there is no safe zone anymore...--it never ends." It really doesn't. There is always something to worry about...always.

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  5. Whatever worry I had when pregnant has amplified 1000 times since having had a baby. The anxiety and worry is unreal. It has really surprised me and I have to remind myself that it will be this way forever and is the new normal to always be anxious about something or other. Its not just the big things like SIDS etc, its small things like is this color of poop normal, is this spit up or vomit, why is she coughing, why is she sleeping so little/so much, etc. Also you seem a lot like me in wanting to investigate things and be in control. But I learned that at some point one just needs to do one's best and let go of the rest. Easier said than done for sure. All this is coming from my experience. Have a wonderful New Year and so happy that it is all going so well.

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