Early pregnancy loss is found to occur in up to 10% of all clinically recognized pregnancies.¹ Pregnancy loss may be managed expectantly with the use of medications or surgery. The management decision is determined by a combination of factors including clinical risk for bleeding and patient preference.¹ Pregnancy loss is not an indication to pump and dump and medical and surgical management of early pregnancy loss or termination  are not absolute indications for pumping and dumping breast milk.

Furthermore, lactating parents who experience a pregnancy loss or those in need of a termination of pregnancy have additional considerations when deciding on management including the time required away from their infant, risks and side effects of medications, potential blood loss, the effect of anemia on milk production, and the need to pump while separated from their infant. Pumping during separation of the dyad is important to prevent lactation complications such as engorgement, plugged ducts and changes to milk production.

For more detailed information and references on specific medications, please refer to LactMed, e-lactancia, Infant Risk, or Mother to Baby.

Medical management of pregnancy loss or termination of pregnancy is most commonly accomplished with the use of two medications: misoprostol and mifepristone.^1,2

Misoprostol (Cytotec) is the mainstay medication for treatment of pregnancy loss.¹ It can be found in breastmilk in very low amounts, it has a short half-life, and is considered safe during lactation. There is no absolute indication to pump and dump.

Mifepristone is used for medical termination of pregnancy and is offered as part of medical management for early pregnancy loss when available. With the current recommended dosing (single low dose) used for treatment of these conditions, the excretion into breast milk is clinically non-significant and is therefore considered compatible with breastfeeding. There is no absolute indication to pump and dump.

In general, surgical management of early pregnancy loss and termination of pregnancy is not an absolute indication to pump and dump. Considerations noted above regarding separation of the dyad should be included in pre-operative planning.

Anesthesia used at time of surgery does not generally require pumping and dumping. For more information, see the section on Anesthesia.

A single dose of doxycycline is recommended pre-procedure when undergoing surgical management of early pregnancy loss.² This would be compatible with breastfeeding and no reason to pump or dump milk. For more information, see the section on Antibacterial Agents.