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PostPosted: Wed Nov 04, 2015 4:40 am 
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:? Hello, I'm 26 weeks pregnant with a baby boy, due early February.
I've been perscribed subutex 8mg a day. I'm really only taking 1/8th a day.
I just save my medication for back up because it's super expensive. I'm worried my baby might go through withdrawal. Does anyone know exactly how much of this medication passes through the placenta to the baby? Or has anyone been on low doses and had a baby born w/ no withdrawals? Please help. I almost wanna go cold turkey. I'm just scared too. I'm taking 1mg a day maybe a tiny bit more than that. Some days less than that. But most days it's 1mg or 1 1/2 mg a day.


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PostPosted: Wed Nov 04, 2015 5:53 am 
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Hi! I just wanted to let you know that I deleted your duplicate post in Q & A. We try not to have duplicate posts on the forum. Welcome to the forum and I'm sure that someone will come along soon and leave a post for you!

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PostPosted: Wed Nov 04, 2015 7:57 am 
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Hi & congratulations! Imo no one can answer how much sub passes to the placenta. There may be educated guesses though.

Have you read through the pregnancy thread here? Are you planning on breastfeeding?

You can also do a search to read threads with similar questions because allot of the moms posted what happened after the birth.


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PostPosted: Wed Nov 04, 2015 9:42 pm 
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Tiki is right in that there are so many variables... the absorption of buprenorphine into your body, the amount that gets transferred across the placenta, and then most importantly, the fraction that makes it through to the other side of the fetal liver. Blood from the placenta goes to the baby's liver first, and then to the general circulation, removing many of the substances that make it across the placenta.

There are a number of studies, though, that look at the risk of 'neonatal abstinence syndrome', aka opioid withdrawal in the newborn. Babies of women on methadone have a 100% incidence of abstinence symptoms. Babies of women on buprenorphine have a 50% incidence. In the studies I've read, the risk is NOT reduced by lowering the dose of buprenorphine that women are taking. But I have a hard time believing those findings, because we know that there would be a zero incidence in women taking NO buprenorphine. So it only makes sense that at some dose range, the incidence of withdrawal will be affected by the mother's dose of buprenorphine.

From personal experiences with patients on buprenorphine, the risk of withdrawal symptoms is MOST related to the attitudes of nursing staff. When my patients go to hospitals with neonatal ICU's, their babies end up treated for 'withdrawal'. But when they go to the smaller area hospitals, their babies tend to go home when mom goes home.

I suppose the referral hospitals would say that those smaller hospitals are 'missing' the diagnosis of neonatal abstinence syndrome... and I see how that may be true, given that the symptoms tend to be delayed a few days with buprenorphine, compared to methadone and other opioids. But if the babies do fine, and never require readmission, what's the big deal in 'missing' the diagnosis?

Patients should be honest with their docs, and with their babies' docs. It is never a good idea to hide anything in this type of situation. But the most 'advanced' and expensive option is NOT always the 'best' option. If a mom ends up getting home, with baby, after 18 hours, that's great(!) Most of the time, everything is going to go smoothly. If a person is in that situation and the baby stops nursing, then by all means, have the baby evaluated ASAP.

I strongly suspect that pediatric nurses become biased, when they know a baby is born to an opioid-dependent mother. For that reason, I wish those nurses were blinded to buprenorphine use by the mother, to help make sure that babies are not put on morphine tapers needlessly. But of course THAT will never happen. If you are a mom whose baby is placed on a taper, I recommend that you just go with the flow. If you try to get in the way, you'll only be accused of being a 'bad mom'-- and once that label is applied, it is impossible to get it removed. A taper is inconvenient-- but it will NOT hurt your child in any way. Your bonding will be delayed a few days-- just as it would have been if your baby was born a few days later.

If you are considering where to have your baby, being on buprenorphine does NOT mean you need to be in a high-risk setting-- unless your doctor insists, in which case you need to agree-- or find a new OB.


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PostPosted: Thu Nov 05, 2015 1:49 am 
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I do plan on breast feeding. I'm hoping to stop taking the subutex for a whole month before baby is born.


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PostPosted: Thu Nov 05, 2015 7:17 pm 
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Hi! I visit this forum from time to time but because of your question I decided to finally register.
I have two boys. One is 4 and one is 6 months. Luckily my older son was not exposed to Subutex during my pregnancy, there was no need at the time. However my second son was. I got pregnant about 6 months into my Suboxen treatment. My Dr. Immediately switched me to Subutex. I was on 8mg when I got pregnant and it was decided that I would do a rapid wean down, with the goal of being completely off by my third trimester. I did great with the cut back until we hit 4mgs. I couldn't go any further. I ended up cutting myself back (like you have) to 2mgs. Which actually sent me into early labor, three weeks early. My boy was born at 6 pounds 4 ounces and 19 inches long. Labor and delivery went smoothly. And he was perfect. I remember how extremely stressful it was for us in the hospital because they were watching him like a hawk!! He did have just a few slight WD symptoms. His cry was a bit high pitched, and he sneezed, a lot! But that was it! He scored super low on the chart for NNWS I think it's called. We only had to stay one extra day and were released. he never showed any other signs after either, and is such a mellow, happy, chubby baby! With such a low dose I think your baby will be just fine! Good luck momma, and I hope this helps you rest easy!


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PostPosted: Thu Nov 05, 2015 7:34 pm 
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Silk, did your doctor tell you that doing a cold turkey from subutex could cause a miscarriage? Because he or she should have. The last poster (thank you for your story) went into premature labor from stopping hers. She is lucky that everything turned out great for her baby, but premature birth is not ideal for the baby.

Your doctor should have told you that you are supposed to stay on the sub until you give birth. As Dr. Junig said, if your baby has to be tapered off in the hospital it's not going to harm him or her. If you get off subutex your baby will go through withdrawal too before it's born. I don't know that I would take that risk just for the sake of being off sub. Good luck with whatever you decide. I know that you only have your baby's best interest at heart.

Amy

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PostPosted: Sat Nov 14, 2015 2:27 pm 
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I had both my boys on Subutex..my first was a normal vaginal delivery, was on 8mg at the time and he had no withdrawal symptoms..i breastfed for a year on the medication, again no probs, he's seven yrs old and one of smartest in his class. My second son however was a high risk pregnancy with placenta previa resulting in a partial abrubtion and was born at 35 weeks (i was on 4mg then) but he developed respiratory compromise and was in NICU for 10 days..they did put him on a methadone taper but didnt start it until 5 days post birth, I was sceptical because babies born from opiates even subutex will exp wd in first 3 days, not 5, had he been delivered normally he would have already been home..i am a nurse and tho he was irritable, colicy, and had some projectile vomiting, there was absolutely no way he could have scored a 21 on the NAS, I believe the nurses just wanted a quiet baby, well it worked, he was knocked out until I took him home..i regret the decision to allow them to do that..but I didnt know what to do at the time..just review the NAS online and go with ur gut, its hard to see our children suffer but there is a big difference between colic/discomfort and wd in babies..


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PostPosted: Wed Jan 20, 2016 3:51 pm 
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I also had a baby on subutex. And I tried to stop right after I started 2nd trimester but I couldn't, I was feeling the withdrawals x2 and I knew that it could possibly cause a still birth or a miscarriage still at tht point in time.

I weaned myself down to about 1/4 pill a day and ended up having my baby at 38W1D, we only stayed 1 extra day and the only symptoms he showed were little jitters (I also smoked cigarettes) and sneezing. I did breastfeed for a little while to help him, now if you decided to breastfeed MAKE SURE YOU STAY ON THE SAME DOSE, YOU CAN NOT TAKE A QUARTER ONE DAY AND A HALF THE NEXT. They do not get nearly as much as they while they r in the womb, that is why it's important to stick with the same dose every time.

We were lucky and he did not need any medication to help him withdrawal. My OB and I talked and decided that we would wait and see how he was. I had heard every horror story known to man about how women's babies were in the hospital for weeks, n they had to be on all kinds of different medications etc etc. But for us we didn't. Now do I know for a fact tht it was because I weaned down to so little....no I do not. But do I think it helped, tremendously!

Goodluck to you and your baby!
Here's to a safe & healthy delivery!


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

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