“害怕停药”与“想要停药”：探索女性使用多潘立酮作为催乳剂的体验——一项定性研究。
"Fear of stopping" vs "wanting to get off the medication": exploring women's experiences of using domperidone as a galactagogue - a qualitative study.
机构信息
Faculty of Health and Medical Science, The University of Adelaide, Adelaide, Australia.
SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia.
出版信息
Int Breastfeed J. 2021 Dec 9;16(1):92. doi: 10.1186/s13006-021-00438-5.
BACKGROUND
Domperidone is the most frequently prescribed medicine used to increase breast milk supply. There is considerable controversy surrounding the use of domperidone in lactation, due to limited evidence about efficacy and concerns about rare but life-threatening side-effects. Despite this, in many high-income settings such as Australia, use of domperidone among breastfeeding mothers appears to be increasing. The aim of this paper was to explore women's experiences of using domperidone during breastfeeding.
METHODS
Semi-structured interviews were conducted in 2019 with 15 women in Australia who reported using domperidone as a galactagogue during breastfeeding. Interviews were recorded, transcribed and analysed thematically.
RESULTS
Women reported a wide variety of practices concerning the timing of initiation of domperidone use, including prophylactic use, as well as the dose and duration of use. Prolonged periods of use and unsupervised dosing were commonly reported, these practices were sometimes associated with a fear of the consequences of stopping, insufficient provision of information about the drug or feeling dismissed by health professionals. Some women indicated that when doctors refused to prescribe domperidone they responded by doctor shopping and seeking anecdotal information about benefits and risks online, leading to unsupervised practices. Women often reported high expectations surrounding the effectiveness of domperidone, and most used the medication in conjunction with food/herbal galactagogues and non-galactagogue support. Positive outcomes following domperidone use included having greater confidence in breastfeeding and pride at achieving breastfeeding goals.
CONCLUSIONS
This study identified a variety of practices concerning domperidone use, including potentially unsafe practices, linked in some cases to inconsistent advice from health professionals and a reliance on online, anecdotal information sources. These findings emphasise the urgent need for development of clinical practice guidelines and a greater focus on translating existing evidence concerning domperidone into clinical practice, including clinical support that is tailored to women's needs.
背景
多潘立酮是最常开的增加母乳供应的药物。由于关于疗效的证据有限，并且对罕见但危及生命的副作用的担忧，多潘立酮在哺乳期的使用存在很大争议。尽管如此，在澳大利亚等许多高收入国家，母乳喂养的母亲使用多潘立酮的情况似乎正在增加。本文旨在探讨女性在母乳喂养期间使用多潘立酮的经验。
方法
2019 年，对澳大利亚的 15 名报告在母乳喂养期间使用多潘立酮作为催乳素的女性进行了半结构化访谈。对访谈进行了记录、转录和主题分析。
结果
女性报告了在开始使用多潘立酮的时间方面存在各种做法，包括预防性使用，以及剂量和使用持续时间。长期使用和未经监督的剂量是常见的，这些做法有时与对停药后果的恐惧、对药物的信息提供不足或被卫生专业人员忽视有关。一些女性表示，当医生拒绝开多潘立酮时，她们会通过找医生和在网上寻找关于好处和风险的传闻信息来寻求治疗，从而导致未经监督的做法。女性通常对多潘立酮的有效性抱有很高的期望，大多数人将药物与食物/草药催乳素和非催乳素支持一起使用。使用多潘立酮后的积极结果包括对母乳喂养更有信心和为实现母乳喂养目标感到自豪。
结论
本研究确定了与多潘立酮使用有关的各种做法，包括在某些情况下可能不安全的做法，这些做法与卫生专业人员的意见不一致以及对在线传闻信息源的依赖有关。这些发现强调了迫切需要制定临床实践指南，并更加注重将现有关于多潘立酮的证据转化为临床实践，包括针对女性需求的临床支持。
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