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PostPosted: Sat Jun 05, 2010 7:55 pm 
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Hi, I have a few questions which I hope some of you can answer or relate to! First some background: I have a history of opiate use and abuse, I started MMT 2 yrs ago, then 1 yr ago quit methadone (thank goodness!) and started on suboxone and have been much happier since! Anyway, I started out needing 24mg suboxone a day, and was doing fine with that. My husband and I found out I was pregnant a few months later, this wasn't planned however, and I worried greatly about the effect this would have on the baby. My doctor switched me to subutex, and against my physicians advise have decreased my dose down to .12-.25mg per day. I am now 39wks pregnant and due to have a c-section on Tuesday (3 days). I have some concerns about the way the subutex will interfere with pain management. I talked with my Dr., and he said the subutex still has a blockade effect to other opiates but just to let the anesthesiologist know and they will know what to do. However, I'm not confident they will. I told my OB I was taking suboxone, and he didn't even know what it was! This is a group practice of six different physicians, none of which who remember anything you've told them from visit to visit anyway.
:?: My question is: are there any other pregnant women out there who have been in this situation? How does the subs affect pain management? What do I tell my doctors? Will I be in excrutiating pain after this procedure? Will my baby suffer terrible withdrawals until my milk comes in?
I stopped my last dose last night and will try and keep it out of my system until Tuesday, but will this even matter? I am so scared, and I have put off talking with the doc- as I didn't know which one would be doing my surgery anyway and figured I would talk with him before they perform surgery.
Is there anything else I should be sure to tell him before hand? I'm a little scared of going into details about my using subutex because I'm afraid they will look at me as 'just another addict' and under medicate my pain, or fear giving me pain medication due to my history.
:!: I hope someone can help me! Very very nervous about this.


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PostPosted: Sat Jun 05, 2010 8:26 pm 
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1. Another woman on this site just had a C-Section while on suboxone I think either 2 or 4mg per day and she didn't mention anything about pain control issues, but she had a lot of other things going on at the time. I don't think she is likely to respond as she is at home with a newborn and 2 other kids.

2. Your baby may have some mild withdrawals from the subutex but it seems to be kind of hit and miss and it also seems to be that they score the infants high because they expect them to be in withdrawal when that isn't always the case. From what I understand, you have to really watch them do the scoring to make sure it isn't too high and that they don't give the infant methadone for withdrawal. From what I understand, most want to avoid this.

3. There is an article that Hatmaker posted under the suboxone and surgery forum that is great for pain control, surgery, while on suboxone. You may want to try to find that. It was posted in the last 2 months. Should be easy to find.

4. Dr. Junig has some great articles on suboxone and pregnancy you may want to read.

5. From what I understand, there will be an automatic 72 hour hour hold or something like that when you give birth on suboxone. Expect your baby to stay in the hospital at least this long.

6. I have seen 2 women post now about having an issue with the hospital drug testing the baby AFTER they have given you narcotics and prior to you giving birth. Clearly your baby will then test positive for opiates. You need to be ready to point this out to them. It seems they often tend to get child protective services involved but CPS seems to go away and close the case very quickly also. It is ok to be on subutex while pregnant and when prescribed by your doctor.

7. I realize it is difficult to decide on your current dosing of subutex when your OB doesn't even know about it. It seems many get their advice from their sub doctor during pregnancy. I highly recommend following their advice on the dosing. It seems most of them recommend you do NOT fully discontinue your sub prior to giving birth. I do not know WHY this is exactly but I assume it has a lot to do with your blood pressure, heart rate, and anxiety. I suspect it may actually be worse for the baby for you to experience withdrawals while pregnant and it is easier for them to do it on their own if it is going to happen. Personally, I think that is because most addicts make withdrawal worse by incessantly thinking about it and thinking about taking subs and thinking about the baby and thinking and thinking and thinking which drives your heart rate and blood pressure even higher. The baby on its' own accord will not have the capacity to do this so they are likely to experience less stress on their own. AGAIN.......I have never heard a doctor say this. It is my own personal theory and thoughts on the topic. I am NOT a medical professional.

All in all, I think everything will work out for you ok. Some people have had small bumps in the road, but nothing you can't handle if you are prepared and are careful. Better to walk in expecting the worst and experiencing the best right :-) I do think you will be ok.

Best Wishes & Congratulations!!!!
Cherie

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PostPosted: Sat Jun 05, 2010 9:30 pm 
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Thank you Cherie for the reply, I appreciate this a lot. I will see what articles and info Dr. Jung (?) has posted.

I just read a lot of the posts in this forum and some of the birth stories have me scared. I don't want my baby to go to the NICU which is why I've tried to decrease my dose as low as possible at this point. I'm worried they will treat this baby different than other babies due to the knowledge of my sub use, and that any sign of distress, like crying, etc. will be interpreted as withdrawal and they will take the baby away from me.
I'm so scared for Tuesday to come. I work in a hospital so I know how quickly a patient can lose control of a situation based on hospital protocols and fears. I just want my baby to stay with me after the birth.

If I breastfed wouldn't this help decrease NAS?


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PostPosted: Sat Jun 05, 2010 9:37 pm 
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I responded to you under a different post when you asked about this situation, although Jackcrack's response was more comprehensive. Here's some of Dr. J's blog posts: http://suboxonetalkzone.com/?cat=53

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PostPosted: Sun Jun 06, 2010 12:14 am 
Hi Mandaloou and welcome. If I understand you correctly you are are on 0.12 to 0.24mg a day of Sub? That is a very low dose, and it's my understanding that at very low doses the half life of sub becomes dramatically shorter. If you know when you are going in for the C-section you could probably just not dose for the previous 12 to 24 hours and not have the sub block the pain medication. Also, as others have pointed out, not all babies born to mothers on Sub even show signs of NAS, and with you being on such a low dose I think you have a good chance of being in that lucky category.
I know it's hard not to worry, but it sounds like you've taken care of yourself and been honest with all the doctors. Everything is going to work out OK. I wish you all the best.
Lilly


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PostPosted: Sun Jun 06, 2010 12:34 am 
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Hi Mandalou. I just read your post and I am the person who posted a question about 8 months ago before I had my baby. First let me say I understand how you are feeling and what you are going through. I will tell you about my experience. I also would like to clarify what dose you are taking. If you are taking the .12 to .25 of a mg of sub then you are taking next to nothing.

I managed to get down to about 1 mg before the c-section. I had all the concerns that you do. Will the baby be okay? Will there be withdrawals? Will I get effective pain relief? Let me preface my experience with one thing. I made a very thought out decision not to tell my surgeon or OB about the sub. I had enough to get me through the pregnancy. I am by now means telling you this is a good idea. It was my choice because I feel that most doctors are SEVERELY undereduated- or not eduated at all- on suboxone, bupe, subutex, etc. Also, lets face it. People treat opiate addicts like they are trash 90% of the time. I did not want to be withheld proper pain control while in the hospital because of someone else's jusgments. I did not want people fearing that my child was somehow in danger because of this. I am an amazing mom to three very well adjusted kids.

So I had stopped the sub about 42 hours before surgery. I was already starting to go into mild withdrawals as my dose was low and I have a very high metabolism. Surgery went absolutely fine. And I was in a lot of pain afterwards. I required a lot of opiates for pain control. Not because of the sub but because I had a huge baby and they really had pull like hell to get her out. She even had to make the incision bigger so it didn't tear. My baby was FINE. Again, I think that if I had told them I was on the sub they would have gone out of their way to find withdrawals symptoms where there were none. There are even a lot of studies that say that a lot of what they might call w/d symptoms are really just the newborn adjusting to life outside the womb. I should also say that if anything had gone wrong at any time with me or my baby I would have told them about the sub. So we eventually got my pain under control. I had my husband control my meds at home and I was very honest with myself about whether or not I needed them. I did this to protect myself and I'm glad that I did. I needed those opiate pain meds for my major abdominal surgery. But I needed to not have control of them. Oh, and I personally don't feel like just the sub alone would have come ANYWHERE close to controlling my pain after either c-section.

Please also keep in mind this is my second "sub baby" and c-section. The first was an equally positive outcome. If you are at that low of a dose I think you and your baby will do great. I know you are close to surgery day. Gosh I remember those feelings like yesterday. I'm sorry this is so long. I hope you get this message in time. If you have any other questions please feel free to respond or send me a private message. I will be happy to help you.


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PostPosted: Sun Jun 06, 2010 4:22 am 
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Hi Mandaloou and everyone,
I have been reading this really wonderful forum in order to gather information to help a family member taking suboxone. I hadn't intended to post, but I am an RN working postpartum mother-baby at a large US hospital, and I see you're scheduled to give birth on Tuesday, so I braved butting in, in hopes that I can help a little.

First of all, congratulations! And weaning yourself down to such a tiny dose during pregnancy must have been difficult.

I have to say that I haven't had a patient taking suboxone yet, but I've had patients on high methadone doses, and other patients on oxycodone, etc. At our hospital, the neonatologist or the pediatrician decide where the baby will go (nicu, observation nursery, or with mom). In all the new moms I've taken care of who are taking methadone, the baby has gone to newborn nursery and then out to mom after the bath. We use a behavioral scale to assess any withdrawal signs. I haven't ever seen anything other than mild withdrawal signs in these babies. The baby would go to nicu if the withdrawal scale was over a certain amount. Learning to swaddle the baby well, and use of pacifier for comfort can help. Breastfeeding is comforting to any baby, and the moms reported to me that they felt their babies were helped by it, and that it helped with withdrawal of the baby. Since subutex is a relatively new drug, I don't know if there's too much info about the safety of breastfeeding while taking. Again, you are on a tiny dose, and maybe will even be off by the birth, I understand?

Your pain management while in the hospital will be dicey for you no matter what, let's face it. You'll have to decide whether to tell the doctors about the sub or not. Yes, some doctors and nurses will judge and label and try to under-medicate, and many will not ever have heard of the med. Though sub may be unfamiliar, having an addicted patient is more and more common. Please don't be afraid to ask for what you need. Ask your nurse to phone your doctor if you feel you need something different. Ask for the charge nurse if she tries to stonewall you. Remember that breathing deeply and relaxation techniques are always good tools in your arsenal in dealing with the discomfort. Get out of bed as soon as they let you. You'll recover much more quickly. Walk in the halls as soon as they let you, and then 3-4 times a day (helps get the GI tract moving and prevents painful gas buildup.) Take gas x and colace (ask your nurse to get an order if there's not an automatic one.)
Hot tea helps with gas. Prune juice is an old-fashioned but effective help. Keep an extra pillow at hand and press it over your lower abdomen if you are going to cough or sneeze. Or laugh, if your baby makes funny faces at you. :) A heating pad feels really good on the tummy as well.

Wow, this sounds really bossy and I don't mean it that way! Of course take what works for you and leave the rest! Sorry to everyone for the ridiculous length of this.

Also, did you say, are you having a boy or girl???? :)


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PostPosted: Sun Jun 06, 2010 8:41 am 
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Based on your reply I just want to add one more thing. They will NOT NOT NOT take your baby from you just because your baby has a few possible signs of withdrawal or even FULL withdrawal. It is about what the baby tests positive for. If the baby tests positive for only the sub, you will be fine. Even the 2 mothers I have seen post about BAD experiences still had full access to their babies at the hospital. They couldn't take them home for 72 hours but that was just policy. It had nothing to do with the actual symptoms.

Secondly, is that another woman just posted about an AMAZING birth experience.

It is true that you have to decide what to do in terms of reporting your subutex use. I am not a big proponent of withholding information from the medical professionals although I can understand the decision to do so. I just think if anything goes wrong and then you have to report it you look way worse.

Cherie

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Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.

- Winston Churchill


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PostPosted: Sun Jun 06, 2010 10:31 am 
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Yes I agree, no one will take your baby away from you! If the baby has to go to nicu for observation, you'll still have full access. In my area, cps only comes out if the mother tests positive on admission for opiates, cocaine, or benzos, if she is not prescribed them. I've never seen them take a baby away for drugs.


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PostPosted: Sun Jun 06, 2010 1:33 pm 
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That is great advice from Meethinks. I also wanted to add that an abdominal support binder helped me immensely. Get the tight ones- not just like a belly band. I think mine is a Medela one and I got it from Babies R Us. It really gave support to the incision area and prevents that feeling that everything is going to fall out that many women experience when first standing up. On the other hand, when you are home it is very easy to over do things when you start to feel decent. DONT DO THAT. I think this is your first child so that will make it easier. I had two other children to care for when I got home and it's so hard to stop. I think I lifted my 2 year old reflexively one night without even thinking. Boy did I pay the price for that. Anyway, just be careful and take care of yourself.

I also wanted to repeat that I am in no ways condoning keeping the sub a secret. I gave it a lot of thought and I just couldn't do it. The secretive part of it did make me feel like an addict. And the pp is right- if something would have happened and I had to admit it- it would have looked much worse. I guess it was just the risk I was willing to take. I knew in my heart and soul that everything would be okay. And I just could not have dealt with being treated poorly or being withheld pain management. Anyway, I just wanted to clarify that.


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