GPs' decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey

Abstract

BackgroundMany breastfeeding women seek medical care from general practitioners (GPs) for various health problems and GPs may consider prescribing medicines in these consultations. Prescribing medicines to a breastfeeding mother may lead to untimely cessation of breastfeeding or a breastfeeding mother may be denied medicines due to the possible risk to her infant, both of which may lead to unwanted consequences. Information on factors governing GPs' decision-making and their views in such situations is limited.MethodsGPs providing shared maternity care at the Royal Women's Hospital, Melbourne were surveyed using an anonymous postal survey to determine their knowledge, attitudes and practices on medicines and breastfeeding, in 2007/2008 (n = 640). Content analysis of their response to a question concerning decision-making about the use of medicine for a breastfeeding woman was conducted. A thematic network was constructed with basic, organising and global themes.Results335 (52%) GPs responded to the survey, and 253 (76%) provided information on the last time they had to decide about the use of medicine for a breastfeeding woman. Conditions reported were mastitis (24%), other infections (24%) and depressive disorders (21%). The global theme that emerged was "complexity of managing risk in prescribing for breastfeeding women". The organising themes were: certainty around decision-making; uncertainty around decision-making; need for drug information to be available, consistent and reliable; joint decision-making; the vulnerable "third party" and infant feeding decision. Decision-making is a spectrum from a straight forward decision, such as treatment of mastitis, to a complicated one requiring multiple inputs and consideration. GPs use more information seeking and collaboration in decision-making when they perceive the problem to be more complex, for example, in postnatal depression.ConclusionGPs feel that prescribing medicines for breastfeeding women is a contentious issue. They manage the risk of prescribing by gathering information and assessing the possible effects on the breastfed infant. Without evidence-based information, they sometimes recommend cessation of breastfeeding unnecessarily.

Use of Medications by Breastfeeding Women in the 2015 Pelotas (Brazil) Birth Cohort Study

“…Many women use medicines during lactation, and health care providers face the challenge of determining which medications are compatible with breastfeeding. Although there is a large amount of literature on the availability of active components of medications in the breast milk, the quality of information about their safety during lactation varies and can be conflicting [9,10]; therefore, many women can be advised by health practitioners to stop breastfeeding unnecessarily or avoid treatment without evidence-based information [11,12]. For instance, there are several controversies regarding the safety of hormonal contraceptive medication use, which is widely used by women at this stage, during lactation.…”

Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies

“…One paper reported content analysis of open questions in a survey (31) and the fifth, (32) a non-peer reviewed report, covered perinatal mental health more generally. These papers were included due to the early stage of research in the area but their findings were used to support themes found in the other studies rather than initiating themes.Three papers focused on the postnatal period (28,29,31), one on pregnancy (30) and one on the "perinatal period" (32).…”

Lactantes em tratamento medicamentoso da rede pública de saúde

“…Após o parto, o uso de medicamentos é frequente entre as lactantes, devido à necessidade de tratamento para combater infecções, depressão, além das doenças crônicas que requerem medicamentos de uso contínuo (4)(5)(6) . Sabe-se que mais de 50% das mulheres que estão amamentando usam algum tipo de medicamento (7,8) .…”