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 Post subject: 35 Weeks and Worried
PostPosted: Tue May 16, 2017 11:09 am 
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Hello,

I really need some advice/reassurance. I am 35 weeks pregnant with my first child (32 years old). I have been taking suboxone for almost a year and a half and have been doing very well on it. I was only taking about 1 mg a day when I found out I was pregnant. My sub doctor assured me that there would be no adverse effects to the baby and encouraged me to stay on my small dose. Well, my OB immediately dismissed me from his practice upon learning I was on this medicine. Luckily, I found a new OB who was willing to work with me and sent me to see a Maternal Fetal Medicine doctor to monitor growth. The baby has been doing fantastic - no issues whatsoever - he even measures slightly bigger than average! He wouldn't confirm that the baby wouldn't have any issues with withdrawal/NAS at birth but seemed confident that the odds were in my favor due to my low dose and the fact that I am not using multiple drugs. The MFM doc encouraged me to wean if I wanted to (I did), and since 20 weeks I have gotten down to .25 mg a day. I wanted to be off before delivery and I am hoping that I still can be. I guess my question is what is the likelyhood of my baby experiencing any NAS symptoms at this dose? If I stop now, will I even have to mention that I ever took this medicine at the hospital? I have a ton of shame and guilt about this and not a lot of people even know I am taking this medicine except me and my doctors. I don't want to deal with the negative attitudes/stigma associated with this medicine and I don't want my baby to be scored inaccurately for NAS just because the hospital staff is expecting to see symptoms. I'm up every night worrying/researching and I just can't find a clear answer on what to do. HELP!


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Tue May 16, 2017 1:10 pm 
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Hey Firsttimemom welcome to the forum!! And congrats on ur pregnancy!

.25 is a low dose and it is very possible that ur baby may not have any withdrawal symptoms. I have a thread I want u to read on this forum. It's in this section, Suboxone and Pregnancy and the name of the thread is Less NAS for Bupe Maintained Moms. I'm on my phone so I can't link it but go read that thread. Dr Junig and docm2 both posted on that thread and they're both buprenorphine doctors. The thread talks about what ur asking. Not all babies have withdrawal symptoms from buprenorphine and if they do it's not as severe as regular opiates. I also encourage u to read as much as u can in this section, there's tons of mothers just like u documenting their journey.

As far as what to do about telling the hospital when u give birth about the buprenorphine.... I don't see how they wouldn't find out if ur OB knows. I understand why u don't want everyone knowing but it'll be ok, I'm sure u won't be the first and won't be the last either.

I've had three children but that was before I became actively addicted. I didn't start using until after I turned 30. I couldn't imagine how tough it'd be going through all that during pregnancy. Pregnancy is tough enough and adding that into the mix has to be overwhelming at times. Just know how strong u are! Plus u tapered down to .25, so ur strong. U will get through this and I wish u all the happiness in the world! Maybe Dr J or docm2 will respond also.

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 Post subject: Re: 35 Weeks and Worried
PostPosted: Tue May 16, 2017 2:27 pm 
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Thank you so much for your reply. I feel in my gut that my baby won't experience withdrawal, but I am just so worried that the hospital will make a big deal about monitoring and documenting symptoms just because they are looking for them. I have read most of the posts on this topic, they are very encouraging. I am hoping to just stop taking it in the next few weeks. If I do, will that completely eliminate any chance of withdrawal? I am hoping that jumping from .25 mg will be manageable - so far I've been doing pretty well.


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Wed May 17, 2017 10:25 am 
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I would feel more comfortable if one of the doctors could help answer ur questions because I sure wouldn't want to tell ya the wrong thing.

I do think though that u should do whatever u think is best for u. If that's to be completely off by the time the baby is born, then I totally understand that because ur the one who knows how u feel. If I had become pregnant while taking buprenorphine, I think I would have chosen to stay on a dose close to the ceiling level.

I'm not sure if u do stop completely, that the hospital still won't possibly look or monitor for withdrawal since ur so close to the end of pregnancy, but I think there's a huge chance ur baby may have none. U have gotten to a low dose. There's been ladies give birth on 2-4 mg and report that their baby was fine when born. Others have had to stay a few more days with their baby in the hospital. In the end, even if ur baby does show signs of withdrawal, things will be ok. I know that's the last thing u want to think of but everything will be ok.

Since ur OB knows about ur suboxone, I'm not sure there's a chance of ur hospital not knowing either. I think they're going to be aware regardless if u stop or not before birth. I could be wrong but with ur OB knowing, how could they not? My OB is who delivered my children.... unless he was not on call and then it was still someone he spoke to (I have 3 kids). So I'm not sure how you'd get by without the hospital not knowing.

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 Post subject: Re: 35 Weeks and Worried
PostPosted: Wed May 17, 2017 1:57 pm 
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In our 3 county area every doctor that delivers babies has an EHR tied to the hospitals. So their clinic notes, lab, ultrasounds are all available on the labor unit when the patient is admitted. For years OB's have been sending their records to the hospital so they are available for any attending or house staff if they cannot be there. Admitting staff would also be checking the state data base so there is another source to find out you have been prescribed Buprenorphine.
You are on a low dose so the likelihood of NAS is slim. I have encouraged my patients to stay on Buprenorphine throughout. Labor, delivery, post delivery pain, new born stresses, family stresses can all be triggers for relapse. Most hospitals will also advocate and encourage you to breast feed unless you are on other medications that prevent breastfeeding.
Good luck, even if bambino (bambina) has NAS they will soon be home and there are no long term affects.


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Wed May 17, 2017 2:27 pm 
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Good to see one of our two doctors has given you his honest medical opinion...
Aside from what we've all seen other posters say, it is definitely not something I'd be overly worried with. You got the best advice you could ask for from docm..

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 Post subject: Re: 35 Weeks and Worried
PostPosted: Thu May 18, 2017 3:04 am 
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My girlfriend was taking around 8mg/day when she found out she was pregnant.
I contacted pretty everyone know here in Sweden and that goes to subotex clinics. Quite many have children of different age... the ones talked to told me that when the they learnt they were pregnant they actually had their dose raised by the clinic doctors.... i felt it sounds really stupid and are they even thinking about the little one... The reason for a bigger dose was that pregnant women get more blood in their system, and their body needed more to not feel any withdrawal symptoms which seemes to be more dangerous than taking the buprenorphine.
Honestly.... we both felt that it just feels wrong........ at least for us....as she was not getting hers trough the clinic or "legal".
So she went down to 2mg/day as everyone we talked to and everything we were reading on this matter said that going trough the withdrawal was something that would hurt the little one most.
We were really nervous he would have any symptoms when he was born and that anyone would notice it....... and how horrible it would be to see ones child going trough it.
But he never showed the slightest bit of not being or feeling ok.
A friend told us, and that had a baby the year before and while on subotex...... that her doctor told her that as 30% or so of the buprenorfine seems to come trough with the breast-milk it would only help with even giving the baby even an easier getting of if now did feel small bit of symptoms.

edited'****
Must just add that did not write about how it was for us meaning to say it was the best solution, or that im even pretending to know what is the best thing to do. Just felt like sharing how we handled a really constantly worrying issue and did what we felt was best after talking to everyone could and that went trough similar thing.
Our little dude is today a 9 months old healthy,happy and a super cute little darling.


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Fri May 19, 2017 1:05 pm 
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Thank you all so much for your advice. I am now down to .125 daily. I am hoping that this dose is low enough and that he will not have to deal with any withdrawal at birth. The guilt I feel is huge. I was told by my sub doctor that he wouldn't withdrawal but my other docs didn't seem to want to say he 100 percent wouldn't. The problem is that no one - not even my husband - knows I am still taking this small dose (my docs do know). I know that I should have told him, but this is such a shameful thing for me. He does know I was on this medicine before, but thought I was able to quit completely. Sigh, I've made a mess of things.


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Fri May 19, 2017 2:25 pm 
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Hey FTM,

I'm outta my league here and guessing you read this already. pregnant-subs-t13407.html Far different from you bc this gal had no Dr or script which made it risky if she were discovered bc of pain or baby had NAS. If I understand where you're heading, bc its in your record, they will look for NAS but if you test neg for bup at admittance then perhaps they're less likely to look for NAS or bring it up. The link sorta gets to tapering off. Do you have any pain mgmt needs ie c section delivery? I'm referring to bup's opiate blocking effect where it takes more full analgesics to cover pain, altho at your tiny dose, that will help offset this issue. Anyway, wishing you my best bc sometimes this is all so hard! Peli

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
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 Post subject: Re: 35 Weeks and Worried
PostPosted: Sun May 21, 2017 9:35 pm 
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Congrats on your lil bundle of joy!

First, I'd like to remind you how brave you were/are to take back your life and enter recovery! I tried nearly every treatment option before Buprenmorphine. But, nothing I tried led me to lasting recovery......until the day I finally gave Buprenmorphine a chance.

I was stable on Bupe for about a year before I learned I was pregnant. I was absolutely terrified to tell my husband that we were expecting (because I knew I'd hafta inform him about my medication assisted treatment, which he didn't approve of). I gauged his response accurately, he was furious that I was taking Sub and actually wanted me to abort.

I soul searched and decided to keep our lil blessing. Creating our son ended up being one of the best things I've ever done! My husband was angry for awhile, but I chose not to focus on that, but to instead make sure I kept myself and our baby happy & healthy.

I found an OBGYN and was 100% honest with him from the beginning. In fact, I had already decided I did NOT want narcotics in the event that a section was necessary. So, my goal was to have a doctor that specialized with such cases and to work together to create a thorough birthing plan. That's exactly what we did.

I also researched and researched and researched so that I could not only school my husband but also become an advocate for myself and my child (as MANY healthcare professionals are STILL in the dark about MAT). Unfortunately, even some doctors, nurses, or people in general whom are knowledgeable about Buprenmorphine and Methadone still judge those whom choose to include it in their recovery.

You would be VERY surprised to see the positive effects that being an advocate for yourself can have on you and your birthing experience.

I had a beautiful pregnancy! And, my birthing experience was even more fabulous. I did require a section. I chose a partial epidural (so that I was fully alert). My doc placed a pain pump containing an NSAID at the incision site. I took ZERO narcotics post operatively. I was on 16mg of Subutex throughout most of my pregnancy and our son was born healthy....without any complications....AND without NAS. I will say that the nurses did seem anxious to try to score him when they began looking for withdrawal symptoms. However, we went home after two days.

Today, our son is six years old. He's literally at the top of his class. I'm thankful for him and the decisions that I made every day.

You need to do what's best for you and your baby. I honestly think you should be totally honest with your husband and doctors. You don't need the added stress of worrying about hiding something.
And, I totally understand your feelings of guilt and shame surrounding your MAT. However, what's more shameful.....being healthy and in recovery or possibly relapsing?
I agree with DocM2 and think it's wise to maintain your dose at least several months post partum. Post operative pain, sleepless nights, and added stress can all be triggers.

I wish you all the best!
Feel free to reach out and PM me for additional info!


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Mon May 22, 2017 9:46 am 
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Nothing like a newborn baby to make all that worry and stress just dissipate. I look at my 5 year-old daughter, and I remember how bad of a person I was with my other kids when they were her same age...I was NOT a father. I was unhappy with myself..unhappy with life...just didn't want to "be"...

That's what opiates did for me. With my youngest son, right as he was around 3 years old, I was cleaned up...and he got to see a side of me he hadn't seen before -- the compassionate daddy that I should've been all along.
Then he started school. I had grown to enjoy the role of daddy to a young toddler...so it just didn't seem right to have nobody here during the daytime chasing after me...being my shadow...
I guess out of boredom, the mommy+daddy time after the school bus ran was the solution to that issue..
School had barely been in a week when we found out there would be another baby.
So ...time has flown by. I just can't believe she's starting school August 8th...
This time it's different though..no more babies. I know it would be happening if we could..there's no doubt. But, we have plenty...aging from 16 years to 5 years. Having + chasing kids makes you old...

I can say without a doubt that Suboxone has no effect on a pregnant woman when it's "transmitted"...
If it would happen, I'd transmit another one to her...but tubal ligation ...

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 Post subject: Re: 35 Weeks and Worried
PostPosted: Mon May 22, 2017 11:23 am 
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Again, thank you everyone for your advice and encouragement. It is really helping me stay sane right now. I do not have any pain control worries as I am not "planning" on a csection (although you really never know, I guess emergencies happen). My sub doctor told me that the dose of .125 daily may not even show up on a drug screen, and my OBGYN explained he couldn't even screen for BUP if he wanted to. I'm sure the hospital can? Anyway, i plan to get as low as I comfortably can and will be prepared to begin again after birth if I need to. I just want to do whatever is best for my baby, and I don't know what that is. Continue on what I'm on and breastfeed and hope that my baby isn't unfairly scored just because they know he was exposed to buprenorphine or wean totally off before birth (if that even makes a difference at this point?!). Sorry if I'm rambling!


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Mon May 22, 2017 11:27 am 
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One more question... do they really have to hold babies born to mothers on bup for 72 hours? (I live in Florida). What if they do not show any NAS symptoms? The OBGYN explained that I would likely be discharged after 48 hours but the baby would most likely stay an extra day just for monitoring. This really bothers me. :(


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Mon May 22, 2017 12:31 pm 
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It varies by state and hospital. Often NAS from Buprenorphine and Methadone doesn't really show up until 72-96 hours so they may well have a policy to observe for several days.
It would seem reasonable to have daily visits with a visiting nurse or go to the pediatricians but 'reason' cannot interfere with policy.


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Wed May 24, 2017 11:20 am 
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Do the nurses/staff start scoring only after the notice symptoms or do they score the baby automatically? I have read that a smaller dose does not necessarily mean a lesser likelihood of the baby showing NAS symtpoms. However, I have read some posts from the docs on this forum that say they do believe that the smaller dose would reduce the risk. Also... if I stop now (down to .125 and feeling very stable) would that definitely eliminate any chance of my baby having symptoms? I'm 36 weeks 3 days today. Again, I am so so so appreciative of everyone's help.


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Wed May 24, 2017 12:23 pm 
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IDK on your questions. Hopefully the Doctors will answer!

I would think they will watch for NAS at the outset bc prescribed bup will be in your medical history. I went back and read some of the studies of moms on bup and yes while dose didn't correlate with NAS, meaning some moms on higher doses had babies w no NAS and some mom's on lower doses had babies w NAS, but, none of the mom's were on the tiny dose you are so I'm not sure what you can even apply to you so maybe is good news. I'd call the hospital maybe anonymously and ask what is their NAS protocol for mom's on prescribed medication assisted treatment aka MAT - methadone or bup. Some moms also called and asked what drugs if any are tested for at admittance. Some hospitals do admittance drug tests, maybe bc in areas w high opiate addiction, IDK. Who is delivering your baby? Surely they know or can ask that hospital what are the procedures/policies. If I were a parent to be, I'd fully demand all my rights to be fully informed.

I understand you'd like to get thru this wo your husband knowing and w no NAS. And I can see how if you came into delivery, if they test and no bup shows, and you can say you've been off for awhile, the nurses may be far less likely to look for NAS. Imo, since there are no data to say for sure, logic says if you stop now, and if you go to term for another ~3 wks, bup would be gone and any NAS as well. The problem lies if you stop bup and are unable to stay off. Altho not pregnant, we often see folks stop and if it gets hard and if they restart, often is at higher doses than when they stopped which is the opposite of what you want. Also, would be awful if you stopped and then took some full opiates. man that'd be freakin awful. We don't know you and what all is going on in your world and would hate to have things go sideways for you, making what you'd experience now - a picnic compared to that.

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Stopping went well -- its the staying stopped -- where the real work begins.
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 Post subject: Re: 35 Weeks and Worried
PostPosted: Wed May 24, 2017 2:53 pm 
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Thank you for your response! My OB doesn't really seem to know the answers to my questions. He just said that the baby would most likely have to stay 72 hours to be observed (a day longer than me - and this really stresses me out.) He seems confident that there won't be any NAS, because according to what he has seen/read the babies born to moms on buprenorphine usually don't withdrawal unless they are mixing the bup with benzos, or slipping up and using oxy or heroin as well. He says he knows that is not my case, but the hospital doesn't know that, so they will be looking. He tells me not to worry, but I am. It is literally all I can think about and is ruining this most exciting time that we have waited our whole life for.

As far as stopping, I'm going to try and do 1/16 of a mg per day for the next few days and come off. Hopefully this will completely eliminate any issues for the baby. Relapse on oxycodone (my prior drug of choice) is not an option for me at this point. I am very far removed from that part of my life and honestly wouldn't even have a way of getting that even if I wanted to. Thanks to this medicine, I was able to get my life back. I really was in danger of losing everything and the best thing I did was speak to a doctor and start treatment with suboxone. Now, the fact that my poor past decisions are about to effect my newborn son make me feel terrible. I know I am doing what I can but the shame is still there. Especially since I do not have anyone to talk to about it (only very few people know - my doctors and one friend). I'm very grateful for finding this forum. I am hoping that in a few weeks I can come back and share a positive story with everyone.


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Thu Aug 03, 2017 2:20 pm 
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FirstTimeMom I would love to hear how everything went for you and your delivery and after. How was your baby?


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Thu Aug 03, 2017 2:51 pm 
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She was last on the site June 2. I PM'd her, hope she comes back.
Like Paul Harvey used to say, "now you know the rest of the story."


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 Post subject: Re: 35 Weeks and Worried
PostPosted: Thu Aug 03, 2017 4:02 pm 
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Hey! I'm so sorry that I have not been back to update. I have been very busy with my new little guy. Here's how everything went...

I'm not sure if I mentioned it but I was put on bedrest for preeclampsia at 35 weeks. On June 4 (38 weeks) I began to have very blurry vision and my BP got extremely high. We went to the hospital and I was induced. Our boy was born the next day at 7:19 pm weighing 6lbs 6oz. Now, I explained to to the nurses my need for privacy in regards to my medicine. My doctor even added this info into my chart so everyone knew to only discuss with me.

When I was sent to the postpartum room the nurse informed me she was required to do a urine drug screen on the baby. I understood, and I could tell she felt bad about it. The next morning when they took him to the nursery for his bath and shots I went down there to talk to another nurse. She explained that she noticed some sneezing and that he has some very slight jitters but that was all she saw, and both were extremely mild and could be not even related to the suboxone. He was going to have to stay an extra day longer than me to be watched. My doctor was awesome and had them keep me to monitor my BP so I could stay with him. He had no issues - he fed well and was very calm. We went home after 72 hours. The pediatrician said he looked perfect and I just had to keep an eye on him. Once we got him home we noticed no issues at all. He is gaining weight and eating like crazy and is a very healthy little guy. I'm so so so relieved. Thank you everyone for your support. :)


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