Navigating breastfeeding through cancer treatment
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q1284 (Published 08 July 2024) Cite this as: BMJ 2024;386:q1284
- Abi Rimmer
When my daughter was around 3 months old, I had a sigmoidoscopy which revealed a tumour, suspected cancerous, in my rectum. Leaving my baby for the initial appointment felt like a huge upheaval. Little did I know what was to come.
That appointment was to be the start of my treatment journey for stage 3 colorectal cancer, and the start of my struggle to get my clinical team to understand they weren’t just treating a single person. My daughter and I were a package, not least because I was breastfeeding.
Just stop for 48 hours
One of the first problems I hit as a breastfeeding patient was the investigations that I needed to determine whether I did, in fact, have cancer. You name a scan, I’ve had it. Every time I received an appointment letter for a colonoscopy, an MRI, CT, or PET scan, I had to call the specialist cancer nurses to try to find out whether it was safe to breastfeed afterwards. They often wouldn’t know, and I’d be left to battle with the hospital switchboard for hours, desperately trying to reach the right department, the right person, who might.
When I did find someone to ask, the blanket advice was invariably to stop breastfeeding for 48 hours afterwards. When you’re breastfeeding, stopping for any length of time can be physically and emotionally distressing for you and your child. Two whole days of not breastfeeding is a long time. To add insult to injury, I often found—from the wonderful Breastfeeding Network’s “Drugs in Breastmilk” fact sheets—that this advice was wrong.
Breastfeeding around surgeries
I had three abdominal operations during the first year of my daughter’s life, and breastfed after all of them. This was not an easy feat. After each operation I stayed in hospital for at least one night. My daughter wasn’t allowed to visit me on the wards for her own safety. The breastfeeding network recommends that if a mother is separated from her baby for any length of time postoperatively then she needs access to a breast pump and a means to store the milk safely.
Unfortunately, no one from my team ever asked me how they could support my breastfeeding postoperatively. I took my own breast pump to the hospital and pumped both before and after the operations. Most of the milk was thrown away because of a lack of appropriate storage, which at the time felt extremely upsetting. For me, feeding my baby became a huge motivation to return home as soon as I could. I wish that someone had spent time creating a plan with me on how I could best manage my wish to continue breastfeeding. This would have shown me the team understood how important this was for me.
The necessary evil of stopping
Chemotherapy eventually drew to an end my journey as a breastfeeding cancer patient. This made me very sad. I felt that the decision of when I stopped breastfeeding my child had been taken away from me.Although it was a necessary evil, it would have helped to have had a discussion about it with my medical team, or been signposted to services that could help me through the process. Things were made additionally difficult when I was prescribed domperidone to deal with the nausea caused by the chemotherapy. When my milk supply failed to dry up I realised that this medication might be to blame.
On many occasions during my treatment, I was asked (as a distraction) what I would be doing if I wasn’t in hospital that day. My answer was always that I would be looking after my baby. Yet I felt that no one thought about what being separated from my young baby meant for me, or how they might be able to help me through this incredibly difficult time.
What you need to know
When treating a new mother, consider the needs of the mother and baby as a whole, including breastfeeding support
The breastfeeding network drug fact sheet offers advice for breastfeeding in relation to treatments and investigations
If a mother has recently stopped breastfeeding, check that any medications you prescribe do not promote lactation
Education in practice
When might you create a plan to support a mother to continue breastfeeding throughout her treatment or hospital stay?
What information or resources could you share?
How could you support a mother who has to be separated from her baby during treatment?
Additional information
Breastfeeding Network fact sheet. https://www.breastfeedingnetwork.org.uk/drugs-factsheets/?_factsheet_text=CT
NHS. Pregnancy, breastfeeding and fertility while taking domperidone. https://www.nhs.uk/medicines/domperidone/pregnancy-breastfeeding-and-fertility-while-taking-domperidone/#:~:text=It's%20been%20used%20during%20breastfeeding,other%20things%20have%20not%20worked.
Footnotes
Competing interests: none.