Lactating parents get a lot of bad advice. Often this comes from family members, friends, and social media.

As a breastfeeding medicine physician myself, I find it is especially frustrating when this advice comes from physicians and other healthcare providers.

Over the past decade I have seen more physicians and non-physician providers becoming knowledgeable about lactation care, which is wonderful.

Yet many still give presumably well-intentioned but harmful advice, especially when it comes to telling a patient to “pump and dump” while taking medications.

Advising someone to “pump and dump” is rarely medically necessary.

It should NOT be a knee-jerk reaction designed to help protect the baby. In fact, pumping and dumping can put the baby at risk by jeopardizing the continued breastfeeding relationship! The interruption of breastfeeding should be advised only after review of evidence-based sources and consideration of alternative options for treatment.

Like any other treatment, the risk and benefit of pumping and dumping must be understood and explained to the patient. Shared decision making is crucial in this case.

To all the patients reading this, please take this article to your physician and other healthcare providers!  We need to spread the word and make your healthcare team understand that lactating parents deserve the standard of care in medication advice, just like they would expect in any other situation.

I have heard patients unnecessarily advised to “pump and dump” for a variety of reasons. Sometimes for 1-2 hours, sometimes for just ‘a few squirts of milk’, and sometimes for 1-2 weeks!

• • Amoxicillin or other common antibiotic for minor infection
  • Topical steroid cream
  • Injectable numbing medicine for dental work or other minor office procedure
  • Topical anesthetic gel for eyebrow micro blading
  • Skin peels, botox, fillers, laser procedures
  • Tanning beds, spray tans, hair treatments
  • Tattoos
  • Dental cleaning or teeth whitening
  • Massage
  • Acupuncture
  • Ultrasound, x-ray, mammogram, CT, MRI
  • Eye dilation drops at eye doctor exam
  • Travel to countries outside the United States
  • Surgery and anesthesia
  • Anti-depressants
  • COVID-19 or other viral illness in the lactating parent
  • Ibuprofen and other over the counter medications
  • Small quantity of alcohol ingestion
  • Airport security scanner
  • Animal bites on the breast

Understandably, no physician wants to risk harm to a baby.

And many of the mainstream medical reference or ‘Big Pharma’ sources are not exactly evidence-based in regards to medication safety during lactation. So physicians often opt for a solution that may seem less risky – pumping and dumping the milk – to be sure the infant isn’t exposed to any medications. If we had no better sources to turn to, I could maybe forgive this advice more often.

But there ARE excellent sources at our fingertips to look up the safety of medications during lactation.

It turns out we don’t have to guess!

Many sources are even cheap or free!

These references take into account well established pharmacologic principles such as oral bioavailability, half life, volume of distribution, and molecular weight. Most medications are either safe during lactation or can be easily substituted for medicines that are safer.

There ARE some medications and procedures that are NOT safe and either require patients to “pump and dump” for a period of time OR full weaning must occur first.  But these are few and far between and are listed in these references!

I strongly suggest ALL physicians who care for ANY young children or patients of child-bearing age get one of these resources ASAP and get familiar with using it. It doesn’t take much time or effort to use these sources. Plus you are sure to be providing the best evidence-based advice and you will build trust with your patients!

• • Infant Risk app or hotline.
    • https://www.infantrisk.com/
    • https://www.infantrisk.com/infantrisk-center-products

• • LactMed free online database
    • https://www.ncbi.nlm.nih.gov/books/NBK501922/

• • Trash the Pump and Dump
    • https://trashthepumpanddump.org

• • E-lactancia
    • https://www.e-lactancia.org

• • MotherToBaby
    • https://mothertobaby.org

• • American College of Radiology – Contrast Media (page 101)
    • https://www.acr.org/-/media/ACR/files/clinical-resources/contrast_media.pdf

• • Academy of Breastfeeding Medicine Protocols
    • Imaging – https://liebertpub.com/doi/pdf/10.1089/bfm.2019.29128.kbm
    • Analgesia & Anesthesia – https://abm.mclms.net/en/package/5953/course/11301/view

We often talk about whether a medication exposure would be harmful to the infant ingesting the breastmilk. But rarely do we hear physicians discussing the RISKS of interrupting lactation. This isn’t a benign, no-big-deal recommendation!

As any lactating parent can tell you, this is a tricky situation and can have lasting consequences:

• Many parents are Exact Producers, meaning they do not have the ability to stash milk away in the freezer ‘just in case’.
• Some babies will refuse bottles or formula if offered suddenly – and we can’t usually predict ahead of time which ones will do this!
• Some parents do not respond and empty well from a pump, exposing them to risks of supply loss, plugged ducts, and mastitis.
• Some parents may not even own a pump or may not have one that is properly fitted. A poorly fitted pump can tear up a parent’s nipples REALLY quickly, which exposes them to infection and a host of other lactation issues.
• Some parents end up weaning long before they planned – this has real emotional and even public health consequences.
• Some lactating parents will even put off needed care, risking harm to themselves, due to this incorrect advice.

I promise you, this information is readily available and won’t take much extra time in clinical encounters.

We must recognize that this is the standard of care our patients deserve. If you think you’ve never given bad advice regarding whether a patient should “pump and dump”, then you may just be part of the problem. I will be the first to admit that I did not always know these resources and did not realize the harm I could cause with incompetent advice in this area.

Let’s hold each other accountable and all work to do better for our patients and our profession. In short, it’s time we trash the “pump and dump”.