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PostPosted: Wed Jun 21, 2017 4:56 pm 
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Hello all. I know there are numerous posts regarding this but some are quite a few years old and I would like more current information.
I live in Alabama and am currently on 12mg Subutex prescribed by my psychiatrist (addiction specialist) and cleared by my OB. (OB did not and does not recommend discontinuing or weaning at any point). His stance is that, although methadone is the standard of care for opioid addiction in pregnancy at this time, he does not understand why this is the case when Subutex is shown to be much better. I trust my OB and don't believe he would have me do something that could be detrimental to me or my baby and I don't believe he would neglect to inform me of possible consequences.
However, we haven't talked yet about what happens once the baby is born. I don't know the hospital's policy on NAS or even the possibility of it. Do they automatically assume since the mother is on Subutex that the baby will develop NAS and therefore keep all babies born to mother's on maintenance treatment for several days to watch them? I feel I have had more and more questions arise in the few days I've been on this forum.
Initially I was under the assumption that since I am prescribed this medication and under the care of a physician for it and that I have been honest from day 1 of my pregnancy that there would be no need for DHS to be involved and that unless my baby exhibits true signs of dependence the hospital would have no reason to intervene. However, now I'm afraid that once the nurses know that they'll look for signs that aren't there and my baby will end up in the NICU being treated for something she may not even have.
I did a little research and found that some counties in AL have chemical endangerment laws allowing prosecution of mother's using any substances during pregnancy, while under the care of a physician or not! I couldn't find anything indicating my county operates this way but was hoping I could find some recent, relevant responses here. I live in Tuscaloosa County in Alabama.
Again, my OB was knowledgeable on Subutex and I didn't feel like he was giving me any inaccurate information regarding how it could affect my baby down the road.
He did say my baby would definitely be dependent... I hate the thought of this but hate the thought more that if she isn't that she and I will both be treated as if she is regardless.
I see him next week for my next appointment and plan to ask him about all of this. What happens if she is? How they treat it? How long she has to be monitored if that's policy?
I see some posts here where people are saying there is a definite window of time they will keep the baby if NAS is a possibility but then there are others where women are saying they left the next day and there was never any issue. Most of my family knows I take this medication but I don't believe my boyfriend's family does and I would hate for them to find out about it because my baby is needing to stay in the hospital for 5 days "just in case."


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PostPosted: Wed Jun 21, 2017 6:33 pm 
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Hello Brittanne...

This is the conclusion to a study I found...

"Buprenorphine substitution seems to be safe during pregnancy, and has had no teratogenic effects reported to date. It induces NAS of variable intensity that is less prolonged in comparison to methadone; the neurodevelopmental outcome of exposed children is normal in the majority of cases, although some presented with transient motor abnormalities that resolved completely in 85% of those recruited to our study."

So it seems it does induce NAS but apparently is fairly easily treated. I can't attest to the quality of this study, but wanted to be able to reassure you that bupe looks superior to methadone in its affect on newborns.

Here's the link to the study itself.

https://www.ncbi.nlm.nih.gov/pubmed/14616186

I'm certain others will weigh in, hopefully mom's who've been in similar situation. Also we have a couple
of expert physicians who might well be interested in your post.

Please don't forget, your sobriety matters. I completely understand your concerns of course. I'd also recommend pursuing this with your physician in more detail. Ask him for studies, and what you might expect with your new baby.

If he's a good and caring physician, he won't mind.

Best wishes,
Godfrey


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PostPosted: Wed Jun 21, 2017 7:41 pm 
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Hi brittanne09,

Some good stuff Godfrey posted for you. Not knowing much about this topic I will leave it up to those with experience to help you out. What I did do though was to delete a carbon copy of this thread so you didn't have two of the same thing on here. Sometimes a member needs to wait a bit for the forum to process the post. If you hit the Submit button a 2nd time it will post another one. That's the one I deleted.

Welcome to the forum and congratulations on your pregnancy!

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PostPosted: Thu Jun 22, 2017 10:03 am 
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Britt09,
you have many excellent questions. However, there many regional differences in practice so my observations may have very little validity in Alabama. Sounds like CPS procedures are different as well.
I would recommend you write down your questions to ask your OB. You may need to go to the director of nursing or similar position at the hospital as well.
Will CPS be notified if I have a prescription and you know I am taking Subutex?
Will my baby be held in the NICU for a set amount of time?
What medication and how do they manage NAS?
How many moms have you had on Subutex and what was your experience with labor and delivery?
Can I have an epidural?
Can I breast feed and stay on my Subutex?

My answers won't help, because what matters is who will be involved in your management.

I doubt if it will have trickled out to general practice by the time you deliver, but a study in JAMA recently compared morphine and buprenorphine for NAS. The study included moms on any opiate prior to delivery and their child developed NAS. The babies getting buprenorphine had stays about 1/2 as long as those on morphine and required lower initial doses. The infants were randomized so staff didn't know which they were getting when they would do their ratings.

Godfrey shared a good link, moms taking buprenorphine have infants that develop NAS less frequently and severely than moms taking methadone (or heroin for that matter)
I think your OB's thoughts on MAT are valid, Subutex is better and the standard of care is swinging towards buprenorphine and is now considered equivalent to methadone.
good luck, be strong


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PostPosted: Thu Jun 22, 2017 10:48 am 
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Sorry, New England Journal of Medicine, not JAMA.
Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome
http://www.nejm.org/doi/full/10.1056/NEJMoa1614835
You can see the abstract with this link. Fee for the full article


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PostPosted: Mon Jun 26, 2017 11:17 am 
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I recently had my daughter March 27th of this year and I was on suboxone through my pregnancy. I live in Florida and chose not to inform my doctor because she was baby number four for me and with my previous 3 (there's a 7 year age gap between my last youngest and my newbie) I was not on any medications so I had a good idea of what to look for and if I felt she was in any form of discomfort I would have informed the doctors, but luckily she was perfectly normal and weighted a healthy 9 pounds and 6 ounces. Before I was pregnant I took between 8 and 12 mg daily. When I found out I was pregnant I kept my dose the same for the first 3 months until I was past the "high miscarriage" phase. From that point I gradually started to lessen my dose by 25% every 3 or 4 days sometimes longer depending on how I felt. By the time I gave birth I was at .25 of a mg. I would speak to your doctor if they know your taking them and start working towards tapering down, it lessens the risk of the baby suffering from any NAS. Also you know if your feeling rough so is the baby which is a good thing because when baby comes out they cannot communicate how they feel but for now you can feel what they feel. During my taper I had some slight discomfort but nothing I couldn't handle when I put my mind to it (alot of it is psychological for me anyways). I also split my dose and took it every 12 hours instead of once a day, it just worked better for me. When I first started my taper I actually cut my dose in half and had zero symptoms but everyone is different. I used that fact that I didn't want my baby to go through any withdrawals and pay for my choices, it was my drive and determination not to see her in pain that allowed to get to such a minimal dose. She was luckily born with no issues at all, my epidural worked perfectly fine and we went home 36 hours later. She eats perfectly normal and slept through the night around 2 weeks old. I know it's not easy and you feel guilty but your doing the best you can. If you have any questions I'll check back, good luck momma :)


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PostPosted: Tue Jun 27, 2017 8:28 am 
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Looks like we have quite a few Bama people as of late.

Hello, Brittanne...Not far from Tuscaloosa. In fact, I'll be coming through sometime in the next few days on my way to McComb, MS to pick up my youngest son from a 3 week visit with family...

Sorry I can't give any advice on the pregnancy thing...
My plumbing is totally different.

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PostPosted: Fri Jun 30, 2017 1:51 pm 
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Hi! That is great that mommyof4 was able to taper ok. Awesome! And if you can get into that same mind set then great. But if not, don't compare yourself to someone who could and beat yourself up. Don't force yourself if you feel misersble while doing so. Everyone is different and is going through different things. And I don't really agree with the theory that you know how baby feels when he/she is inside of you so you can control the withdraw. But still, I applaud anyone who is able to safely tapper during pregnancy. I also support anyone who doesn't feel that they can taper. I was forced to taper and then had a heavy breakdown during the beginning of my 3rd trimester and had to get all sorts of back up to get my sub doc to raise my dose. Looking back now i find it sort of curious that i was nearly preclamptic until my dose wss raised. So for me it was worse being tapered down then just staying where at was when i got pregnant. Got to go to work now but will check back again...


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PostPosted: Sun Jul 02, 2017 1:42 am 
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You are on Subutex (generic) so that is the first most important controllable factor.

Yes, Subutex considered better than Methadone, supported by research.

If your baby does have NAS it will suck watching but baby will be okay!

+ and - to watching video:

Watch "Newborn Son NICU Dextox - Part 1 of 2 - The Pregnancy" on YouTube
https://youtu.be/smG8F3Ut7Pk

One person's experience but it can get emotional and may be too intense. I'm just trying to give you "the real". So, do not watch if you think such may scare you. Regardless, baby will be okay.

As always, we must defer to your doctors. DO NOT be afraid to ask your Subutex doctor and OB specific questions! If they say "I don't know" ask them based on their experience or what they have seen.

In addition to those who can give you first hand accounts, the docs will be able to provide the best information!


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