It is currently Wed Aug 23, 2017 12:56 pm



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 11 posts ] 
Author Message
PostPosted: Mon Sep 19, 2016 11:52 pm 
Offline
Average Poster
Average Poster

Joined: Fri Apr 29, 2016 6:38 pm
Posts: 24
I am currently almost 38 weeks pregnant, and have been tapering off subutex, currently on .75mg-1mg daily. My baby is breech, and I had an ECV, where the dr's manually turn the baby about a week ago, and it was successful until today I was told she flipped back into the breech position and I am gonna have a scheduled C-section at 39 weeks, so I will find out the date tomorrow. I have been told different things from different doctors, and have read up on everything I can about pain management, etc. My sub dr wanted me to stay at 16mg up until delivery, but I think he just wants the 100 bucks every two weeks. I was told by my nurse to stay at the low dose I am at until delivery, and one of my doctors told me that for a C-section I have to be completely off the subutex, for 7 days! I am so confused and afraid that the pain meds won't work. I am planning on getting completely off at least 3 days before my date, but 7 days of withdrawals, when I am already having panic attacks, severe depression, and now I am reading all these horror stories about women having C-sections on subutex! If anyone has any experience or knowledge any info would be greatly appreciated!!! I am also so afraid that are going to treat me like a drug addict low life junkie at the hospital, and not give me proper pain relief like they would to someone who is not an addict. I am not looking to get high on pain meds, I just want pain relief they would give to anyone else! I am so terrified by all of this as I was planning on a vaginal birth as I did with my son. I am also scared about taking pain meds and relapsing as well, especially if they won't give me anything to take for pain and I just can't tolerate how excruciating the pain will be! Please help if any of you have had a si,iliar experience or can offer any advice! Thank you so much!


Top
 Profile  
 
PostPosted: Tue Sep 20, 2016 11:00 am 
Offline
Moderator
Moderator
User avatar

Joined: Mon Sep 15, 2014 7:15 pm
Posts: 2317
Location: Tennessee
Dawn I can hear the panic in ur post and I totally understand why but I really think it'll be ok. U know what I'd do, my butt would have stayed on suboxone to begin with. So I don't think that the tiny dose ur on right now will hurt. Now I know I have no experience with this medicine and childbirth but there's tons of women who've done it while still taking buprenorphine. There's a lot of ladies posted their experience in this section (suboxone and pregnancy). Read as much as ya can, maybe you'll feel a little bit better about it. What can they do if ur not off.....u have a valid script right? Also read around in the surgery and suboxone section, there's tons of info about pain management while on buprenorphine. Don't panic Dawn, it'll all be ok :)

_________________
Jennifer


Top
 Profile  
 
PostPosted: Tue Sep 20, 2016 11:41 am 
Offline
Average Poster
Average Poster

Joined: Fri Apr 29, 2016 6:38 pm
Posts: 24
Yes, I do have a valid script. My sub doctor is the one who has been telling me not to taper and wanted me to stay on 16 mg a day the whole pregnancy. I am going today at 1pm to talk to my ob and get a date for the C-section. I couldn't sleep last night. All I can think about is being cut open. I have read a lot about subutex and getting a C-section, but there isn't too much specific information. Most people suggest to be totally off the subs for at least three days. I am not even as terrified of being cut open, because I know the actual surgery won't hurt. I am more terrified of the recovery process, like what if I can't handle the pain? I dunno I am driving myself crazy. I have never so terrified in my entire life. I just want to get this over with! Thank you so much for your response jennjenn!! :-)


Top
 Profile  
 
Our Sponsors
PostPosted: Tue Sep 20, 2016 12:28 pm 
Offline
Power Poster
Power Poster

Joined: Sun Jun 22, 2014 11:37 pm
Posts: 70
I know it's easier said than done, but seriously try to not stress too much about it. It all reality everything will most likely work out ok. The best thing you've got going for you is that your down to a low dose of bupe, which means they WILL be able to manage your pain (may have to use a bit more Ned's than normal, but it can be done) AND from what I've read even though they say it doesn't matter what dose your on, neonatal w/d is about 50/50, the fact that you are on a low dose is in your favor.

I would actually really like Dr J to weigh in on that aspect though. I wonder if he has any data on neonatal w/d if your at 1mg or below, but not completely off. Are the stats any better??
My common sense would tell me that even though your injesting 1mg, the bioavailability is even less than that, and the baby is getting even less than that??? I don't know, just a thought I had. I could be COMPLETELY wrong abou that though. But your right, there isn't much info out there on pregnant women who are on really low doses of Bupe AND getting C sections.

It would be very good for you to post a follow up on how everything goes, since there's not a lot of info about it out there. I find a lot of people come to the internet in crisis asking questions but then never follow up with outcomes and that is what we really need.

Don't beat yourself up, like I said most likely you will look back on this and wish you wouldn't have worried so much.


Top
 Profile  
 
PostPosted: Tue Sep 20, 2016 1:08 pm 
Offline
Moderator
Moderator
User avatar

Joined: Mon Sep 15, 2014 7:15 pm
Posts: 2317
Location: Tennessee
Yes I hope Dr J sees this and weighs in on it with his opinion. This is definitely something that ppl need to know more about and even after it's over please keep this thread going. U can be helping so many ppl out there that's looking for advice or help just to ease their mind. Things will be ok, ur doing exactly what ur supposed to be doing. I absolutely understand the worry, but u will be ok. U and 1234km are very brave and inspiring to everyone!

_________________
Jennifer


Top
 Profile  
 
PostPosted: Tue Sep 20, 2016 1:49 pm 
Offline
Long Time Member
Long Time Member

Joined: Thu Aug 08, 2013 5:40 pm
Posts: 423
I would actually really like Dr J to weigh in on that aspect though. I wonder if he has any data on neonatal w/d if your at 1mg or below, but not completely off. Are the stats any better??

I can give you mine: 6 moms taking 2-6 mg, no NAS.
One mom taking 16 mg a day, mild NAS, no replacement therapy used - swaddling, breast feeding and the baby is a happy, bouncing toddler now.
I haven't had anyone get to as low a dose as you are taking.
My N is small but is reflective of what I have read.
See Dr. Junig's blog posts about pain management after surgery. He has a print out that can be helpful for your delivery team.


Top
 Profile  
 
PostPosted: Tue Sep 20, 2016 2:09 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1544
I will try to add more tonight when I have more time, but I read a number of studies a year ago when I gave a talk to a group of community health nurses. The two take-homes from all that reading surprised me-- both of them: 1. the incidence of NAS in babies to moms on bupe was about 50% across the dose range. I was surprised that lower doses did not have lower incidence of NAS. But none of the studies used 'subclinical doses', i.e. doses less than 4 mg of buprenorphine per day. I have to think that the incidence is lower in low-dose patients, as docm2 describes; 2. in the several studies that followed the babies into childhood, there were NO deficits found in development, cognition, reasoning, etc out at least to first grade-- when adjusted for other factors like cigarette smoking and lack of prenatal care.

The standard of care is to stay on buprenorphine through delivery. If mom goes through 7 days of withdrawal, so does baby-- and neither of you can afford to be weakened at the time of delivery. Your baby needs his/her strength and stamina to get through the process--- which is actually about as difficult as it is for mom. Remember that many babies struggle with that first breath after being squeezed, pushed, and marginally-oxygenated for hours.

Even if you stop the buprenorphine, your tolerance will still be high. If you have a c-section, the anesthetic won't be different at all on or off buprenorphine; the only difference will be post-op pain control. Talk to the anesthesiologist about getting a day of very dilute local anesthetic through the epidural (i.e. leave it in after delivery for 24 hours). If that isn't an option, patients do fine with a high-enough dose of oxycodone. I usually give 15 mg every 3 hours in people taking 8 mg buprenorphine per day-- and those people have tolerated most surgeries just fine. If you have pain, the solution is a higher dose of oxycodone--- NOT several small doses of other narcotics! I'll see surgeons give this much morphine, then change to this much dilaudid, then this much oxycodone... you need one potent opioid-- oxycodone or dilaudid-- and then taper up until pain is controlled, using respiratory rate as your guide. If respiratory rate is greater than 18 or 20, more narcotic is indicated.

Gotta go!


Top
 Profile  
 
PostPosted: Tue Sep 20, 2016 3:15 pm 
Offline
Moderator
Moderator
User avatar

Joined: Mon Sep 15, 2014 7:15 pm
Posts: 2317
Location: Tennessee
Thank u Dr J and docm2! Dawn u got great responses from 2 different suboxone doctors....can't get better than that! I hope this helps answer ur questions and eases ur mind a little bit.

_________________
Jennifer


Top
 Profile  
 
PostPosted: Tue Sep 20, 2016 6:46 pm 
Offline
Power Poster
Power Poster

Joined: Sun Jun 22, 2014 11:37 pm
Posts: 70
Thank you to both docs for weighing in on the subject!! De J you mention to have the anesthesiologist giving you a dilute solution through your epidural and they did this for me last time..... I had mentioned to him that I had just (72 hours before) finished my taper and maybe that's why they did it or maybe they did it because they had a harder time controlling my pain right out of surgery, but they gave me Dilaudid through my epidural with what I think was also a dilute solution to help keep me numb and that did the trick. The only issue with that was that my legs stayed numb and I needed to get up and start walking around, so they had to discontinue it.
And after they took my epidural out it was only oral pain meds. Which after the initial difficulty of getting managed, my pain was managed with 7.5 Percocet every 4 hours I believe. But I think they initially tried to manage my pain with morphine, and as I've read on this forum wouldn't probably work.
So maybe my OB did know what he was doing and I just don't give him enough credit. But I really think if I were to go to him with my concerns of pain control he would think I was drug seeking. Being on such a low dose, I would see how he would think that too. But maybe at my next and last appointment with him I will bring it up. Ask him what his experience and philosophy is regarding his patients and bupe. I just worry because he knows my past addiction history and has ALWAYS been careful with what he prescribes me. In fact, about 7 years ago when I was in active addiction to Tramadol no less (seriously don't get hooked on it, it's a lousy high, lol) I went into his office with some story why he needed to prescribe it to me. Most docs would be like sure, it's not a narcotic...... but not him, he wasn't about to give it to me. So like I said I have a long history with him with my addiction that goes clear back 12 years with my first child.


Top
 Profile  
 
   
PostPosted: Tue Sep 20, 2016 10:28 pm 
Offline
Average Poster
Average Poster

Joined: Fri Apr 29, 2016 6:38 pm
Posts: 24
First of all, thank you so much to the doctors and everyone else who responded! I am so grateful that I found this forum! It helps so much to know that I am not alone and there are others out there dealing with the same issues. Today I went to my ob, expecting to get a date for a scheduled C-section. When I was getting my ultrasound, the dr. told me that the baby was back in the heads down vertex position!!! I was so shocked! Just yesterday she was breech! I was thrilled! I am so scared that she will just go right back to breech again though, so I am trying to not get too excited yet! I have an apt Thursday for a non stress test, and then next week on the 27th, for another ultrasound to see the babys position. If she is breech again, I can try another ecv and then if its successful, get induced, and if it doesn't work get a C-section scheduled. I just wish she would stay put! So much of my anxiety and worry has been lifted today when I found out that she was heads down! I was set on getting a date today though! This is gonna be the longest week ever! Anyway I will keep posting my experience on here and hopefully it will help others in the future! Thanks again everyone! :-)


Top
 Profile  
 
PostPosted: Wed Sep 21, 2016 3:16 pm 
Offline
Power Poster
Power Poster
User avatar

Joined: Fri Feb 26, 2016 12:20 pm
Posts: 44
Location: Toledo, OH
Hello Dawn just wanted to wish you good luck with the birthing process and to let you know that you are very inspiring and brave! And please come back and let us know how everything went!!! Soon your baby will be in your arms! How exciting :D

_________________
"Though no one can go back and make a brand new start, Anyone can start from now and make a brand new ending." -Unknown


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 11 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 1 guest


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

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

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

Powered by phpBB® Forum Software © phpBB Group