STOP Pumping & Dumping!

Yet again, I was contacted today by a mom who was told by a doctor to pump and dump for two weeks due to an antibiotic she needed to take. Fortunately, mom reached out to me to get the facts about the medication (and one alternative medication she was told was an option).  One was safer than the other according to the research but neither requires pumping and dumping, especially given the age of her baby.

This makes me so mad.  I told her that the only doctor she should be discussing this with is her pediatrician and she said her pediatrician said they don't know...which is surprising and sad. All doctors for babies should know about the InfantRisk Center and their call/fax service as well as their book (updated every other year) AND their app for care providers. Fortunately, many pediatricians, family medicine doctors and family nurse practitioners DO know this information.  In this case, mom knew to contact me so I could share the research details with her and her partner to help in their decision process.

First, most medicines do NOT require pumping and dumping because the amount of medicine that actually gets to the baby is none or minimal.  The way drugs work in a pregnant body related to a fetus' health is vastly different than how drugs work related to human milk and a baby's health.

Second, even if SOME pumping is required due to concern for the baby, it is entirely possible to SAVE that milk and later mix it with milk pumped when mom wasn't taking the medication.  If some milk does, indeed, need to be pumped and not given to the baby at that time, then giving donor milk is also an option (in addition to any previously frozen milk of the parent).

Third, some babies either don't yet know how to take a bottle or during the time of avoiding nursing, the baby can reach a point where they then refuse the breast (contact me and we can work on either issue!).

Fourth, some parents don't respond to their pump well (or any pump, for that matter), so milk production can suffer.  Of course, there's also the time involved in pumping and bottlefeeding that is hard on any  parent (kudos to the parents who choose to exclusively pump, it's hard!).

Fifth, if a baby is exclusively human milk-fed, they may not like formula or may react poorly to it because it's more difficult to digest. And, formula, while of course, necessary for babies who can't get access to human milk, is a good thing so babies can eat, it can negatively impact the gut health of an exclusively human milk-fed baby. It's just biology. 

Sixth, the age of the child (and health status of the child) matters.  If baby is a preemie or newborn, guidelines are likely to be more strict than for a nursing toddler. How often a child nurses or drinks human milk also comes into play in the decision.

Below is more information for those who want to read more about the science on this topic, but ultimately, suffice it to say that the hundreds of times I've looked up medications for parents, maybe a handful of times did I report to the parents that it is likely they'd need to pump and NOT feed that milk to the baby (but SAVE it for later).  It's super rare.

Unfortunately, there are many parents who don't know to ask. I remember a mom telling me many years ago (a few weeks after she stopped nursing) that her now 5-week-old was 100% formula-fed because a few days after baby was born she developed a urinary tract infection and was given antibiotics and told to pump and dump.  Not only was her milk supply reduced because she didn't make enough while pumping (likely due to the type of pump she had and size flanges she was pumping with) but the baby wouldn't nurse when she tried to get baby back to the breast. I offered to help get her milk supply back up and get baby back to the breast but she was already devastated and tearfully thanked me but said she felt too defeated and had figured out a rhythm with formula-feeding.  But her breastfeeding wishes were decimated by 100% incorrect information.  Antibiotics for a UTI??? Fine for breastfeeding. Grrrr. 

I feel for the many parents who are incorrectly told to pump and dump or told that they'll have to quit breastfeeding. I've counseled several parents who were nursing toddlers and told they need to quit breastfeeding in order to undergo fertility treatments. First of all, after looking up all the medications that parents were told they would be taken, there wasn't an issue with the nursling's health, but that some of the medications may lower milk supply. 

So, do they really need to stop nursing? Well, if they don't yet have ovulation occurring, then yes, often stopping nursing helps ovulation cycles to come back. But if ovulation issues aren't the reason for the fertility treatments, then technically, no, stopping nursing isn't needed.  UNFORTUNATELY, our current misinformed insurance company policies threaten to deny insurance coverage to parents who are nursing and seeking fertility treatments (if your insurance finds out you were doing both).  This doesn't make sense medically, but hey, so much in our current world of medicine and lactation doesn't. 

Some parents are still being told that they need to pump and dump for anesthesia, this is INCORRECT. As soon as a parent is awake enough to safely hold the baby, they can nurse the baby or pump and feed that milk to the baby.  Some parents are still being told they need to pump and dump for dental work, which is INCORRECT.   Some parents are still being told they need to pump and dump for an MRI or CT Scan, which is INCORRECT (see link below).  I've also heard a mom tell me she was told she had to pump and dump for 24 hours due to a colonoscopy, which was INCORRECT.  This pandemic of misinformation has GOT to stop!!!  

Ohhh, speaking of pandemics, parents who have COVID-19 and are strong enough to hold and nurse their babies, are supposed to practice good hygiene and wear a mask and NURSE their babies! If they don't feel well enough to nurse, they can carefully pump and the milk can be fed to baby.  This actually provides immune support to the child against COVID-19 so it's even more important right now for babies to get human milk! See below for more info on this. 

Please folks, spread the word to your friends with babies or expecting babies. It's extremely rare to need to pump and dump but sometimes finding a different medication is a good option...but even if there's not an alternative, it's extremely rare to need to pump and dump.  Remember, either feed your baby or pump and SAVE and contact me, your baby's doctor and maybe even the InfantRisk Center, too!

Oh, and this is a whole other topic, but pumping and dumping for drinking alcohol is also not needed.  First, if you are too intoxicated to safety drive, you shouldn't be holding a baby or sleeping next to a baby. Second, if you are too intoxicated to drive/nurse, then PUMP and SAVE that milk!  Contact me for suggestions on what to do with it.  For one typical drink you might enjoy over dinner or over the course of an evening, nurse your baby. Technically, the safest time to nurse your baby is when you are actively drinking an alcoholic beverage.  You do NOT need those dipsticks they sell (save your money and instead spend that money on attending one of our Breastmilk & Conversation groups or More Milk Mamas groups).  Planning on getting very tipsy or drunk, pump milk ahead of time for baby and then while you're drink, pump and save that milk!   Again, message me and we can come up with a plan for it.

I don't make any decisions for people, of course, that's not my role. I give them the information and encourage them to discuss that with their baby's care provider. But still, I wish I didn't need to do this because all care providers were knowledgeable about this, but alas, this is NOT the reality in our country right now. 

So, folks, feel free to reach out to me. It's a FREE service I provide.  

~ Jeanette Mesite Frem, MHS, IBCLC, RLC
jeanette@babiesincommon.com

 

Further Reading

Drug Entry into Human Milk from the InfantRisk Center

An Interview with Dr. Hale, author of Medications & Mothers' Milk

Use of Radioisotopes (and other imaging agents) in Lactation

Breastfeeding and COVID-19 by the World Health Organization

Breastfeeding advice during the COVID-19 outbreak by the World Health Organization (graphics)