Mifepristone while breastfeeding is a danger to the baby. Medical abortion while breastfeeding. Infant preparation

Abortion with HB is not uncommon. Contrary to popular belief that pregnancy cannot occur with breastfeeding, this is confirmed by a non-isolated case in gynecology. In this case, the woman is rarely ready for new pregnancy, she has to have an abortion during lactation.

Comes one and a half months after the birth of the baby. In most cases, this applies to women who are not breastfeeding. There were cases of the release of the egg and in the fourth week after childbirth during lactation. A breastfeeding period of 6 weeks protects against unwanted pregnancy only 98%.

It is possible if the woman does not protect herself. Doctors do not recommend giving birth, as the body did not have time to recover. Repeated bearing of a child will greatly undermine health, especially if carried out C-section. In the latter case, it is allowed to give birth no earlier than after 3 years. In an unplanned pregnancy, doctors insist on an abortion to preserve health.

Reason #1

The cause of pregnancy may be the frequency of feeding. When applying the baby to the breast 5-6 times a day, with the amount of milk drunk in 150-180 ml per feeding, the risk of becoming pregnant is higher than in those women whose children eat a smaller volume, even if they apply them more often.

Reason #2

The likelihood of conception increases if the mother observes the hourly feeding schedule. Do not wait 3-4 or more hours between feedings if the baby asks to eat. Optimal time intervals are 2 hours.

Reason #3

With the introduction of complementary foods, usually at 4 months, the mother begins to breastfeed less often, and by 7-8 months she completely transfers the child to baby food. In such cases, the likelihood of conception increases.

abortion during lactation

The method of abortion during breastfeeding is selected for the patient depending on factors. Experts consider:

terms of pregnancy;
mother's desire to continue lactation;
previous birth method.

The patient can stop feeding for a few days, expressing milk, or continue to apply after a few hours. It all depends on the specific situation, which the woman should discuss with her doctor.

medical

Abortion with the use of drugs - the use of drugs that cause the rejection of the embryo from the uterine cavity. The procedure is paid, in order to carry it out, the patient must have a delay in menstruation no more than two weeks, and pregnancy - up to five weeks. Mostly used products containing mifepristone. There is no information about the effect of the substance on lactation and the baby's body through feeding.

According to official sources, mifepristone enters the patient's blood in low doses and is quickly excreted, which is not a reason to stop feeding.

The second most commonly used drug is misoprostol. It enters the milk in minimal portions, it is quickly excreted from it.

The third substance is gemeprost. It is similar to the previous two, but is excreted from the body in a day, and not in 5-6 hours. To be completely sure that the drugs will not harm the baby, doctors recommend starting feeding a few days after a medical abortion, usually after 3-14 days.

mini abortion

Vacuum abortion is done using a machine that sucks out a fetal egg attached to the uterus. The method is the most sparing for the patient, but is carried out only on early dates. The procedure lasts no more than 10 minutes. Goes away with local anesthesia. Lidocaine and propofol are used, which pass into milk in small quantities, are removed after a couple of pumping. This type of abortion involves stopping breastfeeding for a few hours.

It is extremely rare, but situations are possible when a woman is prescribed a course of antibiotics. Then GV will have to stop at the time of taking medications.

Surgical

Instrumental abortion is performed by expanding cervical canal, scraping the walls of the uterus with a special tool - curettage. The procedure is carried out up to 12 weeks of pregnancy. At medical indicators or rape - up to 22 weeks. This type of abortion is mainly used when the deadlines for more gentle methods are missed. The operation has consequences in the form of perforation of the walls of the uterus, infertility, etc. Their appearance depends on the timing of pregnancy and the doctor.

Surgery can have a psychological impact that will affect lactation.

Mother's condition after abortion

During abortion, the patient does not feel anything, except for a slight discomfort when the cervix opens. After recovering from anesthesia, you may feel pain in the lower abdomen due to uterine contractions. Nausea and dizziness should also not cause concern. To normalize the condition, a woman needs to lie down for at least an hour. The doctor can put on the stomach cold compress so that the uterus contracts better. If this does not happen, the patient may be injected with oxytocin.

To check how the procedure went, the woman needs to do an ultrasound. If the remains of the embryo are found, a mandatory surgical abortion is performed. After vacuum and surgical abortions antibiotics may be prescribed. Drugs are prescribed to kill microorganisms that can get on the wounded surface of the uterus and cause infection.

After vacuum aspiration and surgery in a woman for some time there is blood from the vagina. On average, this period lasts from 5 to 15 days, normal periods after an instrumental abortion can go in 28-35 days.

After the procedures, the patient may begin dangerous bleeding, other complications. If a woman observes the following signs, she needs to see a doctor:

blood from the vagina did not go immediately after the abortion, but after a few days;
weak or heavy bleeding;
lack of blood;
pain in the lower abdomen;
nausea, dizziness;
discharge with impurities of pus, too red or having a pungent odor.

Artificial termination of pregnancy also has psychological consequences for the patient. After an abortion, a woman needs the moral support of her family and friends.

Features of breastfeeding after medical abortion

After med. abortion breastfeeding needs some adjustment. After taking the first pill, a woman should not feed the baby. If you want to keep lactation in the same volume, the mother needs to express her breasts with the same frequency with which the baby ate.

Approximately on the fifth day, when the ultrasound is ready, you can continue to breastfeed the baby.

Caused by a change in the taste of milk due to pregnancy or subsequent miscarriage, insufficient pumping. This rarely happens, mostly the lactation period is completely restored.

Features of HB after surgical abortion

Termination of pregnancy with surgical method is not a reason to stop lactation, except for the time of removing general anesthesia from the body (about 6 hours). After this time, the mother needs to express milk well, after which you can start normal feeding.

How to return GV if you had to suspend?

Abortion while breastfeeding causes hormonal changes. Because of this, the taste of milk, its quantity often changes. Some relaxation methods:

Frequent application. The frequency of applying the baby to the chest is at least once every 3 hours.
Body contact. This method involves the frequent presence of the baby next to the mother, free access to the breast so that the child can take it himself if desired.
Good food plentiful drink. To produce milk, a woman needs to eat right. A diet during this period is not required, but it is recommended to limit the consumption of fatty, fried, smoked, spicy and salty foods.
Massage. The production of milk is facilitated by a light massage of the chest and interscapular zone.
Night applications. It is at night that the mother's body produces prolactin, which is responsible for the production of milk, so night feedings are useful.

Avoid pacifiers if possible. They satisfy the sucking reflex, the baby is less drawn to the breast. Do not stop feeding, even if the child refuses natural nutrition. Until he begins to drink milk, a woman needs to express herself so that the milk does not disappear.

Abortion is unpleasant for any woman psychologically and physically. In order to avoid consequences, it is important to choose reliable methods of contraception, not to rely on chance.

Medical or surgical termination of pregnancy during lactation affects the amount of milk and the quality of breastfeeding. Before deciding to have an abortion with hepatitis B, it is necessary to study information about the features various techniques this procedure.

Before an abortion, a woman should consult a doctor, undergo an examination, take tests and do an ultrasound scan. This is necessary to confirm the presence of pregnancy and choose the method of termination. You can also contact a breastfeeding specialist who will give recommendations on maintaining lactation and tell you about the forced break in feeding and its timing. right amount milk and freeze it in special containers so that the child does not lack nutrition.

In addition, a woman needs psychological help before an abortion: during lactation, the maternal instinct is highly developed, which can negatively affect the emotional state.

In this case, you can go to a psychologist for help and, after talking with him, make a conscious decision to maintain or terminate the pregnancy. No less important is the support of relatives and partner during this period, their understanding and approval.

Infant preparation

The child during breastfeeding is emotionally and physically attached to the mother, so he also needs to be prepared for her temporary absence. Leave the baby with one of the relatives for a short time so that he understands that, even when he leaves, the mother always returns. You should also accustom the baby to a bottle with an orthodontic nipple. She repeats the shape of the female nipple, respectively, the child subsequently will not stop sucking the breast. If there is not enough milk, it is necessary to introduce a properly selected artificial adapted mixture into the child’s diet and make sure that there are no allergies and other negative reactions child's body.

Types of abortions

There are the following types of abortion:

- medication (tablets);
- surgical (instrumental);
- vacuum (mini-abortion).

At medical method termination of pregnancy occurs with the help of special medicines. They cause rejection of the fetal egg from the uterine cavity. The duration of the procedure varies from 2 to 4 days. During this period, a woman needs to stop breastfeeding, because the potent substance of the drug enters the mother's bloodstream and can be passed on to the child with milk. Depending on choice medicinal product your doctor may recommend a break from breastfeeding for a longer period of time (up to 14 days). instrumental method termination of pregnancy means surgical intervention and curettage, which is why it is considered the most dangerous of all types of abortion. Average duration procedures - 30-40 minutes. When it is carried out, a woman is given a local or general anesthesia, which affects the subsequent resumption of lactation. In most cases, breastfeeding can be continued immediately after the anesthetic wears off. In rare cases, doctors recommend refraining from feeding for several days. A mini-abortion is performed using a special vacuum apparatus and is considered the most gentle method of terminating an unwanted pregnancy. The duration of the procedure is 7-10 minutes. After completion, it is not necessary to interrupt breastfeeding, because. female body recovered in a short period of time. In rare cases, doctors prescribe a course for a woman to prevent infection from entering the body. Then the GW will have to be abandoned for a long time.

After the abortion procedure and the termination of the action of anesthetic drugs, you may experience pain lower abdomen. It has to do with uterine contractions. To alleviate the condition, doctors recommend putting a cold compress on the stomach. In addition, after an abortion, patients often experience nausea, vomiting, and diarrhea. In this case, you need to contact a specialist who will select suitable medicines. When wondering if it is possible to breastfeed after an abortion, remember that this depends on the method of termination of pregnancy, the drugs used during the procedure and the subsequent state of the body.

Termination of pregnancy entails hormonal changes that affect the production of breast milk, its taste and quantity.

Therefore, there are cases when children refuse breastfeeding and lactation stops. To keep it, put the baby to the breast more often and do not skip night feedings.

To subsequently exclude, do not use the contraceptive properties of lactation and coitus interruptus as methods of protection. After an abortion, it is advisable to consult a gynecologist. He will pick up suitable remedy contraception that does not affect breastfeeding.

Dear Colleagues!

As early as 6 weeks after birth, 15% of non-breastfeeding and 5% of breastfeeding women ovulate. The earliest ovulation was registered on the 4th week after birth. Only complete exclusive breastfeeding (lactational amenorrhea method - LAM) reduces the likelihood of pregnancy in the first 6 months after birth (provided there is no menstruation). The Pearl Index in this case is 2 (for comparison: when using condoms it is 14, "mini-drank" - 5). If after the use of LLA for 6 months after childbirth, the woman remains amenorrhea, and she continues to breastfeed before each feeding, then it becomes possible to extend the LLA to 9-12 months (Pearl index in these cases is 3-6). However, lactating women do not always comply with the requirements of the MLA, which leads to unwanted pregnancies.
An analysis of Internet resources has shown that the issue of termination of pregnancy during lactation is not so rare. With the spread of medical abortion frequently asked question is the possibility of continuing breastfeeding against the background of termination of pregnancy by this method. At the same time, there is unanimity in the answers to this question on the websites medical organizations No.

Question from a patient on the forum:

My baby is 10 months old! I want to make medical abortion. Is it still possible sometimes to violate the conditions and breastfeed the baby! How might this affect his health? Thank you in advance!
Answer 1:
When conducting a medical abortion, breastfeeding should be stopped for 14 days after using the drug Mifegin. We do not have any data on what will happen to the child if this rule is violated. If the rules for the use of the drug say that breastfeeding should be temporarily excluded, then this is probably due to the fact that the drug will adversely affect the health of the child.
Source:http://www.farm-abort.ru/faq/answer.php?id=2173
Answer 2:
When conducting a medical abortion against the background of lactation, breastfeeding must be abandoned (at least 3 days).
Source:http://www.iampregnant.ru/question/4882
The "scatter" of opinions on the part of practitioners is due to the fact that the instructions for drugs of different brands indicate different periods recommended for stopping breastfeeding - from 3 to 14 days, which is confirmed by the data of our study, which showed that only 13% of respondents were aware about the pharmacokinetics of mifepristone and misoprostol in lactating women and the possibility of stopping breastfeeding for only 4-6 hours. The rest would advise their patients to stop breastfeeding for 10-14 days. It is interesting to note that 23% of doctors would advise taking a 3-day break (as indicated in the instructions for miropristone), not taking into account the 7-day break recommended for misoprostol (Fig. 1).

Rice. 1. The total number of votes received in response to the question posed during the interactive lecture " Recovery period: complications, treatment, prevention" by voting with remote controls in different regions (n=470) (data by G.B. Dicke, 2012)

In this regard, we conducted an analysis of the literature on this issue, the purpose of which was to determine the most optimal tactics for breastfeeding a child by a mother during a medical abortion. Below are the recommendations of the most authoritative sources.

Scientific researchVogelD. et al. (Switzerland, Germany, 2004):

The aim of the study was to compare the concentration in milk and blood plasma after a single use of misoprostol 200 mg and methylergometrine 250 mg in the postpartum period for uterine contraction. It has been shown that the level of misoprostol in mother's milk rises to an average of 3.6 (7.6±2.8) pg/mL within an hour (1.1±0.2) and decreases very rapidly, reaching almost zero values in 5 hours - 0.20 pg \ mL (Fig. 2), while the half-life was half that of methylergometrine (1.1 ± 0.3 hours; median 0.6 hours versus 2.33 ± 0.3 hours ; median 1.9 hours; P≤003, respectively). Milk/plasma concentration ratios for misoprostol were 3-fold lower than those for methylergometrine at 1 and 2 hours (P≤0.0001 and P≤0.0015, respectively).

Rice. 2. Concentration of misoprostolic acid in milk after taking 200 mcg misoprostol once orally, pg/ml
Source: Vogel D, Burkhardt T, Rentsch K et al. Misoprostol versus methylergometrine: pharmacokinetics in human milk. American Journal of Obstetrics and Gynecology, 2004, 191:2168-2173
http://www.geburtshilfe.usz.ch/Documents/LehreUndForschung/Publikationen/MisoprostolAJOG.pdf

RecommendationsICMA(UK, 2004):

There is some evidence that mifepristone is excreted in breast milk, but there is little evidence for an effect on adrenal function in infants, suggesting that the amount of mifepristone ingested by an infant is unlikely to cause harm.
Since misoprostol levels decrease rapidly, it is recommended that misoprostol be taken immediately after a feed and that the next feed be resumed after a four-hour break for oral misoprostol and somewhat later (after 6 hours) after vaginal administration.
However, if a woman fears that the drugs may pass into breast milk, she may refuse to feed within 24 hours of taking mifepristone/misoprostol or misoprostol alone.
Literature:

1. Hill NC, Selinger M, Ferguson J et al. The placental transfer of mifepristone during the second trimester and its influence upon maternal and fetal steroid concentrations. British Journal of Obstetrics and Gynaecology, 1990, 97:406-411. http://46.4.230.144/web/UpToDate.v19.2/contents/f36/20/37522.htm?/abstract/33&utdPopup=true
2. Vogel D, Burkhardt T, Rentsch K et al. Misoprostol versus methylergometrine: pharmacokinetics in human milk. American Journal of Obstetrics and Gynecology, 2004, 191:2168-2173.

Source: http://icma.org/en/icma/home
WHO recommendations (Geneva, 2007):

Mifepristone may pass into breast milk. When studying the effects of mifepristone on endocrine system fetus marked increase in levels of adrenocorticotropic hormone and cortisol. Clinical Significance these changes are not known.
It also enters breast milk fairly quickly after administration. a small amount of misoprostol, however, whether this affects the child's condition or not is not known. The serum concentration of misoprostol when taken orally decreases rapidly, so misoprostol is recommended to be taken orally immediately after breastfeeding, and the next feeding to be carried out after 4 hours. Serum levels of misoprostol remain high for longer when administered intravaginally, so feeding should be carried out after 6 hours or later. Unfortunately, the available data do not allow precise recommendations on the optimal timing of misoprostol administration while breastfeeding.
Source: Frequently Asked Questions about Medical Abortion. Based on the results of the international conciliation conference on medical abortion in the first trimester of pregnancy, November 1-5, 2004. Belladio, Italy. - WHO, Geneva, 2007. - 33 p.
http://whqlibdoc.who.int/publications/2007/9241594845_eng.pdf

Misoprostol is rapidly metabolized in the mother's blood to misoprostol acid, which is biologically active and is excreted in breast milk. There are no published reports of adverse effects of misoprostol on infants of mothers taking misoprostol.
Source: Medication Guide by the U.S. Food and Drug Administration.LAB-0061-16.0 RevisedDecember 2010. ReferenceID: 2881258. http://www.accessdata.fda.gov/drugsatfda

Scientific researchSäävI., FialaC.ssoauthor. (Sweden, 2010):

The levels of mifepristone in breast milk from 12 women undergoing medical abortion were studied. Milk samples were collected during the first 7 days after administration of either 200 mg (n=2) or 600 mg (n=10) mifepristone. In addition, serum samples were collected on day 3 (n = 4). Mifepristone levels were determined by radioimmunoassay. The highest concentrations of mifepristone were found in the first sample during the first 12 hours after taking the drug, and ranged from undetectable (<0,013 мкмоль/л) до 0,913 мкмоль/л. После этого, отмечалось снижение концентрации мифепристона до неопределяемых значений в течение 7 дней. Самый низкий уровень мифепристона в молоке был получен после приема дозы 200 мг. Соотношение концентраций молоко:сыворотка колебалось от <0,013:1 до 0,042:1 на 3 день (n = 4). Расчетная относительная доза для ребенка (RID) составила 1,5 % на самом высоком уровне. Выводы: уровни мифепристона, определяемые в молоке, являются низкими, особенно при использовании дозы 200 мг. Грудное вскармливание может быть безопасно продолжено без перерывов во время медикаментозного аборта.

Many young breastfeeding mothers are sure that during lactation they will not be able to get pregnant and additional contraceptive measures should not be taken. As practice shows, cases when a couple was able to conceive a child in the first months after childbirth are not uncommon, and then parents find themselves at a crossroads: save the fetus or resort to abortion. Artificial termination of pregnancy during breastfeeding can be of two types: surgical (destruction of the fetus in the uterus) and medication (taking mefiprestone and preparations based on it for miscarriage). The features of each procedure, their advantages, disadvantages will be discussed in this article.

Do you know how many women get pregnant within the first three months after having a baby?

According to medical statistics, every 5 young mother finds signs of an "interesting situation" in the first trimester after childbirth.

Conducting a surgical termination of pregnancy does not imply stopping breastfeeding, however, surgical intervention in the reproductive organs of a woman and the subsequent rehabilitation period frightens a young mother. In addition, the possible complications that can lead to infertility do not bode well, as well as anesthesia for the period of the operation can affect the quality of breast milk. For the first few days after an abortion, a woman will be in a state of stress and impotence, and it will be extremely difficult for her to fully care for a child without outside help.

Termination of pregnancy with medicines

Despite the fact that taking pharmaceuticals for the purpose of artificial miscarriage is becoming increasingly popular, this method has a number of serious limitations, so you should think a few times before deciding to do this.

Are there safe abortion methods?

The most significant disadvantages of medical abortion are:

It takes from 2 to 3 days, depending on the woman's body.
Used only for up to 6 weeks.
The need to take a break from breastfeeding. The active ingredient in abortion pills greatly affects the taste and quality of milk and can cause vomiting or diarrhea in the baby.
A visit to a gynecologist involves at least three visits, during which the specialist will make sure that you are pregnant, prescribe medication, control the process after 48 hours, and check the uterus for the absence of a fetus, probable bleeding and inflammation in two weeks.
The drugs have more than 20 contraindications, including suspected ectopic pregnancy, abnormalities in the development of the fetus, anemia, uterine myoma, kidney failure, preeclampsia, inflammation of the genital organs, allergic reactions, etc. It is not recommended to take abortive drugs for women with respiratory problems, in particular with bronchial asthma.
Unpleasant side effects: migraine, chills and weakness, vomiting, asthenia, dizziness, diarrhea and cutting pains in the lower abdomen, bleeding, anxiety and sleep disturbance.

Advice

According to the rules, medical abortion must be done in a medical facility under the supervision of a gynecologist, but most often a woman performs such a procedure at home. Be sure to have a family member with you in case of an emergency.

Conclusion:

Termination of pregnancy during breastfeeding is fraught with great difficulties, both for the mother and for the baby. Both options for artificial abortion - surgical and medical are fraught with a number of complications and contraindications and do not go unnoticed for the female body. The best way to avoid an unpleasant procedure is reliable contraception from the first days after childbirth.

Breastfeeding during pregnancy

In this case, the woman will be in a situation where she needs to terminate an unplanned pregnancy and continue breastfeeding. There are two options - surgical and medical abortion.

During a surgical abortion, a woman can continue to breastfeed, but in the case of a medical abortion, this is not possible, a break in breastfeeding should be taken at least for a few days. This is because misoprostol (the active ingredient in abortion pills) passes into your milk. Misoprostol can cause diarrhea in a child.

There are several reasons why women prefer medical rather than surgical abortion. For example, the fact that medical abortion does not involve surgery is less invasive and does not require anesthesia. It is not even necessary to undergo hospitalization, the process can be completed at home.

While there are some reasons why medical abortion may be preferred, there are certain medical conditions that preclude this possibility. Therefore, before making a decision, you should obtain all possible information.

How RU486 is applied

What is RU486

RU486 (sold as Mifeprex or Mifegin) is widely used, effectively and safely used for many years in France, Sweden, Great Britain.

For medical abortion, you should go to a medical facility and visit it three times. The first part is taking the abortifacient RU486. Then, if necessary, another drug, misoprostol, will be taken. to terminate the pregnancy.

Time required: three visits to the doctor (in 17 days).

How it's done

First visit. At the first visit, the doctor must make sure that you are really pregnant (through a pregnancy test or pelvic exam). If you are pregnant, your doctor may also order an ultrasound.

To perform a medical abortion, your doctor will give you three tablets (200 mg each) of mifepristone (RU486) to take right there. This dose is usually enough for the fertilized egg to separate from the uterine wall.

You will then be scheduled a second visit in 2 days.

Second visit. During your second visit (due 48 hours after taking mifepristone), your doctor will examine you to see if the pregnancy was terminated successfully. If not, you will be given a second remedy, misoprostol, in the form of two tablets or a vaginal suppository. Misoprostol should also be taken under the supervision of a physician. It will cause the termination of pregnancy in a short time - from 6 hours to 1 week.

Misoprostol causes uterine contractions, so you may experience cramping and bleeding. Your doctor will prescribe painkillers for you and give you instructions on what to do in case of complications.

Last visit. You must see a doctor two weeks after taking misoprostol. The doctor must confirm that the pregnancy was successfully terminated and make sure that there are no problems (bleeding, inflammation). If the pregnancy is found to be ongoing, a surgical abortion is recommended. According to the instructions for mifepristone, patients whose pregnancy has not been terminated are at risk of fetal malformations. Surgical termination of pregnancy is recommended.