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Master Thesis

Évaluation des pratiques professionnelles de prise en charge de l'inhibition de la lactation en suites de couches chez des femmes ne souhaitant pas allaiter

Abstract : Introduction/aim: in 2015, the recommendations of the CNGOF for post-partum clinical practice have changed. Our study endeavoured to list the different management methods for lactation inhibition in the Ile-de-France area following the 2015 post-partum recommendations. Material and method: we conducted a transverse and multicentre observational study. Data was collected through an anonymous questionnaire sent to midwives working in maternities in Ile-de-France, through coordinating midwives. The analyses were done with Excel software, biostaTGV, XLSTAT, and with the tests of Chi2, Fisher, Student and Anova. The significance threshold has been set to p < 0,050. Results: 370 midwives took part in this study, all working in maternity wards in Paris and suburb. 61,9% of them currently have a protocol to support the inhibition of lactation. 37,9% of midwives interviewed declare to suggest a drug method to support the inhibition of lactation, with 32,2% prescribing cabergoline (Dostinex®), and 5,7% prescribing lisuride (Arolac®). 75,7% midwives offer a homeopathic approach as a first intention, either on its own or supporting an allopathic treatment. Midwives working frequently in maternity service prescribe more homeopathy (p = 0,003) and are better acquainted with the adverse effects of the drug method (p = 0,027). Midwives working in type 3 maternity prescribe less homeopathy (p = 0,009) and less lisuride (p = 0,029) than midwives of type 1 and 2. The most recently graduated midwives advise more non-medicated (conservative) means to be put into place (brassieres, cold compresses, etc.) (p < 0,0001). With regard to the drug method, the midwives who graduated before 2004 are more reluctant to prescribe it compared to those most recently graduated (p = 0,006) and find that we do not have enough hindsight on the use of these molecules (p = 0,003). Conclusion: the current care for lactation inhibition is not standard in Ile-de-France. Indeed, this support varies according to the different maternity wards and depending on the midwives within the same maternity.
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Raphaële Houlbracq. Évaluation des pratiques professionnelles de prise en charge de l'inhibition de la lactation en suites de couches chez des femmes ne souhaitant pas allaiter. Gynécologie et obstétrique. 2019. ⟨dumas-02303768⟩

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