James Truslow Adams, in his book The Epic of America, which was written in 1931, stated that the American dream is "that dream of a land in which life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement. It is a difficult dream for the European upper classes to interpret adequately, and too many of us ourselves have grown weary and mistrustful of it. It is not a dream of motor cars and high wages merely, but a dream of social order in which each man and each woman shall be able to attain to the fullest stature of which they are innately capable, and be recognized by others for what they are, regardless of the fortuitous circumstances of birth or position." (-215)
Physicians must weigh the risks of replacing breastfeeding with artificial feeding against the risk of medication exposure through breast milk. Even a temporary interruption in breastfeeding carries the risk of premature weaning, with the subsequent risks of long-term artificial feeding. There are very few substances for which breastfeeding should be stopped. Generally, it is recommended that breastfeeding should be interrupted if the mother ingests most drugs of abuse, antimetabolite medications such as chemotherapeutic agents, and certain radioactive compounds. 28 Among antidepressants, cardiovascular medications, immunosuppressants, and many other classes of medications, certain drugs are preferred over others for lactating women. 7, 29 In a particular class of medications, it is best to choose a drug that has the least passage into breast milk, a shorter half-life, fewer active metabolites, and/or is used locally rather than systemically. 7, 29, 30 Physicians should counsel patients before ordering medications or procedures. Often, patients will be counseled inappropriately by well-meaning health care professionals to “pump and dump” or to stop breastfeeding based on old information or package inserts. Family physicians should be aware of up-to-date information and advocate for patients to continue breastfeeding safely. Some medications and substances, such as bromocriptine, cabergoline, pseudoephedrine 31 , and estrogen-containing oral contraceptives, are known to decrease milk supply. Contraceptive alternatives for breastfeeding mothers are discussed below (see Contraception in the Breastfeeding Mother section).