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PostPosted: Wed Dec 30, 2015 1:26 am 
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Ugh,I live in Florida & i delivered aa healthy baby girl 5pounds14oz(i have small babies even before the sub.) Well i gave birth at the same hospital i had my second youngest,but when i had her,i had not yet started on the pain pills.so i had a nice experience at this hospital the first time. Well i gave birth at 12:40pm on a Thursday..well since dcf case worker decided to show up at the hospital & tell the nurses & drs i had been taking the subs (i missed my dec appt & they couldn't reschedule me until jan 11th so i had to borrow from a friend until the 11th..so they treat it as if ive never had an rx & im just taking them illegally(which yeah i guess) so this child services lady tells the nurses & drs that ive been using illicit drugs again which i havent in over a year so anyway at like 4pm this child services lady tells me that the baby is showing signs of withdrawl (& im thinking to myself,thats impossible i had taken 2mg at 5am & 2mg at 10am.so theres no way the baby is showing any signs already) but of coarse they listened to the "nice government lady"(she was far from nice lol) & they started scoring her when she was i believe 12 hours old & i had her in the room with me until after dinner & she was FINE, no crying,no tremors,no nothing..every time im with her she is just like any other baby.they did a urine drug screen on me & the baby & they also checked her meconium & we were both negative for everything (they dont have subs on the test ) however i did notice some mild symtoms,sneezing, frequent yawning & some dirrhea by day 2 they start her on .13ml of morphine & now she is 19 days old & still in the hospital,still on morphine, theyve tapered her slowly every 48hours & now shes on .05 & they will lower her again tomorrow.there was one time she was on .11 & the Dr tried lowering her to .08 but she didnt handle that so well so they increased it up to .10 & now theyve been doing .1ml at a time usually..once or twice theyve tried going down by .02ml & she did fine..ive noticed some of the nurses tend to give her higher scores everytime they have her on their shift & then theres some nurses that always score her on the lower side..im hoping she will handle the rest of the last few decreases well so she can come home. But a friend of mine had a baby at the same hospital 2 months ago & her story is identical to mine except shes never had a rx for them. & her baby was in the hospital on morphine for 43 days :( so im hoping since the lowest dose is .02 (they'll go down to .01ml if absolutely necessary) that ahell be home real soon..i hope my experience can help some one & give them an idea of possibly what to expect.i wish they didn't start her on morphine unil it was necessary,not when her symptoms were so mild & manageable.i wouldn't object if i thought my baby girl was in any way uncomfortable or in pain. of coarse i just want her to get better & be happy.


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PostPosted: Wed Dec 30, 2015 2:33 pm 
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Dr. J? Do you have any input?

Amy

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PostPosted: Wed Dec 30, 2015 2:50 pm 
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Sorry for what you're going through. Here's a recent post from Dr. J on suboxonetalkzone.com. If you go there and look under the topic "Pregnancy" you'll find a lot more. Also, in the pregnancy section of this forum you'll find many stories similar to yours. Usually as long as you're not actively using, the state will eventually get out of your life.
Good luck, and keep us posted.
Lilly

Baby’s Buprenorphine Withdrawal - by Dr. Junig

This morning I responded to a woman at SuboxForum. Her baby was taken to the NICU for ‘withdrawal’, which is better identified as neonatal abstinence syndrome. She said that the baby is eating well, but there is concern that the baby sleep only 2 hours at a stretch. The baby is on morphine, and mom is wondering when they both can go home. She is kicking herself for not trying to stop buprenorphine before the delivery. I spent a while responding, so I decided to post my response here as well, in case a mom in a similar situation stops by. My comments:

I have written a number of posts about neonatal abstinence, and I invite you to read a post in my blog about the guilt you are feeling.

First of all, you did the right thing. Period. Every medical specialist, study, or text will say the same thing: that women addicted to opioids should be maintained on a long-acting opioid until the baby is born. Traditionally, that opioid was methadone. But women on methadone who are pregnant often end up on very high doses of that drug– pushing their tolerance to high levels, so that virtually all their newborns have significant withdrawal. Of course, the babies do fine in the long run— and the experience of withdrawal is not among the worst things that a baby experiences, by far.

People see a shivering newborn and somehow imagine that the baby just ‘came to be’, at that moment. In reality, a couple hours earlier the baby was in the birth canal, squeezed so tightly that shoulders are sometimes broken, probably experiencing a sensation akin to suffocation. I say that because while oxygen is being delivered via the umbilical cord, during deliver the cord is often compressed, causing changes in oxygen and carbon dioxide that would cause the same physiologic sensations as asphyxiation. The low oxygen tension and high carbon dioxide levels stimulate the ‘preborn’ to breathe, a hopeless challenge when the baby’s face is tightly wrapped by the birth canal!

And of course before that, the baby was upside down, getting pushed, squeezed, bounced… we picture this wonderful intra-uterine environment, but in reality we have no idea what it ‘feels like’ to the fetus. All the things we see after the birth were before birth, except perhaps the shivering. When the baby is born, there is no ‘on switch’ that suddenly starts recording his experiences!

As buprenorphine has become more-available, the trend has been to use buprenorphine instead of methadone. There are several advantages– the tolerance of the mother is much lower, meaning any withdrawal in the baby will likely be less severe. According to a number of studies, about half of babies born to moms on buprenorphine show signs of neonatal abstinence syndrome, compared to almost all babies born to moms on methadone. Studies show no benefit to tapering buprenorphine to lower doses before delivery, but I tend to think that there must be value in doing so. I wonder if those studies truly had good control over the doses that study subjects were taking. My patients seemed to benefit by reducing to 4- 8 mg during pregnancy– but perhaps my impressions are biased.

Another biased impression of mine is that babies have experiences largely dictated by the sensibilities of their neonatologists. Almost all of my patients who delivered at the local, small community hospital did great, and moms and babies went home at the regular time. If there was any withdrawal, it wasn’t noticed. Maybe it was treated by the buprenorphine in breast milk, because all of the mothers were encouraged to breast feed. Nursing while on buprenorphine seems to me to be the ideal way to wean a baby off the medication; the baby’s immature liver gets better and better at metabolizing medications after birth, allowing the amount of buprenorphine in the bloodstream to decrease over time.

Hospitals with neonatologists and a neonatal ICU are going to USE those things. The regular OB nurses in those environments tend to become less-familiar and less-comfortable with anything other than ‘normal’, and watch for reasons to send babies to a higher level of care. Every nurse on the OB unit knows that this baby’s mom is an addict. If the baby cries along with all the other babies, the nurses will believe that ‘this’ baby is suffering from withdrawal. And when the baby is sleeping along with all the other babies, the nurses will think ‘this’ baby is sedated from buprenorphine.

They will transfer the baby to the neonatal ICU, where the environment makes ANY baby look sick and miserable, opioid withdrawal or not. Just look at the environment, and all of the little ways that mom’s experience changes…. instead of smiling nurses wheeling the baby into the room, congratulating mom repeatedly in front of smiling family, you have busy, serious-faced nurses and doctors bent over charts or computers. When they take time to talk with mom, the conversations are serious, and certain to instill guilt and fear. The baby is attached to wires or tubes, perhaps wearing oxygen, under unnatural lighting that changes skin color from healthy-looking to some type of medical specimen.

The baby will remember none of this, just as the baby won’t remember the difficult journey down the birth canal… or the circumcision! Rest assured that all of the pain and misery will reside completely in mom, which is probably where the doctors and nurses intend for it to go. I realize, of course, that there are good doctors and nurses out there… but I know that when you get a group of people together, the urge to look down their noses at people with addictions often becomes too powerful to avoid.

Most important of all: a couple years ago I did a talk for a large group of public health nurses, social workers, and AODA professionals about the impact of opioid dependence on pregnancy and on children born to women addicted to opioids. I did an extensive literature search to prepare for the talk, and I was glad—and surprised— to find that there are NO known long-term effects on children from methadone or buprenorphine treatment during pregnancy. There ARE problems in some children born to addicted moms, but when the studies are controlled for cigarette smoking, poor or absent prenatal care, use of alcohol, and other factors, the use of opioids has no long-term developmental impact. That is VERY good news.


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PostPosted: Wed Dec 30, 2015 4:43 pm 
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Hey hcabales welcome to the forum!

I hope ur baby girl gets to come home soon, I'm sure u just want her home so u can start some normalcy. Keep positive and hopefully soon this will be over. Good luck and congrats to u on ur new journey with ur daughter.

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PostPosted: Wed Dec 30, 2015 9:41 pm 
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I've been away for a few days, so thanks Amy and Jenn for sharing my thoughts!

Cabales, the main thing for you to know is that NONE of this will have a lasting impact on your child. The last two weeks seem like forever to you, understandably. But your daughter is at an age where things just don't get 'recorded'. Just 20 years ago, babies were put through major surgery without anesthesia-- other than paralytic agents and perhaps some narcotic. Attitudes toward surgical anesthesia have changed, but babies still go through a number of painful experiences around the time of delivery, ranging from the delivery itself to circumcision. If you had delivered two weeks later, your baby would be in your uterus right now, exerting great effort to inhale and exhale the amniotic fluid that it would be resting in. Of course your baby would not remember THAT experience-- just as she won't remember THIS experience, occurring at the same age but outside of your body.

Maybe the use of someone else's medication is influencing things, or maybe not-- but what's done is done. You will soon have your baby back, providing you don't start using illicit substances--- which does not sound likely. In the meantime, try to accept the fact that we sometimes have no control over a situation... and try to tolerate the sadness, shame, and anger in an appropriate way, WITHOUT reacting in a way that causes more problems. I promise you--- all of this will be a minor issue when you look back a few months from now--- and your baby will have no ill effects from what is happening. I don't mean to downplay your frustration--- as waiting for your child to come home must be very difficult. But there are worse things... and you have much to be grateful for. The people with your daughter, honestly, are trying to do everything in their power to keep her SAFE.

That's a good thing. Remember that in the end, you both have the same concerns in mind.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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