Crash Cart Emergency Medicine

Moving Beyond “Pump and Dump”

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When caring for breastfeeding patients in the ED, it’s essential to understand the unique challenges they face. While the phrase “pump and dump” has been commonly used, it’s time to retire it and embrace practices that protect both the health of the parent and the breastfeeding relationship. Dr. Krystin Miller shares insights based on her experiences as both an emergency physician and a mother, provides practical tips for better supporting lactating patients in the ED, and answers which medications are safe for lactating patients.

Guest: Krystin Miller, MD. Host: Kim Bambach, MD. Editors: Jennah Morgan, MD and Kim Bambach, MD.

Key Learning Points:

  • Ask about breastfeeding: It’s important to ask if patients are breastfeeding, not only for medication choices, but also to make the patient comfortable while in the ED.
  • Provide access to a breast pump: If a patient needs to pump, ensure they have access to a pump, and minimize their NPO time to support hydration and milk supply.
  • Say “pump and save” instead of “pump and dump”: Most medications are safe for breastfeeding, and when in doubt, milk can be saved for later use rather than discarded.
  • Medications that are safe: Most pain medications, sedation agents, antibiotics, and imaging contrasts are safe for breastfeeding. Avoid codeine, tramadol, and meperidine, and be cautious with medications that reduce milk supply, like steroids, pseudoephedrine, and phenylephrine.
  • Use reliable resources: For medication safety, refer to the InfantRisk app or LactMed for up-to-date guidance on drugs and breastfeeding.
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    Crash Cart Emergency MedicineBy The Ohio State University
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