Modifiable barriers to breastfeeding counseling for women with epilepsy: A qualitative study of provider perspectives

Breastfeeding (BF) rates are significantly lower in women with epilepsy (WWE) compared to the general population. Yet, reasons for this disparity are not fully understood. We aimed to examine the perceived barriers to BF counseling among neurologists and obstetricians caring for WWE.

In this qualitative study, we performed virtual, semi-structured interviews with 18 providers (11 neurologists [all epilepsy specialists] and 7 obstetricians [general obstetricians and maternal-fetal medicine specialists] from U.S. academic institutions, conducted from June 2022 to June 2023. The interview guide was guided by the Theory of Planned Behavior and results from our previous quantitative survey on the same topic. Thematic analysis with an inductive coding approach was used to identify major themes.

Five key barriers to breastfeeding counseling were identified: 1) Obstetricians had specific concerns about the risk of sleep deprivation provoking seizures; 2) Insufficient provider knowledge of anti-seizure medications safety with breastfeeding; 3) Perception that clinical practice guidelines and research are inadequate to provide management guidance on antiseizure medication safety with lactation; 4) Healthcare system challenges, such as limited clinic time; and 5) Suboptimal interdisciplinary communication, leading to ineffective patient education.

This study identified multiple modifiable barriers to breastfeeding counseling for women with epilepsy among neurologists and obstetricians. Interventions to reduce these barriers include improved provider education, clearer clinical guidelines, and optimized interdisciplinary communication, to support counseling and improve breastfeeding outcomes for women with epilepsy.