Should I Tell My Patient To Pump & Dump?

Breastfeeding
Written By Lindsay Moore-Ostby

Lactating parents often get inaccurate advice. Unfortunately, much of it comes from the medical profession. Well-intentioned physicians and other members of the healthcare team often worry that it may be unsafe to breastfeed while taking certain medications or during procedures and imaging tests. Today I am here to take on this age old question: should I tell my patient to ‘pump and dump’?

SPOILER ALERT: probably not!!

Telling a parent to pump and dump should NOT be a knee-jerk reaction. It should be advised only after review of evidence-based sources. Most medications are actually safe with breastfeeding, and often there are alternative treatment options for the exceptions to this rule.

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 parents 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.

No physician wants to risk harm to a baby. Many resources are not evidence-based when it comes to advice for use during lactation. This includes may of the common resources doctors are used to turning to for medication guidance! This often leads physicians to tell parents to pump and dump their milk. This seems like a safer solution at first glance. But this advice can have a lot of unintended consequences to the mother and the baby.

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 of these 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 pumping and dumping for a period of time OR full weaning must occur first.  But these are few and far between and are listed in these references!

For a list of some of the most common and most farfetched reasons I have seen patients told to pump and dump their breastmilk, check out this article I wrote for SoMeDocs.

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!

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 with this advice to ‘just pump and dump’. 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 may not even own a pump or may not have one that is properly fitted - trust me when I say 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, 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. 

If you need medical care for breastfeeding problems including management of medications while you are lactating, you can find my services at https://www.lindsaymooremd.com.

Lindsay Moore-Ostby
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