Induction of lactation: taking a history and why each question matters
| History | Items that are important to ask about | Why the answer matters |
|---|---|---|
| Age | Patient's age | Combined oral contraceptive pill (COCP) contraindicated over 35 years of age due to increased risks of side-effects (e.g.thrombosis) |
| Gender identity | Female | |
| Transgender | Transgender woman who wishes to induce lactation should be managed in partnership with her endocrinologist | |
| Previous pregnancies or birth experience | Breastmilk production is likely to be higher if the woman has had a previous pregnancy, since pregnancy ‘primes’ the breast for lactation with hormones reaching much higher levels than achieved with a COCP, for instance | |
| Who will/has birthed the infant? | Surrogate mother | |
| Infant is adopted | ||
| Partner | ||
| Other - please detail | ||
| Reason not able to/not choosing to conceive | Medical condition - please detail | May be relevant to considerations of risks of hormonal induction |
| Infertility without identifiable cause | ||
| Other - please detail | ||
| Past medical/surgical history | Cigarette smoking - pack years, number of cigarettes daily | COCP contraindicated if > 15 cigs/day. If less than 15/day and < 35 years of age, you may weigh up risks of cardiovascular disease (myocardial infarction, thrombosis, stroke in discussion with the patient. |
| Vaping | ||
| Thrombosis | History of deep venous thrombosis, stroke, or clotting disorder is contraindication | |
| Other cardiac condition - please detail | Consider relvance to COCP and domperidone | |
| Hypertension | COCP may be contraindicated | |
| Migraine | COCP may be contraindicated | |
| Diabetes | Check lipid profile and blood pressure. COCP contraindicated if hypertriglyceridemia or hypertension | |
| Cardiac arrhythmia | Domperidone contraindicated | |
| Liver disease | COCP may be contraindicated | |
| Renal or adrenal insufficiency | Drosperinone (new generation progesterone in Yasmin) contraindicated | |
| Depression | Domperidone is self-reported to worsen mood in some women | |
| Medications | Taking drugs which interact with domperidone or prolong QTc interval? The most common examples are erythromycin, fluconazole, citalopram and escitalopram | Domperidone is contraindicated when these other medications are being taken. |
| Previous COCP use - please detail | Helps determine tolerance to and potential side-effects of COCP use | |
| Allergies | ||
| Family history | Sudden unexplained cardiac death | Domperidone may be contraindicated |
| Cardiac arrhythmia | Domperidone may be contraindicated | |
| Clotting or bleeding disorders | May be relevant to your patient's use of COCP |
You can find this item downloadable as a pdf or word document for use in clinical consultations if you are participating in the NDC Lactation Fellowship.
