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PostPosted: Fri Aug 18, 2017 12:27 pm 
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Hey all. I don't really have a question or anything too specific to talk about... just needing to vent I guess. I started looking for info and experiences here well into the 2nd trimester of my pregnancy {FTM}. I wasn't told very much by my OB regarding what to expect once my daughter is born and I am my psychiatrist's (suboxone prescriber) first pregnant patient so he doesn't have very much information either. Seems they're both just taking things in stride and seeing how things go with me.

My OB has been very supportive and not at all judgmental. He's basically said that it's up to the neonatologist whether or not my daughter will need to stay to be monitored (there doesn't seem to be a policy or rule in place regarding sub babies and a mandatory stay) but that in most cases baby goes home when mom goes home.
This was initially reassuring for me and I didn't have any reason to question it but knowing that dose of sub has no correlation to chances of NAS gives me some anxiety. My OB said my baby "will be dependent" (not necessarily experiencing any signs or symptoms of WD).
I feel like I have all the knowledge and information I can... but not being able to control, or affect, the outcome in any way gives me anxiety. The "not knowing" and the inability to do anything about anything...
Not knowing how I'll handle it if my baby does have to stay in the hospital or God forbid if she has to be treated with morphine/methadone... I have no idea how I will explain her needing to stay to family or even be able to look my boyfriend in the eye. I've told him during this entire pregnancy that my staying on Subutex was for the best and that there would not be anything wrong with our baby because of it. He is aware now there is a possibility that she'll need to stay and be monitored for wd and he seems to understand what it means if she does end up scoring high enough to be diagnosed and treated.

Still... it's not at all how I pictured this experience when I would daydream about having kids one day. This just wasn't part of it. Having to accept this is difficult.
Wondering if, while I'm holding her, looking at her, trying to memorize every second of the moment I get to meet her, in the back of my mind I'll be consumed with worry about what happens next. That's part of the fear of this too I guess. How even the possibility of NAS will color my memory of this day...

I know in the end it's about going home with a healthy baby. I know it but I can't get past the "what ifs" . Again, just needed to get all of that out there somehow. :?


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PostPosted: Sat Aug 19, 2017 1:46 pm 
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I think that this would be an excellent time to meditate and try to remain as calm as possible. I don't want to pile more on you, but the most recent research is pointing to stress hormones like cortisol affecting the baby before it is born. I say this not to make you more stressed, but to give you incentive to actively seek a more calm state of mind. I'm sure there are meditation exercises online. You could do some pregnancy yoga. You could find books to read that don't trigger a stress response. Just try to keep your mind from dwelling on the "what ifs", ok?

Let us know if there is anything we can do to help!

Amy

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PostPosted: Sat Aug 19, 2017 7:42 pm 
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Hi Brittanne,
Congrats on getting this far along in your pregnancy and good luck with the final days and the birth of your child. I can't remember if you have other children or if this is your first. I am going to assume it is your first and if not you can disregard that aspect of what I have to say. I mention that because I want you to know that it is perfectly normal for one's anxiety to increase as the due date gets closer, even for someone who has no history of addiction and is not on a medication that may cause NAS.

There are so many unknowns going into the birth of a child. I won't start listing them because I don't want to add to your anxiety! Then add in the concerns of withdrawal and NAS, the uncertainty of whether your baby will be able to go home with you, or stay longer to be monitored or treated for NAS, it is perfectly normal for you to be anxious. You will be anxious, you will worry, and you will continue to wonder "what if this" scenarios. The challenge is to not let this worry consume you and overshadow the important events happening right in front of you related to the birth of your child.

I don't know how you feel about NA or 12 step philosophy (I have mixed feelings myself), and this may sound cliche, but I think the Serenity Prayer really is applicable in this type of situation. You have done everything you can at this point to ensure that the birth goes perfectly. Nothing you do now will change whether your baby will go through withdrawal, or if your birth plan has to change on that day. What you can do is choose now to stay in the moment and focus on what is happening right in front of you, and making the best possible decisions that you can in the moment.

Try to forget that image you have in your head about what the day you have children, or what you are going to think, feel, say or do the first (or tenth) time you see your baby. Letting go of those expectations can reduce some of your anxiety and can allow you to actually experience the birth, rather than constantly measuring it against some vision you have had of what it "should be". Plus, children have a way of totally screwing with your plans, and often we have to make completely new ones.
I have a few personal experiences that I was going to use to help illustrate this (I wasn't on Bup while pregnant but did have a few other issues), but I've written too much already and I need to run. I'll hopefully be back later to share. Best of luck!
Tragicom


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PostPosted: Sun Aug 20, 2017 6:58 pm 
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Please read this: http://suboxonetalkzone.com/withdrawal-in-newborns-lay-off-the-guilt-trip/


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PostPosted: Mon Aug 21, 2017 8:07 am 
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Dr Junig I had never read that, I just now read it from beginning to the last comment. Some of those comments make me very angry and I'd love to find a couple of those ppl and give them a piece of my mind! Thankfully u did :)

I just don't understand ppl, I really don't.

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PostPosted: Mon Aug 28, 2017 12:45 pm 
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Thank you so much to everyone who has responded to this!!

Amy- It's interesting that you mention this because my godmother just told me about a meditation app she wanted me to try. She knows how my anxiety affects me and how my mind automatically goes to the "what ifs" and all of the other things I can't control. It's like my mind just goes to the 'worst case scenario" and wants to plan or figure out how to handle the situation if this or that or that or this happens... I've been in counseling for this (and was taking medication before I got pregnant) and have been doing better. I don't let the worry consume me exactly... just when I talk about it, I think it's obvious that the anxiety is there... at least for people who know me well and can hear my speech speed up and hear how short of breath I get when I do talk about it. I'm not sure how to turn off the what if's that play over and over but I will absolutely look into any exercises. Maybe I should schedule an appointment with my counselor. I was making progress but I had to cancel my last appointment so it's been a couple months since I've seen her.

Tragicom- You are so very right!! I even do believe this deep down and wrote that exact sentence on a blog type post in another group the other day. I said that I have done everything I can, everything that is the very best (regarding staying on Sub for pregnancy) for me and baby. I had someone tell me that, outside of being informed and educated about NAS, that the next best thing I could do is pray that my baby won't be affected by this medication. She said it was something she did throughout her pregnancy and that she believes it made all the difference in the end. Obviously, with that comes a certain amount of faith necessary on top of "letting go"...

suboxdoc- I have read this many, many times and have shared it and referred to it when discussing this with other people. My brain knows this part of things... just doesn't always help with the emotional part of the process I suppose. The possibility she'll have NAS symptoms requiring treatment... my brain goes to worst case scenario.

Definitely going to work on some meditation exercises so I can learn to deal with the what if's in a better way that doesn't cause so many negative feelings. Thanks everyone for your responses! They did help ease the anxiety.


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PostPosted: Mon Aug 28, 2017 3:34 pm 
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Beyond just giving you advice I also want to provide you some comfort if I can.

There are many things that we have no control over and this is one of them. There are many parents who have babies and, for one reason or another, the babies end up in the NICU and can't go home right away. As a mom, it's natural to go through feelings of responsibility when the outcome isn't perfect at first. A mom might think, "If I had eaten better my baby wouldn't be having problems right now!"

I had wanted a completely natural birth with my son. Instead, I ended up with every single intervention there was. I felt all kinds of guilty that I let my midwife talk me into being induced, which I felt precipitated all the other interventions. I felt guilty that I had a hard time producing enough milk and had to supplement occasionally with formula. My son is now 19 and actually pretty brilliant! He is also kind and thoughtful, and a good friend. My point is that these first few weeks have so little to do with how your daughter will end up. When you look back you will remember them just flying by.

Let's think of another scenario. A woman is addicted to opioids. She is shooting heroin every day and is using sex to pay for it. Her nutrition is poor and her health is compromised. Still, when she finds she is pregnant she quits the heroin cold turkey. Let's say that quitting cold turkey did not cause her to miscarry, because it could have. She spends her pregnancy white knuckling it, but she has a lapse. Because she has been abstinent her tolerance goes down, but she uses the same amount of heroin as before, so she overdoses. Fortunately, her parents find her, start CPR because she is not breathing and call 911. She is saved with Narcan. Again, let's say that she didn't miscarry the pregnancy, which is a very real risk. The doctors have no idea if this crisis has caused the baby to be without oxygen and what effects it has had on the fetus. She spends the rest of her pregnancy guilty and worrying about her baby. She only messed up one time, but she didn't have buprenorphine in her system to block the effects of the heroin. She goes through her last few weeks worried and stressed. Now, this mom tried to do her very best for her baby. She thought that quitting heroin would guarantee that her baby would be born healthy and not addicted. But the baby is born with some deficits, although the doctors are not sure if they will last. Mom is feeling extremely guilty, so she scores some H just to feel a little bit better. The cycle continues and her parents end up taking care of the baby.

The scenario I wrote out above happens all the time. Maybe the addict doesn't want anyone to know she is addicted, so she quits without support and medical care. Or her family knows, but is ashamed of her. It's more important to them that she is abstinent than anything else. To them, methadone or buprenorphine just substitute one drug for another. The point is that she is unstable. She thinks of nothing but getting high, so she has a lapse and then completely relapses after the baby is born. This happens every day, Brittattane. Is it going to happen to you? No! You are stable and in recovery. Even if you were tempted to lapse, you know that the buprenorphine will protect you from getting high. The buprenorphine is protecting you and your baby. So there is a chance that your baby will experience NAS but you have no control over this. If this does happen, your baby will be kept comfortable and without much discomfort at all. She will be kept well and will have access to her mom every day. Your stability means that she has the best of her mom. She has a mom who is strong, available, attentive, loving, and devoted to her care. Your daughter is incredibly fortunate.

If people get nosy, don't feel that you have to tell them squat! There are numerous situations that can lead to a NICU stay. One of the most common for a full term infant is called Meconium Aspiration. Almost everyone has heard of that and it often requires several weeks in the NICU. Feel free to read up on it and use it if anyone starts questioning you. You could start with a general phrase like, "she had a little trouble breathing at birth so they want to make sure she is healthy before she goes home."

You don't owe anyone an explanation but you can chose how you would like to handle it if your baby has to be in the NICU for any length of time. Sometimes babies who aspirate meconium are put on pain killers and part of their NICU stay includes tapering off the meds!

You are doing the absolute right thing for your baby. You are a great mommy already and your baby is lucky to have you! There are women in your situation who insist on tapering off their buprenorphine so that no one will find out that they are addicts. I find that point of view somewhat selfish. They are willing to risk their pregnancy so they can pretend they are someone they are not. They would rather have their baby go through withdrawal in the womb where it receives no comfort than to have NAS and be medicated for it after they are born. I don't blame you for not wanting to advertise to the world that you are addicted to opioids. That is your private information. There are strict rules for medical personnel regarding the privacy of an addict's information. You could actually sue them if they say anything to another person regarding your status as an addict. Make sure you are very clear with your doctor and any nurse. It might be in your best interest to let the charge nurse know your status and your wishes regarding privacy.

Brittanne, it's normal to have some anxiety, particularly in your situation. But please don't let it get the best of you. If I were your counselor, (and yes you should go see her!) I would have you come up with some positive affirmations to say to yourself when you feel yourself spiraling into all the "what ifs". Meditation, as we've talked about, would be a great tool for you as well.

I know that whatever happens, you will just take it in stride and continue to do what's best for your sweet girl. You will take it one day at a time and just do the best you can. Post here anytime! We will be here for you!

Amy

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Dr. Jeffrey Junig, M.D., Ph.D.

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