Can mothers breastfeed after a medical termination of pregnancy?

Medically terminating a pregnancy during breastfeeding

Mifepristone and misoprostol are recommended for medical termination of pregnancy (abortion) (1)

• are often given as single doses, with mifepristone being administered first, followed by misoprostol; although further doses of misoprostol may be required.
• as there are negligible amounts for each medicine found in breast milk and the risk of accumulation in the infant is minimal, they are considered compatible with breast feeding.
• there are no data on the direct effect of mifepristone or misoprostol on the lactation process.
• gemeprost is no longer routinely recommended
• a review states that breastfeeding and multi-fetal pregnancies are not contraindications to medical termination (2)
• previous guidance stated that as a precaution,infants exposed to mifepristone or misoprostol via breastmilk should be monitored for nausea, vomiting and poor feeding (3)

Mifepristone use in breasfeeding:

• use with caution
  • mifepristone can be used during breastfeeding due to negligible levels in milk.
  • infant monitoring
    • as a precaution, monitor the infant for nausea, vomiting, diarrhoea and poor feeding.
  • further information
    • limited data suggest that the levels of mifepristone in milk are negligible when single doses of up to 600mg have been administered
      • breastfeeding can continue in an uninterrupted manner during medical termination.
    • no side effects have been reported for infants after exposure to mifepristone via breast milk

Misoprostol use in breastfeeding

• use with caution
  • misoprostol can be used during breastfeeding due to negligible levels in milk.
  • infant monitoring
    • as a precaution, monitor the infant for nausea, vomiting, diarrhoea and poor feeding.
  • further information
    • oral misoprostol is excreted into breast milk in negligible to very small amounts when doses up to 600mg have been administered, which are rapidly eliminated.
    • although there is no evidence for vaginal or rectal administration, similar low levels are anticipated in breast milk.
• no interruption of breastfeeding is necessary when misoprostol is given by any route, or if repeated doses are required in the short term
• no side effects have been reported for infants after exposure to misoprostol via breast milk

Reference:

• NHS Specialist Pharmacy Service (September 2023). Medically terminating a pregnancy during breastfeeding
• Bateson D, McNamee K, Harvey C. Medical abortion in primary care. Aust Prescr. 2021 Dec;44(6):187-192. doi: 10.18773/austprescr.2021.050. Epub 2021 Dec 1. PMID: 35002030; PMCID: PMC8671011
• NHS Specialist Pharmacy Service (October 15th 2020). Can mothers breastfeed after a medical termination of pregnancy?