To Interrupt or Not to Interrupt? A Case-Based Survey on Physician Management of Breastfeeding After Radiological Imaging and Medication in the Emergency Department.

Abstract

Background: Maternal illness requiring medication or diagnostic imaging may challenge breastfeeding continuation, particularly in emergency departments (ED), where rapid clinical decisions are required. This study aimed to evaluate emergency physicians' knowledge, attitudes, and clinical practices regarding breastfeeding continuation after medication use and imaging.

Methods: This descriptive cross-sectional study was conducted among physicians. A structured, scenario-based online questionnaire consisting of 20 items was distributed to physicians working in ED. The survey assessed sociodemographic characteristics, frequency of encounters with breastfeeding mothers, and clinical approaches.

Results: Of 160 invited physicians, 71 completed the survey (response rate: 44.4%). The mean age was 32.9 ± 6.4 years, and 62% were male. Physicians frequently encountered breastfeeding mothers in clinical practice, with 49.3% reporting daily, 28.2% weekly, and 22.5% monthly encounters. In scenario-based questions, the proportion of participants reporting that breastfeeding could be continued without interruption was 47.9% for ibuprofen, 29.6% for methylprednisolone, 70.4% for ondansetron, 56.3% for omeprazole, 54.9% for adenosine, and 26.8% for metoprolol. For radiological procedures, continuation rates were 91.5% for plain X-ray, 38% for contrast-enhanced CT, and 49.3% for MRI. Nearly half of the participants (47.9%) reported insufficient knowledge regarding breastfeeding management. Knowledge scores differed significantly by professional title (p = 0.001), with general practitioners scoring lower than residents and specialists.

Conclusion: Emergency physicians, despite frequently encountering breastfeeding mothers, may show variability in their knowledge, attitudes, and clinical approaches to the management of breastfeeding patients. On the other hand, a higher level of knowledge among residents and specialists suggests that specialist training can be effective in ensuring correct clinical practice. Increasing access to guidelines and integrating evidence-based breastfeeding education into specialist training curricula, including medical school curricula, can improve clinical decision-making processes and prevent unnecessary interventions in breastfeeding.