“Pump and Dump” - Why This Advice Is Outdated, and What You Should Do Instead
May 13, 2026
If you’re new here, I’m Alisa- a pediatric nurse practitioner and a mom of two, and I write about the things I wish someone had told me before I lived them.
Picture this: You’re six months postpartum, exhausted, have a sinus infection, and you finally drag yourself to the doctor. You get a prescription, and then you’re told that you’ll have to stop breastfeeding for the duration of the medication. Pump and dump.
That happened to me.
And here’s what I want every breastfeeding mama to know: that advice was wrong.
The Problem with “Pump and Dump”
“Pump and dump” - the practice of expressing and discarding your breast milk after taking a medication - has been handed out as reflexive advice for decades. A provider isn’t sure about a drug? Pump and dump. The medication insert has a vague warning? Pump and dump.
The intention behind this advice is good. Providers want to protect your baby, and when in doubt, stopping breastfeeding feels like the cautious choice. But here’s the problem: mothers are still being inappropriately advised to stop breastfeeding due to concerns about medication exposure in breast milk, even when the data clearly shows those medications are safe. The reality is that many commonly used medications are relatively safe during breastfeeding. Blanket “pump and dump” advice doesn’t just cost you precious milk. It can disrupt your supply, cut short a breastfeeding relationship you’ve worked hard to build, and cause unnecessary stress during an already demanding season.
My Story: Azithromycin and a Doctor Who Didn’t Know the Data
At six months postpartum, I went to my doctor with a sinus infection and was prescribed azithromycin. I was told that I would not be able to breastfeed my baby while taking the medication and would need to pump and dump for the entire course. I knew something didn’t feel right about that. So before I filled the prescription, I did what I always encourage my clients to do: I looked it up.
I pulled up LactMed - the Drugs and Lactation Database, a free, NIH-sponsored resource that compiles current research on medications and breastfeeding - and searched azithromycin. What I found was clear: azithromycin is excreted in very low levels into breast milk, no problems have been observed in infants whose mothers have taken it, and multiple expert authors consider azithromycin compatible with breastfeeding. The American Academy of Pediatrics classifies azithromycin as usually compatible with breastfeeding, and the LactMed database reports low drug levels in breast milk with no significant adverse effects.
I brought this data to my doctor and pushed back, respectfully but firmly. And then, when I picked up my prescription, I ran it by the pharmacist as well to double-check. The pharmacist confirmed: azithromycin was compatible with breastfeeding.
I never pumped and dumped an ounce.
Why Your Provider May Not Always Be the Most Up-to-Date Source
This is the part that’s uncomfortable to say, but it needs to be said: your doctor or midwife may not have the most current information on medications and breastfeeding. This isn’t a criticism of providers. Medicine is vast, and lactation pharmacology is a specialty unto itself. Sometimes well-meaning healthcare providers are unsure or may consult outdated references, and may rely on a “first, do no harm” instinct when telling moms to stop breastfeeding. The result is overly cautious advice that isn’t grounded in the current evidence.
This means the responsibility can sometimes fall on you to know where to look and to feel empowered to push back when the advice you’re receiving doesn’t match the data. You are allowed to ask questions. You are allowed to seek a second opinion. You are allowed to say, “I’d like to look at the research before making this decision.”
Not All Medications Are the Same - This Requires a Nuanced Approach
Here’s what the evidence actually supports: the question of whether a medication is safe during breastfeeding is not a one-size-fits-all answer. It requires looking at the specific drug, the specific dose, the age and health of your baby, how much of the medication actually transfers into breast milk, and what the known risks to a nursing infant are.
Research highlights that many medications pass into breast milk in such small amounts that continuing to breastfeed is safe and appropriate - and yet the reflexive advice to pump and dump persists.
There are, of course, medications that do require pausing or stopping breastfeeding. The key is an individualized, evidence-based approach that looks at each mother-baby pair specifically, weighs the benefits of breastfeeding against the actual risk of the medication, and uses current data to guide the decision.
Resources You Should Know About
You don’t have to navigate this alone, and you don’t have to take one provider’s word for it. Here are the resources I trust and recommend:
1. LactMed (Drugs and Lactation Database)
A free, searchable database maintained by the National Institutes of Health. It contains up-to-date research on hundreds of medications and their safety during breastfeeding. This is the first place I go.
A research center at Texas Tech University specializing in medication safety during pregnancy and breastfeeding. They also have a hotline: 1-806-352-2519
3. Your pharmacist
Often an underutilized resource, pharmacists have deep training in drug interactions and can be a fantastic second check when your provider gives you advice that doesn’t feel right.
4. An IBCLC - Lactation consultants are knowledgeable in breastfeeding and can point you in the right direction for resources when you need them.
I Talk About This in My New Parent Prep Class
Knowing how to navigate the postpartum healthcare system - including how to advocate for yourself around breastfeeding - is something we cover in my New Parent Prep Class. Because walking into motherhood informed isn’t just empowering, it’s protective. For you and for your baby.
References
National Institute of Child Health and Human Development. (2006–present). Azithromycin. Drugs and Lactation Database (LactMed®). National Institutes of Health. https://www.ncbi.nlm.nih.gov/books/NBK501200/
Cobb, B., Liu, R., Valentine, E., & Onuoha, O. Academy of Breastfeeding Medicine. (2017). ABM Clinical Protocol #15: Analgesia and anesthesia for the breastfeeding mother, revised 2017. Breastfeeding Medicine, 12(9), 500–506. https://pmc.ncbi.nlm.nih.gov/articles/PMC4582419/
Salman, S., Davis, T. M., Page-Sharp, M., Camara, B., Oluwalana, C., Bojang, A., D’Alessandro, U., & Roca, A. (2015). Pharmacokinetics of transfer of azithromycin into the breast milk of African mothers. Antimicrobial Agents and Chemotherapy, 60(3), 1592–1599. https://doi.org/10.1128/aac.02668-15
For more on breastfeeding:
Breastfeeding, Formula, and the Space Between: A Pediatric NP's Take
Why Is Breastfeeding So Hard If It’s Natural? A Pediatric NP & Mom of 2 Gets Honest
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