title: Treatment of insufficient lactation is often not evidence-based.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Gynækologisk-Obstetrisk Afdeling, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark. paulbryde@gmail.com.
authors.forename: Paul Bryde
authors.initials: PB
authors.lastname: Axelsson
authors.forename: Flemming
authors.initials: F
authors.lastname: Bjerrum
authors.forename: Ellen Christine Leth
authors.initials: EC
authors.lastname: Løkkegaard
mesh_terms: D001942:Breast Feeding; D003718:Denmark; D065127:Dopamine D2 Receptor Antagonists / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007775:Lactation Disorders / Q000628:therapy*; D008787:Metoclopramide / Q000627:therapeutic use; D009359:Neonatology; D009774:Obstetrics; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
chemical_list: D065127:Dopamine D2 Receptor Antagonists; D010120:Oxytocics; D010121:Oxytocin; D008787:Metoclopramide