It is currently Sat Aug 19, 2017 5:19 am



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 98 posts ]  Go to page 1, 2, 3, 4, 5  Next
Author Message
PostPosted: Tue Dec 27, 2016 3:56 pm 
Offline
Power Poster
Power Poster

Joined: Tue Dec 27, 2016 3:21 pm
Posts: 71
I feel guilty but my emotional state is out weighing that guilt. I am now 31 weeks pregnant. I have been struggling to get down to 2mg since the beginning of my pregnancy. I had actually started off optimistic and after talking to my OB was planning to go down to 1mg by delivery. But I became mentally ill and was started on zoloft,which I had taken during my last pregnancy and it helped. But this mental illness is different. Before i go into what doses i have been taking recently i want to explain my emotional state... I have zero connection to my baby. I had a boy last time and this time I am having a girl. I love my 3 year old boy more then ever and each day going to work away from him is emotionally painful. Then there was some stuff i found on my husbands phone of him talking to other girls on snapchat and other chat aps. Some of the girls are just bots and some are real. But this really threw me as i never would think he would cheat... and i am still trying to work that out if i would even feel cheated on if it weren't for these pregnancy hormones... maybe i would just view it as more like porn (which iam fine with). Idk... but how it makes me feel now is awful and confused that he would spend any time talking to another girl in any sexual way, especially while I am pregnant. Plus my dad is battling cancer and gets sicker everyday. Another result of him having cancer is that my mom is super stressed with him and has very little energy left to support me emotionally or physically. I feel so alone and lost. And i think often of inflicting some amount of physical pain as it actually has provided a nice release and distraction when i have dug my nails into my skin... so now for my suboxone dose...About a month and a half ago my sub doc, who is a primary care physician and family doctor and not just a sub doctor and really stresses taking a little medication as possible, actually decided to put me at 3mg instead of 2mg and leave it there until a couple months after the baby comes before even talking about reducing. He did this due to my.mental state. So I was at 3mg for a month, sometimes taking 4mg. I was feeling better then I did at the 2mg, certainly, but heavily struggling with not taking more due to the level of anxiety and increased pain in hips/ tailbone. But mostly due to how distracted and figity and sweaty I get. And then I can't focus on work or anything. I start despairing. Two weeks ago I had my refill appointment and right before that I found more stuff on my husbands phone. This time we got in a big fight over it, due to the way I addressed him about it, and I don't want to go into every detail. But at the end of the fight I ended up feeling awful and apologizing and then later feeling like I was just duped and redirected. So now I am questioning the person I always thought I could trust. I started taking 4 to 6 MG a day. And, I do actually feel better mentally and physically at that dose. Except I am now worried about the effect on the baby. But then wonder what is more harmful to get in the long run. All this self hate and misery I feel at a lower dose... or the higher dose of suboxone with a more mentally stable mon? Of course when I did a walk in with my subs doctor to tell him what I had been taking he insisted on staying at 3mg. Which I know is the right thing to do and I feel like a monster for wanting differently. I want to be at 4mg a day. Has anyone been at that dose at time of delivery? I am also taking 75 MG of zoloft.oh... and i quite smoking 1 month before getting pregnant and have been struggling off and on with that as well. I haven't smoked once but I get that urge a lot lately,but not since taking the higher dose of sub. I guess I don't know what I am asking for.. I just felt I could talk and tell more of the truth here then I can even with my counselor. Oh.. and my OB is fully aware. I am worried about what will happen at the hospital. I tried asking what the procedure would be when I went in for a private tour but she said there was no procedure. They would do the same thing they do with any normal birth. I find that hard to believe? Any words, thoughts or advise. I think just hearing from someone might help me. Thank you


Last edited by Pregnant&Lost on Thu Dec 29, 2016 6:44 pm, edited 1 time in total.

Top
 Profile  
 
PostPosted: Tue Dec 27, 2016 4:46 pm 
Offline
Moderator
Moderator
User avatar

Joined: Mon Sep 15, 2014 7:15 pm
Posts: 2300
Location: Tennessee
Hey PregnantAndLost, welcome to the forum!

I have had 3 children, before I became addicted, and I know how emotional it can be....add all the stuff ur dealing with and I just couldn't imagine. U have every right to feel how u feel, after all those are ur true real feelings and it's ok. Ur baby's father sure isn't making things easier for u like he should be!

I know a lot of pregnant ladies want to get down as low as possible on their suboxone dose, but if I was pregnant I'd stay at my regular dose or maybe 4mg, but that's the lowest I'd probably go. Now I know not everyone feels like that but don't feel guilty for it. It's ok to not want to suffer any more than u already are. I may or may not be politically correct in saying that but that's how I'd be. So give urself a tiny break for wanting to feel better than u have been.

Ur baby's father needs to stay away from talking to other ppl if it bothers u. If he knows it bothers anf upsets u, then for u he needs to cut it out. U have every right to be upset. Heck I'd be ticked off pregnancy or no pregnancy. Don't let him convince u that ur overreacting because ur not. He needs to be catering to his pregnant woman. And ur taking care of a 3 yr old and working, girl ur a rock star :)

As far as how they do in the hospital when ur giving birth, u will be able to get the epidural regardless of being on suboxone. Now I'm not sure about aftercare but there should be lot's of information in the Pregnancy and Suboxone section, do lot's of reading because it'll help u a lot.

_________________
Jennifer


Top
 Profile  
 
PostPosted: Tue Dec 27, 2016 5:16 pm 
Offline
Power Poster
Power Poster

Joined: Tue Dec 27, 2016 3:21 pm
Posts: 71
Thank you for your quick reply. I want to be on 4mg but my sub doc today said no, I need to get back down to 3mg. He didn't lecture me for taking over the amount he had prescribed, which was great, but he wasn't open to me taking over 3mg. He had 2 months ago decreased me all the way down to 2mg after months of doing and 2 to 3mg a day (like 2 days at 2mg then 1 day at 3mg). That failed miserably and I finally came out with my mental illness and he increased me to 3mg and said he wouldn't try to decrease me again until.after baby. So I can get why he doesn't want to increase again to 4mg. I just don't know if I can do the 3mg... so what i fear will happen is I will take 4mg, run low then worry worry worry over that. Then either have to reduce to 2mg for a bit to make up for it or ask for help from.my friend or admit to him again that I took over.i just don't know how excepting he will be if I run out early again. So I have to find a way to do 3mg. I just really hope I can do it without too much struggle and turmoil.
And in regards to my husband... it is cimplicated and hard. I have felt often that I don't get the support I need but he is a veteran with ptsd and a bad back and is managing a retail store and working 50 plus hours a week. He will try to support me but I can tell he is also trying to keep himself from not falling apart. And after the last time I found stuff he deactivated accounts and stuff so idk if he will do it again. He felt like it wasn't taking time away from us as he would do it after we were asleep and he didn't feel no emotional connection. But just today when I was crying and finally broke down enough after seeing my doc, I began to use my finger nails to dig into my skin cuz that kind of helps ground me (and I am at work by the way, hoping no one will come to my office), right before I broke skin a text came from him and I looked down at my phone and could see that he just wrote "how are you feeling today? " just out of know where he asked me this. I told him about the appointment and doses and everything and how I wish I were stronger. And he told me I am stronger then I think... so he can be very supportive. He just has his own dark demons too I guess. What he did was wrong, and me hacking into his accounts and snooping around was wrong. I still amiss weirded out by it all, but find weverything have been healthier around each other if I don't think about it.
The aftercare is what I am worried about... mainly because I dont want my mother in law to know about me! I know that even if my baby had withdraw it will be a little and there won't be long term effects from what I have read. But how do we explain it if she is taken to the NICU? Or if we have to even stay for several days? I just wish they would tell me the procedure but when I went in for the personal.tour to ask she said they didn't do anything differently. Really? I don't believe that at all. From what I have read they hold you for at least.3 days for observation and sometimes the babies.go straight to the NICU. If they try to touch my baby with morphine I am going to totally freak out though. I feel like as long as she is with me and getting my breast milk she will be fine. My sub doc thinks they should hold us for several days to.monitor for withdraw. But can't we do that from home and bring her in if we see signs? I feel that would be better.


Top
 Profile  
 
Our Sponsors
PostPosted: Tue Dec 27, 2016 5:27 pm 
Offline
Power Poster
Power Poster

Joined: Tue Dec 27, 2016 3:21 pm
Posts: 71
So... just an add on since I feel I can be totally honest on here. I took 2mg at 8:30 this morning before going to see the doc. I can't go work after doc and have gotten nothing done as I have been crying or reading these forums or writing on here, and just being a mess. I started to get the panic shaking... I know it is from my anxiety, not from withdraw. But about 40 minutes ago I took another 2mg and now I am feeling so much calmer. To me, they act as an anti-anxiety too, which my sub doc does not want me to use them in they way at all, but they help. I have suffered from anxiety since I was a child. And i.can fight it.sometimes but not so much now. So.. crap! I havery already taken 1mg over and I normally take one morning dose and one evening dose. And the evening dose actually tends to be the one more needed. This is what I fear of being at 3mg. I hope I can figure this out.


Top
 Profile  
 
PostPosted: Tue Dec 27, 2016 7:42 pm 
Offline
Average Poster
Average Poster

Joined: Tue Dec 27, 2016 3:59 pm
Posts: 5
Pregnant&Lost wrote:
So... just an add on since I feel I can be totally honest on here. I took 2mg at 8:30 this morning before going to see the doc. I can't go work after doc and have gotten nothing done as I have been crying or reading these forums or writing on here, and just being a mess. I started to get the panic shaking... I know it is from my anxiety, not from withdraw. But about 40 minutes ago I took another 2mg and now I am feeling so much calmer. To me, they act as an anti-anxiety too, which my sub doc does not want me to use them in they way at all, but they help. I have suffered from anxiety since I was a child. And i.can fight it.sometimes but not so much now. So.. crap! I havery already taken 1mg over and I normally take one morning dose and one evening dose. And the evening dose actually tends to be the one more needed. This is what I fear of being at 3mg. I hope I can figure this out.


Wish you the best!!


Top
 Profile  
 
PostPosted: Tue Dec 27, 2016 9:10 pm 
Offline
Power Poster
Power Poster

Joined: Tue Dec 27, 2016 3:21 pm
Posts: 71
Wow... this day is just really getting out of control for me... I have dug my nails into myself before. But around 4 I started feeling anxious again and feeling of ickyness and more aches. I know I can't take any more sub for the day after my doc told me he wouldn't move up from 3mg (and I already took 4mg today). So I started to break down and sometimes my nails will ground and center me. So i did that, but I cut them short so i couldnt do that to myself anymore. And i wanted more. I used my scissors. I have officially cut myself for the first time. I am such a baby when it comes to pain but this felt good. Except now I am so scared of what that means that I am crying. So that backfired. Really don't know who this person is that I am. 8 months ago I was working and getting in shape. I had quite smoking. I felt happy and in control. Now I am loosing myself.


Top
 Profile  
 
PostPosted: Tue Dec 27, 2016 10:29 pm 
Offline
Super Poster
Super Poster

Joined: Thu Nov 17, 2016 9:25 am
Posts: 160
Oh hun, I just want to reach out and give you a big hug! Do you think it would help if you made a phone call to your doctor and tell him that you must be on 4mg? Maybe tell him 3 is not enough and tell him that you will continue to run out early and that will be very dangerous for the baby if you run out??? Maybe tell him that you are under a lot of stress too and ask him to help you cross something that causes a great deal of stress off of your list so it would be one less thing for you to worry about.?? It's worth a shot I think. Are you in therapy? I apologize if you have already answered this. I can't give you any advice or opinion on the self harm subject-other than to get in therapy if you aren't already. Your child needs a healthy mommy inside and out. Is this your first baby? Congratulations by the way!


Top
 Profile  
 
PostPosted: Tue Dec 27, 2016 10:45 pm 
Offline
Power Poster
Power Poster

Joined: Tue Dec 27, 2016 3:21 pm
Posts: 71
Thank you for writing.
I have told him about everything. He suggested I should switch to a different counselor that specializes working with pregnant women. I am going to talk to my OB to see if he can advocate for a higher dose. I tried calling him today but he is on vacation right now. I am seriously see toyed of fighting. If I could take anxiety pills that would be fine...a lower sub dose would be fine. But anxiety pills are vertu dangerous to baby. And suboxone does help the anxiety.
And I can't keep cutting. I feel like that harms baby more then the subs..the nasty energy and chemicals that must be released by doing that. Plus I suck at hiding things and dread explaining it to any body who sees.
I think talking gm here may help me. So thank you for anybody who writes..even if it is sharing their own story. I want to know mg taken and the aftermath. All of that.


Top
 Profile  
 
PostPosted: Tue Dec 27, 2016 11:29 pm 
Offline
Super Poster
Super Poster

Joined: Thu Nov 17, 2016 9:25 am
Posts: 160
Well shoot-he actually told you to switch?? Wow!! Right, if you could take your meds for anxiety, the lower dose would be ok. Yes, self harm does hurt the baby, because she needs her momma. There are some stories of pregnancy on Suboxone on this forum, I'm sure you have read them. See, with everything you have going on, your number one concern is the baby. I was not on Suboxone when I was pregnant, but I was alone. Went through every little thing by myself, kept everything I was feeling inside. I was sad a lot, stressed a lot-did everything alone even though my spouse lives with me. I would be lying if I were to say that was one of the happiest times of my life. There is an app/website called babycenter-it is mostly moms, but they do have a group for moms who are on suboxone/methadone and most of them were on it while pregnant. Those posts might help you find some more information


Top
 Profile  
 
   
PostPosted: Wed Dec 28, 2016 12:36 am 
Offline
6 Months or More
6 Months or More
User avatar

Joined: Wed Nov 18, 2009 1:43 am
Posts: 190
Pregnant&Lost,

First- CONGRATS on deciding to not only take control of your life by entering recovery, but I'm also so very proud of you for choosing to love your baby enough to continue working your recovery!

There are soooooo many things I wanna say to you. Let me get the main points out first.

- NEVER feel ashamed of having a medication assisted recovery! I know it can be embarrassing & scary sometimes when people discover you're an addict or the details of your recovery. But PLEASE know what you're doing is so brave and lifesaving!

- The absolute most important thing in your world needs to be YOU and your baby second. You cannot be the best mom, wife, employee, or friend....if you're not taking care of/loving yourself first. Once you feel healthy, happy, and stable everything else will become much easier and fulfilling.

- I don't know all of the details of your marriage, but I know a husband and wife need to trust each other, respect each other, and take care on one another. Your husband needs to support you now more than ever. Do not make excuses for his bad behavior or feel guilty for feeling hurt by it. Please have a heart to heart with him and make it clear what your needs are.

- If at all possible, find a new Sub doc. I can't remember exactly why Subutex is safer during pregnancy
but I know that it is. Lots of people have had better luck with physiatrists whom prescribe Sub as well.
I don't know your history, but 3-4mg is a pretty low dose whether you're pregnant or not. I've also read that your blood levels are effected during pregnancy, creating a lower level of medication in your system (which is highly likely why the 3mg suddenly isn't working). With everything you have on your plate, you do NOT need the added worry & stress of running out. And, above that you deserve to feel stable. PLEASE make it very clear to your current doc that your dose simply isn't working. At the same time, start searching for a new one who'll support your needs.

- Be 100% open and honest with your OBGYN about EVERYTHING. Most OB's will do whatever they can to ensure you & your baby are healthy and happy. But, if you're not completely honest it's very difficult for them to treat, protect, and care for you and your child.

- RESEARCH, RESEARCH, RESEARCH!!!!!
Google everything you can find about Suboxone, Subutex, and Sub during pregnancy. I truly believe you will have a much better pregnancy and birthing experience if you're your own advocate. Things have improved a bit, but there's still a very large portion of our society whom are still completely mis-informed & uneducated about this medication (including doctors). Team up with your OB to make a birthing plan....including worst & best case scenarios. Communicate this with the birthing wing of your delivery hospital as well.

- PLEASE, PLEASE, PLEASE speak with a therapist about your anxiety, depression, and hurting yourself.
Not just once, but at least biweekly sessions. Being stable, happy, and healthy emotionally and mentally are so very important for you and your baby's overall health.



* I induced on Suboxone about a year before I became pregnant. My doc switched me to Subutex and I maintained 24mg my entire pregnancy. I gave birth via c-section (without any additional narcotics. Only a partial epidural and an analgesic pain pump at incision) to a healthy baby without any signs of NAS.
Learn how nurses score infants for NAS and make it clear to them beforehand if you wish to avoid having your baby be given narcotics if symptoms are present. I also breastfed my baby for 5 months (would have much longer had he not grown teeth so early). I highly recommend breastfeeding. My son is now almost 6......incredibly smart, healthy, and happy. I've slowly reduced to 3mg over the years & I'm currently the strongest and healthiest I've EVER been in my life. I don't ever regret my decision to induce and maintain a sub assisted recovery and neither should you! I've struggled with anxiety & depression since I was young and this med definitely helps me in regards to managing it. You'll find it's also helped many others this way.

I know I've given you lots to think about. PLEASE continue to post, read as much as possible in the pregnancy section here, and LOVE YOURSELF. We're all here for you and we all believe in YOU!!


Top
 Profile  
 
PostPosted: Wed Dec 28, 2016 12:52 am 
Offline
6 Months or More
6 Months or More
User avatar

Joined: Wed Nov 18, 2009 1:43 am
Posts: 190
Feel free to PM me as well!!


Top
 Profile  
 
PostPosted: Wed Dec 28, 2016 1:41 am 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4127
Please read what our resident psychiatrist has to say about suboxone and pregnancy! It is downright irresponsible of your doctor to hold your dose at 3mg!

http://suboxonetalkzone.com/buprenorphi ... pregnancy/

Amy

P.S. I deleted your other post on that old pregnancy thread since you're getting plenty of advice on this thread.

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Wed Dec 28, 2016 1:50 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1543
Great comments already, but I'll reinforce them. First, there is very little difference from your baby's perspective whether you are on 2 mg, 4 mg, or 16 mg. To answer your question, most of the patients I see who have been through pregnancy stay on their regular dose-- usually 8-16 mg of buprenorphine or Suboxone (they are the same, btw-- we tend to use buprenorphine during pregnancy but naloxone is a safe medication during pregnancy, and reaches the baby in very minute amounts).

A controlled study that looked at the incidence of neonatal abstinence syndrome found that lowering the dose of buprenorphine during pregnancy did not affect the incidence of withdrawal symptoms. That finding is hard to understand, but we have to go by what we know, not by what we think 'should' happen. The result probably relates to the ceiling nature of the opioid effect of buprenorphine, although I think most docs would 'expect' the incidence to go down with dose. I don't remember the lowest dose in the study; I think it was around 4 mg per day.

As has been suggested (and thanks to those who shared my link!), read my blog posts about guilt and buprenorphine during pregnancy. If you google 'buprenorphine' and 'lay off the guilt trip' you will find my favorite one... babies routinely face much larger challenges than neonatal discontinuation syndrome. People tend to think that the baby's brain gets turned on as soon as it leaves the birth canal; understand that babies are born between 38-42 weeks gestation, and so many babies that are lying in a crib are at the same place in brain development as babies in the whom, and vice versa. The baby crying in the OB unit could just as well be crying in a uterus-- where efforts to breathe are much, much more difficult as the baby is moving fluid instead of air in that environment. Yet we don't worry about that unseen crying and unseen gasping. Whether in the uterus or out, the baby has no memory of those moments.

Finally, I did a lecture to a large, tri-county group of nurses about opioid dependence and newborns. When I researched the topic I truly expected to find some evidence that opioids impact development. An increase in ADD, a lower birth weight... something. But I could find nothing after controls for other factors like smoking and neonatal care. Babies born to mothers on methadone or buprenorphine have the same developmental trajectory as any other child, with no greater incidence of ADD or other problems.

You are doing the right thing. Do what you can to advocate for yourself; try to drop any guilt, and try to avoid anger. Express what you need-- and things will work out. As others have written, please stick around-- there are many helpful people here.


Top
 Profile  
 
   
PostPosted: Wed Dec 28, 2016 3:33 pm 
Offline
Power Poster
Power Poster

Joined: Tue Dec 27, 2016 3:21 pm
Posts: 71
Thank you for your replies... i do have a lot to think about and do. Researching and being online like this has actually caused me more breakdowns and anxiety, but I think it is maybe necessary that I now do this. It is just so time consuming and hard to do with a full time job and a 3 year old. And here I am writing while at work(badbad).
Something else I have wondered and for which I have been told repeatedly suboxone is not for, is if it can help relieve anxiety, headaches, body aches, and that sort of thing. I wasn't using it for these purposes before my pregnancy. I was using it as maintaince and had started working out and changing my eating habits to deal with my anxiety issues and body aches and stuff. I was doing good. I quite smoking about a month before I got pregnant and had a hard time with that. So my doc raised me to 6mg from the 3-4mg I was at. Then found out I was pregnant 2 weeks later and said we had to get it down to 3mg at the most then 2mg. So I have been struggling with this reduction my entire pregnancy. And I think once he raised me back up to 3mg I was still feeling that struggle and discomfort and at this point was so worn out from it that I just said "no more" and took more (4-6mg) and it did help me not feel like I am struggling through most of the day. However, my depression has still morphed and deepened. I don't know why. In between the times I take suboxone anxiety will flutter in. Or if something stressful happens, even if right after taking a dose, I can still totally spiral into depression and loneliness. So it isn't like subs fix everything. I know I still need help. I just feel like they would take away alot of the struggling. And I certainly don't feel as agitated and annoyed with others as I did before I increased my dose. But maybe that is just the hormones morphing. I wrote to my doc to admit I didn't do 3mg yesterday after seeing him, buthe 6mg. And said I would try the 3mg, but tried to explain more why I felt it wasn't the right amount. But I just don't see him budging. It was a big deal for him to go to 3mg and unless another professional advices him to change it I don't think he will due to anything I say. And the only other sub doc close by works for the health company I work for. So no way will I go to him.
I only have enough now to go to Friday at 3mg so that is my only choice.


Top
 Profile  
 
PostPosted: Wed Dec 28, 2016 4:39 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4127
Just so you know, the suboxdoc is the founder of this site. His name is Dr. Junig and he has a background in anesthesia and is now a practicing psychiatrist. You can take what he wrote as extremely accurate and valuable.

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Wed Dec 28, 2016 4:43 pm 
Offline
Power Poster
Power Poster

Joined: Tue Dec 27, 2016 3:21 pm
Posts: 71
Sorry everyone... i normally write stuff like this just to myself in my notes section on my phone, but am now doing it here. So i apologize if it is too much...
When I saw my doc yesterday I had only ever scratched myself with my nails, but I told him I had started to think more about cutting during my breakdown times. I know I need proper counseling and he said he is going to help me find the right counselor or physcologist for me. But he still didnt feel like a higher dose of suboxone was necessary, even though I think it would help somewhat. And i can see now that I acted like a petulant child yesterday... I felt horrible at the time I did this and my nails were not working for me. But it was like I threw a fit because I was freaking out over having to go back down to 3mg,although I mostly just felt alone at that time and ashamed that I couldn't just be ok with the 3mg. Well I finally cut myself with something other then my nails, my work scissors ...not deep at all but I am just irritated because now I have to wear long sleeves. But I am thinking of cutting even more...and places to do it that are easier to hide.I am a very aware and logical person and I know how badly this hurts me and it just further distances me from my baby girl. I really hope I can find a good physiologist or something...kind of waiting on my sub doc to get back to me on that.
I was hooked on hydrocodone during my first pregnancy and although my OB knew I took it, he didn't know the extent to which I did. I felt guilt and worry over taking that med the entire pregnancy, but I felt very connected and loving towards my baby. I would constantly talk to him. This time I don't feel guilt or much worry over the suboxone effects on her, since they seem to be marginal and not long lasting. I worry of how the nursing staff will treat me and my baby though, since i have been honest this time. I do feel guilt over the disconnect I feel towards this baby and that I think to hurt myself, because I feel like my sorrow and pain hurts her the most. I think this disconnect is partially because I haven't felt the level of support I grew up with and am accustomed to, so I began stressing over feeling like no one was there for me because I had already been pregnant... when i told him ididn't feel as much support this time my husband even said "well it is your second so there isn't as much excitement and we are both working." I felt like I couldn't even get the support I wanted from him (mainly just attention and snuggles). I think feeling this way may have made me feel disconnected from my baby? I am not sure but I can't seem to find myself enough to be present with her. She is inside me yet I feel no excitement for her, as if I an growing her for someone else. I really really really want to be excited for her like I was for my son. I hope I will find a way to get there before delivery because right now I can't imagine going through delivery feeling this way.


Top
 Profile  
 
PostPosted: Wed Dec 28, 2016 4:48 pm 
Offline
Power Poster
Power Poster

Joined: Tue Dec 27, 2016 3:21 pm
Posts: 71
Amy-Work In Progress wrote:
Just so you know, the suboxdoc is the founder of this site. His name is Dr. Junig and he has a background in anesthesia and is now a practicing psychiatrist. You can't take what he wrote as extremely accurate and valuable.

Amy


Thank you Amy. I followed a link to his blog I believe, that someone had posted. Alot of the stuff was posted several years ago and I think if I show it to my doc he will dismiss is as being outdated. I need to stop venting all my issues that have built up within me and get some work done, then research for studies and articles that will help me. And also how to measure NAS so I can do it along with the nurses. So any links to articles that support me being at a 4mg dose instead of 3mg and any links on how to score NAS would be awesome. Thank you.


Top
 Profile  
 
PostPosted: Wed Dec 28, 2016 4:53 pm 
Offline
Power Poster
Power Poster

Joined: Tue Dec 27, 2016 3:21 pm
Posts: 71
suboxdoc wrote:
Great comments already, but I'll reinforce them. First, there is very little difference from your baby's perspective whether you are on 2 mg, 4 mg, or 16 mg. To answer your question, most of the patients I see who have been through pregnancy stay on their regular dose-- usually 8-16 mg of buprenorphine or Suboxone (they are the same, btw-- we tend to use buprenorphine during pregnancy but naloxone is a safe medication during pregnancy, and reaches the baby in very minute amounts).

A controlled study that looked at the incidence of neonatal abstinence syndrome found that lowering the dose of buprenorphine during pregnancy did not affect the incidence of withdrawal symptoms. That finding is hard to understand, but we have to go by what we know, not by what we think 'should' happen. The result probably relates to the ceiling nature of the opioid effect of buprenorphine, although I think most docs would 'expect' the incidence to go down with dose. I don't remember the lowest dose in the study; I think it was around 4 mg per day.

As has been suggested (and thanks to those who shared my link!), read my blog posts about guilt and buprenorphine during pregnancy. If you google 'buprenorphine' and 'lay off the guilt trip' you will find my favorite one... babies routinely face much larger challenges than neonatal discontinuation syndrome. People tend to think that the baby's brain gets turned on as soon as it leaves the birth canal; understand that babies are born between 38-42 weeks gestation, and so many babies that are lying in a crib are at the same place in brain development as babies in the whom, and vice versa. The baby crying in the OB unit could just as well be crying in a uterus-- where efforts to breathe are much, much more difficult as the baby is moving fluid instead of air in that environment. Yet we don't worry about that unseen crying and unseen gasping. Whether in the uterus or out, the baby has no memory of those moments.

Finally, I did a lecture to a large, tri-county group of nurses about opioid dependence and newborns. When I researched the topic I truly expected to find some evidence that opioids impact development. An increase in ADD, a lower birth weight... something. But I could find nothing after controls for other factors like smoking and neonatal care. Babies born to mothers on methadone or buprenorphine have the same developmental trajectory as any other child, with no greater incidence of ADD or other problems.

You are doing the right thing. Do what you can to advocate for yourself; try to drop any guilt, and try to avoid anger. Express what you need-- and things will work out. As others have written, please stick around-- there are many helpful people here.


Thank you! I will look further at this tonight once my 3 year old is asleep. Try to find more info on you and find things my doctor will pay attention to and not dismiss. He makes it sound like he has already consulted with other doctors and they have found 2mg or lower is the best dose for pregnant women to reduce chance of NAS. Not sure what it would take to change his mind.


Top
 Profile  
 
PostPosted: Wed Dec 28, 2016 6:46 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4127
One of the facts you can hit him with is that a pregnant woman's blood volume increases, which he should know. But it makes the burpenorphine less concentrated, so it's like you're taking less than before.

I also found this article, which I will copy and paste here. Perhaps you can print this out. The article is from 2014. You might want to copy and paste this into a document and print it out for your doctor! Obviously, this is a scholarly article, but that might please your doctor. This article basically says that this study shows no relation between buprenorphine dose and newborn outcomes of withdrawal.

"Neonatal outcomes and their relationship to maternal buprenorphine dose during pregnancy RSS Download PDF

Hendrée E. Jones, Erin Dengler, Anna Garrison, Kevin E. O’Grady, Carl Seashore, Evette Horton, Kim Andringa, Lauren M. Jansson and John Thorp
Drug and Alcohol Dependence, 2014-01-01, Volume 134, Pages 414-417, Copyright © 2013 Elsevier Ireland Ltd

Open reading mode
Abstract

Background

Buprenorphine pharmacotherapy for opioid-dependent pregnant women is associated with maternal and neonatal outcomes superior to untreated opioid dependence. However, the literature is inconsistent regarding the possible existence of a dose–response relationship between maternal buprenorphine dose and neonatal clinical outcomes.

Methods

The present secondary analysis study (1) examined the relationship between maternal buprenorphine dose at delivery and neonatal abstinence syndrome (NAS) peak score, estimated gestational age at delivery, Apgar scores at 1 and 5 min, neonatal head circumference, length, and weight at birth, amount of morphine needed to treat NAS, duration of NAS treatment, and duration of neonatal hospital stay and (2) compared neonates who required pharmacotherapy for NAS to neonates who did not require such pharmacotherapy on these same outcomes, in 58 opioid-dependent pregnant women receiving buprenorphine as participants in a randomized clinical trial.

Results

(1) Analyses failed to provide evidence of a relationship between maternal buprenorphine dose at delivery and any of the 10 outcomes (all p -values > .48) and (2) significant mean differences between the untreated ( n = 31) and treated ( n = 27) for NAS groups were found for duration of neonatal hospital stay and NAS peak score (both p -values < .001).

Conclusions

(1) Findings failed to support the existence of a dose–response relationship between maternal buprenorphine dose at delivery and any of 10 neonatal clinical outcomes, including NAS severity and (2) that infants treated for NAS had a higher mean NAS peak score and, spent a longer time in the hospital than did the group not treated for NAS is unsurprising.

1
Introduction

Research has strongly suggested that buprenorphine pharmacotherapy for pregnant women with opioid use disorder is associated with superior maternal and neonatal outcomes relative to untreated opioid use disorder. Moreover, in terms of the relative efficacy of buprenorphine compared to methadone during pregnancy, Jones et al. (2012b) presented a systematic review of the literature in which they reported that buprenorphine and methadone have comparable maternal efficacy, that buprenorphine may produce less physiological suppression of fetal heart rate and movements than methadone, and that exposure in utero to buprenorphine results in a less severe neonatal abstinence syndrome (NAS) than methadone. A focus on NAS is of considerable current importance because its incidence in the US has increased from 1.2 to 3.4 per 1000 hospital live births from 2000 to 2009. During this same period, mean hospital charges for treatment of neonates with NAS increased more than 35%, from $39,400 to $53,400 ( Patrick et al., 2012 ).

However, the relationship between maternal buprenorphine dose and either neonatal abstinence syndrome (NAS) incidence or severity has been inconsistent ( Jones et al., 2005; Lejeune et al., 2006 ), a finding also reported for methadone ( Jones et al., 2013; O’Grady et al., 2013 ). Infant urinary concentrations of norbuprenorphine, the primary buprenorphine metabolite, have been found to correlate with infant length of hospital stay but not duration of NAS pharmacotherapy ( Hytinantti et al., 2008 ). In line with this finding, total buprenorphine concentrations in meconium and buprenorphine/norbuprenorphine ratios were associated with the presence of a diagnosable NAS, although not necessarily one requiring pharmacotherapy ( Kacinko et al., 2008 ). Examination of the possibility of such a dose–response relationship between maternal dose of buprenorphine and neonatal outcomes including NAS severity is of considerable clinical importance, because determination of the existence of such a relationship would have implications for the medical management of pregnant women with opioid use disorder. Such a finding would suggest the potential need to limit or restrict the buprenorphine dose for the mother in order to reduce the deleterious impact of a higher dose on the neonate. Such a restriction could be potentially disadvantageous to the treatment of the mother if the dose was insufficient to ameliorate or reduce illicit opioid use or licit opioid misuse. Moreover, knowing the extent to which buprenorphine-exposed neonates who require pharmacotherapy for NAS differ from buprenorphine-exposed neonates who do not require pharmacotherapy for NAS on clinically relevant neonatal outcomes would provide information that could be used to guide the medical management of NAS.

Research on the relationship between buprenorphine dose and neonatal clinical outcomes has largely although not entirely focused on the differences between buprenorphine and methadone in NAS occurrence or severity, and to a lesser extent on morphine dose to treat NAS, and length of hospitalization for NAS treatment. Research on the relationship between buprenorphine dose and severity of NAS has typically failed to find any such relationship ( Bakstad et al., 2009; Fischer et al., 2006; Kacinko et al., 2008; Lejeune et al., 2006; O’Connor et al., 2011 ). Metz et al. (2011) also reported a failure to find relationships between buprenorphine dose and need for and amount of NAS medication, peak NAS score, and duration of NAS treatment in a sample of 26 neonates prenatally exposed to buprenorphine as part of comprehensive treatment program for maternal opioid use disorder.

The purpose of this secondary analysis study was twofold: (1) to examine the dose–response relationship between maternal buprenorphine and a variety of neonatal clinical outcomes and (2) to compare neonates who require pharmacotherapy for NAS to neonates who do not require such pharmacotherapy on these same outcomes, in a sample of 58 mothers with opioid use disorders who participated in a randomized clinical trial of opioid-agonist pharmacotherapy.

2
Methods

2.1
The Maternal Opioid Treatment: Human Experimental Research (MOTHER) Study

MOTHER ( Jones et al. 2010 ) was a double-blind, double-dummy, flexible-dosing, parallel-group randomized clinical trial comparing outcomes for pregnant women with opioid use disorders and their neonates receiving either buprenorphine or methadone pharmacotherapy provided in the context of comprehensive care. Study findings showed that, on average, neonates in the buprenorphine condition compared to neonates in the methadone condition required significantly less morphine to treat NAS, has a shorter NAS treatment course, and spent significantly less time in the hospital. Details about the MOTHER study necessary to understanding the current analyses follow. More complete information about MOTHER is available in Jones et al. (2010 2012a b) .

2.2
Participants

One-hundred-seventy-five pregnant women with opioid use disorders meeting eligibility criteria participated in the study. Women were randomly assigned to either the buprenorphine or the methadone condition in which double-blind, double-dummy, study medication was dispensed daily with sublingual tablets (buprenorphine or placebo) followed by oral liquid (methadone or placebo). The buprenorphine condition utilized a flexible dose range of 2–32 mg. Concomitant drug use was reduced through the use of monetary vouchers provided to participants for providing three-times-weekly urine samples testing negative for opioids (other than their study medication) and other illicit or non-prescribed drugs. One-hundred-thirty-one of the 175 maternal participants delivered neonates while enrolled in the study, of whom 58 were in the buprenorphine condition. The secondary analyses reported below use the data from the neonates of these 58 maternal participants.

2.3
Neonatal outcomes

2.3.1
Neonatal abstinence syndrome (NAS)

All infants were hospitalized for a minimum of 4 days for observation for the development of NAS. Regardless of in-patient or out-patient status, neonates were assessed for NAS by trained staff for a minimum of 10 days using a modified Finnegan Scale. Oral morphine sulfate was used for NAS treatment. All pharmacotherapy for NAS was delivered to the infants during an inpatient hospital stay; no infant received medication for the treatment of NAS as an outpatient. A NAS peak score, the highest NAS score the neonate obtained during this period, was calculated for each neonate.

2.3.2
Other neonatal outcomes

Additional neonatal outcomes included estimated gestational age at delivery (weeks), Apgar scores at 1 and 5 min, neonatal head circumference (cm), length (cm), and weight at birth (g), total amount of morphine needed to treat NAS (mg), duration of treatment for NAS (days), and duration of neonatal hospital stay (days). See Jones et al. (2010) for detailed descriptions of all measures.

2.4
Statistical analyses

As in the primary outcomes paper ( Jones et al., 2010 ), total amount of morphine needed to treat NAS (mg), infant length of stay in the hospital (days), number of days medicated for NAS (days), estimated gestational age at delivery (weeks), and Apgar scores at 1 and 5 min were analyzed with Poisson regression, allowing for overdispersion. Peak score on the MOTHER NAS scale during the assessment period, and infant head circumference, birth weight, and length were analyzed with ordinary least squares regression. Maternal buprenorphine dose (mg) at delivery, collected as part of the MOTHER trial, and site of MOTHER data collection (US Urban [Baltimore, MD; Philadelphia, PA; Detroit MI; Providence, RI] v . US Rural [Burlington, VT; Nashville, TN] v . European [Vienna]) served as the explanatory variables in all analyses.

3
Results

Maternal buprenorphine dose at delivery was 4–32 mg ( M = 16.6, SD = 7.3). Table 1 contains the descriptive statistics as well as the parameter estimates and standard errors associated with the analyses of the 10 neonatal outcomes. Analyses failed to provide any evidence of a relationship between maternal buprenorphine dose at delivery and the respective outcome measure (all p 's > .48).

Table 1
Total sample means and (standard deviations) and parameter estimates from the regression analyses examining the relationship between buprenorphine dose and 10 neonatal clinical outcomes ( N = 58).
Outcome variable Mean ( SD ) b SE AOR 95% CI p
Total amount of morphine for NAS † (mg) 1.7 (3.0) .98 .90, 1.07 .70
Duration of treatment for NAS † (days) 4.6 (6.2) .99 .92, 1.06 .78
Duration of neonatal hospital stay (days) 10.1 (7.0) .99 .97, 1.03 .95
Gestational age at delivery (weeks) 39.1 (2.2) 1.00 .99, 1.00 .82
Apgar score at 1 minute 8.1 (1.6) 1.00 .99, 1.02 .86
Apgar score at 5 minutes 9.0 (1.1) 1.00 .99, 1.01 .99
NAS peak score a 11.0 (3.4) −.05 .07 .50
Neonatal head circumference at birth (cm) a 33.8 (1.9) .01 .04 .78
Neonatal weight at birth (g) 3096.9 (561.2) 1.34 11.93 .91
Neonatal length at birth (cm) a 49.8 (2.7) .04 .06 .48 View full size
Notes. Means do not equal values found in Table 2 of Jones et al. (2010) , because the latter means are model-derived marginal means from a model that includes site and the methadone condition. SD = Standard Deviation. NAS = Neonatal Abstinence Syndrome. b = unstandardized partial regression coefficient. SE = standard error. AOR = adjusted odds ratio (adjusted for the fixed site factor). 95% CI = 95% confidence interval.
a One case is missing data for this variable.

For those infants requiring pharmacotherapy for NAS, the mean total amount of morphine (mg) was 3.5 ( SD = 3.5), while the mean duration of treatment for NAS was 9.8 days ( SD = 5.5). Significant mean differences between the untreated ( n = 31) and treated ( n = 27) for NAS groups were found for duration of neonatal hospital stay, F (1, 54) = 15.5, p < .001, [ M = 6.5 days ( SE = 1.0) v . M = 14.1 days ( SE = 1.6), respectively] and NAS peak score, F (1, 53) = 66.3, p < .001, [ M = 8.5 ( SE = .4) v . M = 13.9 ( SE = .4), respectively]. All other tests of mean differences between the NAS treatment status groups were nonsignificant (all p -values > .4).

4
Discussion

This secondary analysis study of data from the MOTHER trial failed to support any relationship between maternal buprenorphine dose at delivery and any of a number of clinically important neonatal outcomes. There was no relationship between maternal buprenorphine dose at delivery and NAS severity, as measured by peak NAS score, total amount of morphine needed to treat NAS, duration of treatment for NAS, or duration of neonatal hospital stay, or with any of 6 other neonatal clinical outcomes, including estimated gestational age at delivery, Apgar scores at 1 and 5 min, neonatal head circumference, length, and weight at birth. These results are consistent with and expand upon previously reported findings ( Jones et al., 2013 ), in which no significant relationship was found between maternal methadone dose and neonatal outcome. Moreover, the failure to find a dose–response relationship between buprenorphine and duration of neonatal hospital stay, estimated gestational age at delivery, Apgar scores at 1 and 5 min, neonatal head circumference, length, and weight at birth expand upon the findings of Metz et al. (2011) .

In contrast to many of the previous studies of the relationship between buprenorphine dose and NAS severity, in the present study the failure to find a relationship between buprenorphine dose and neonatal clinical outcomes occurred in a sample in which the concomitant substance use that might serve to confound such relationships was negligible or non-existent, participants had neither alcohol or benzodiazepine use disorders, and minimal use of cocaine and other substances. Thus, the present sample permitted assessment of the relationship between buprenorphine dose and neonatal outcomes without the potentially confounding factor of poly-substance use. Moreover, the assessment of NAS was undertaken with a validated instrument with which all raters had been trained, and on which they received episodic re-training. And, the NAS medication criteria were well-defined and uniformly applied.

That the infants treated for NAS had a higher mean NAS peak score and, on average, spent a longer time in the hospital than did the group not treated for NAS is unsurprising. Both of these outcomes are likely the result from a more severe NAS presentation and need for greater pharmacotherapy for the infants treated for NAS.

The failure to find a dose–response relationship between maternal buprenorphine dose and any of a number of neonatal clinical outcomes in a well-controlled clinical trial is an important result. The use of any medication has fundamental benefits and risks. This circumstance is particularly true with pharmacotherapy for opioid use disorder in pregnant women, in whom the risks as well as the benefits are likely to be of a large magnitude. There remains a persistent misunderstanding that limiting the exposure of the fetus to maintenance medications for the treatment of maternal opioid use disorder is in the best interests of both the mother and neonate. In these dyads, wellness of the mother is inherently tied to infant outcomes. Maternal abstinence from illicit opioid use, which is necessarily accomplished in many such mothers by maintenance on an appropriate dose of a medication such as methadone or buprenorphine, leading to improved access to prenatal care and subsequent avoidance of myriad medical and psychosocial complications of continued drug use, are of profound importance to the infant. The present findings, together with those of Jones et al. (2013) , lend support to the belief that there is no sound basis for limiting the dose of opioid agonist medication provided to pregnant women with opioid use disorder in order to minimize its impact on the neonate. Future research needs to examine the relationship between buprenorphine dose and neonatal clinical outcomes in other samples of neonates that are more diverse in terms of such factors as their exposure to other illicit substances, and/or whose mothers are not in comprehensive care for their opioid use disorder. Finally, more research needs to be conducted regarding the longer-term effects of in utero exposure to opioid agonist and mixed agonist/antagonist medications.

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Wed Dec 28, 2016 7:05 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4127
I want to mention that, while we can pass on information to you and try to support you to the best of our ability, we are not mental health professionals. You should never discount what your therapist/counselor/psychiatrist is telling you. Especially with a subject as serious as self-harm. We do not know how to help you with that.

You may have other and deeper psychological problems that cannot be addressed here. Even the doctors who chime in here cannot give you the care that you need. All we can do is give you our best educated guesses. You definitely need to be under the care of a psychologist/psychiatrist to help you deal with your mental problems. I suggest that you make an emergency appointment for yourself and get there as soon as possible. We are very concerned about your talk of self harming as well as other alarming information.

That doesn't mean that we are abandoning you! You just need to know how we are able to help and how we are not. Please get help as soon as possible and call 911 if you feel like hurting yourself again.

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 98 posts ]  Go to page 1, 2, 3, 4, 5  Next

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 0 guests


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