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PostPosted: Tue Nov 17, 2009 1:03 pm 
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I am hoping to get pregnant in the next couple of months---my husband and I have done a lot of thinking, planning, discussing, etc. and plan on officially ditching the birth control next month and seeing what happens.

I have been on Subutex for around 4 years now after many years of the opiate addiction/treatment/relapse/jails/hospitals/misery roller coaster. Subutex literally saved my life as I don't think I'd have been able to stay clean without it.

But, when I got married and then we started talking about babies, I was so worried that being on Subutex would preclude me--or that I'd have to come off of the subutex--which I knew in my heart I could never do without great risk of relapse. I started talking to my addictionologist and trying to do research and continued to be dismayed to find that the "norm" was to have pregnant women take methadone. I knew I didn't want to switch to methadone.

So, the research and discussion continued, and I have been blessed to find an ob/gyn practice where they were willing to work with me even if stayed on Subutex. They referred me to see a high-risk/perinatologist because of the fact that I take Subutex, plus Ambien, plus Ritalin. I will come off of the Ritalin this month, but the perinatologist said I could stay on the Subutex and Ambien, no problem. That was a HUGE relief---

Here's what still scares me, though---the fact that while all of the doctors are comfortable with me (hopefully) getting pregnant sometime this winter/spring, none of them have direct experience. In fact, the perinatologist really had no idea what subutex was until she did some research while I was in her office. They have never had a pregnant woman give birth while on subutex before, which really surprises me---I live in a big city so really am shocked that I may be the first.

My fears are partially assuaged, but I still have some worries simply because there isn't a lot of research/data. So, I long to hear more personal experiences. I'm printing off info from this site to share with all three of my doctors, so I'm grateful for this site and the Dr.'s personal and professional experiences. I worry about the reactions I'll get once I end up in labor--we all know how awful some doctors and nurses can be. My perinatologist even came right out and said that she'll want to have a consult with the anesthesiologist (I always spell that wrong but am too lazy to care) BEFORE labor-time because she doesn't want me to run into any issues. I was grateful that she acknowledged that the problem exists and wants to try to combat it before-hand, but how frustrating that other doctors don't take a stand more often and rail back against the prejudice and ignorance of some of their colleagues.

My perinatologist did make one statement which, after reading info here, makes me less than enthusiastic---she made it sound like the chances of my future baby experiencing NAS was 100%--now reading here, I discover that this is not necessarily the case---that babies can be born and not experience ANY withdrawal symptoms--and in fact, subutex is probably LESS likely from the get-go to cause NAS than methadone....can anyone confirm that I'm interpreting those facts correctly?

Anyhow, I'm glad this forum exists, and I hope that more women can come on and give info about their experiences. As I begin this journey, the more info I can get from women who have been there, the better!

Thanks!


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PostPosted: Thu Nov 19, 2009 5:49 am 
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Hi hopefloats, welcome to the forum. I don't have direct experience with your situation, but I know there are a few women here who are pregnant or who gave birth while on subutex. Dr. Junig has also had patients deliver babies while on subutex.

I believe at least one of our members reported that her baby had absolutely no symptoms of NAS, and I think Dr. J wrote somewhere that Subutex is safer for the baby than methadone, but don't quote me on that.

You are so smart to be doing this research ahead of time. I know one thing you can do is go to a university library and ask the librarian how to do a database search for articles about subutex and pregnancy. That way you might be able to find some info that will set your doctor's mind at ease about the NAS.

Best of luck to you, and hopefully some of our members with more direct experience will chime in soon.

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You can't stop the waves, but you can learn to surf.

-Jack Kornfield


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PostPosted: Tue Dec 01, 2009 11:27 am 
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Hello!
I was told subutex is safe for the baby and have been on 12 mgs all 9 months. im down to 8 mgs and hope to be at 4mgs by due date, 12/22. I am ALSO the 1st patient the drs have dealt with on subutex. its strange bc its a popular drug and yet i couldnt even get it filled here in LONG ISLAND NEW YORK!!! but i guess suboxone is more popular. the docs said subutex is better for the baby bc of the absence of the other drug, i forget what is called, nal--something? anyway, you can look up articles on pubmed.gov, thats been very helpful. My neonatologist who will be looking after the baby in the nicu said my baby will HAVE to saty for at least a week for observation bc withdrawel symptons can start as late as 7 days. i was REALLY upset abt that but what can i do. I may not be allowed to breast feed either. They did say coming to them b4 hand was a great thing and it shows i care for the baby, etc. they were used to ladies coming in and not saying anything and then rushing their newborns to the er 3 days later, they saidit happens a lot with women on xanax. well i also applaud you for researching this stuff b4 baby comes, it is a huge deal. I will let you know if my baby suffers from NAS which i pray to God she does not. she moves a lot!!!! inside and my doc said babies on methadone do not move as much bc theyre so sleepy. anyway, i hope ive helped. If u hear anything abt breastfeeding pls let me know! go to pubmed.gov!!!


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PostPosted: Sun Dec 06, 2009 2:37 pm 
Leela - Just wanted to write a quick note and congratulate you and ask if you have delivered your baby yet! Please post when you get a chance and let us know how everything went for you.

Hopefloats - Hoping all is well with you and would love an update on your 'progress' in your hopes at a pregnancy soon!

I also wanted to commend the both of you. I was a labor and delivery nurse for many years in a relatively large city hospital. I saw a lot during those years - the good, the bad, and the ugly!! What I never saw (and I only quit practicing a year ago) was a mom on Suboxone. Saw moms on pretty much everything else imaginable, but not Sub.
Anyway, I want to commend you for doing your research, being forthright with your doctors, and doing everything you can do to ensure a healthy outcome for your baby and babies-to-be. I can't tell you how many times I've encountered situations in which if the mother had told the truth about her drug issues, things would have gone so much better for her and her baby!
Yes, unfortunately you are bound to encounter someone in the medical field along the way who will be less than kind about your history and your Suboxone use. There's little doubt about that. However, any professional who is worth you caring about their opinion, will be respectful of your honesty and your disclosure. What they really want most of the time is for you to give them all the information they need in order to provide you with the best care possible. Medical professionals DO NOT LIKE surprises!! I could tell you some stories, trust me!!! (thinking of the woman who not only lied about her drug history, but also lied about her HIV status and the fact that she was about to deliver premature twins and not a full-term singleton!!)
Any way - will stop here - just wishing you the best and patting you on the back for doing the right thing ladies!!


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PostPosted: Thu Feb 04, 2010 1:20 pm 
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Well, it's been a couple of months since I first posted this thread...and I'm thrilled to report that I am now pregnant. Almost 6 weeks, so still very very early, but praying, of course, for a safe and healthy next 8 months.

And I'm still taking my subutex. It's frustrating because w/my ob/gyn group, you see a different person every time you go---so I'm constantly having to re-explain what medications I am on, and inevitably the nurse/doc says "What is that?" when I mention subutex. But, since I went through a fair amount of pre-conception visiting with docs and a high-risk specialist, I know that I can continue taking it.

Here are my next steps:
1) I do need to call the perinatalogist that I saw before conception to let her know that we are pregnant and see when/if she wants to see me and what her role will be in my pre-natal care/birth. She had never heard of subutex before I met her, which was disconcerting, and while she was very open, her experience has always been with methadone babies, so I'm nervous that she is going to assume that my baby will 100% go through withdrawals, which, as we know, isn't always the case with subutex. So, whenever i see her next, I'm going to attempt to go in armed with enough info to share with her to show that NAS is not a 100% certainty.
2) as the months go by, I also want to make sure that I have a birth-plan that includes detailed info on what I can/will need for pain control, possible C-section, after-birth pain control, etc. Again, if I could know that I'd go into labor on a day when the doctor-nurse-midwife on call is one that is familiar with my case, I'd rest easier. But the chances are that we'll be teaching as we push! :lol: So, I want to have a birth/pain plan very detailed and in hand so that the moment we check in, we can get everyone on board. I've had surgery on subutex before and that was easy b/c we knew when it would happen, so we COULD make sure that the doctors/nurses knew and could give me the proper management. But with birth/labor, it could happen any time, day or night, on your due date or way earlier/later.
3) I need to also check in with my addictionologist and beg him to be proactive in contacting my ob/gyn and perinatalogist to educate them and to be involved in my care plan.

I'd love to hear more advice from others who have done this---what else do I need to be doing at this point? Any suggestions for the months to come?

I admit, I wish I could just be a "normal" pregnant woman. There are SO many worries in pregnancy to begin with, and me being on this very unique and un-heard of medication for a disease that carries so much stigma and shame adds a HUGE burden that I wish I could get rid of. But, the reality is, I can't. I am what I am, and I need to hold my head high and demand that my medical professionals educate themselves and treat me with respect. Easier said than done, unfortunately....

Is there a good "pregnancy and subutex" primer available anywhere that I could print and give to my doc? I've seen the ebook for sale on this site and am more than happy to pay to read it---but I need more in-depth info than just "you can get pregnant while on sub" info. And I don't think I can print and share the ebook---so I'm reticent. But if I'm wrong, or if anyone knows of a great publication that I could share with my doctors, please let me know.


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PostPosted: Mon Feb 08, 2010 11:36 am 
Big Congratulations to you!!! That is awesome!! It really sounds like you have your act together....you've planned accordingly and done everything possible to ensure that all goes well. You deserve to feel real good about yourself!
I'd say to go ahead and contact the perinatologist that you had the pre-pregnancy consult with and let him know that you are pregnant. He may want to see you for an indepth eval at around 18-20 weeks, unless you are planning extensive antenatal testing (CVS or amnio or something) in which case you may need seen sooner by the perinatologist.
I agree your addictionologist needs to be in contact with your OB....you want everyone on the same page.
You'll probably have you first OB eval at around the 8 week point. Hopefully everything will check out perfectly and you'll be able to relax for several months and just enjoy being pregnant. As you get closer to your EDC, you'll probably be scheduled to do a pre admit kind of thing in which you tour the L & D unit and meet with an anesthesiologist. They'll take a brief history and you can discuss your Sub at that time. Another thing you might want to do is schedule a meeting with a Neonatologist there at the hospital where you're going to deliver. You may need to educate him/her about bupe, give them a chance to research it so they'll know the NAS is not gonna be like a methadone baby. I know when I worked l and d, if we had a mom in labor and there was any question about problems with the baby....we always called NICU to attend the birth and check the baby out. Hopefully, that won't happen...they'll be educated and will expect a normal healthy baby and just let you deliver, keep baby in your room and so forth. But just in case you get an ignorant nurse or whatever...the NICU/Neo will have a file on you and they'll be clear on what to expect.
Hey, also, get yourself in the mindset that you are a "normal" pregnant woman. Only the people taking care of you need to know about your medications. From what I've read, you have nothing more to worry about than every other 'normal' pregnant woman has to worry about. So just keep doing what you've been doing and give yourself a break....you've taken every precaution you could to do the right thing for your baby.
Just some thoughts. I'm so happy for you. Thanks for letting us know your good news!!


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PostPosted: Tue Mar 02, 2010 10:37 am 
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Thank you, setmefree! I appreciate your comments about getting into the mindset of being a "normal" pregnant women---I find myself so worried that the subutex I'm taking IS affecting the growth of my little baby right now...even though I know it "shouldn't" so I appreciate that sentiment and reassurance from you.

Update on me: I'm 10 weeks (feels like I should be later...time is CRAWLING!) and I will be getting a transnuchal/first semester genetic test in 2 weeks on March 19th. That will be with the high risk perinatalogist that I saw originally for a pre-conception consult. So, hopefully at that time I'll have a chance to have a more in-depth conversation with her about subutex and we can begin to discuss plans. Luckily, I see my addictionologist next week, so I'll get his opinions and permission to share his contact info with the perinatologist and beg him to be in contact with her. He is the expert on subutex and she is the expert on pregnancy, so if they would both speak to each other I'd feel better.

I really wish there was some sort of publication that laid out some of the main issues of pregnancy while taking subutex that I could share with the perinatologist. I think I'll end up writing my own, but of course doctors are going to take it more seriously if it was something written by one of their peers!

What I'm thinking about is a document including the following info:

1) Explaining what suboxone/subutex is, what it does, and how it works--compare/contrast it with medications like methadone.

2) Explain why some people will need to be on this medication for a life-time and that persons taking suboxone/subutex are people with a disease who are actively taking the appropriate steps to treat that disease and keep it in remission, if you will.

3) Discuss findings that suboxone/subutex does not seem to cause any issues for the baby in utero (this is where I really need more info/medical articles)

4) Discuss special needs of women taking suboxone/subutex when it comes to labor & delivery -- ie pain relief (epidurals should work the same, in situations where a patient may normally be given a opiod---can fentanyl be used instead for sub patients? I know fentanyl is one that seems to 'break-through' the suboxone barrier--in the past I had surgery and stayed on my sub and they used IV fentanyl to help stop pain right after surgery and then I had oral dilaudid combined with sub after that---which wasn't so great---I really needed HIGH amounts of the Dilaudid, and if i had to do it over again I'd prefer to stay on the fentanyl---but, this is one of the questions I'll discuss with my addictionologist next week) Also discuss pain control AFTER birth---lots of time women DO need opiods for severe tears/stitches, so what can be used. And, of course, plan of action if a C-section is necessary for someone who has been taking suboxone/subutex.

5) Discuss NAS---how likely is it in babies of women who took sub while pregnant, difference in statistical likelihood of NAS b/t methadone babies and sub babies--how should NAS be handled in sub babies if it does appear?


6) Discuss breast-feeding---research shows that it is OK, cite articles, etc.

7) Discuss feelings of shame, inadequacy, anxiety, embarassment in women who are pregnant while taking suboxone, and encourage medical professionals to work to reassure women NOT to feel this way, to reduce shame/stigma around addiction and to celebrate the fact that someone is in recovery. Discuss the need for education and being open to learning since this is actually a very common disease that is still sorely misunderstood. Encourage active communication between a patient, her ob/gyn/perinatologist and her addictionologist.

I will work on preparing something that covers all of these issues and will be happy to share it with the forum -- I'd love feedback/input from others who are more knowledgable than I! I plan on putting together initial thoughts to bring to my addictionologists appt and hopefully he can help me fill in the blanks--then I'll share with the perinatologist and keep on filling in the blanks until we have something that we all feel covers all questions/issues that may arise.


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PostPosted: Fri Oct 25, 2013 8:21 pm 
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Hi, I know this response is posted late...as I see your original post was in 09. I just wanted to share my story of planned pregnancy while on subutex and ambien. My doctors...my OBGYN and sub doctor were both fine with both medications. I started out on 8mg of subutex and I successfully tapered all the way off of it by the end of my pregnancy because I was so afraid my child would be born addicted. I stopped taking the subutex .25 mg 4 days before my delivery date and my little girl was born perfectly healthy and not addicted what so ever. My biggest fear was my family finding out I had been taking subutex while pregnant. (Trust me they wouldn't have understood) So, now my little girl is 2 1/2 years old and is a normal healthy little girl. To any pregnant women out there who are tapering...take it slow, I followed Robert_325 taper plan of reducing by .25 every few weeks. I had my dr prescribe 2 mg tablets and I cut them into small .25 pieces. It was rough in patches...mainly toward the 1mg mark. But trust me...if I can do it, anyone can!! And also...I breast feed my daughter for 8 months and stayed at a 1mg dose throughout the breast feeding. It was hard to stay low but worth it, I would recommend breast feeding as long as you are on 2mg or less...that's what the lactation consultant advised me. I just wanted to share my story for any worried pregnant women out there. I read every forum and it really saved me throughout that hard time in my life when I felt alone:( you are not alone, and it will be fine...just take it slow and steady and any progress is progress with tapering while pregnant. Good luck to any and all women pregnant and on subutex, my love and heart are with you.


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