I seem to be getting predominantly complicated cases in the new year and once again I need help from the knowledge and experience on Lactnet. I have permission to post.

A pregnant mother of twins, currently 35 weeks and living in Netherlands, contacted me some days ago with difficult questions. She was diagnosed with Hodgkin's lymphoma around 9-10 weeks. Mom underwent 4 courses of chemo so far, standart ABVD protocol, the last one finished early in December. The doctors told her they will wait for the babies to be born and start radiation therapy after the birth (5 days a week, 15 min, above the diafragm, so breasts would be directly exposed). No more rounds of chemo for now and no scheduled delivery, they will wait for the birth to happen on its own. There is a PET scan to be done too after the babies are born.

Mom wants to know if it will be possible to bf the babies - the ultrasound shows no problems with them, but she feels guilty for the chemo and wants to bf for as long as possible in her situation. She has other 3 sons, all of them bf for various lenght of time (had enormous oversupply with the first) and wants to bf the twins too. She got breast implants 3 years ago, placed "under the gland", as mom described it.

I researched the information available about the drugs and was able to find Dr. Hale's answer to a similar question 3 years ago too. He states perhaps it will be ok to bf 2-3 weeks after the last round of chemo because of the short half lives of the drugs, so that's good news for the mother. Her doctors told her radiation wouldn't affect the breasts or the milk and as far as the PET scan goes, I was able to find information about the drug commonly used in situations like hers and it will require only 24 hours of pumping and dumping - she will ask the radiologist what drug exactly will be used to be sure.

We talked about how important it is to be open and flexible in her goals because of the possible changes in her situation, her exaustion from the chemo and the twin pregnancy and her other children she has to care for too, so she is prepared it won't be easy.

It will be very helpful if you can point me out to any resources about bf after chemo - esp if there is an online group for pregnant and bf moms with cancer or more information about the problems she faces.

And I wanted to ask if anyone of the LC's in Netherlands is willing to take over her care  - it goes far beyond my knowledge and skills, not to speak about how far I am,  and she will need competent help in her challenging situation. I don't know where exactly she lives, but I will ask. She doesn's speak Dutch, but she speaks English.

TIA,

Christina Yaneva
BF Peer Councellor
Bulgaria

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