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 for use in clinical consultations in the Resource Hub if you are participating in NDC Accreditation.