What a caring person -- giving this great gift to her brother, and naturally concerned about maintaining her breastfeeding relationship with her latest beautiful baby.

And your question is apt --does she really have to stop breastfeeding?  the logistics of injections and the harvest are going to be disruptive, so she will need the general information that breastfeeding mothers need when they're having medical procedures.  But the medication doesn't seem to be a huge issue.   As you noted, Hale has as an L2 -- a low level of concern.  And it can be a good resource for her to call Hale's organization Infantrisk.org.  And Lactmed doesn't contra-indicate the medication during lactation, noting that anything that does transfer doesn't seem to be well absorbed orally.
http://toxnet.nlm.nih.gov/cgi-bin/sis/search2

After she has passed this information along to the doctors (since this is not their area of expertise) she can ask what information they are basing their recommendations on?  And then she can make her decision.

If someone knew they were facing that extended a disruption, it might be useful to start expressing early on since she'd need to have stored 8 days X 30 oz. a day =240 oz.  If she were putting by 4 oz. or more a day, she could do that in less than 60 days, without creating a significant oversupply (which a third-time mother might need to watch out for).

And  after the disruption, the baby is likely to be thrilled to get back to the breast (after all, we expect working mothers to go on business trips and come back to breastfeed again).  If there is any difficulty, a great, determined mother like this could certainly woo a baby back to breastfeeding by treating it as a nursing strike.

But the first question to resolve is whether the medication does actually require anything like this disruption.

Margaret Wills, IBCLC, Maryland
P.S.  Here's to the campaign to get rid of the ugly phrase "pump and dump."  -- maybe, if it's ever really necessary "Pump and sacrifice in an abundance of caution and love."



> Date:    Mon, 21 Sep 2015 21:40:13 -0400
> From:    Sue Pace <[log in to unmask]>
> Subject: Stem cell donor
> 
> Permission to post
> I have a client who will be donating stems cells in December for her brother who has myeloma.
> As part of her preparation she will need to have G-CSF (Filgastrim, granulocyte-colony stimulating factor) subcutaneous injections for 4-5 days prior to harvest which will take place over 5-6 hours. At the time of harvesting (in December) she will have an  8 week old baby-her third baby due in October. The transplant team coordinator has advised her to stop breastfeeding for the duration of the injections and 3-4 days afterwards. Mum has signifcant breastfeeding experience have exclusively breast fed baby number 1 born at 34 weeks and baby no. 2 diagnosed with Hirschprungs at 2 days, both babies breastfed until at least 18months old
> Her concerns are-
> Does she really have to stop breastfeeding?
> What would the effect be on her baby if she continues?
> If she has to stop how early should she start expressing to build a milk bank for the duration of stopping? She realises if she stops she will have to pump adn dump to maintain supply.
> A big concern is getting her baby back to the breast afterwards-she is very comitted to breastfeeding and found significant benefit to feeding her son with Hirschsprungs.
> Hale's catergorise it as L@
> Any ideas, help, support will be welcome
> 
>             ***

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