Episode # 3 • 17 Jan 2025
Breastfeeding: What OB/GYNs Need to Know
Can I have a glass of wine? Do I have to pump and dump after my CT scan? Will my antidepressant hurt the baby? Did I fail if we need formula? Every OBGYN hears these breastfeeding questions, sometimes at 3 AM on rounds, and the answers are usually more reassuring than patients expect. On this episode of BackTable Women's Health, Dr. Nicole Faulkner is joined by Dr. Janelle Alvarez, an OBGYN who shares women's health education with more than 40,000 followers as Paging Dr. Alvarez, to help OBGYNs feel ready for breastfeeding questions on rounds, at postpartum visits, and in the patient portal. Dr. Alvarez explains why lactation gets lost in a four-year residency and which parts belong to OBGYNs, which she sums up as breast, meds, and moods. The two then clear up common myths, from pumping and dumping after alcohol, contrast, or anesthesia to the strict criteria for lactational amenorrhea, and show how looking up a medication in LactMed in front of the patient builds trust.
Timestamps
00:00 - Introduction
02:21 - Choosing OBGYN and Educating Patients Online
07:11 - Gaps in OBGYN Breastfeeding Training
13:06 - Myths About Alcohol, Imaging, Anesthesia, and Medications
17:00 - Pump Output, Plugged Ducts, and Lactational Amenorrhea
21:29 - Social Media Trends: Supply Hacks, Formula, and Supplements
26:23 - Colostrum, Newborn Weight Loss, and a Feeding Plan
35:13 - The Mental Load and Why Breastfeeding Is Not Purely Instinctual
40:19 - Breastfeeding Pain as a Reason to Stop
43:24 - Returning to Work, Pumping Rights, and Advocacy
53:53 - Back-to-Work Letters, Milk Storage, and Supply Drops
59:04 - Assessing Breast Pain: Flange Fit, Vasospasm, and the Mastitis Spectrum
1:06:22 - Examining the Patient and Closing Remarks
Resources
- Drugs and Lactation Database (LactMed). National Library of Medicine
- Birth Interrupted. Dr. Janelle Alvarez, Substack https://janellealvarez.substack.com/
- Breast Milk Storage and Preparation. Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/breastfeeding/breast-milk-preparation-and-storage/handling-breastmilk.html
- International Society for the Study of Women's Sexual Health (ISSWSH) https://www.isswsh.org/
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More about this episode
They go on to the supply hacks, formula debates, and unregulated supplements patients see on social media, how to set expectations for colostrum and newborn weight loss before delivery, why every family needs a feeding plan as much as a birth plan, and why Dr. Alvarez rejects the idea that breastfeeding is purely instinctual. Dr. Faulkner shares the day she asked a hotel near a national OBGYN meeting for a private place to pump, which leads to a practical review of workplace rights under the federal PUMP Act, back-to-work letters, and milk storage. They close with a stepwise approach to breast pain, from flange fit and vasospasm to the mastitis spectrum and when antibiotics are actually needed.
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