The vast majority of medical or lifestyle circumstances do not require women to “pump and dump” their breastmilk. Uninterrupted breastfeeding is safe with these common scenarios:
- Surgery
- Anesthesia
- MRI and CT scan with contrast, x-ray’s, mammograms
- Breast biopsy with titanium clip placement
- Breast masses and nipple discharge
- Injectable numbing medication
- Teeth whitening
- Caffeine
- Reasonable amounts of alcohol (too drunk to drive is too drunk to breastfeed)
- Acupuncture
- Dental procedures
- Nyquil and other over-the-counter cold medications
- Airport security scans
- Skin peels
- Botox (if it got into your breastmilk, it would also paralyze other parts of your body!)
- Fillers
- Laser procedures
- Tanning beds
- Spray tans
- Hair dyes or other hair treatments
- Tattoos
- Anti-depressants and anti-anxiety medication
- Blood pressure medication
- Acne medication
- Animal bites on the breast
Moms with Covid do not need to separate from infants, interrupt, or stop breastfeeding. In fact, a study recently published in Lancet on maternal-infant feeding and separation policies showed infant deaths would dramatically increase if moms with Covid were recommended to separate from their newborns and stop breastfeeding. Another study showed that breastfeeding moms who received the Covid vaccine passed on antibodies to their infants, particularly older infants or toddlers.
Evidence on marijuana safety during lactation continues to be updated as new studies are published related to the legalization of marijuana. In general, marijuana is not safe with breastfeeding because it concentrates in breastmilk and fat, and and the infant’s brain is mostly fat. However, like many other medical decisions, an overall risk-benefit analysis based on individual circumstances should be explored. If a mom is consuming very rare marijuana, the risk of providing formula outweighs the risk of continuing to breastfeed. However, very frequent marijuana use is a risk that outweighs the risk of formula.
Cigarette smoking and vaping is also not advised during breastfeeding due to the carcinogens in smoke and the fact that nicotine in infants is a risk factor for Sudden Infant Death Syndrome. It would be preferable for a woman to use bupropion for smoking cessation during lactation. As described with marijuana and breastfeeding (as well as all other environmental exposures), risk-benefit based on multiple factors applies.
Evidence-Based Resources
I am part of a multidisciplinary, multi-institutional group that is working to “trash the pump and dump” and provide evidence-based guidelines regarding the safety of continuing to breastfeed in most situations. Please download the app and refer to this and other evidence-based resources below.
LactMed
Comprehensive, searchable National Institute of Health (NIH) medications and lactation database for nearly every medication you can imagine
‘Medications and Mother’s Milk’
Dr. Thomas Hale’s textbook on medications and the pharmacology behind their use in breastfeeding
Infant Risk Center
Physician hotline (research center for medication safety during pregnancy and lactation)
+1-806-352-2519
e-lactancia
A comprehensive medication and herbal medicine database, in English and Spanish
Organization of Teratology Information Specialists
Information on medications during pregnancy and lactation, with free online chats and phone calls
Motherisk
Hospital for Sick Children, Toronto, Canada: +1 877-439-2744
Breastfeeding and Human Lactation Study Center
+1-585-275-0088
