Hello all, wanted to wait and go through the archives to see if you've
already discussed this but thought it looked timely, given recent threads,
so I'll throw it out there:

Background:  Had a patient last week who went into premature labor (35
weeks gestation) after her mother's sudden death. (Her mother had been away
on a mission for nearly two years and her return home, which had been
scheduled for the following week, had been eagerly looked forward to by her
daughter.)

The patient had breastfed two previous infants and was looking forward to
breastfeeding again; she had not yet been allowed to hold or feed her baby
at the time I first saw her in the hospital (over 24 h postpartum).  She
had pumped 4 times before I saw her, but with no visible results.  She felt
strongly she would not be able to let down due to emotional distress.  I
gave her counseling and reassurance, and education on how to facilitate
let-down with a baby in NICU.  I also put her on a more frequent pumping
schedule.

I also believed that in this case Syntocinon nasal spray would give her an
important physical and psychological boost, and explained it would be very
short term use only.  Her doctor concurred.

Problem:  the in-hospital pharmacist felt it is inappropriate to ever use
Syntocinon, and told me it would be difficult or impossible to obtain any
due to its having been withdrawn from the market. He could not tell me why
it had been withdrawn, whether there were liability issues, and if so, what
they entailed. I asked for the mfr's phone number, which he would not
provide.  Of course I can and will follow it up through other channels but
what is the reason that Syntocinon has been withdrawn, if true?  Lack of
profit, or ...?

The next day the pharmacy delivered the Syntocinon "at no charge" to the
pt.  She reported she was able to successfully initiate pumping.    Pt is
relieved and happy about breastfeeding, and feeling confident about her
breastfeeding future.

Of course "tincture of time" is an important variable here, given the
progression from colostrum to milk postpartum; other important variables
include the beneficial effect of the previous pumping and the education and
verbal support I gave her.  Yet I feel the prompt use of Syntocinon was
appropriate in this unusual situation, given her emotional duress, her
repeated statements that she "couldn't let down" despite a history of
successful breastfeeding with previous children, and her increasing belief
that failure was imminent.  Comments?

Arly Helm

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