Just a little update (actually it’s very long - sorry!): more for any future women in my position than anything else to be honest.
I appreciate that their are many issues and questions around whether both physically and mentally I will be able to breastfeed and also obviously the question of chemicals in my milk. However the chemo will be over 3 months after baby is born and I planned on breastfeeding for 12 months; the emphasis is also on getting my life back so why should I accept straight away that I can’t have my 9 months of ‘normality’ if it MIGHT be possible?
I’ve had lots of ‘no, you can’t breastfeed’ but not really any supporting evidence as to why. I can think of many reasons why it makes things more difficult but nothing that says I will kill my baby or harm myself. More to do with toxins and how long they stay in your system and reduced milk flow due to stress and tiredness and potentially the operation. My Midwife is 100% supportive of what I’m suggesting so long as the specialists agree with the research I’ve found.
Anyway, this is what I have been sent from La Leche League. I intend to write it into a balanced letter and send it to my Oncologist and Obstetrician and ask their opinion before making any decisions. I have research to say that you CAN breastfeed whilst having chemo and radiotherapy, it just means that you have to express and throw away your milk for a few days each cycle. What I don’t know, and which is why I’m asking my specialists to look over what I’ve found out, is sample sizes etc but it is a starting point if nothing else.
Medications and Mothers Milk 2008 has the following statement for Docetaxel (which I’ll be having 3 cycles of once baby is born): “Withhold breastfeeding for a minimum of four to five days.”
Medications and Mothers’ Milk, by Thomas W Hale PhD, 2008, makes the following statements about the EC medications:
Epirubicin: “Mothers should be advised to discontinue breastfeeding for at least seven to ten days following the use of this product.” And “Withhold breastfeeding for at least seven to ten days.”
Cyclophosphamide: “Withhold breastfeeding for a period of at least 72 hours.”
The other medication you may have if you switch to the FEC treatment after the birth is Fluorouracil. Hales states “Mothers receiving injections of 5-FU should withhold breastfeeding for a minimum of 24 hours.”
Although Hale recommends testing for some chemotherapy drugs which can take weeks to clear from the body, it isn’t mentioned for these. The book also states “Because chemotherapy often consists of numerous medications used simultaneously, you should always choose to discontinue breastfeeding relative to the agent with the longest half-life.” In your case, Epirubicin has the longest half-life and clearance time.
Being able to feed your baby colostrum after birth will make a big difference for him/her. Even establishing breastfeeding for a few days after birth could make it easier for you to rebuild a milk supply later.
As for radiotherapy, you can breastfeed during this. The reason mothers may need to feed from just one breast is that this may affect a treated breast’s ability to produce milk. It is possible for a mother to feed her baby from one breast. So if you decide to pump and dump while on chemotherapy, if you wanted you could concentrate on the unaffected breast which won’t have milk production affected by the radiotherapy.
The Breastfeeding Answer Book states:
“Like diagnostic x-rays, radiation therapy does not cause human milk to become radioactive, so breastfeeding can continue. Radiation of the breast, however, damages a woman’s breast tissue, which may affect breast development and lactation in that breast at the time of treatment and with subsequent pregnancies (Neifert 1992). One study showed that breast rradiation causes “ductal shrinkage, condensation of cytoplasm in cells lining the ducts, atrophy of the lobules, and perilobar and periductal fibrosis” (David 1985). Studies on women who had undergone radiation therapy to one breast and later became pregnant indicate that some women will produce enough milk to sustain their babies. In one study of thirteen pregnancies, the treated breast produced milk in four cases and failed to produce milk in six cases; milk production was suppressed with drugs in the other three. All reported little or no change in the treated breast during pregnancy (Higgins and Haffty 1994). In another study, eighteen of the 53 women (34%) reported some milk production from the irradiated breast and thirteen (24.5%) breastfed., with five (9%) describing their treated breast as smaller. Two-thirds of the nine women who commented on milk production in the treated breast described it as “less but adequate”. One baby refused to nurse from the treated breast.”
“Like a mother who has had breast reduction surgery, a mother who has undergone radiation treatments to one breast will not know before her baby’s birth if she will produce enough milk to sustain her baby. The only way to find out is to give breastfeeding a try. If her baby needs more milk than she can produce, she can continue breastfeeding and supplement at the breast with a nursing supplementer or give supplements using other feeding methods.”
“If only one breast is receiving radiation treatments, breastfeeding can continue on the unradiated breast. The treatments will not affect the function of the other breast.”
Whichever option you choose, radiotherapy will impact how much milk you can produce, but you may still be able to produce a substantial amount for your baby. Even small amounts of breastmilk can make a difference to a baby. Mothers who have found themselves in this sort of situation have decided to define their own levels of success with breastfeeding in terms of what it is possible for them to achieve.
I’ll also add the the info above from La Leche League has been very supportive of the specialists treating me and always advises to get their opinions etc before making a decision. Also, this information was for my specific case so might not be suitable for everyone. I just wanted to give a slightly different viewpoint from that which is most common so that people aren’t automatically told ‘No’ and have yet another opion in their lives taken away from them
Good luck to anyone reading this who it helps 
Faye
