What did / should your GP do to support your breastfeeding?

[FrozenNorthPole]

DH is a GP, and is starting a new job at the beginning of July in our local surgery (previously military medic with forays into NHS).

We strongly want him to be one of those doctors who has the knowledge and ability to support breastfeeding relationships rather than, as so often seems to be the case, undermining them with outdated knowledge, inappropriate prescribing or a lack of awareness of other support mechanisms to which mums can be signposted. We have 3 breastfed children ourselves so obviously he knows a fair bit about it, but I know that there are a wider range of experiences out there than we personally have experienced. We are in an area of the country in which breastfeeding incidence and duration are low compared to the national mean (not helped by local paediatrics department/HVs who push formula inappropriately).

We plan to get him on an NCT / LLL / similar course for professionals if we can find one locally.

However, what I would really like to know is: What did or should your GP do to support your breastfeeding relationship? Please share your experiences, good or bad!

Er gp did nothing. Either time. Midwives were only slightly less useless. All my decent advice and help came from here tbh....

Could a leaflet for new mums be given out? With here, kellymom and other links/numbers be put on it? And then just say here to help?

Give me Lansinoh on prescription. My GP refused to - she was strictly obeying the rules, though I believe some do.

Mind you, she gave me some of the most helpful advice I've ever received and that was to begin expressing milk and bottle-feeding it to DD when she was 2 weeks old. Did it with both my DC and it worked a treat as DH could then feed them sometimes.

At my GP surgery I see a different GP every time so the experience varies.

What one GP did not do well was prescribe antibiotics (for me) which were bf-friendly and not likely to upset my DC2's stomach. After a few days of green poo and colic, I went back to see another GP, was prescribed different antibiotics (this GP did more reading on which ones were better for bf babies) and had a better experience.

Otherwise, as PP has said, it was the midwives and HVs who helped/hindered. TBH I was sent a make midwife for my returning-home check with DC1 and I was very unhappy with him advising me on latch and so on (I know he was a trained professional but he had no idea how it felt to bf). Sorry to say, I would much rather deal with a female who'd breastfed her own DCs.

I should clarify - not expecting DH to get involved in helping sort out latch / evaluating transfer, more just hoping that he can be an encouraging and knowledgable voice, and not get in the way / signpost appropriately.

Dacky - good idea: we thought maybe including details of local drop ins, helplines and websites would cover all bases.

Poppy - yes, like you I prefer to deal with people who have 'been there' for advice on latching etc. which is why I like the LLL as they stipulate that you must have fed for a minimum period before becoming a leader.

Use LactMed & the Breastfeeding Network drug information sheets.

I'm a doctor and since I've been breastfeeding, it's really annoyed me how little doctors know/are taught about breastfeeding & that there are loads of drugs that can be safely used.

Thank you Dino, very useful tip! It is a bit bizzare, isn't it? I've been given the most appalling advice on feeding by doctors, albeit paeds rather than GPs.

Refer to infant feeding people quickly. My GP jas been great. Listened without jumping to conclusions and whem she was unsure she phoned the specialist person amd we had a 3 way phone chat and got an appointment with her the nextmorning. GP also gave me details of LLL. She has since followed it up by phoning me which was unexpected. I am very impressed with how my breastfeeding issues have been handled.

As much bf knowledge a possible. The main one is for him not to tell anyone to "stop breastfeeding" like ever! There's hardly ever need to say this. Use the BFN book to prescribe alternative medicines and encourage breastfeeding, maybe a well done!

As much bf knowledge as possible. Encourage other GPs to improve their knowledge as well. Listen to bf mothers rather than dismissing them. Read the BFN leaflet on thrush and the treatment thereof. Be interested and sympathetic, not dismissive. Give Lansinoh on prescription. Still cross with my own GP for being rubbish at all of the above? You bet.

I don't really remember seeing my GP much when my children were tiny. There was the six week check, but I think that was more about ds's development and my c-section scar than anything else, and I can't remember if I even had one with dd. There again I was very lucky to have no problems with feeding either of my children.

I do wonder looking back if the GP was right to tell me that the medicine s/he prescribed me for labrynthitis was really not possible to take whilst breastfeeding, so that's something that your dh could do well, really know what you can take whilst breastfeeding and what you can't (and how to stop breastfeeding without your breasts blowing up perhaps too!)

Prescribe properly in the event of mastitis and thrush.

Have more knowledge about tongue ties and diagnosing them, particularly posterior tongue tie. Or know who to refer to.

Know who the infant feeding coordinators at the hospitals are and how patients can access them. As well as local support with breastfeeding.

Our GP's practice run a course for new parents: 6 sessions, on feeding (by local infant feeding counsellor), sleeping, first aid and illness, baby massage and bonding/development, exercise for new mothers (run by local physio) and the effect of being new parents on the couple. It is free and brilliant. It also allows the senior nurse (who has had 6 children herself) to keep an eye out for those who might need extra help (depressed, feeding problems etc) and to offer it informally at the edge of sessions. This nurse saved my bfding: I had every problem in the book and was reduced to expressing round the clock and feeding bm through a bottle, so was exhausted, looked it etc. She took me aside and organised a visit by a peer counsellor as well as a review by an experienced GP (one of the registrars had done a lot of harm with very wrong prescription and advice). It worked and I breastfed DS1 until 23 months and 5 months' pregnant with DS2 (who is 14 months and bfed too).

Second all the notes re LactMed, BfN etc and would add Dr Jack Newman's site: the advice on thrush treatment was v useful.

Also early referrals to infant feeding and tongue tie specialists.

My gp told me I should stop bf dd (2-3 times a day at that point) altogether, as I was pg with ds. I ignored her advice as it didn't feel right, and chose to cut dd down to bedtimes only - but many would have stopped bf unnecessarily.

For me it's the most basic do not tell women to wait till they have stopped bf to sort out contraception

Oh yes, lots of rubbish about having to stop bfding while pregnant. I actually got it from a gynaecologist. The idiot. My own ob/gyn, who works at another hospital and knows him, was not impressed.

It might be worth your DH making sure his practice colleagues (including nurses, HVs, midwives) are as well-educated and on message as he is. In my experience all the midwives but one did more harm than good, spouting Grazia-style advice on subjects they knew less than nothing about.

Absolutely second the need to give medications that are safe while breastfeeding. My GP (male) has been fantastic, especially since I react to amoxicillin which rules out lots of popular alternatives.

Be supportive when they're still feeding a toddler.

Listen to parents when they say their baby is being abnormally sick. Especially when it isn't their first baby, and they have some idea of what to expect.

Have some strategies to suggest if prescribing the baby something that needs to be mixed with milk, like baby gaviscon.

Yes to referrals, and maybe get to know the local HV teams and who is supportive of BF.

I was quite impressed to see the nursery nurse from our hv team at the local breastfeeding support group. She said that if she was referring people to it she wanted to have been there herself.

Proper prescribing - I had to print out BfN leaflet on thrush as first meds were ineffective

Get proper training about bf, don't weigh before and after a feed to assess milk intake, don't suggest pumping to assess supply

Learn about tongue tie, really learn about it. It's obvious my first born has a tongue tie, my observations were dismissed by everyone we saw.

My GPs have never really been involved with the mother and baby stuff, but when necessary have been kinder and more helpful than the midwives. Not afraid to look up stuff that don't know, eg what medications, or see me OOH for mastitis. I would have liked to feel there was a HCP I could build up a relationship with so I am not embarrassed to bother them, I know that's not realistic but perhaps they coul understand new mums are very emotionally vulnerable and be sensitive and"nothing's too much trouble". I also think an information leaflet about problems such as mastitis, reflux, thrush and tongue tie and where to seek advice would be helpful.

I am a GP with 20 years experience. I knew next to nothing about BFing until I had DS1 some 10 years ago - it's just not taught.

I had lots of problems and used lots of services to help with sorting them out.
I am now the To Go To Person for BFing problems in the practice - it just kind of grew. I have no formal qualifications and I would never dream of even trying to replace the local LLL/BFing advisers/peersupporters etc.

Here are my tips for a busy dr (who has quite a lot else going on as well, let's not forget ):

• Do not judge woman's choices how they are planning to feed.
• Do not be scared to challenge myths ("I won't be able to BF as my mother couldn't" "I have a big baby and won't be able to satisfy him" "The MW/HV said to feed her every 3 hours"). Sadly, a lot of myths are spread by some HCP and wellmeaning relatives. Bear in mind that most mothers of new mothers will have had them at a time where BFing was almost universally discouraged.
• Have a list of websites to visit for info during pregnancy and afterwards. My favorites are kellymom, Breastfeedingnetwork (I just love their 'Reasons to be proud'), Dr JackNewman (lots of links to youtube videos re good latch, different holds, tonguetie etc) and of course MN if you are not worried about being outed
• be prepared to spend time. A 10min appoint never rarely is enough time to sort out a problem.
• remember that most pregnant women start out wanting to BF, but are discouraged by many things, including but not limited to: partner/family/random strangers/HCP's comments, time, effort, expectations, unsettled babies etc etc

Oh I could go on, but won't you'll be relieved to hear.

I don't think that your DH needs to know everything there is to know about BF, but he needs to have a right attitude and know where to get the RL help in a timely manner for his patients.

Good luck to him. I suspect the NHS might be a bit of shock to him if he's served in the Forces until now .

Mine have a poster advertising the local bf support group that meets weekly, and they have one HV on staff who is excellent - and can regularly be found at said support group which is actually aimed at all new mothers to support all kinds of feeding, and seems to do pretty well at encouraging all mothers whether bf or not, and being there for women with or on the cusp of PND who just need somewhere to go with a cup of tea, space for babies and older children to play, and some non-patronising adult experts to chat to.

This is in contrast to other local HVs whose response when asked about places providing bf support was to say they'd never heard of such things. Luckily the internet told me about ones locally.

Re GP, learn which drugs really are contraindicated with bf and also for pregnancy, as opposed to the majority where evidence suggests no real or lasting harm but the manufacturers won't confirm safety.

Learn how to check for tongue tie and oral thrush - my GP.was v apologetic after she hadn't found thrush in ds's mouth despite a consultant pointing it out two hours earlier, until I begged her to look again and she saw it at the back of his mouth when he screamed. And ensure nurses learn too.

And ensure nurses doing jabs and health checks are aware that the correct response when someone answers the question on the form 'are you still bfing' at 6mo or 13mo is 'excellent', maybe with general chat.about how weaning is going.

But generally it's part of being a good GP - take patients' concerns seriously and know when and where to refer, and when to keep your mouth shut if you don't know the answer. I have a lot of respect for the GPs I see who use reference books and internet in my appts to double-check things. (I see docs a lot for various reasons)

Get him to ask all women with small children if they are BFing before prescribing anything. And look up the BNF before making the prescription.

GPs I saw seemed utterly baffled about how to prescribe for someone feeding an older baby/toddler.

I've come across a few GPs prescribing an insufficient course of ABs for mastitis (7days instead of 10-14). Know about all the local support available and pass info on to mums

Jolly, if asked all women with small children if they are BFing before prescribing most of my patients would consider me mad - some might anyway (BFing rates are very low indeed here and almost non-existant after very few months).

I do ask expecting women whether they have considered how to feed their baby and if say say "Oh, bottle, what else?" I ask them what their concerns are.

I also don't think it is unreasonable to think that a woman who is BFing an older child might mention it to her dr/pharmacist etc.

I suppose as ever, it's all about communication - verbal and non-verbal, on both sides. And being aware that ones own experiences have a way of creeping in to what one expects of others...

I never once saw my GP about my BFing problems, but had the benefit of several very good BFing specialist MWs, LLL v close and a brilliant peer support program.

Well as my Mum was a Health Visitor it was TINA as far as I was concerned! With a high pain threshold I got mastitis tho'. DS was very into his milk and I expressed using an electric pump when I returned to work and he went to Day Nursery aged 4 1/2 months He was weaned onto artificial (follow-on) milk at nine months (please don't call it 'Formula' as that is a marketing tool invented by the companies) DD stopped of her own accord - it was too much like hard work - aged 7 months so they are all different! Looking back I obviously hope and trust that my grandchildren will have mother's milk but really I also want women to be empowered to do things their way so EVERY BABY MUST RECEIVE THE VITAL COLOSTRUM but after that it's up to the mother!
Livestock farmers do everything in their power to make sure baby lambs calves and foals have the all-important first milk because it primes their immune systems and sets them up for life! It is scandalous that human mothers have always been told that the first milk is merely watery stuff and the 'real' milk comes in on day three - newborns are hardly going to make you sore and the question of feeding in public does not arise so why not? Every baby has the right to his or her colostrum!