OB says my anxiety rx is fine, pediatrician says stop breastfeeding

Health & Wellness Reproductive
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i’m not on any peptides right now, just back on a low dose of sertraline for the PPA that came back around week four postpartum. my OB, who i’ve seen for years, was the one who restarted it for me. at my six week checkup last tuesday she was completely supportive, said it was one of the most studied drugs for breastfeeding, risks were low, and a healthy mom was the most important thing.

i felt this huge sense of relief. then today we had the two month appointment with the pediatrician. different practice, new doctor for us.

i mentioned the sertraline when she asked about my health, and her entire tone shifted. she didn’t say “stop taking it,” but she said "we strongly advise mothers to pump and dump

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the “entire tone shifted” part is the whole problem in miniature. You’re seeing the coordination gap between specialties play out in real time.

The OB is managing your health; the pediatrician is managing the baby’s risk profile. Neither is technically wrong on their own terms, but there’s no incentive for their channels to sync up, so the entire burden of resolving the conflict lands on you.

It’s a structural problem, not a personal one. The incentive to write the script doesn’t exist in the same channel as the incentive to monitor the downstream effects, and the system defaults to putting the patient in the middle to adjudicate. 📊

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