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PostPosted: Sun Jan 24, 2010 11:03 am 
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I have been maintained on Suboxone therapy for several years. I was lucky to be introduced to the therapy by a doctor who specializes in addiction therapy and more specifically in Suboxone treatment. He had been studying the use of this drug before it was ever an acceptable form of treatment in the United States. When I became pregnant, he was confident that many mothers in Europe had given birth to babies while taking Suboxone and that I should do fine. I was the first patient my ob/gyn had encountered taking Suboxone, but he was willing to work with me. With my daughter, I started having contractions the day after my duedate, late in the evening. I had taken a dose of Suboxone that morning I believe, 6mg. At the hospital the contractions were very mild and I was not in any real pain yet. I was given IM Stadol late that night. It worked very well for me and I was out. I was discharged and went back home. The next morning the contractions really started and the pain was increasing a great deal as it does with any woman. I went back to the hospital and was found to be in early labor. I received several more IM shots of Stadol, but the pain was a 10. The nurses knew I was on Suboxone, I always made sure they knew when I was being admitted. Well, when I finally made it to 4 cetimeters dilated, which was 2 days after my last dose of Suboxone, I could finally get an epidural!! I was so relieved. In moments my day got a whole lot better and I virtually slept until I was 10 centimeters dilated. I delivered a baby girl who weighed 8lbs 10oz and was 21 inches long. I planned on breastfeeding because of the information I had found and my Suboxone doctor believed I could nurse without creating problems for the baby. The nurses were all very helpful and got me started , putting my baby to the breast and aiding me in any way I needed. Well the pediatrician at the hospital, who had no understanding of Suboxone started saying that my baby was having withdrawal. Nobody else thought so. Well, he advised me not to breastfeed. My baby and I went home on the second day after she was born. I continued to breastfeed albeit half heartedly while supplementing with formula. Now I am pregnant with my second child. I am still maintained on Suboxone therapy and I am due in about 2 and 1/2 weeks. This time around I am more confident in breastfeeding, but I am worried about the birth experience as it is so unpredictable. I am not sure which drugs the anesthesiologist used in my epidural last time. I did have an episiotomy last time, but the ibuprofen seemed to work well and I did not take the percocet, I restarted the Suboxone while still in the hospital, which actually helped a lot for me.


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PostPosted: Sun Jan 24, 2010 2:36 pm 
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Wow, what a great story, and congrats on your soon-to-be new baby. And props to you for deciding to breastfeed...even though you had one ignorant doctor.

You can request your medical records from your last delivery to find out what drugs the doc used in your epidural.

I think there are some other members around who have had babies while on Sub, hopefully they'll chime in.

Good luck!

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PostPosted: Mon Jan 25, 2010 12:01 pm 
Hi Tangerine and welcome! Congratulations in advance on your new baby! And congrats on your recovery!
I'm sure you're getting anxious, being so close to delivery time. Thank you for sharing your experiences with your first labor and delivery on Suboxone and I'm glad you were treated well and everything went well for you. I was an L and D nurse for a long, long time and only left the profession about a year ago. I had never encountered a patient on Suboxone during those years. And I worked in a pretty big hospital. I'm sure as the years go on, there will be more and more pregnant women maintained on buprenorphine and hopefully doctors and nursing staff will beceom educated about it. Sounds like you were lucky in getting doctors and nurses who worked with you well while in labor.
I have good news for you - As I'm sure you've already heard, your second baby should come a little bit faster and easier than the first. Plus, you've been through it before so you'll know better what to expect this time. I found it interesting that the IM Stadol worked so well for you in early labor. That's great...you'll know to tell the nurses that it worked for you before. As far as your epidural....I would only expect it to work just as well for you as it would for anyone else not on Suboxone. Typically the medications that are used in the epidural consist of a local anesthetic agent (the "caine" family of meds) and often an opioid (like Fentanyl). To my understanding most of the 'numbing' of the epidural comes from the 'caine' part of the mix. The opioid part acts locally there as well but is taken up into the maternal blood and therefore into the brain to a much lesser degree however, than if the opioid were given in your IV. So as you can see, your being on Suboxone shouldn't get in the way of how well your epidural works. Because your pain releif via epidural is happening in your back (so-to-speak) not in your brain. I hope that makes some degree of sense and reassures you a little bit!! I really think you should do just fine. You are so, so right to be open and honest about your history and medications. It's so important for everyone to know in order to take the best care of you and your baby.
As far as the breastfeeding....I think you just go for it. Everything I've read indicates that your Suboxone, while it does pass into the breast milk, does not appear much if any in the baby's system because the medication is 'lost' if you will, in baby's digestion processes.
Anyway....thanks for sharing and please come back and talk more. You never know who you've helped by sharing your experiences here!!


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 Post subject: Congrats....
PostPosted: Mon Jan 25, 2010 3:50 pm 
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Hi Tangerine,
I can't offer any advice on this matter ( 49 yo male ) But I am a Father of 2 Girls. So I can send you my congrats on the upcoming addition to your healthy family.....
Congrats on educating yourself the first time giving birth and for sharing with others that might be going thru the same thing!! Thats what this Forum is all about. Great job. :)

Good Luck & God Bless!
TW


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 Post subject: subutex.. and pregnancy
PostPosted: Wed Jan 27, 2010 9:23 am 
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hi.. i am 35 weeks pregnant and i am so scared .. i lose sleep and i cry all the time because of the fact that im on subutex and pregnant... i wish i could start over in my pregnancy and not be on this medication just because i am SO scared for my baby ..especially seeing how bad the withdrawl is for methadone babies.. they get so sick and end up staying in the hospital for several weeks...i dont know if its the same withdrawl for the babies on subutex........ ive been reading the posts and its definately making me feel much better ..knowing other mothers out there have given birth to babies on subutex and everything end up working out is comforting. i am currently taking 8 mg a day ,, im wondering if its to late to taper down a little to help decrease the withdrawl for baby... and i also wanted to know if by chance something happened and i needed to get a c-section would i be in serious pain and the pain meds not work for me because im on subutex? i know the epideral should work still but if you get a csection they slice u open so i know they give you pain meds ,, will they work for me?
please get back to me someone,, im very worried..
Jen


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PostPosted: Thu Jan 28, 2010 3:07 pm 
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Thank you so much for the replies. I am still pregnant, no baby yet. I am anxious, but I try to remind myself that in no time I will be back home, taking care of a newborn and a little girl, and this anxiety will have passed.
Setmefree, I am so grateful for your reply regarding the specifics about the epidural anesthesia and your experience as an L and D nurse. I have also received more information in the form of reports about breastfeeding and the poor bioavailability of buprenorphine in the GI tract, especially that of a baby. Thank you for your encouragement.


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PostPosted: Thu Jan 28, 2010 4:45 pm 
Tangerine - glad I was able to help. Glad you posted again....still pregnant huh? Not much longer though! I'm glad you've been able to put some of your fears and concerns to rest and enjoy this super special and exciting time in your life. It's so important to do like you've been doing and gather all the information available....knowledge is power! Keep up the good work and please come back and let us know how everything goes for you.
I did get a PM from Sweetheart and replied to her. I decided to go ahead and post my private message to her below in case for some reason she didn't get it or in case someone else may benefit from the response.

"I'm sorry you're so scared. I don't blame you....I'm sure it is scary when you want to do what's best for your baby and you aren't sure how to do that. I'm hoping you get your Sub from a doctor and I'm hoping that your OB knows you are taking it. It is always best to honest with your healthcare providers. I know that is not always easy.....doctors and nurses can be judgemental sometimes and make you feel bad for being an "addict", but in these circumstances they MUST know you're on Sub. You need to be able to talk about your concerns with your doctor and the doctor should be telling you what to do as your due date gets closer.
Personally, I think it might be good for you to go ahead and cut back on your dose. In all honesty, most people (myself included) can drop to 4mg/day and not notice much of any difference. I'm not sure this will make much difference where your baby is concerned because what I've read says Sub babies don't have withdrawal....nothing like Methadone babies. The reason I'd like to see you cut back is more for you. The less Sub you're on, the easier it will be for pain meds to "break through" the Sub and work for you in case of an emergency or a C/Section. I've heard of several people saying that they've been on 2-4mg/day of Sub and have gotten relief from opiate pain meds for tooth extraction, kidney stones, stuff like that. Ideally, you'd be able to stop your Sub 3 days before you deliver, but since you don't know when that's gonna be, that's gonna be difficult!! Unless your doc schedules you to be induced....and if that happens, I think he'll advise you to stop your Sub 3 days before induction and any necessary pain meds should work pretty fine.
Try not to worry too much. If you tell the hospital medical personnel about your Sub, they should be able to work with you. Maybe over the next few weeks you could try to reduce your Sub a little. If nothing else, I think you'd feel good about it and maybe you'd rest better. I really don't think you'll have any trouble dropping down to 4mg/day. Talk to your doctor about it. And try not to worry too much. You've done the best you can to take care of yourself and this baby. Everything should turn out okay."

I should add, as I talked about in my original response to Tangerine, that the blocks that are used in labor and delivery whether a vaginal birth or a C/Section are usually epidural or spinal anesthesia. Both of these blocks work mainly by non-opiate drugs and being on Suboxone should have minimal if any affect on how well they work. In true emergency situations when there is no block in place and a C/Section is necessary, the patient is usually "put to sleep" via general anesthesia. While opiates are often used in these situations, it is the other non-opiate drugs that are used which put you "under". So again, Suboxone should have minimal affects. Now, after surgery is another story. Being on Suboxone will impact your pain relief because most of the best drugs for post op pain ARE opiates. That is why if a surgery is a planned thing, the doctors usually recommend going off Sub for a few days before the scheduled surgery. Obviously that's not possible in the event of an unplanned emergency C/Section. This is one of the reasons it is so imperative that the medical staff know you're on Suboxone. There are non-opiate meds (Toradol for example) that are often used after a C/Section which do work pretty well, but for the first day or two many women need something stronger, and if you're on Sub it may be a little harder to get your pain under control. That's all kind of worst case scenario though. Hopefully, you will have a nice, quick, easy labor and delivery and you'll do great with an epidural and won't need any opiates at all.
Please let us know how you're doing and please talk about your concerns with your doctors.


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PostPosted: Thu Jan 28, 2010 7:37 pm 
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i will definately keep you guys updated ! i really hope i do have an easy , quick delivery and everything goes well for my baby and i :) well i guess im going to cut down on my subutex within the next day or 2 .. b/c im gettin down there .. and i will let my doctor know whats going on with that as well .. you have no idea how happy i am that i found this site. i felt so alone before .. its really nice knowing that other moms are going through this .. and its nice having someone to talk to who has medical experience ,. Tangerine are you on Subutex or Suboxone?- and how far are you? sounds like your somewhere around the same time as me . My daughter is due March 2nd . when is your baby due?
Do you work ? i'm a student right now .. im going to school for Medical Assisting . just recently i took a leave of absence for the baby . its getting very tireding these days .. my mind is strickly set on Nesting , Resting , and Eating .. lol . anyway thank you ladies for taking the time to read and respond to my msgs , you have no idea how much youve helped me :) Thank you! :)


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PostPosted: Sun Jan 31, 2010 4:31 pm 
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Sweetheart,
I am SO glad to see that you are finding help here. I just stumbled on this site as well, as I was beginning to worry being so close to delivery day, but not knowing what day it will be... My duedate is Feb. 10 and this is my second child. I work from home, but there has been a decline in work so I have simply been preparing for my baby and caring for my daughter. I was a full-time student during my last pregnancy and returned to school 2 weeks after her birth. I was doing a LPN program which I completed, but I have not worked as a nurse, hopefully some day I will. I just kept finding so many areas of study I was interested in and could not commit to just one... Now with this baby I am no longer in school and plan to be home with him. I am just so excited to have this new baby, I can't wait to hold him, I am sure you are feeling these same emotions waiting for your daughter. I have also been nesting, organizing and re-organizing the baby clothing and supplies. Having that spike of energy has been wonderful!! I have been craving peanut butter and cookie dough icecream. I am taking Suboxone and was during my previous pregnancy as well. Good luck this week!! I will continue to update on my impending birth.

Setmefree, thank you for posting the PM here I really appreciate your caring guidance.


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PostPosted: Sun Jan 31, 2010 7:29 pm 
Tange and Sweetie (lol) - I sure hope you ladies will keep posting here. I'm so excited for both of you....having new babies...all so exciting and wonderful. It's been a long time since I had my last one....those will forever be some of my favorite times....having a newborn....a love like no other!! I miss my work in labor and delivery, so if I've helped you guys in any way, I'm thrilled to have done so. You should be so proud of yourselves for the work you've done in recovery and for being honest with your care providers about your histories. It sounds to me like you've done absolutely everything you can to give your babies a healthy start in life. In my book, that's the beginning of being great mothers. There is no more important job in this world, in my opinion, than being a good mother!
I know you're gonna be busy, but please try and find time for us here on the forum. We're all rooting for you! Can't wait to hear how everything goes!


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 Post subject: Welcome to the site...
PostPosted: Mon Feb 01, 2010 11:06 pm 
Tangerine,
welcome to the forum! You sound like a great Mom! I can't think of a better person to have kids than someone who has gotten her life together by taking Suboxone to address your addiction. Congrats on the one you already had, and the one on the way. That was really, really brave to share your drug historyn and current Suboxone maintenance with your care providers. Just remember, take the time to take care of yourself while you look after baby, so you don't get run down. And keep taking your Sub. Great story! Here's to another successful pregnancy and happy, healthy baby for you!
JD


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PostPosted: Mon Feb 08, 2010 4:24 pm 
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Hi there,

I have been looking for information about breastfeeding while on Subutex. I have not found many places where it is suggested/advised to breastfeed while on Subutex, yet I see that most will assume it passes through the baby rather than absorb. Does anyone have any advise or links to information that suggests that breastfeeding is NOT contraindicated? I would really like to go back to breastfeeding, but since the pain meds from my c-section caused the need to be back on Subutex (and, for the record, I took the pain meds as prescribed. So much for following the rules and staying safe), but for now I am pumping and dumping with the hopes to get off the Subutex sooner rather than later.

Thank you for any and all advise on this matter!


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PostPosted: Wed Feb 10, 2010 11:14 am 
Hi Catie and welcome! I'm sorry for what has happened to you! The ole "pump and dump" things sucks!! (no pun intended) I can't remember specifically where I got my info.....but I do remember how I found it. Do a google search for buprenorphine or Subutex and pregnancy studies. You should find a study that was done in Australia. That study talks about bupe and pregnancy, but it also goes into the breatfeeding issue. As I recall it said that babies who breastfed from moms who were on bupe showed minimal if any bupe in their bloodstream....the theory being that the vast majority of the bupe is lost in first pass metabolism through baby's digestive processes. Just do a search and I bet you'll find it. It it were me....I'd probably go ahead and breastfeed.
But I'm not a doctor or an expert, so do your research and discuss with your baby's pediatrician!
Best of luck.
Glad to have you here....please keep coming back! And congratulations on the new baby!!


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PostPosted: Sun Feb 28, 2010 11:18 am 
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Hello, I wanted to check back in. I must try to make it short, for I have my sleeping baby in one hand, trying to type with the other. I am grateful beyond comprehension that the birth of this baby went smoothly and that he entered the world with a vigorous, healthy cry. We were discharged after 24 hours and have been adjusting to this new realm of life. I will post details later. Thank you all so much for your encouragement and help.


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PostPosted: Sun Feb 28, 2010 3:30 pm 
Tangerine!! Congratulations on your baby son!! I'm so glad you took a moment to let us know that everything went well for you......home 24 hours after giving birth!! It doesn't get much better than that!! Fantastic and way to go!!
When you get another minute or two....give us some more details. More than anything else, savor these moments with your new baby and rest whenver you can!!
Super, super news!!


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PostPosted: Tue Mar 02, 2010 10:14 am 
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Tangerine wrote:
Hello, I wanted to check back in. I must try to make it short, for I have my sleeping baby in one hand, trying to type with the other. I am grateful beyond comprehension that the birth of this baby went smoothly and that he entered the world with a vigorous, healthy cry. We were discharged after 24 hours and have been adjusting to this new realm of life. I will post details later. Thank you all so much for your encouragement and help.


Congratulations Tangerine!

I'm sure you must be very busy (and probably not getting much sleep) these days, but I hope you can come back soon and give us more details. I'm only 10 weeks, but already nervous about labor and delivery as a subutex-taking-patient. I'd love to hear about how your interactions with the L&D staff went---what they did for pain control (both during and after birth) -- whether or not they were paranoid about baby going into withdrawals (and sounds like that didn't happen, so yay!), etc. etc.

But, til then, enjoy your new baby and relax! :D


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PostPosted: Wed Mar 03, 2010 10:59 pm 
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Once again I have baby in one arm, so I will make it quick. I had to be induced because I was close to 2 weeks past my due date. I went into the hospital at noon last Monday. I started contracting and went home. The contractions intensified throughout the night and I went back into the hospital at 9am Tuesday. Sometime around noon I had my water broken, which immediately put me into extremely intense contractions so I asked for an epidural. While I waited for the anesthesiologist I asked for some pain relief, and was given IV Nubain. This caused me to sleep in between contractions. I received the epidural finally and it worked wonderfully. I did have a patient controlled analgesia button, but never needed it. Before I knew it, I was 10cm dilated and was asked to push. I could not feel the sensation to even know where to push (something I never imagined) but did it anyway and about 40 minutes later I delivered a baby boy. He weighed 8lbs 5oz 21 1/2 inches long. I started nursing him within the hour. The nurses were extremely helpful and kind. I did end up taking Percocet and Ibuprofen for pain the following day. The baby had his initial checkup with the Ped. on PP day 1 and again on day 6, which went well. He did not have any jaundice. Not knowing the day I was going to go into labor was difficult, but I tried not to worry about it too much, since I have been through it before. I am glad it is over now though.


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PostPosted: Thu Mar 04, 2010 12:33 am 
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Congrats!!! Tangerine! I'm so happy for you! it sounds like everything went really well since you were discharged so soon. I'd love to hear how your delivery went and how your baby is adjusting to life on the "outside" lol! I am almost 27 weeks along and think about how the birth will be a lot. I know I have to have a c-section like I did with my daughter, I'm not really worried about that and pain mgmt. I'm sure it will be fine. How many mg. of Subutex were you on before you gave birth? Not sure if you posted it in a previous thread... Well, good luck to you and your new little one and post when you get a chance.


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PostPosted: Thu Mar 04, 2010 10:58 pm 
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alael wrote:
Congrats!!! Tangerine! I'm so happy for you! it sounds like everything went really well since you were discharged so soon. I'd love to hear how your delivery went and how your baby is adjusting to life on the "outside" lol! I am almost 27 weeks along and think about how the birth will be a lot. I know I have to have a c-section like I did with my daughter, I'm not really worried about that and pain mgmt. I'm sure it will be fine. How many mg. of Subutex were you on before you gave birth? Not sure if you posted it in a previous thread... Well, good luck to you and your new little one and post when you get a chance.


Thank you! Yes, things went well thank God. Life outside the womb does take some adjustment. The things poor babies have to go through just to be brought into the world, then poked and prodded at, given vaccinations, circumcision, etc...
It is wonderful having my baby here now, after 9 long months of preparation. I love to stare at him when he's sleeping and rub his little neck. Suprisingly he did not have much hair. My daughter head a head full.
I was taking 6mg sub. I continued this dose through the day of induction, then started again the day after I returned home. Post partum in the hospital I received normal doses of Percocet mainly for the after pains which are brought on while nursing in the first few days. I did not have any tears or an episiotomy this time, so healing has been quick. Good luck Alael and enjoy the remainder of your pregnancy, it is such a beautiful time of life.


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PostPosted: Sat Mar 06, 2010 12:45 pm 
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That is so wonderful!!! Did your baby have any signs of NAS? just curious.


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