What barriers and facilitators to self-management are experienced by mothers who wish to breastfeed but require concurrent pharmacotherapy in the first two years postpartum? A mixed-methods systematic review protocol.

Background: Breastfeeding is the recommended method of infant feeding. The postpartum period can be a challenging time for women who experience illness requiring pharmacotherapy. However, breastfeeding women may use medication less frequently than their counterparts who are not breastfeeding. Some women report the need for pharmacotherapy as a reason for earlier than desired breastfeeding cessation. The experiences of women in relation to self-management of medication use and breastfeeding are poorly understood. Aim: The aim of this systematic review is to explore the barriers and facilitators to self-management for women who wish to breastfeed but require concurrent pharmacotherapy in the first two years postpartum, using mixed-methods and a systems-based theoretical framework. Methods: Systematic searches will be performed using six electronic bibliographic databases. Dual independent selection, data extraction and quality assessment of studies will be carried out. A convergent integrated approach to data synthesis will be used. The System Engineering Initiative for Patient Safety (SEIPS) model will be used as a theoretical framework to guide data synthesis. Input and collaboration from public and patient involvement (PPI) contributors will be sought throughout. Conclusion: Enhancing understanding of mothers' self-management experiences when they wish to breastfeed and take medication is arguably key to improving maternal and child health and quality of life. The proposed review will synthesise the available data regarding the barriers and facilitators to self-management for women who face the need for concurrent pharmacotherapy and breastfeeding. In doing so, important supports and unmet needs of this cohort will be revealed. PROSPERO registration number CRD420251000918. Amendments to this protocol will be uploaded as revision notes to any platforms where the protocol was published.