To think GP’s should encourage breastfeeding?

[Sofedup2022]

I’m so fed up and furious this evening! I’ve been struggling with anxiety and depression for a few months now and have an 11 month old baby.

I finally worked up the courage to book a doctors appointment - which was a nightmare in itself as it’s impossible to book into our local surgery. I finally got a telephone appointment with a nurse this morning.

I explained how I was feeling and she asked if I was breastfeeding. Once I said yes she said that meant I couldn’t take any drugs and the only option was to refer me to counselling. I politely said I’d been told by the breastfeeding network that there were antidepressants that were safe while breastfeeding, at which point she said she’d speak to the junior doctor and call me back.

She rang me back to tell me that almost all antidepressants aren’t safe while breastfeeding as it passes to the baby so I had two options

1. Take Amitriptyline which may make the baby sleepy
2. Stop breastfeeding and take another antidepressant!

I was pretty irritated but decided I would try the Amitriptyline. I have gone to take my first dose this evening and realised I have been prescribed 10mg. I have checked the NICE guidelines and that is the dosage they prescribe for back pain, while they advise at least 50mg for treating depression.

I am so furious. It took a lot for me to make the appointment and they made me feel like a selfish mother for wanting drugs and have essentially made it clear that if I want anything that will actually help me they expect me to stop breastfeeding.

Breastfeeding has been hugely protective for my mental health and has been one area of motherhood that I feel really good about. I have no intention of stopping and luckily know enough to query what she said initially or I’d have ended up stuck on an 18 month long waiting list for counselling! I do have counselling privately which I did explain to her, it’s not that I’m looking for a magic pill to fix everything, but I have taken antidepressants in the past and they were the only thing that was truly effective.

WIBU to complain? Should I book another appointment? Who would I even complain to?!

@ParalysisByAnalysis

Why are you believing the “breastfeeding network” (whatever that is) over the opinion of two doctors?!

Also, with the best will in the world, your almost-1 year old will benefit much more from you being in good mental health, than your breast milk.

My GP didn't have a clue about the medication I was on when I got pregnant and referred me to the EPU or to have a look online .

My sisters GP tried to prescribe her anti biotics that weren't recommended for pregnant women past 30 weeks, only she's a nurse and recognised the name. The same GP tried to take me off thyroxine when I was pregnant and argued with me about it, I have hypothyroidism so it would have been dangerous for the baby. So I don't consider them a beacon of knowledge in this area. But tbf said GP was a fecking eejit and the reason I left the practice.

GP here, also currently sitting breastfeeding my 13 month old. You have every right to be annoyed that you’ve been given unhelpful/ outdated information. The education for GPs is very poor (I think I had perhaps an hour in all of my training), and sadly I come across this frequently with patients at my practice. It wasn’t til I was feeding my first I realised that a lot of what I’d been spouting was incredibly unhelpful!
I would suggest you email the practice to complain/ request an appointment with someone to rectify this. As part of your complaint you could suggest that they arrange education to improve understanding.
There’s quite a bit of evidence around breastfeeding being protective for mental health, and WHO recommends to keep going til at least 2 years. The most important thing is that you’re not ready to stop.

These might help:
gpifn.org.uk/ Website written by GPs and full of sensible information.
www.breastfeedingnetwork.org.uk/drugs-factsheets/ I think that you linked to this.

Feel free to pm me if you have more questions you’d like to ask.

Whilst I think there is a time and a place for the ANP role I think when you should have been booked in with a GP for this appointment. Then when you saw her and the ANP was unsure she should have recognised this and referred you to GP. And junior doc shouldn't have advised on something they weren't sure about without a discussion with their senior. I feel an appointment with a GP is required but I do understand it must have taken a lot for you to visit the docs in the first place for this and the thought of going through the process again is probably quite sensitive. If your HV is attached to the practice they might be able to speak to one of the docs they know for you and see about getting you back in.

I remember one night looking after a lady who was in a lot of pain with gallstones and was feeding a 3 month old. She was screaming out in pain and the FY1 would only prescribe paracetamol because she was breastfeeding. He said to me well if she agrees to stop breastfeeding right now then I'll give her some codeine. I had to approach a more senior doctor who called obs and gyne and got clarification on what to prescribe.

Hi I am an ANP in a surgery and I'm in agreement that I'm surprised you were on her appt list. You should be seen by a gp and in a face to face appt.
I hope you get the medication and further support you need

@Jellyfishjean

They're just telling you the scientific facts.They can't change them just because you don't like them.

They're not though the info they gave op was incorrect.

Oh this is weird, don’t be fobbed off OP. I didn’t take any in the end but I was offered them when BFing, the doctor didn’t mention them being unsafe in the slightest.

My GP would absolutely offer counselling before medication, regardless of the actual issue here.

The fact they're telling you medication doesn't exist that you can take is concerning.

I started taking sertraline when my baby was 2 weeks old after a difficult birth/ hospital stay. My midwife/GP/perinatal MH nurse and doctor/lactation consultant all told me how safe they were when breastfeeding. I found I had no side effects and it helped me when I was wobbly at the beginning. My son is 11 months now and I’ve just come off, but I wouldn’t hesitate requesting it again if I needed to.

I had to comment as I think your GP has given you the wrong advice! I was breastfeeding when I went to my GP with really bad anxiety, she checked with the perinatal mental health team and they said sertraline was safest to use (all drugs have a tiny risk of being passed to baby) I took sertaline for a year whisker breastfeeding and it saved my mental health! Defo ask for a second opinion if you can.

@Sofedup2022 I have worked in this field as a healthcare professional and you are correct. If you have been diagnosed with moderate/severe depression then antidepressants are indicated in breastfeeding women (in addition to talking therapy) - this is because the risks of not treating the depression outweigh the risks of any potential side effect from the antidepressant. In breastfeeding women who have never had an antidepressant, sertraline is usually the first line drug because it is present at minimal concentrations in the breast milk. However, there are reasons why the doctor may have suggested amitriptyline eg. if you have had an antidepressant in the past and it has worked well, then that would be the first line drug as long as there are no contraindications. So If you have had amitriptyline for depression before, then this would be the reason they are using it now. Yes you are correct the dose is too low, but they would start at a low dose and work up to the dose that previously had the best effect for you in the past.

The answer to your title thread is yabu gps shouldn't be if they don't think it's in the best interest of their patient.

However you definitely need to get back to the GP and speak to someone else. I would also be more assertive about what medication you know you can try whilst breastfeeding. If you go in armed with knowledge they're more likely to research it.

However what I would say about amitriptyline you start at a low dose and work up to 50mg, trust me you wouldn't want to suddenly start taking 50mg of it. You'd barely be able to function

I was given Prozac while breastfeeding. I had previously also been told I would need to give up breastfeeding.

@Jellyfishjean

They're just telling you the scientific facts.They can't change them just because you don't like them.

They're not

OP go back and ask again. Good luck.

Yanbu op. I've often been amazed by how outdated the views are among older NHS staff around bf. They are stuck in about 1970.

YWBU to complain about the low dose (I'm on amitriptyline for something else and was started at 10mg to check tolerance before it was increased, was told that was standard). But - absolutely NBU to complain that your choice is that or counselling only when there are other suitable medicines available. Counselling might be helpful though? Though I remember I was suffering like you when ds1 was a similar age and what would really have helped was just to be able to sleep!! I was prescribed something then (can't remember what though, but not amitriptyline) and was still bfing.
Leaflet in my amitriptyline says discuss with your doctor, and that it's about weighing up risks and benefits (both to you on taking the medication and your child in continuing to breastfeed).
Is there a doctor or nurse practitioner at your surgery that specialises in women's issues? If so, try and get an appointment with them.

@Jellyfishjean

They're just telling you the scientific facts.They can't change them just because you don't like them.

This is poorly informed nonsense.

Her GP is not giving her "the scientific facts".

You are entirely wrong if you think your GP only hands out scientifically proven facts. A GP is a general practitioner not a specialist in everything you throw at them and they don't always get it right. Breastfeeding is an area that GPs often get it wrong, through a combination of very poor training for GPs and other medics in this area, the UK being in a country with one ok the lowest BFing rates in the world and in which we've lost a lot of the cultural knowledge about how to support mothers BFing and what normal BFing looks like, a lack of decent support for mothers with BFing issues within the NHS - hence the necessity for brilliant organisations like the Breastfeeding Network - and a lack of decent info to refer to within the NHS.

The British National Formulary for example - the resource that the GPs use to look up drugs - is massively overly cautious about BFing. e.g. it consistently gives a blanket "no" to BFing for several medicines where actually there is evidence that there would be any harm to older DC, the concern would only be newborns, yet it doesn't distinguish. The OP's child is 1, yet the GP is probably acting in advice here that's suitable for newborns, not 1 year olds.

The OP needs to speak to the experts, and try another, better informed GP.

OP when you complain - and you should, this isn't good enough - suggest there is a training need and the GP in question can contact the GP Information Network for support. They are a peer to peer support and information service for GPs so they can help each other be better informed on BFing

Dosulepin just popped into my head as the one I was given (17+ years ago). I've just googled it though and you don't want that either!

*isn't evident it'd be harm to older kids, I mean!

Yep I took sertraline throughout pregnancy and 18 months of breastfeeding, prescribed by perinatal team.

@Juann00 nice try. Reported.

[quote dizzydizzydizzy]@ParalysisByAnalysis doctors and midwives have very little training in breastfeeding whereas the breastfeeding network do nothing else.

OP - you could also try phoning a breastfeeding counsellor at the NCT. They know about this stuff too, [/quote]
Not sure why you are dragging midwives into this, but actually they are very well trained in BF and it is the bread and butter of their job.

@PrivateHall

Midwives are not as a general rule very well trained in breastfeeding at all!
Often they are unable to troubleshoot and the answer to any BF problem is to supplement with formula.

Sadly bad advice from midwives has led to myself and many of my friends having our breastfeeding journeys ending early.

Hello I might get a mouthful for this but it sounds as though your gp practice might be like mine! Receptionists try to fob you off at the first instance. But if you’re lucky a telephone appointment. I have found that using the online service Livi which they are subscribed to much better. Check if your practice offers this. You get to speak to an online gp live at a time if your choosing. If this doctor thinks action needed by your own gp they send a message to them advising. Much better and helped me with a kidney infection recently!