Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Judith Lumley Centre, La Trobe University | Royal Women's Hospital, Parkville, Victoria, Australia.
PLoS One. 2021 May 3;16(5):e0249599. doi: 10.1371/journal.pone.0249599. eCollection 2021.
Galactagogues are foods, herbs or medications thought to support or increase breast milk supply. The use of galactagogues during lactation is becoming increasingly common despite limited evidence regarding effectiveness and safety, and no definitive recommendations for use in clinical practice. The aim of this study is to explore factors influencing women's decisions to use galactagogues during lactation. Twenty-two semi-structured interviews were conducted in October and November 2019 (over the telephone or in person) with participants located in most Australian states and territories, including metro and regional areas. Interviews were audio-recorded, transcribed verbatim and thematically analysed using NVivo. Analysis revealed that following a concern about breast milk supply, the decision to use galactagogues was influenced by three core and interrelated domains: access to and quality of breastfeeding support, maternal agency and determination to provide breast milk. Women revealed many problematic experiences with health care professionals that left them feeling dismissed and confused due to provision of inconsistent and insufficient information that was sometimes at odds with their desire to provide breast milk. In this instance, some women turned to galactagogues to regain agency. A range of broader dimensions influencing decision-making also emerged. These were separated into categories that emphasise distinctions relating to breast milk supply, which included: maternal emotional wellbeing, social norms and pressures, concerns about infant development, maternal physical health and lactation history, as well as those relating specifically to galactagogue use, including: desire for a guaranteed/urgent response, risk-risk trade-off, acceptance and trust, and accessibility and cost. In understanding the complexity of decision-making concerning these substances, we identify opportunities to improve breastfeeding counselling and support. We recommend that support be individually tailored to manage conflicting information, adopt communication styles that encourage trust and processes that enable shared decision-making to enhance or restore maternal agency. There is also considerable need to address evidence gaps regarding the effectiveness and safety of commonly used galactagogues, so that women can be appropriately counselled about potential benefits and harms.
催乳剂是被认为可以支持或增加母乳供应的食物、草药或药物。尽管关于有效性和安全性的证据有限，并且在临床实践中没有明确的使用建议，但在哺乳期使用催乳剂的做法越来越普遍。本研究旨在探讨影响女性在哺乳期使用催乳剂的决定因素。2019 年 10 月至 11 月期间，在澳大利亚大多数州和地区（包括市区和偏远地区），通过电话或面对面的方式对 22 名参与者进行了半结构化访谈。访谈内容被录音、逐字转录，并使用 NVivo 进行主题分析。分析结果显示，在对母乳供应产生担忧后，使用催乳剂的决定受到三个核心且相互关联的因素影响：获得和母乳喂养支持的质量、产妇的能动性以及提供母乳的决心。女性报告了许多与医疗保健专业人员有关的问题，这些问题使她们感到被忽视和困惑，因为提供的信息不一致且不充分，有时与她们提供母乳的愿望相矛盾。在这种情况下，一些女性求助于催乳剂来恢复能动性。还出现了一系列影响决策的更广泛的维度。这些维度分为强调与母乳供应相关的区别的类别，包括：产妇的情绪健康、社会规范和压力、对婴儿发育的担忧、产妇的身体健康和哺乳史，以及与催乳剂使用具体相关的类别，包括：对保证/紧急响应的渴望、风险-风险权衡、接受和信任，以及可及性和成本。在理解这些物质决策的复杂性时，我们发现了改善母乳喂养咨询和支持的机会。我们建议根据个人情况量身定制支持，采用鼓励信任的沟通方式，并建立能够促进共同决策的流程，以增强或恢复产妇的能动性。还需要解决关于常用催乳剂的有效性和安全性的证据差距，以便能够适当地向女性提供有关潜在益处和危害的咨询。
