Thanks, Frank, for your post and for your efforts to communicate with the FDA.
Where I work we used to give methergine tablets for three days to all
women with suspected retained bits of placental membranes.  I don't
remember when or why we stopped but it was years ago. We never made
any bother about the breastfeeding, never gave it a thought at all,
and we never saw any problems. For a long time after that, it was
routine practice to give a combined syntocinon and methergine
injection to women in third stage labor, at various points in the
course of things. Some units gave it "after anterior shoulder was
'delivered' " and some gave it after baby was born and we checked that
there was not an undiagnosed twin still in utero, to effect delivery
of the placenta, and some gave it after the delivery of the placenta
ostensibly to prevent atonic hemorrhage.  And some places didn't use
methergine at all, preferring to use only syntocinon, with all the
same unfathomable variation of opinion as to the correct timing of the
treatment.

Common to all of the procedures was the fact that it was given so
early that the volume of milk intake by the baby would be in drops
rather than ml or cups.  This was routine practice for decades and to
my knowledge there were no adverse effects in babies, ever.  I do know
that a baby was once mistakenly given methergine IM instead of Vitamin
K in the delivery room. The midwife (who was not yours truly)
experienced near-syncope when she realized what she had done. No
adverse effects were observed in the baby then either.

What is the FDA's reasoning for this warning? Could the breastmilk
substitute industry be behind this, to reduce the likelihood of
exclusive breastfeeding ever happening again by making it medically
contraindicated to let babies come to breast in the first 12 hours
postpartum?

Rachel Myr
Kristiansand, Norway

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