Termination of pregnancy during lactation. Abortion while breastfeeding. Medical abortion and breastfeeding

Medical or surgical termination of pregnancy during lactation affects milk quantity and quality. 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 interrupting 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 laying on the stomach. cold compress. 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 (the 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? Thanks 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. one. 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 effects on adrenal function in infants, suggesting that the amount of mifepristone ingested by the 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 resume 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.

If you have a child that you are breastfeeding and have made the decision to have an abortion, it can be stressful to expect problems with your baby's feeding. Many believe that if you have an abortion, you need to say goodbye to breastfeeding, and give examples of their acquaintances or girlfriends; in fact, this is most often not the case.

There are two main types of abortion - medical and surgical. Below is information that you can discuss with your doctor. Feeding may need to be interrupted for a period of time; and someone will continue to feed on the same day. It all depends on the specific situation; each time you should discuss with your doctor the risks and benefits of delaying feeding for a given period of time. If breastfeeding is important to you, then it is best to find a doctor who understands this, appreciates breastfeeding, and is willing to weigh all the factors and work with you to choose the right regimen for you. The steps after checking the drug are described in detail in the article? You may find the links below the article helpful.

In addition, if you decide to stop feeding for a while (from a few hours to several days), you can keep feeding by continuing to express milk during this period, if necessary. You may find the tips in . Perhaps some of the tips from the section will be useful - for example, about night feedings.

Medical abortion and breastfeeding

The use of drugs such as mifepristone, misoprostol and gemeprost. There are no detailed studies on the effect of mifepristone, misoprostol and gemeprost on lactation and on the breastfeeding child. According to some data (3), the level of mifepristone in the blood is low enough, which makes it possible to keep HB in a continuous mode during the production of medical abortion, while regimens containing 200 rather than 600 mg of the drug should be preferred. (While the manufacturer's recommendation to interrupt breastfeeding for 26 days actually means stopping lactation, the study (3) concludes that there is no need to follow this recommendation).
Misoprostol is excreted into milk in small amounts and is rapidly eliminated. The mother can interrupt breastfeeding for 5 hours after oral administration of the drug to eliminate all possible risks. Research: (4), (5). Conclusions: (1)
Gemprost is presumably (data not available) excreted into breast milk, with a half-life after intravenous administration of 24 hours. Interruption of breastfeeding for 24 hours after intravaginal administration seems to be sufficient. Source (1) recommends interruption for at least 6 hours after intravaginal administration.

Surgical abortion and breastfeeding. When can you breastfeed?

As for the compatibility of anesthesia with breastfeeding, it all depends on the type of anesthesia. However, the mother is usually able to breastfeed after the anesthesia wears off (as after any other operation performed under anesthesia).
Since mini-abortion, which is possible in the early stages, is adequate in terms of safety to medical abortion (6,7), and when performed under local anesthesia, there is no need to interrupt breastfeeding, mini-abortion may become the method of choice for a nursing mother.

I am grateful for the help in the development of this article to the obstetrician-gynecologist, participant of AKEV Rudneva O.V.

Have an unplanned pregnancy and are you breastfeeding?

Medical abortion can be considered as one of the options for terminating a pregnancy. However, many patients are afraid to have interruptions because of this factor.

The choice of a way to get rid of an unwanted pregnancy while breastfeeding depends on many factors:

from the desire to continue breastfeeding,
on whether a caesarean section was performed during the last birth,
from the duration of pregnancy.

On average, it takes 2-3 days. In the first hours after taking the first drug - blocking the local action of the pregnancy hormone - progesterone, the concentration of this substance in the blood is at its peak.

It is during the first day that the chemical compounds of this remedy reach their maximum value, they also enter breast milk. At the stage of taking the second drug, which contains prostaglandins, which stimulate the contractility of the muscle fibers of the uterus, chemicals from this drug are released into breast milk through the blood.

Action funds for farm. abortion for lactation

Pharmacological agents used to perform medical abortion in a clinic that has all the necessary documents for their use in order to terminate an unwanted pregnancy penetrate into breast milk and, if ingested by a baby, can provoke allergies or other toxic lesions.

The intake of these drugs does not affect the amount of milk produced. After the removal of residual substances from the breakdown of drugs for medical abortion (4-5 days), the concentration of these drugs is negligible, it cannot harm the child.

Feeding schedule for medical abortion

If a woman, together with a gynecologist, opted for a pharmacological method of abortion, then it is necessary to adjust breastfeeding.

After taking the first pills, it is impossible to breastfeed the baby, but at the same time, if a woman wants to maintain lactation in the same volume, it is necessary to express milk regularly. The expressed milk is not suitable for feeding the baby, but it is necessary to pump with the same frequency and regularity as if the child were doing it. With this mode of pumping, milk production will remain the same.

On the fifth day, after the miscarriage, which was confirmed by the ultrasound protocol, you can continue breastfeeding the baby. Moms should be aware that if a baby refuses to breastfeed, then this may be due to a change in his taste due to the very fact of pregnancy and further miscarriage, or poor-quality pumping.

In most cases, breastfeeding is fully restored and continued. When feeding is resumed, there is no need to do breast milk tests, its indicators remain normal.

Due to the temporary interruption of breastfeeding, and the inconvenience associated with it, the choice of terminating unwanted pregnancies at an early stage in nursing mothers often stops at the vacuum method.

The site is a medical portal for online consultations of pediatric and adult doctors of all specialties. You can ask a question about "abortion while breastfeeding" and get a free online consultation with a doctor.

Ask your question

Questions and answers on: abortion while breastfeeding

2009-03-22 10:19:51

Lesya asks:

Hello, can you please tell me if it is possible to have a medical abortion while breastfeeding?

Answers:

Hello! After taking the drug for medical abortion, it is not recommended to breastfeed for 2 weeks. Express milk this time so that you can return to feeding later. All the best!

2013-02-01 16:00:54

Anastasia asks:

Hello. During breastfeeding (1 year 4 months) I became pregnant. I had a medical abortion with misoprostol and mifepristone and immediately quit breastfeeding. After the abortion, the chest began to ache; fibrocystic mastopathy was found. I understand it is due to a hormonal imbalance. The mammologist initially prescribed me a drug that increases progesterone, but it does not help, now he has prescribed a drug that lowers prolactin. Tell me what to do with my hormones? What happens to hormones after honey. abortion? After all, treatment must be selected based on the cause.

Responsible Wild Nadezhda Ivanovna:

It is necessary to determine the level of hormones: FSH, LH, Prolactin, estriol, progesterone - in the 1st phase of the MC and in the second phase of the MC. During feeding, the level of prolactin is elevated, but the medical abortion provoked a greater increase in the level of prolactin. You need to know his current level. Mastopathy was most likely before pregnancy, and after the medical abortion it manifested itself in a larger volume. Treatment and control of fibrocystic mastopathy is long-term, regular monitoring is necessary.

2011-05-24 00:38:02

Nata asks:

Hello. I am 30 years old, I am a woman who gave birth, but not without problems. I hope you will help me, give an answer to my question, which concerns postpartum recovery. The explanation of my situation will be lengthy, but I will try to make it clear. However, please be patient, read it to the end and give the correct answer. Thanks in advance. On January 25, 2011, she gave birth to her second child. The delivery was normal, but the contraction of the uterus was very painful. The doctor said that this is normal, because after each birth, the uterus contracts more and more painfully. Four days after giving birth, I was discharged despite complaints of severe pain, especially during breastfeeding. Ultrasound showed some accumulation of fluid, but the doctor said that everything would come out in time. (But later it turned into large clots and endometriosis.) In the evening of the same day (01/29/2011) I became very ill. Body t increased to 38.2. I took the ambulance, they put me in the hospital: a dropper with oxytocin, injections with an antibiotic, oxytocin and manual cleaning of the uterine cavity - that was all the treatment. Breast milk almost disappeared, but after the active application of the child to the breast, it more or less recovered, but not for long. First it disappeared in the right breast, then in the left. Since 04.05.2011 the child has been completely artificially fed. But on 04/12/2011, some strange smearing brown discharge, then pale pink, went on. Lasted about a week. They resumed on May 14, 2011 exactly the same, but lasted approximately 10 days. There was no particular pain, it does not look like the usual menstruation. What could it be??? Pregnancy third, childbirth second. (The first pregnancy was ectopic, ended with an operation to remove the left fallopian tube. A year later, the second pregnancy, a boy weighing 4.040 kg was born. After 11 months, an unplanned pregnancy, an abortion was not allowed, because ultrasound detected myoma nodes about 2.5 cm in size. As a result, a girl weighing 3,850 kg was born.) What could you advise in my situation?

Responsible Serpeninova Irina Viktorovna:

Hello. The reason for the slow contraction of the uterus could be the myomatous nodes found in you during the 3rd pregnancy. You need to do an ultrasound with a vaginal probe, colposcopy (to exclude the pathology of the cervix) and donate blood for sex hormones: FSH, LH, prolactin, estradiol, progesterone and depending on the results, decide on the appointment of treatment.

2010-01-24 09:19:17

Alena asks:

Hello, tell me please! What is the probability of getting pregnant while breastfeeding? If you make a test, how much can you believe it?

Responsible Medical consultant of the portal "site":

Hello Alena! Lactational amenorrhea, as a method of contraception, is one of the most ineffective methods. On average, the degree of protection using this method is about 60%. That is, the onset of pregnancy in the absence of other contraceptive methods is quite likely. A pregnancy test shows quite reliable results, including during breastfeeding. Lactation does not affect the test results in any way. You can also breastfeed your baby in the post-abortion period, unless you are prescribed drugs that make breastfeeding temporarily contraindicated (for example, antibiotics). Take care of your health!

2012-06-27 15:26:20

asks Evgenia Sirobaba:

Good afternoon. two years ago I gave birth to a daughter (caesarean section). Breastfed up to 1.5 years. It so happened that at the same time I became pregnant again. I had an abortion. About two weeks ago, I noticed discharge from the chest (it looks like colostrum in color). Sometimes just a few drops, and sometimes a small trickle. I don't feel any discomfort. Only now, before menstruation, there were pulling sensations in the breasts. And after the cessation of feeding, she drank a course of complex vitamins. I don't know if I should be worried or if this is normal.

Responsible Demisheva Inna Vladimirovna:

Good evening, you should not worry, but contact a mammologist, he will prescribe drugs that will bring everything back to normal.

2012-05-07 20:32:56

Larissa asks:

I am 40 years old. I have a second child, 1.5 years old, I am still breastfeeding and there are no periods after childbirth. I had a caesarean section. A long break between births. My first daughter is 18 years old. - as far as I remember, the simplest T-shaped one and a year later I became pregnant with it. I had an abortion without removing the IUD, since no doctors in those years warned us that it was necessary to remove the spiral. as a result, the wreckage was dragged after the abortion with forceps. it hurts terribly. after a friend advised another gynecologist. she said that pills would be better for my body, but the spiral does not fit at all. Considering that a lot of time has passed, is it possible to still put an IUD if I don’t want to give birth anymore? and which one to choose? My husband and I tried to protect ourselves and put Pharmatex suppositories - the baby starts to vomit from feedings .. and the husband does not want condoms

Responsible Serpeninova Irina Viktorovna:

Good afternoon. Do a colposcopy and, in the absence of contraindications, enter Mirena. The reliability of this IUD is comparable to the reliability of tubal ligation.

2011-04-24 15:19:05

Inga asks:

Hello!
Very useful information about medical abortion. And not only. One upsets - moralizing out of place. My condom broke. Postinor was taken immediately within 30 minutes. Only the result was not long in coming. Unfortunately, an unwanted pregnancy. I want to say a big thank you to my doctor. Who at one time cured my infertility at the age of 30 and thanks to whom I have a daughter. He also helped in this difficult situation for me. Women do not take the life of their children from a good life. And talking about the dangers of abortion is not always appropriate. Okay, this is a lyric.
And now the question.
The child was breastfed until 2 years 2 months. 14.02. Then there was a medical abortion. After a while, I can say that everything seems to be fine in terms of well-being. I would like to know the opinions of doctors, after what time you can think about a normal pregnancy. My doctor disagreed on this. And what you need to restore hormonal balance, as well as after prolonged feeding. My age is 33 years old.

Responsible Medical consultant of the portal "site":

Hello Inga! You can think about pregnancy no earlier than 6 months after medical abortion. In order to restore the hormonal balance, you need to know exactly the nature of its violation - a consultation with a gynecologist-endocrinologist and an examination of the hormonal profile will help you with this. Your thoughts on abortion and situations that push women to terminate a pregnancy are worthy of respect. However, in the responses we express our opinion, which does not have to coincide with the opinion of our visitors. Take care of your health!

2011-04-11 11:59:00

Mary asks:

Hello! I'm 34, I have 3 children, the youngest is 5 months old, I'm breastfeeding! I got pregnant. Please tell me how to have a medical abortion and after what period of time can I return to breastfeeding after taking medication! Once I took Cytotec, 5 tablets under the tongue, every hour, and the next day 3 tablets! to take and what dose! Thank you BIG in advance!