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PostPosted: Fri Sep 27, 2013 12:53 pm 
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I have a few questions. A little background I've been a heroin addict for about 10 years with a few try's at sobriety. I've been clean for 15 months and been on Suboxobe the whole time. Because of how long I used my dr recommended I stay on the program for 1-2 years. I found out I wS pregnant in Feb so my dr told me to stay on and tamper down over time. It's been a lot harder than I thought! I'll try to taper down, but then I'll start stressing myself out...will this cause me to go into labor? Is the baby hurting? So here I am 35 weeks and scheduled to have a baby in 24 days!! My OB doesn't know because frankly I guess I was just too embarrassed! But I do have a legit prescription and they obviously know Im pregnant. I'm taking 1 sub strip a day and don't know if I should try and quit cold turkey now so don't have issues during delivery or take them the rest of the time and have a very painful birth. I've heard an epidural won't work while on subs and I'm having a C-Section! My last C-Section my epidural failed and it was like a horror movie!! The worst pain I think anyone could experience! So I'm scared of that!! I've also heard it's 50/50 that the baby will have any issues from it..because of my history my biggest concern is it showing up in the baby system! My baby and I will be tested for opiates. I know on a standard test it doesn't show, they have to specifically test for subs, which the hospital won't do because they're looking for heroin...(none of my kids have ever tested positive, but they test because I was up front with my history). But what I don't know is when they take our blood will the suboxone show up?? And if it did would I be ok since I have a prescription or trouble because I didn't tell my OB? I also know I'll be in horrible pain since the pain pulls won't help me so with this and stressing on it showing up in our blood I'm considering just quitting and seeing how bad it really would be..,but I know that's not the smartest idea...I'm just out of time, I have 24 days left and don't know what to do!! I'm beating myself up for not taking care of this earlier!! Any advice would be greatly appreciated! Thanks in advance!


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PostPosted: Fri Sep 27, 2013 1:37 pm 
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Hi Mommy and welcome to the forum.

Wow, talk about pressure! I'm sure you are stressing over this, but maybe you can do a few things to get yourself in better position for you and baby.

I would suggest you begin by telling your doctors about the subs. And the OB needs to know right away. You should be switched to Subutex immediately to further protect the baby. Be honest with everyone so they can all provide you with the best help and care available! I am a first time to be mommy soon and was also on Suboxone and immediately switched to Subutex. It's standard procedure to put pregnant ladies on Subutex rather than Suboxone.

I would begin a taper down from the subs right away also. If you just stop completely, or jump at the dose your on, it's going to be rough on both you and that baby. Your best option is to taper down as low as possible before the baby arrives. Time is short so you should act now.

You may have to taper much quicker than would normally be ideal. You said your taking "one sub strip" per day which I am going to assume means 8mg? You should begin by reducing your dose right away to give you and baby a good chance of getting by with the least amount of problems.

This is my suggestion and what I would do if it were me.....

Begin by reducing to 4mg per day and remain there for 3-4 days...
Then reduce to 2mg and also remain there for 3-4 days...
Again reduce to 1mg for 3-4 days...
At that point reduce to .50mg for 3-4 days...
Then .25mg for 3-4 days...

That would make it approximately 20 days and get you down to a low dose of .25mg. At that point I would again reduce lower to HALF of that .25mg which would be .125mg and then jump from there after 3-4 additional days. Hopefully the baby won't be here by then and give you time to get completely off the Subutex. With any luck the symptoms will be very minor, and any pain med or epidural they give you will have maximum benefit and work quite well for you.

Again this taper schedule is what I would do myself and is far from the ideal way to go if the circumstances were different and you had lots of time. But you don't have that time and I definitely WOULD NOT jump from a dose of 8mg right now. Reducing, although rather fast, will give you the best chance as I said, and in my opinion.

Maybe others have different suggestions, but that's mine. You take care of yourself and please tell the OB and get switched to Subutex right away! You need everyone working together on this, mom, baby, and all doctors! Keep us informed how it goes. The very best of luck to you and baby. I hope it works out well for both of you. If you have other questions let us know. We're here for you all the way if needed!

Hugs Mommy,
Karen xoxo


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PostPosted: Fri Sep 27, 2013 2:26 pm 
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I'm no expert on Suboxone and pregnancy, but from what I've read, tapering or jumping off Suboxone in the 1st or 3rd trimester is a no-no.

Also, with 24 days to go until you give birth, I don't know how much good it would do to switch from Suboxone to Subutex? It's my understanding that the only reason pregnant women are switched to Subutex is because it has one less ingredient, no Naloxone. To the best of my understanding, Naloxone hasn't been proven to be harmful to a fetus, but doctors take the approach that one less ingredient is safer.

I've seen the 50/50 number thrown around about the baby experiencing wd, but from what I've read on this forum, it seems like the majority of women who give birth while on Suboxone (Subutex) have babies that do not present with NAS. Please read some other stories in the pregnancy section here and see what you think.

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PostPosted: Fri Sep 27, 2013 2:41 pm 
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If you're dead set on tapering I would run Karen's advice by your sub doctor just to be sure. I'm a little cautious about suggesting that you taper completely off suboxone or at all. I've seen many people come here and say that their physician told them not to taper off their medication or risk miscarriage. So, any advice you get from this forum, please remember that we are not doctors, we just make our best guess given what we know. That's why Karen was sure to write that this is just how she would do it.

I totally don't want to be Donna Doubter, Debbie Downer, or Negative Nancy (lol) when I say that having your baby go through withdrawals and having your doctor and nurses find out about it is not the worst thing that could happen! The worst thing would be having your baby be harmed by the decisions you make. That's why I want you to make really sure that tapering is in the baby's best interest. I also want to point out that those 50/50 stats occur whether you're at 8 mg or .25 mg. The amount that you're on doesn't seem to matter.

I don't believe that many hospitals are testing for the metabolites that suboxone leaves in your blood, but it is a possibility. In the best case scenario, your baby will be fine and no one will find out. But if your baby does go through significant withdrawals, they will probably figure it out. I definitely understand the impulse to keep the suboxone secret. If the nurses have a bias against any drug use, even suboxone, they are likely to chalk regular newborn symptoms up as signs of withdrawal.

I'm so sorry that you are stuck between a rock and a hard place. And I'm sorry that I can't give you a definite course of action. Do the best you can and just keep baby's best interest in mind.

Amy

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PostPosted: Fri Sep 27, 2013 8:42 pm 
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I am going to Ditto what Amy said. This is a very delicate subject and a new human life is involved. From what I've heard and read in the past is to just leave things as they are unless instructed otherwise by your physician. You do not want to cause any stress to the baby whatsoever.

We are not doctors, that is the most important thing to take away from all this advice you're getting. Ask your Suboxone doctor to talk to your OB/Gyn or vice versa.

There is another pregnant woman here that I'd like her opinion on. Tinydancer, What do you think? What did your doctor tell you?

BTW, congrats on being an almost new mommie!

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PostPosted: Fri Sep 27, 2013 9:25 pm 
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Thank you for the advice! Switching to subtex was the first discussion my sub dr and I had when I found out I was pregnant. My dr thought that since I had been on suboxone for about 8 months at that point that it would be more harmful to switch so he kept me on suboxone. He also said there's no proof that naloxone has any effects on the baby. I took his advice and stayed on the suboxone. I know I should of told my OB but I was just scared and now I feel like it's too late! And yes when I say 1 strip I mean 8 mg. today I took 6 mg and I'll do it tomorrow. I'm trying to do the "Roberts taper plan" where you taper down every 4 days and if I can do it I'll be off 8-9 days before the baby is due and hopefully I won't have any problems with the pain medication working or have to stress if it shows up or not. I feel like if I tell my OB now the fact that I've been hiding it looks bad....like he may think I've been using the whole time and just got on subs...I don't know. I also want to be off of it! It's been 15 months and I'm ready to stop! I know it was the safest thing for me to stay on, but that doesn't make me feel any less guilty for putting my baby through it, even if he is the 50% with no problems I still feel guilty! I'm trying my best to taper down in time, I guess I'm just worried if I go into lAbor before that...will it show up on our blood? Will my epidural fail?? Stressing on all the what ifs! I just pray tapering down isn't as hard as some make it out to be and I can get this done in time! Thank you everyone for your advice! I really appreciate it!


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PostPosted: Fri Sep 27, 2013 9:51 pm 
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Hi MommyOC,

Have you discussed the tapering with your doctor at all? I know your OB doesn't know, but does your regular doctor know this is your plan? I don't have first hand experience but I do have two friends that were pregnant on maintenance. One was on methadone and the other was on suboxone, then switched to subutex. Both were advised not to taper and keep at a consistent dose. The idea, as it was explained to them, was that the benefits of tapering/ jumping during pregnancy, do not outweigh the risks. The complications with tapering/jumping have the potential to be greater than the complications of baby withdrawal, if that were to happen. Obviously this is a very personal choice, but one than should not be made lightly, and at least be in communication with your regular doc so you have some professional guidance. Tapering causes great stress on the body.

I know you're scared. Scared about what could happen during the procedure, for the baby's well being, and possibly for getting in trouble or feeling guilty. Please hang in there and please try to talk to someone. You haven't done anything wrong, remember that.


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PostPosted: Sat Sep 28, 2013 2:58 am 
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I'm sure it's scary to consider going through another c-section with a failed epidural. Most epidurals fail because they are misplaced. The odds of that happening a second time is not great. However, if the epidural is misplaced, tapering from suboxone will have NO effect on whether the epidural works or not.

Also, although narcotics are typically used in an epidural, they are not the numbing medication! Epidurals numb because of the bupivacaine, chloroprocaine, or lidocaine in them. Adding narcotics to the mix allows anesthesiologists to lower the dose of the numbing medication, but it does not take its place. You can ask for your epidural to include no narcotics! Some people do this anyway to avoid having their babies exposed to narcotics.

So the only thing tapering would be useful for, besides maybe keeping your secret from the ob/gyn, is if you are offered narcotic pain meds after the baby is born! Plenty of moms decline pain meds after c-sections to keep narcotics from their breast milk. That's what I did before I was ever addicted to them. In fact, we have at least one member who got hooked on opiates from taking them after childbirth.

I know that you are dealing with plenty of guilt with your baby being on suboxone and the potential of withdrawal symptoms after birth. But have you considered what your baby will have to go through while you're tapering? Any withdrawal symptoms you feel, your baby will feel also. At least after birth the baby can be medicated to keep him comfortable if he goes into withdrawal. When you're withdrawing while pregnant, the baby has no buffer against feeling those horrid symptoms. Is it really more important to keep the secret of your suboxone use than it is to safeguard your baby's health?

I have been tough on you to bring up these questions. I'm sorry for that. In the long run, it may not make much of a difference if your baby suffers discomfort and stress while in utero. I just want to make sure that you are thinking of ALL the potential consequences of tapering right now before you really get started.

I wish you the very best with the rest of your pregnancy and the birth of your baby.

Amy

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PostPosted: Sat Sep 28, 2013 1:10 pm 
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I appreciate that. Of course the we'll being of my baby comes first, I'm just scared of losing him! My last child I had because the epidural failed during the C/Section they pumped me up with Demorol, Dilaudud, Morphine...next day CPS was at my hospital room questioning me on why my baby tested positive for morphine! I was so upset! I just went through this horrific labor and now I'm being questioned! I explained what happened and they confirmed with the hospital so nothing came of it, but it was scary!! Especially for being an addict in recovery! Here I am now trying to do the right thing and I just feel like people don't understand subs! It's not like getting high, it's keeping me clean! But people still don't know much about the topic and I feel I'll be judged and have to worry about CPS again, even though I have a script! I've changed hospitals to a much better one! I think the last one tests everyone, now I'm going to a catholic hospital where I don't think that's the case, but if I keep my mouth shut and he has w/drs it will be all bad! But what if he doesn't? I know his safety needs to come first! I've talked to my sub dr about tapering and they wanted me off before the baby is born, but now I'm nearing the end and not where I should be! And I know it's not a great idea to taper down so quickly...most likely I'll still be on some amount and I just pray he's not effected!! I'm going out of mind! I want him to be taken care of in cAse of w/drs but I don't want to risk losing him over this!! Sorry still need to vent...


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PostPosted: Sat Sep 28, 2013 2:57 pm 
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You vent away!! You are in a tough spot and I'm so sorry that you are. I don't mean to be saying anything that makes it more difficult for you.

I hope that whatever you decide that you come here for on-going support. Once you've completely made up your mind on a course of action we will just give you our best advice for that situation. Please don't feel like anyone here is judging you. We are here for support.

Amy

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PostPosted: Sun Sep 29, 2013 9:16 am 
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Hey Mommy OC,

I'm so sorry that you are in such a tough spot. First, I want you to understand that nobody here is judging you for any choices you have made! We are all addicts, and any of us could have wound up in the exact spot you are in if the timing was right. We are all here for you and understand your fears!

I want you to know that the CPS will not be able to take your baby from you if he does happen to go through WD. If the subs show up in your system, or his, you have a legitimate prescription and have been advised from your doctor to continue treatment. You have done nothing wrong. They might show up, and poke around, and try to blow about making you feel bad. But they cannot take your baby over this!

Here's what I would do if it were me. I would make sure that you are breastfeeding your little one from the minute he is born. Make it clear that you want him to receive ONLY breastmilk and no supplemental feedings whatsoever. Keep taking whatever amount of suboxone you are on at the time of delivery. He is going to receive enough bupe from the breastmilk to keep him comfortable (hopefully), and allow him to naturally taper off of the buprenorphine in his system. I might even try tapering a little bit before delivery, not to nothing, but some. And then after birth bring your dose back up a little bit. The reasoning for this is that only a small amount of the bupe is going to make it into your breast milk. If you up your dose a bit, it will increase the amount he recieves and keep him more comfortable.

As with ANY advice you recieve here, please run this by your primary suboxone doctor first. Actually, it would be best to tell the OB but I understand why your are reluctant to do so. None of us are medical professionals, and we are only giving advice based on either our own experience or experiences of others we have read here.

I wish you the best of luck MommyOC. My heart goes out to you and your situation. I pray for an easy transition for your little miracle!

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PostPosted: Sun Sep 29, 2013 10:52 am 
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Thank you! You guys are awesome! Any pregnant forum I've been on is filled with judgmental people and they just end up bashing you because they don't understand so I'm not getting any real advice! So thank you for taking time to give me ideas and support. Even though my situation hasn't changed, I feel much better! I've been tapering just a little so like I said most likely I'll still be on it, but if I am I do plan on exclusively breast feeding! I'm just grateful I'm not strung out on heroin!! I know I can get through this and I know GOD is taking care of me and my baby! At least my husband and my parents know the situation and support me, do at least I'm not doing this on my own! I will keep you guys updated...only have 3 weeks left!! If you pray, please pray for us!


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PostPosted: Sun Sep 29, 2013 11:13 am 
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You've got my Prayers Mommy! And no matter what you decide to do you will always have our support here! Just do what's best for YOU and go from there. Just keep us informed along the way as we really do care!

All the best to you and baby!

Hugs,
Karen xoxo


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PostPosted: Sun Sep 29, 2013 4:10 pm 
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MommyOC,

I am praying for you too. Since you brought up prayer, I hope you don't mind me sharing some scripture with you that might be encouraging. I believe, as the bible says, that God is not surprised by this situation MommyOC. Take heart in the fact that He has a plan for you and your child, even before he is born.

Psalm 139:15-16

My frame was not hidden from you, when I was being made in secret, intricately woven in the depths of the earth. (womb)
Your eyes saw my unformed substance; in your book were written, every one of them, the days that were formed for me, when as yet there were none of them.

Jeremiah 29:11-14a

For I know the plans I have for you," declares the LORD, "plans to prosper you and not to harm you, plans to give you hope and a future.
Then you will call upon me and come and pray to me, and I will hear you. You will seek me and find me. When you seek me with all your heart, I will be found by you", declares the Lord.

Keep praying little Mommy! And remember, as much as you love your little one already, God loves him more.

Q :)

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PostPosted: Sun Sep 29, 2013 5:24 pm 
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First off Congrats on the baby!! I m not entirely sure why they switch you to subutex while your pregnant i never asked my Dr when i was pregnant. My best guess was because if the baby went through withdraw they could give the baby meds but if the baby had the naloxone in its system it would block those drugs that are trying to help the baby. I just had a baby 3 weeks ago and he is going through really bad withdraws he is on morphine every 4hrs and they just had to start him on some other kind of narcotic. I was only taking 1/2 of an 8mg subutex a day throughout my pregnancy i tried tapering down even lower but every time i tried i started going through w/d and i could feel my baby kicking like crazy and soon as i took some subutex he would calm down so i was to scared it would effect him if i tried to taper any lower.

My advice is to let your OB know ASAP because if the baby does go through w/d they might not pick that up and if they send the baby home with you and its going through w/d the baby can have seizures and have all sorts of problems! I mean if you are totally against telling your OB i would just keep a close eye on your baby. If he starts showing any signs of w/d like tremors, excessive sucking, if he tries sleeping but cant seem to get comfortable and is crying high pitched i would differently say something. I would say look i was embarrassed and i did not know what to say i would say i was in treatment my entire pregnancy my suboxone dr knows and i would give them his information.

As far as the epidural i didn't really get an epidural i was to far along and the baby was coming fast. They gave me 1 shot in my back which helped for about 10 minutes but for the most part it did work even though i was taking subutex. If they could of got the whole epidural in and if i could of kept getting the meds it probably would have worked better. Just hopefully it will work for you this time with no problems!

Congrats again hopefully your baby will be good with no w/d!


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PostPosted: Sun Sep 29, 2013 5:39 pm 
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Dr Junig's book has an excellent (and IMO Perfect) reference for pregnancy and bupe treatment. I highly recommend you read it over and over.

And to add: I had my first baby completely and utterly drug free. She was the MOST colicky baby anyone has ever seen. One might attribute withdrawal symptoms but she wasn't withdrawing from any drug. Maybe she was exhibiting withdrawal from the womb? My point is that people are quick to give their opinion about the cause of a screamy agitated newborn. And they usually want to make it the mother's fault anyway ("it's 'cause your nervous, you don't have enough milk, your milk makes her gassy, you're spoiling her with all that milk! blah blah blah). My point is to get used to everyone and their uncle telling you you're not doing right. Then remember you are the best mother for your baby and you know what you're doing thank you very much ;)

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PostPosted: Sun Sep 29, 2013 7:35 pm 
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Yeah its very tough having a baby going through withdraw doctors and nurses are very quick to judge and every little thing the baby does they say "ohh that's from withdraw." My son was taken to a hospital 2hrs away from where i live he didn't start showing signs until after 2 days. They where all set to send him home and then the doctor said he seems very agitated so i think he is going to need meds to help him. The doctor that sent him said i think it will be a fairly short stay and here it is 3 weeks later and the doctor that is taking care of him now said it still going to be awhile.

And i mean every little thing he does they say ohh withdraw!! Its like how do you figure... i haven't been around many babies in my life this is my first child but all babies cry, all babies have loose stool (if ur not eating solid foods ur stool wont be solid..duh?) Ill admit my baby has excessive sucking if you take his bottle away just to wipe his mouth he will automatically bring his hands up and start sucking on them and you have to fight him just to get them away from his face just to give his bottle back! But that's not that big of a deal! Another thing they score them on is heart rate.. my sons heart rate was normal and soon as they gave him morphine his heart rate shot up and my husband said something and the nurse said oh that's from w/d! Its like not if his heart rate was fine before you gave him that if he just got morphine he should not be going through w/d!

Its just very difficult one day he will be fine and the next he wont! They will lower his meds then within a day jack it back up! Its just painful to have to leave your child in the hospital and not even have the slightest clue when you will ever be able to take them home! I would not wish this on anyone! I just hope that everything will be different for you and everyone else who has to go through this!!


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PostPosted: Sun Sep 29, 2013 10:53 pm 
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I'm 27 weeks pregnant and currently on 16mg Subutex. The first thing I asked my OB was should I try and taper off before the baby's born. The doc told me the baby will have an equal chance of going through w/d no matter how much Subutex I take. In fact she said that because of increased blood volume and faster metabolism I might have to increase the dosage. And that I shouldn't even think about trying to lower it until the baby is born. I hope that helps.
I understand why you'd wanna keep the fact that you're on subs to yourself. Honestly sometimes I wander if I should've done the same thing. Although most of the people at the hospital where I'm supposed to deliver my baby boy have been very nice and supportive about the whole thing I still get treated differently. The drug test me every time I go there. With a smile and not that we don't trust you..... line. But it still sucks even though I'm absolutely clean and have nothing to hide. It's like we're getting punished for making the right choice and being honest about it.
Just be aware that although chances are your baby will be absolutely fine there's also a chance that he or she will have some w/d symptoms even if you lower you dosage as much as possible. So just keep that in mind and watch out for those.
Best of luck to you and your baby!


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PostPosted: Thu Oct 03, 2013 11:31 pm 
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First of all, BREATHE!!!!


Second of all, honesty is the best policy... usually!

Third of all, I was on 24mg of suboxone from the time I was six months pregnant and forwards (and 150mcg/hour fentanyl patches PLUS oxycodone for breakthroughs (taken daily) to boot. My daughter had ZERO withdrawals. My firstborn, a son, however, had some obvious, but not crippling, withdrawal symptoms (four years prior my daughter's birth) and I was only on a normal dose of daily vicodin for my rheumatoid arthritis/fibrromygalia.


My son's birth was met with a lot of judgement. The nurses did not understand why I NEED narcotics during my pregnancy. My son was kept in the hospital for observation... for five full days. He was released at a week old. I had to meet up with a social worker and such. My ob-gyn was the prescriber of my narcotic painkillers.... however, he wasn't there when my son was delievered and this caused the commotion.


When I was pregnant with my daughter, I knew the fentanyl would cause CRIPPLING withdrawals. So I switched to suboxone. I was honest and upfront with the ob-gyn. A month prior her birth, I scheduled a meeting with the head nurse that would oversee my daughter's care and made sure she understood I was physically dependent on opiates, but trying to make better choices for my daughter, and we had extensive conversation about what I could expect after she was born. How they would assess and observe her for a withdrawal, etc. The idea was to form a positive relationship with the nurses. This goes a LONG way!

I think if they see you are honest and already have a child who is thriving, and are in a good place mentally/physically, they judge a lot less. Fortunately, my hospital, however small, was rather experienced with suboxone and reacted positively.



I kept my daughter in my room the entire visit. She showed no signs of withdrawals. And was released at the normal time as any other newborn (before 48 hours, I had C-section.)


So... I honestly would bring it up with your ob-gyn... have your addictionlogist in touch with your ob-gyn and vouch for you.... and schedule a meeting with the head nurse and appoint a positive and open communication. Make sure to include your fears and hopes. I know I told them I was totally afraid of being misjudged for taking suboxone and I wanted nothing but the best for my baby.

Good luck!


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I just wanted to send an update. I had my baby boy on Oct 21st and he weighed 8lbs 1oz and 20 inches. I was worried my epidural wouldn't work during the C-Section (since it didn't last time) but it did! I obviously didn't take any pain meds during recovery besides Motrin and it did suck for 2 days, but I lived! My son did go to the NIcU which obviously freaked me out, but it turned out he just had extra fluids in his lungs which is very common for a C-Section baby (happened to my last child) so he aS released and because I was doing so well I got released from the hospital after 2 days. Now I never did tell my OB and nothing showed up or at least no one came to ask me why I was on suboxone. I have and continue to look for signs of W/Ds but haven't seen any. He sleeps a lot, which is normal, but he's a great eater, he's gaining weight, the dr said he wAs perfect at his newborn check up and seems to be a very happy baby. I do have some concerns because I'm breastfeeding and my sub dr doubled my dose because they get such a small amount, but because he's not showing signs of W/Ds my husband doesn't think I should do that...why go back to 16mg when it's taken me so to get to 8mg! Now that I'm not pregnant I would quit it cold turkey tomorrow, but now I'm worrying well maybe he's not having withdrawals because I doubled and I'm breast feeding...if I quit then he could go into W/Ds or is he just that lucky 50% that isn't going to have any? There's no way to know unless I stop and I don't want to Chance hurting him..so I figured I'll just taper down while I'm breast feeding and we'll do it together...on drugs.com they explain the amounts and he's barely getting any of the suboxone so I just pray that if he was going to have any withdrawals from this it would have already happened. Anyway, he's ok!! So I stressed for many months and it turned out ok!! But now I'm stressing on this...but so far so good! I feel very lucky! I'm so grateful to GOD because I know I was doing the right thing by taking subs! I know it kept me clean and I had a healthy, beautiful baby!! I just pray now that it continues!!! Thank you all for your help and advice!!


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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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