The mother can, and should, resume BF immediately, or she may really need
contraception before she knows it!

Morning after treatment need not be given unless there are clinical signs of
imminent ovulation, such as ferning of cervical mucus, observed dried on a
slide, under a microscope.  It requires a speculum exam, a swab, a slide and
a microscope.
Ferning starts about a week before ovulation and peaks at ovulation,
disappearing rapidly within about 24 hours afterwards.
If there is no ferning when the woman seeks treatment, there are two
explanations for this.  One is that she is not ovulating because she is, for
example, breastfeeding or postmenopausal and not in need of MAT.  The other
is that she has ovulated more than 24 hours previously, in which case it is
too late for MAT to be effective so it need not be given.

We don't have enough info about this case to know whether such an exam was
done before giving the treatment, but in any case the mother should start
BFing again as soon as possible.

What sign is the clinician going to use to determine whether the treatment
was successful?  Is it expected that she will menstruate in another 2 weeks
or will she simply have to start doing pregnancy tests weekly until all
doubt is erased?

Rachel Myr
midwife, IBCLC and frequent dispenser of MAT in a previous existence
Kristiansand, Norway

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