Abstract: Breastfeeding a child is permitted on Shabbat and Jewish holidays without any restrictions. However, expression of milk into a receptacle for later use is a serious halachic transgression. Therefore, expressing milk on these days in the normal manner is not permitted. When the mother is in pain, or suffering from mastitis, she can pump in a manner that will let the milk go to waste. When the child requires expressed milk, an individual question should be asked. In cases where pumping is permitted, electric machines can be operated wtih a timer.

Discussion: Breastfeeding a child is permitted on Shabbat and Jewish holidays without any restrictions. However, expression of the milk into a receptacle for later use is a serious halachic transgression. Therefore, expressing milk on these days in the normal manner is not permitted. However, as in most areas of Jewish law, serious risk to health takes precedence over the rules of Shabbat and holidays. Therefore, in certain circumstances, expression is permitted. For example, where there is severe discomfort due to engorgement or mastitis [1] [2], the mother is generally advised to express the milk in a way that ensures it cannot be used. Expressing milk in this manner is permissible if needed to alleviate suffering [3] [4]. A woman could express directly into the sink or toilet and allow the milk to run down the drain, or she could put a contaminant like dish soap in the container before expressing to render the milk unfit for use.

When a woman is expressing for a child who needs the milk and is unable to nurse, an individual question must be asked. For the purpose of caring for a sick child, expression will often be permitted. In that case, the rabbi may suggest using a timer or other electrical device on an electrical pump. The health care professional can help the couple in asking the question of the rabbi by explaining the importance of breastmilk in this case and the dangers to the child if the milk pumped over the Shabbat or holiday would be discarded [5].

Turning on electric equipment is also prohibited on Shabbat and Jewish holidays. If a woman is using an electric pump to express breastmilk, it can be placed on a timer. It is important that she place the flanges on her breasts before the timer starts the machine.

Implications for Patient Care: When a woman is advised to express breastmilk, it is important to address in advance the issue of Shabbat and Jewish holidays. She should be given a clear explanation as to the need for this intervention, preferably in writing, with which she can turn to her halachic advisor. It is important that the explanation include the consequences to mother (e.g., mastitis and pain) of not pumping and to the child (e.g., lack of receiving breastmilk) if she does not pump during this time period.

Medical References

[1] Thomsen AC, Espersen T, Maigaard S. Course and treatment of milk stasis, noninfectious inflammation of the breast, and infectious mastitis in nursing women. Am J Obstet Gynecol 1984;149:492-5.

[2] Niebyl JR, Spence MR, Parmley TH. Sporadic (nonepidemic) puerperal mastitis. J Reprod Med 1978;20:97-100.

[3] Mass S. Breast pain: Engorgement, nipple pain and mastitis. Clin Obstet Gynecol 2004;47(3):676-82.

[4] Osterman KL, Rahm VA. Lactation mastitis: Bacterial cultivation of breast milk, symptoms, treatment, and outcome. J Hum Lact 2000;16(4):297-302.

[5] Work Group on Breastfeeding. Pediatrics. Breastfeeding and the use of human milk. Am Acad Pediatr 1997;100:1035-39.