Breastfeeding is considered the most powerful weapon for new born babies against diseases. For the young nursing mother with cancer however, exclusive breast feeding for the first six months of the infant’s life poses an enormous challenge. Many of them have worrying questions such as how safe it is for them to breast feed their infants before, during, and after surgery and treatment : how to hold their baby after a partial mastectomy, and where to go for professional advice.
To find answers to these questions we sought the help of Consultant Clinical Oncologist, Provincial Hospital, Badulla, Dr. Lakshan Abeynaike who drew on his knowledge from researching in this specific field for several years to clear these doubts among cancer afflicted nursing mothers.
Excerpts
Q. Just recently a cancer specialist from the National Cancer Prevention programme (NCPP) discussed with us the link between breast feeding and cancer prevention highlighting the benefits of breast milk as a powerful natural weapon against diseases due to its immunity boosting ingredients. However there still are several worrying questions uppermost in the minds of nursing mothers with cancer. One of them is how they could safely breast feed their babies while undergoing treatment. Will for example the treatment such as radio therapy and chemo therapy, cross into their breast milk and be harmful to the baby? What is your response?
Cancer treatment entails drugs with high amount of undesiarable side effects. This is because cancer treatment (chemotherapy) is aimed to kill cancer cells. As unintended collateral damage these drugs will also kill some normal cells. This destruction of normal cells can be detrimental for the newborn.
Many chemotherapy drugs can excrete in human breast milk.
Hence we advise against breast feeding while the mother is on active cancer treatment with chemotherapy or hormonal tablets
Radiotherapy on the other hand acts only in the site to which it is targeted. Therefore a mother who is on radiation treatment can safely continue to breast feed her newborn.
Q. So what is the option left for them?
A. Formula milk from recognised companies.The formula milks that are available are comparable to human breast milk and are widely available.
Q. What if the mother requires surgery is she still able to safely breast feed her baby prior to surgery given the fact that she may need an anaesthetics or other medicines to prepare her for surgery?
A. Commonly used general anaesthtic drugs act only for a short period of time and are not excreted in the breast milk. Therefore, a mother need not interrupt her breast feeding due to general anasthesia. However, a certain class of drugs used in anasthesia called the ‘opioids’ can cause drowsiness in the newborn and hence is used minimally in the breast feeding mothers who need general anaesthesia.
Q. What about after surgery? Can she nurse her baby ? If so when? As soon as she wakes up ?
A. It is generally safe to commence breast feeding as soon as the mother has completely recovered from general ansthesia.
Q. Alternatively, can she express the milk to use after surgery and store it in the hospital itself?
A. Yes. That too is an option if it is convenient. But there is no pressing medical need for such a practice.
Q. During surgery itself , I understand some mothers might only need to take medicines for a short time — for example, before certain scans or during surgery . Could these medicines be passed on to the baby through the mother’s milk if she is nursing her baby?
A. The contrast media used in CT and MRI scanning are excreted in minimal amounts in breast feeds. These contrast media are not toxic in themselves and are used in far larger doses in imaging studies involving. Therefore, a mother can continue to breastfeed her child before and after she undergoes CT and MRI imaging studies involving contrast injections.
However, there are advanced studies involving radioactive substance. The common examples are PET scans and Bone scans.
As the ‘dyes’ used in these scans emit radiation the mother will be specifically advised to refrain from breast feeding for a certain period of time after these scans.
Q. What about women who have undergone partial breast removal or complete removal of one breast due to cancer and find it harder to produce enough milk to breast feed exclusively.? Can they still successfully breast feed using only one breast?
A. Yes. If part of the breast was removed for cancer it will reduce the milk production. This diminishes even more as radiation treatment is an integral part of removing only part of the breast (breast conservation treatment.). In such an eventuality it is better to supplement breast milk with formula feeds.
Q. How safe and effective are they as sufficient nourishment for the new born baby?
A. Modern formula feeds are safe and are almost identical to breast milk from a nutritional point of view and are widely available and affordable.
If on the other hand, the unaffected breast can produce enough milk she should she continue to exclusively breast feed the newborn.
It is important to note that the nourishment of the newborn should be the priority and not a hypothetical goal of ‘exclusive breast feeding’
Q. It is now an accepted fact that the best milk for a baby is breast milk. On the other hand, apart from the cancer related issues, there are some women who are unable or refuse to breast feed their new borns at all for various reasons. What are some of these reasons?
A. Women who undergo cosmetic breast reductions, augmentations and those procedures can damage the ducts of the breast which may hinder with breast feeding. Some women complain they don’t produce enough milk . Others may be concerned about their physical appearance and opt not to breast feed. In addition we also have a growing number of working mothers who want to get back to their work as early as possible due to fears of being laid off.
Q. Is a defective physical condition in the baby also a reason why some new borns cannot breast feed?
A. Yes. Conditions like cleft lip and cleft palate will make it difficult for baby to suck breast milk properly.
Q. What about Pre-term babies still in the incubator?
A. They usually are given to the mother periodically to be breast fed. If they are too weak or pre-term to suck properly they will be fed via a tube and the mother will be requested to express milk and hand over to the nurses in charge.
Q. Breast feeding is said to establish a close bond between the mother and child. In the case of a mother who is unable to breast feed her baby due to cancer , can she still develop this bond ?If so how?
A. Breast feeding is just a component of the mother to child bond. The mother can sleep with the baby, cuddle it, care for it and still develop a strong bond without breast feeding.
Q. Many mothers experience a deep sense of loss and disappointment when they are unable to breast feed their babies – more so when they are already coping with the ups and downs of cancer treatment. Do you have trained counsellors and psychiarists to deal with their emotional and psychological problems at a time when hey most need such support?
A. In big cancer centres there are counsellors who are trained in all aspects of cancer treatment and its impact on life. That includes mother to child bonding and breast feeding.
Q. Let’s focus now on a very important part of our discussion, which is uppermost in the minds of every young mother with cancer : namely, how should she hold her baby and breast feed infant baby safely. Could you explain?
A. There actually is no specific way that is unique to how a baby should be held by a mother afflicted with cancer. The correct ways to breast feed a baby will be taught to the mother in the maternity home or in the community by trained midwives and public health nursing sisters.
Q. If a mother has only one breast after a partial mastectomy, what is the right position she should hold the baby and ensure the infant has had sufficient feed.?
A. Again, there is no specific, unique position for a mother to hold the baby while nursing following a mastectomy. She should follow the standard guideline common to all women for breastfeeding.
Q. Mothers who have undergone skin cancer surgery or thyroid surgery for suspected cancer, - can they also breast feed safely? How?
A. Yes they can breastfeed safely. Thyroid cancer patients who need to undergo radioactive iodine treatment should stop breastfeeding at least one month prior to the treatment and should not recommence breastfeeding after radioactive iodine treatment.
Q. As an experienced Consultant Oncologist briefly tell us what Oncologists in Sri Lanka have done so far in raising awareness among nursing mothers with cancer.
A. Cancer is a disease that rises in incidence with advancing age. Hence nursing mothers are very rare amongst cancer patients. Hence targeting them as a group for any activity aimed at raising awareness is not cost effective.
However, if there happen to be a nursing mother who is afflicted with cancer we give provide them with the information regarding motherhood and cancer according to the latest evidence based guidelines available.
Q. As many Myths and wrong ideas surround breast feeding by cancer patients in Sri Lanka , leading to prejudice and unnecessary delays in seeking early screening and treatment, what do you consider to be the most common?
A. The most common myth is that a mother who has cancer should not breastfeed at all. There is no truth in this.
Q. What are the gaps you see in providing quality care for all nursing cancer mothers in order to help them exclusively breast feed their babies for the recommended first six months of their lives and how would you fill them.
A. As long a mother is not on chemotherapy or hormonal/targeted treatment for cancer she can and should breastfeed their infants. Exclusive breast feeding in the first 6 months of life is the currently recommended evidence based practice.
Q. Have you a message for nursing mothers affected by cancer?
A. Please continue to breastfeed your infants as long as you are not on chemotherapy, targeted therapy or hormonal treatments. If you have any doubts please ask your consultant oncologist.
They are the professionals who have the knowledge and authority to offer you advice regarding cancer treatments and its repercussions on breastfeeding.