Treatment of insufficient lactation is often not evidence-based

Breast milk has many advantages over formula for infants in developed and developing countries alike. Despite intentions of breastfeeding, some women develop insufficient lactation. Treatment options traditionally include breastfeeding education and pharmacotherapy.

An electronic questionnaire regarding treatment of insufficient lactation was sent to all obstetric departments (n = 21) and neonatal wards (n = 17) in Denmark. Three main questions were included which focused on: breastfeeding education for women, use of pharmacotherapy and availability of local guidelines.

In all, 30 out of a total of 38 departments participated; and among those, 93% offered some form of breastfeeding education. 50% used either metoclopramide or syntocinon to promote lactation. None used domperidone. 73% had a local clinical guideline. 77% offered sessions with a lactation consultant.

Despite lack of evidence, half of the Danish obstetric departments and neonatal wards use metoclopramide and syntocinon for insufficient lactation. Domperidone might provide an alternative, but no departments reported its use. Management of insufficient lactation should always be initiated by counselling and education. Only when these treatment options are exhausted should pharmacotherapy with a suitable medication be considered.