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Unread 12-01-2007, 06:07 PM   #1
NancyB
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Default Bupe and Pregnancy - links and downloads

Here's bupe and pregnancy-related items all in one place.

PCSS Pregnancy and Buprenorphine Treatment
http://pcssb.org/wp-content/uploads/...-treatment.pdf
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Clinical guidelines for the use of buprenorphine in pregnancy

It was written in 2003 before more studies confirmed the safety of bupe during pregnancy but it is helpful nonetheless.
http://www.turningpoint.org.au/Media...p-in-preg.aspx
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Here's a thread by sparkles3333 who delivered a child while on bupe:
http://www.addictionsurvivors.org/vb...ad.php?t=13101

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And jenn's thread who delivered while on bupe also.
http://www.addictionsurvivors.org/vb...ad.php?t=14743

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okie (Michelle) here is on -tex and pregnant:
Quote:
quote:Originally posted by okie

Josie
well first and foremost my drs first concern was switching to tex..
Then when it comes to tapering, it of course depends on the patient and risks of relapse(all of this is according to my dr). If tapering is desired, the safest time to attempt is during the second trimester. My Dr has recommended attempting to drop 2 mgs every 2 weeks..but its all dependant on how I feel.

He warned me that sometimes his patients have had to increase dose in the middle of the pregnancy, and then can start to taper again, kinda weird..but he has had quite a few this happened to.

According to him the risk of the baby being dependant on sub is about 30 percent, but that takes into account all doses..his experience has been expecting moms on 4 mgs or less at delivery have had babies with no wds.

There is a little bit online about pregnancy and sub, but I've found nothing beyond the same things nancy has posted before.

I have wondered about the baby and wds rates and dosages, and am thinking that it probably has alot to do with the actual absorption rate of the individual and then consider how much of that filters thru to the baby..but there just isnt much info out there.
My dr consults with an OB in Birmingham,AL who he says is an expert on sub and pregnancy, and happy to talk to anyone that has questions..I could easily get his number again, he is really really nice.

Michelle

ps have to lol sure its not josie having a baby..
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From the TIP40 PDF page 95, Hardcopy 69:

Effects of Buprenorphine in Pregnancy
Data on the pharmacokinetics of buprenorphine in pregnant women and neonates are extremely limited (Johnson et al. 2003a; Marquet et al. 1997). Likewise, data are limited regarding the clinical use of buprenorphine for the maintenance treatment of opioid addiction in pregnant women. The literature in this area generally consists of case reports and a small number of prospective studies; there have been no controlled clinical trials. In case reports from European and Australian sources on the use of buprenorphine in opioid-addicted pregnant women, doses have ranged from 0.4 to 24 mg per day. In these limited reports, pregnancies have generally progressed normally, with low rates of prematurity or other problems. Maternal clinical laboratory data in these reports generally have been within normal limits; or were deemed either clinically nonsignificant at levels expected during pregnancy, when outside normal limits, or were due to factors other than the medication. For a complete review of the published literature on the use of buprenorphine in the treatment of opioid addiction in pregnant women, see Johnson et al. 2003a.
http://www.naabt.org/links/TIP_40_PDF.pdf
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Thread: pregnant with ?s
http://www.addictionsurvivors.org/vb...ad.php?t=15198
---------------------------------
Clinical Trials:
http://clinicaltrials.gov/ct2/show/N...cr=Open&rank=1
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Unread 02-18-2008, 12:11 PM   #2
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Keystan's thread:
http://www.addictionsurvivors.org/vb...ad.php?t=16694
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Unread 05-16-2008, 02:46 PM   #3
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Is anyone currently on Bup and pregnant? i am 22 weeks preg with a little girl and on 2mgs. would love to touch base with someone who has ANY KIND of experience. Im terrified and would love to be able to chat about it.
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Unread 05-16-2008, 05:47 PM   #4
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Hi!
I just had my little girl march 24 2008..been on sub since jan of 06..
Was up to 16mgs when I had her..
shes perfectly healthy and wonderful..
No need to worry!!
Michelle
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Unread 05-20-2008, 03:41 PM   #5
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Did your daughter experience any symptoms of NAS? i just had to up my dosage 1mg ..i felt like i needed more, did you have to do that as well?
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Unread 05-20-2008, 11:58 PM   #6
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Yes I ended up going up 2 mgs in the beginning of 2nd and then 3rd trimesters.
My dr said its quite normal. He has had several sub patients have babies, all healthy and happy.
And NO nas at all..she acted like a newborn..perfectly normal..I had a horrible pediatrician that didnt know or want to learn about sub at all..
he called her a mehtadone baby and then had some awful nurses that would count every thing she did as wds..which I assure you were not..she was completely able to calm down if I held her. So I spent the time in the hospital awake..to get out of there asap.
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Unread 05-21-2008, 02:09 PM   #7
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Well its very sad how these Dr's and nurses judge and discriminate all bc they are ignorant and know NOTHING about the medication and what not...im glad for you that youre both happy and healthy. I also feel somewhat relieved after hearing your experience.. ive been stressing big time!! which is bad...thanks for responding.
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Unread 05-21-2008, 03:23 PM   #8
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Stop stressing..seriously she is perfect. I was poked prodded and worked over being old and decrepit and all..lol and there was nothing wrong ..
The stress is doing more harm then good I promise..
Michelle
ps congrats!!
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Unread 05-22-2008, 02:10 PM   #9
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Do you have any info/experience as far as breastfeeding while on subutex?
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Unread 05-22-2008, 02:21 PM   #10
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No I didnt. Sorry.
There was another post on one of the other pregnancy threads tho that someone had said she breastfed.
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Unread 11-20-2008, 12:55 PM   #11
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Another pregnancy and delivery of a healthy baby where his mom was on Subutex the entire time:

http://www.addictionsurvivors.org/vb...ad.php?t=20194
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Unread 03-29-2009, 09:41 AM   #12
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This is ohmygoddess's story. Her baby boy did experience withdrawals. Fortunately, both mom and baby are doing well now.

http://www.addictionsurvivors.org/vb...ad.php?t=21201
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Unread 04-02-2009, 11:40 PM   #13
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Default links to bupe/pregnancy studies

Hello, These are a few to look at. I have another one that I am still trying to locate. When I find it I will put it on. I am sure there are many more as this is a big topic that has had much interest and there are many on-going studies. Happy reading.

nan


http://www.ncbi.nlm.nih.gov/pubmed/18283247?log$=activity
http://www.suboxoneassistedtreatment.org/47.html
http://pediatrics.aappublications.org/cgi/content/full/122/3/e601
288: Buprenorphine vs. methadone for treatment for opioid addiction during pregnancy: A retrospective study of prenatal compliance and neonatal outcomes
American Journal of Obstetrics and Gynecology, Volume 199, Issue 6, Supplement 1, December 2008, Page S91




http://stanford.wellsphere.com/drug-addiction-article/suboxone-buprenorphine-and-opiate-withdrawal-in-newborns/539401

I have copied and pasted the following from this website.
Suboxone (buprenorphine) and Opiate Withdrawal in Newborns


Posted Dec 23 08 3:56pm
I received an e-mail today related to an article I had placed on a different web site about using Suboxone during pregnancy:
My son was born November 19th 2008 and is still in the hospital because the mother is on Suboxone. He has tremors, has trouble sleeping and is excessively strong and ‘tight’. The doctors placed him on methadone to treat these symptoms and they are weaning him off the methadone. It is a very emotionally frustrating, confusing and strained time for us all. I see the side effects of the Suboxone and they are real and do happen. For more info. on my case email me. I would be happy to fill you in on more. I am dealing with it right now.
I am frequently frustrated by the lack of knowledge about Suboxone among physicians; the manufacturer of Suboxone sponsors educational seminars and courses, but doctors tend to see addiction as something other than a fatal illness that deserves their best efforts. In just my own collection of patients I have had several encounters with physicians who were literally just ‘guessing’ over their management of patients on Suboxone; they weren’t reading the literature (which there is plenty of), they weren’t asking for consultation from other doctors (who would guess that doctors have egos!); and worst of all, in some cases they were treating the patients on Suboxone with patronizing or disdainful attitudes.
http://suboxonetalkzone.com/wp-conte...et-270x300.jpg Methadone is harder for newborns to kick than Suboxone.

As a Suboxone patient you bear the burden of educating yourself and perhaps educating your physician. Do not assume that every doctor knows what he or she is doing in regard to buprenorphine; you may want to seek second opinions, particularly if your doctor recommends something that isn’t consistent with what you have learned about the actions of Suboxone and buprenorphine.
My response to the e-mail about the newborn with tremors:
Thank you for writing, and I am sorry about your son. I don’t know how you will take what I am about to say, but I am not interested in an argument so please don’t reply with one—I would not read it even if you did, as the issue is your son—not my opinions.
For your own interest, and for your own concerns taking care of your son and finding your son the best care, understand that there is a vast amount of information on buprenorphine, the active ingredient in Suboxone. Unfortunately, there are also more and more examples of improper diagnosis and care related to doctors not knowing enough about buprenorphine. I have seen a number of mistakes made by physicians because of their lack of knowledge about buprenorphine, including mistakes by obstetricians and neonatologists. I don’t know where your son is, but to be frank, their use of methadone to treat ‘Suboxone withdrawal’ is so improper that I have to think that your son is not where he should be. I am sharing some articles with you that will likely make you more knowledgeable than your son’s doctors; I encourage you to read and learn about buprenorphine so that someone can lobby for proper treatment of your son.
I am someone who does know about buprenorphine; I have worked with it for over 10 years, and buprenorphine has been around for over 30 years. In fact, before epidurals buprenorphine was used to treat pain DURING LABOR, as it doesn’t carry the same risk of respiratory depression as other opiates. So understand that buprenorphine has been used for years as a ‘good medication’ for treating pregnant women in labor. It is NOT a ‘new drug’—only the patent and formulation are new.
I keep current in the literature about buprenorphine and Suboxone. There are a number of articles that provide information about the medication, although simply understanding the typical actions of opiate agonists and antagonists is sufficient to understand that it makes no sense to treat Suboxone withdrawal with methadone. You can read the articles, but one pertinent conclusion from the review article is:
From these reports it appears that buprenorphine use during pregnancy induces a more mild withdrawal syndrome in neonates, when compared with methadone.
From another of the attached papers:
Regarding Subutex and buprenorphine: it does not seem to be teratogenic in humans or animals. Administered in monotherapy form as Subutex, it has been used successfully in opioid-dependent pregnant women as a maintenance replacement opioid. A 2003 review of the available clinical studies has been published covering approximately 300 pregnancies. Compared with methadone, a lower incidence of NAS (neonatal abstinence syndrome) has been reported in buprenorphine-exposed neonates. The severity of NAS is reduced as assessed by total opiate required to treat and length of hospital stays. Some data suggest that the placental transfer of this opioid may be limited in comparison with others, such as methadone, thereby limiting fetal exposure and the development of dependency. Deshmukh and colleagues have demonstrated that a large proportion of buprenorphine is metabolized to Norbuprenorphine, the only metabolite formed as determined by high-performance liquid chromatography and mass spectrometry, by placental aromatase (CYP 19) within the microsomal fraction of the trophoblast.
From the attached case report:
If methadone cannot be withdrawn before birth, mild to strong withdrawal signs in the newborn are frequent.4 The present case suggests that buprenorphine might be considered for the treatment of pregnant women addicted to heroin because (1) it does not induce teratogenic or embryotoxic effects in animals, (2) it apparently induces only a weak withdrawal syndrome in the newborn, and (3) the dose absorbed through maternal milk is negligible.
I don’t know the cause of your son’s tremors, but I strongly doubt they are related to the mother’s use of Suboxone or Subutex. Attributing the tremors to those medications would require tossing out all of what we know about the medications—which is a large amount of data. One thing that we absolutely DO know is that methadone causes a much greater ‘abstinence syndrome’ than does buprenorphine—and so if anything, the tremors are likely due to the methadone withdrawal! Since neither buprenorphine nor methadone harm the fetus, however, I would be most concerned that your son’s doctors are doing what is unfortunately typical—focusing on the buprenorphine since it is something they don’t know enough about, and perhaps overlooking the real cause of your son’s tremors. I encourage you to print and share the attached papers with your son’s doctors.
SuboxDoc
The papers I mentioned in my message:
Elkader A and B Sproule. Buprenorphine: Clinical Pharmacokinetics in the Treatment of Opioid Dependence. Clin Pharmacokinet 2005; 44 (7): 661-680.
Marquet P, J Chevrel, P Lavignasse, L Merle, and G Lachltre. Buprenorphine withdrawal syndrome in a newborn. Clinical Pharmacol Ther 1997; 62(5): 569-571.
Helmbrecht G, and S Thiagarajah. Management of Addiction Disorders in Pregnancy. J Addict Med 2008; 2: 1–16.

Last edited by nan; 04-02-2009 at 11:46 PM.. Reason: addition
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Unread 05-28-2009, 10:42 AM   #14
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jamber11's story:

http://www.addictionsurvivors.org/vb...ad.php?t=21627
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Unread 11-19-2009, 08:37 PM   #15
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I was in a study at my local hospital called the MOTHER study that was being conducted nationwide. I ended up being on methadone (they were comparing the 2) and my best friend was on bupe. We were on the same dosage upon delivery (14mgs bupe/55mdone). My baby (7mos old now) had withdrawals, and it was heartbreaking, but he ended up fine. Her baby had NO withdrawals. Both of our babies are doing very, very well. Neither of us really had problems w/ breastfeeding (I got put on suboxone a few days after his birth), but I did have supply problems due to an unrelated thyroid enlargement.

I learned SOOO much from the study, I'm pretty much an expert on bupe & pregnancy, so if anyone needs info or has questions, I'd be happy to help. I have 2 boys, and the first one, well, I wasn't on any drugs during pregnancy & delivery, and the 2nd, I was... So I can draw a good comparison between the 2.

Oh and I also wanted to add that as your blood volume increases, the effectiveness of the bupe will likely decrease. It did for us. So, you will probably need to increase your dose several times, and then after birth, lower it back down over the first 6 months. Both my friend and I started at 6mg bupe/30 mg mdone, and ended up at 14/55, so on bupe, we went up 8mg during pregnancy. Once you start feeling cravings and wds, up your dose. You may need to up it 2 mg 4 times during pg like we did, you may not. But I can say, one dose usually does not get a woman all the way thru pregnancy. Do NOT ever feel guilty if you have to up your dose! Its just b/c your blood volume & fluid retention have increased tremendously! At the very least, doubling every or every-other month.

Also, when I switch to suboxone after giving birth, my doc & midwife (who specializes in treating pg bupe patients) said the bupe & naloxone should not get passed to the baby via breastmilk, but if it does, it would be such a small amt it would do nothing to him or her. The activities of bupe & naloxone are just different in a baby's brain than ours, and it doesn't do for/to them what it does for us, and won't hurt them whatsoever.
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Unread 12-19-2009, 11:47 PM   #16
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Hi there everyone. My last visit here was 4-11-07, so it's been a long time! I just tapered and the actual jump date was 3 days ago. I wanted to share that when I started, 3/12/07 I had a two month old baby and breastfed her while I was on sub for the next 2 years. It didn't effect her at all, and when I weaned her from nursing that didn't phase her either. At some point I was taking 12mg. (started with 2, went up to 12 eventually, and settled back down at 2 for the last year.) Now I'm 6 months pregnant, and just tapered completely off a few days ago. I am suffering from restless legs, a little insomnia, some depression, and since I have hyperemesis this pregancy and am having to take Zofran, I havent' noticed any stomach or nausea problems.

I just wanted to let you know that nursing while on sub is totally ok. I am forever grateful to the people who stay on this site and offer guidance and hope, you guys are truly the best!
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Unread 12-20-2009, 01:31 AM   #17
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Hi lala, Did you discuss stopping suboxone with your dr? I would think if you are feeling wd discomfort then your baby would be also? If you haven't talked with your dr about this, please do. Congratulations on your success with baby number one, and congratulations for the new baby on its way!

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Unread 01-09-2010, 12:19 PM   #18
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could you give me the name or number to the dr. in AL, Im 11 weeks preg. and on subutex. my sub dr along with 2 other ob's told me to stay on the med, dont decrease or quite b/c i will miscarry but the more people criticize and ridicule me i start thinking what if i do or dont wat will happen, my fear is the baby having severe wds or having a severe retardation, which my boyfriends mother rubs in my face allll the time. im so stressed about this and wish there was more research, proof, or just more literature on this very sensitve issue.
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Unread 01-09-2010, 06:56 PM   #19
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My 21 month old is perfectly healthy and fine. I was on sub almost 2 yrs when I found out I was pregnant with her, switched to subutex and went up in dose during my second trimester.

I could care less what anyone else thinks. Screw them. It isnt anyone's business and not a damn thing is wrong with my daughter, or the I dont even know how many other women's sub babies.
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Unread 01-09-2010, 09:00 PM   #20
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all of your posts make me feel alot better to know someone else is going threw or gone threw wat im going threw. i know subutex is ok, and that its better to stay on it then stop taking it because its bad for the baby and it will cause a misscariage. i think the hardest part of this whole thing is dealing with ignorant people who judge you or try to tell you doctors dont know what they are talking about, or how its selfish to stay on the medication, i even heard from someone " oh just smoke pot its better for the baby then those pills" but i try to ignore it because they arent the doctors and to me the doctors opinion is the ONLY one that matters, i hope everyone has a safe delivery and a happy healthy baby. i hope i will...
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Unread 01-10-2010, 10:12 AM   #21
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Really..smoking weed would be better? Give me a break...I think every mom who has taken ANY medication has felt badly..but think about this..how many women suffer injuries or need to take an opiate while pregnant? I know of a few..and I am not talking about ppl abusing opiates..because taking sub as directed is going to be the same as someone taking vicodin(as prescribed of course) when preggo..and it happens every day..ppl break bones, get into accidents, etc.

I also read (and I wish I remember where) in one of the long winded research papers about sub and pregnancy that bupe does not cross the placenta to the baby..my guess would be that in most women this is true, and hence why our babies have no w/ds..

It sounds like your Dr is not giving you trouble..and that is good..ignore ppl who "think" they know everything..
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Unread 01-10-2010, 12:00 PM   #22
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Hi ashley7 I read your post & had to respond I had taken subutex throughout my pregnancy w/my now 7 mn old daughter & she was born PERFECT If I had not taken sub while pregnant she would of been born addicted or not born at all due to the very high risk of miscarriage while you go through withdrawals Listen to your doctors, they know what they are talking about, as for your boyfriends mom & everyone else-they are ignorant to sub & really need to educate themselves before they open their ignorant mouth What do they want you to do? the alternative? risk miscarriage? born addicted? When I was pregnant I told NOONE of my sub use, it was none of anyones business & I did not care to listen to any uneducated feedback And no, weed is not better it's worse. You just keep doing what you need to do for yourself & your unborn child & don't listen or take to heart anything said to you about you taking sub unless it comes from your doctors And best luck with the new baby!!!!
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Unread 02-06-2010, 07:02 PM   #23
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Is there any information on breastfeeding (albeit rarely these days) a very healthy huge 10 month old? I am on suboxone and do not want to wean her drastically. Thanks!
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Unread 02-27-2010, 04:13 PM   #24
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Throughout my pregnancy and breastfeeding, I took 4mg of suboxone daily. After I delivered my baby, the doctors and nurses insisted my son was in wds. I was scared to death and felt extreme guilt. My sub doctor intervened and my son was not in wds. He is perfectly healthy and I am grateful. Is there anything I can do to help prevent this from happening to someone else? Is there anyway my story can be used to gather data or educate health care providers concerning suboxone and pregnancy?
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Unread 02-28-2010, 06:51 AM   #25
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HELLO.I am brand new to talking in on any forums. But, I am desperate to finding some answers about suboxone and pregnancy. I am 35 with one child, who is 4yrs old now, and desperately want another child. I have been on sub for almost 3 years now. My sub physician is pushing me to switch to methadone for a pregnancy. I just can't bear the thought of going into a meth clinic daily at 9 months pregnant!!! Also, I hear wds still happen on methadone. I know first I need to find an Obstetrician who deals with this, and second is it better to switch to subutex (with no naloxone)?? I am currently taking 8mg every am of suboxone and 6mg every pm. I am trying to wean myself off completely, but it is taking soooo long and we all know my biological clock is ticking. Part of me just wants to get pregnant and deal with it, but I want my baby safe. Also, I will have to have a cesarean so how will that work with my pain control after delivery? Does anyone have any advice? THANK YOU SO MUCH!!
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Unread 03-01-2010, 10:35 AM   #26
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Leah
I would find another sub dr. No way in hell would I go on methadone. PERIOD.

I have a healthy happy 2 yr old that I had on subutex, no withdrawals, no problems. And a csection. I pretty much suffered needlessly for the first 36 hrs after the csection, but thats because I had only met the OB 3 days before the csection and her nurse didnt bother to call my sub DR as instructed to, so pain wasnt handled correctly.
Had I not been stressed out by a series of mistakes, due to being seen on a military base, none of the negatives would have occured.
Regardless my daughter is happy, healthy and perfect..I was 35 when I got pregnant with her and 36 when I had her.
Finding an OB who knows sub, is harder then just finding a sub Dr who has had pregnant patients..try the dr patient match system on this site and make sure to mention that you want to have a baby, so need to find a Dr that has dealt with that issue, might not hurt to point out your age as well.
If I were you I would also consider just tapering off the sub...14mgs at 3 yrs out seems a bit high..you may well be fine on much lower dose and not notice a difference at all..6 months after I had my daughter I jumped off sub at 2mgs because I was tired of paying for the sub, and I had been on it for 2.5 yrs..but whichever way..you do not need to go to methadone..yuck!
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Unread 03-01-2010, 12:38 PM   #27
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Hi Leah I had my now almost 9 mn old daughter while taking subutex & she was born perfect. I started on subutex, 24 mgs a day, when I was about 3 mns preggo w/her & going on subutex was probably the best thing I could of done for the both of us. She was born healthy, beautiful w/no withdrawals whatsoever. From what I read & had been told about methadone made choicing sub a no-brainer, the % rate for babies being born addicted to methadone if their mommies took while pregnant was over 90%!!!! From what I understand there hasn't been a whole lot of research done on pregnant mommies taking sub so I listened to my dr & what I read & know now from my own experience. You are probably doing your own research on both meds so you can make the best decisiion for you & your baby. I continued w/sub after I had my daughter & I was switched from subutex to suboxone. I am now about 17 weeks pregnant w/our son & I will continue w/sub treatment during & after this pregnancy as well. Good luck to you!!
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Unread 03-25-2010, 07:33 PM   #28
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http://www.news-line.com/featureone....&-KeyValue=805


FEATURE STORY 04/15/2005
Author: Katherine Ritz
Improving Care for Drug-Addicted Mothers and Newborns
Karen D'Apolito, PhD, RN, is a nurse educator by profession; being a thought leader on how to improve care for drug-addicted mothers and their newborns is her passion. She combines both facets of her career as an assistant professor at Vanderbilt University School of Nursing in Nashville, TN, and director of the school's neonatal nurse practitioner specialty program.

Outside of the halls of academia, D'Apolito is immersing herself in a new multicenter, national study aimed at helping drug-addicted newborns. She is teaming up with Peter Martin, MD, professor of psychiatry and pharmacology and director of the Division of Addiction Medicine at Vanderbilt Medical Center to determine if a new drug-treatment option for pregnant women could mean less severe withdrawal symptoms for their newborns. D'Apolito enters the study with an extensive background in studying drug-addicted newborns. She and Martin will set out to prove what was already suggested by a study at Johns Hopkins University Medical Center: treating the pregnant mothers with buprenorphine instead of methadone might result is better outcomes for their babies.

"Right now, pregnant women who have an opioid addiction are treated with methadone. This is the standard treatment for opioid dependency during pregnancy, and the safest available option for newborns, because it reduces drug use by women during pregnancy and lessens the potential for miscarriage," explains D'Apolito. She says that there may be a better option for newborns, however. "After birth, these babies have severe withdrawal signs and symptoms, or in some cases, seizures. They require pharmacologic treatment that prolongs hospitalization."

Preliminary research shows that treating pregnant women with buprenorphine instead of methadone after delivery lessens neonatal withdrawal symptoms -- a finding that may change the standard treatment of pregnant women with an opioid addiction if the current study replicates these findings.

Vanderbilt Medical Center is one of eight sites participating in the research. D'Apolito will be responsible for training staff nurses to use neonatal abstinence scoring during the study, and then performing checks to make sure the nurses maintain reliability in their scoring. This is an area where D'Apolito has extensive experience, having become nationally known for the Inter-observer Reliability Program she developed to complement the neonatal abstinence syndrome scoring system.

The neonatal abstinence syndrome scoring system, developed by Dr. Loretta Finnegan (also known as a "Finnegan score") measures 21 signs and symptoms of withdrawal. The tool is used to assess a newborn every three to four hours, and a score is assigned for each symptom observed. Any score of eight or higher indicates that the baby's withdrawal symptoms need pharmacological management.

D'Apolito had discovered that observers typically assigned different scores for the same patient, based on their own individual interpretations of the severity of the symptoms, so she developed the Inter-observer Reliability Program, defining each sign and symptom to make the scoring system more objective. Under her program, for example, five minutes of crying would indicate one score, while 10 minutes of crying would warrant a higher score. "It gave some validity to the scores," D'Apolito explains. "Nurses really do need to do the research to validate their practice. Much of what we do has not been validated, and that's where I think nurses play a big role. I think validating our practices through research is the biggest contribution we can make."

She has trained her students in the use of her reliability program in conjunction with the Finnegan scores, and this is the basis of the system that will be used in the study. Periodically, she'll also help the nurses in the study perform examinations to look for signs and symptoms -- a bit of hands-on work she doesn't often get to do since leaving the clinical setting to become a nurse educator.


This article goes on with further info on D'Apolito.
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Unread 03-25-2010, 07:34 PM   #29
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http://www.ncbi.nlm.nih.gov/pubmed/18355989

Buprenorphine and methadone treatment of opiate dependence during pregnancy: comparison of fetal growth and neonatal outcomes in two consecutive case series.
Kakko J, Heilig M, Sarman I.

Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
AIM: To compare the effects of fetal buprenorphine and methadone exposure during maintenance treatment of pregnant heroin dependent subjects. DESIGN AND SETTING: A population based comparison of consecutive, prospectively followed buprenorphine-exposed pregnancies in Stockholm County, Sweden, to retrospectively analyzed consecutive methadone-exposed pregnancies. PARTICIPANTS: All 47 pregnancies in 39 women with opiate dependence and buprenorphine maintenance treatment 2001-2006, and all 35 methadone-exposed pregnancies (26 women) 1982-2006 in Stockholm County. MEASUREMENTS: Intrauterine growth, birth outcome, malformations, neonatal adaptation, withdrawal syndrome and infant mortality. FINDINGS: Buprenorphine-exposed pregnancies resulted in 47 uneventful live births (2 twin pairs), 1 stillbirth (for which no explanation was found) and 1 miscarriage. The birth weight of the infants was normal. Neonatal abstinence syndrome (NAS) occurred in 19 cases (40.4%), the majority mild in nature and only 7 (14.9%) needing withdrawal treatment. Compared to 35 infants born after intrauterine methadone exposure at the same hospital since 1982 (77.8% of them exhibiting NAS and 52.8% needing withdrawal treatment), there were significant advantages with buprenorphine treatment: birth weight was higher, due to longer gestation. Incidence of NAS of any intensity, as well as incidence of NAS that required pharmacological treatment was lower, while length of hospital stay was shorter. When buprenorphine treatment started pre-conception, NAS at any level was significantly less frequent than in subjects with post-conception initiated treatment (7/27, 26%; 12/20, 60%, respectively). CONCLUSIONS: Data from this non-randomized comparison suggest that buprenorphine may offer advantages for treatment of opiate dependence during pregnancy.
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Unread 05-19-2010, 04:04 PM   #30
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Thumbs up Bupe over methadone for pregos

new article about bupe study and pregnant women, Compared bupe to methadone, bupe wins! http://www.docguide.com/news/content...25772800634714
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Unread 07-13-2010, 06:29 PM   #31
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suboxone will go to the baby but subutex does not an if it can its a small chance i was on subutex while pregnant an it did not get to her although the dr did also have me on a depressant and anxiety pill as well and told me they both would not go to her an it did
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Unread 07-13-2010, 07:35 PM   #32
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Hi nikkigz1985, the reason that they like to switch pregnant women to Subutex is because it doesn't have the naloxone in it. The active ingredient in both Suboxone and Subutex is buprenorphine, the naloxone is clinically insignificant, but the preferred formulation is Subutex to eliminate the chance of any reaction from the naloxone in Suboxone. Plus all the data that was around for pregnant women - when Suboxone was FDA approved here in the States - was strictly the monotherapy formulation. There have been women here who gave birth to perfectly babies while taking Suboxone their whole pregnancy.

They've been doing studies in the past few years here, so hopefully we'll some more firm data.

Nancy
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Unread 07-15-2010, 01:15 AM   #33
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Thumbs up

Quote:
Originally Posted by Mike View Post
new article about bupe study and pregnant women, Compared bupe to methadone, bupe wins! http://www.docguide.com/news/content...25772800634714
That's excellent news. I requested Bupe for my pregnancy but at the time I guess there wasn't much info and I was put on methadone. Thankfully, my daughter had no withdrawals symptoms. She only couldn't regulate her temp because she was preemie. We were very lucky she didn't have to go through any of these symptoms while I was taking Methadone during pregnancy!!!!!!! I think the low dosage had A LOT to do with it. 10mg by third trimester! She was only in "Special Care" not NICU for 8days

Danielle
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Unread 12-21-2010, 01:25 PM   #34
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New study affirming the efficacy of buprenorphine for pregnant women.
http://www.nejm.org/doi/pdf/10.1056/NEJMoa1005359

Tim
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Unread 07-07-2011, 01:49 AM   #35
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I would just like to add a few words about people like myself who are pregnant... I have had SOOO many people look down on me because i am pregnant and on Subutex. They have told me that i am a terrible mother... That the baby doesnt deserve this... that i just need to stop taking it "ya because its that easy"... I read a few posts about the same subject... First off i am 22 weeks pregnant and the baby is VERY loved but was NOT planned! My options were to just QUIT suboxone or have a abortion.. I refuse to have an abortion... So what were my options??? I took the first step into recovery about 6 months before i became pregnant. I feel like instead of people saying "I cant believe you are on that medication while you are pregnant" they should be saying "I am so proud that you are getting clean"!!! I feel for any pregnant women who have had this happen to them. I deal with it alot and its hard to explain to people when they have never had an addiction!!! I obviously understand and want to say "Way to go" to everyone who has taken their first step to recovery pregnant or not!!! To the pregnant women... We are a small group but we understand eachother! We understand its a hard position to be in!!! But we know that it has to be done... Congrats to all the pregos
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Unread 07-13-2011, 06:28 PM   #36
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I am 13 weeks pregnant and like you, I have been in recovery for 6 months, this was NOT planned and I refused to have an abortion. I am sorry that you are getting such negative feedback. I have very supportive Dr's., friends and family.
Without getting too personal, how much do you take daily. I am down to 2 mg and would lke to be off sooner than later. Have you tapered at all or ahve pans to be off by the time you give birth. I AM VERY PROUD OF YOU FOR TAKING THE STEPS TO RECOVERY!!!!
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Unread 07-27-2011, 10:31 PM   #37
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I am not pregnant, however, if I were I would do the same as you. I could not imagine trying to recover of this horrible addiction without interception or chemical assistance. Your sobriety should come first so that you are able to adequately care for your child. Take care of your addiction and do not let others opinions shatter what you've worked so hard to achieve in your recovery. That not know of what they speak of.
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Unread 04-18-2012, 07:05 PM   #38
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Default OBGYN Birmingham, AL

I am seeking the OB/GYN Specialist in Birmingham, AL. Does anyone have this doctor's information ?
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Unread 05-25-2012, 01:36 PM   #39
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Hi. After reading your post, I feel much better but I would love to have a friend to talk to about this. I cannot talk to my family about it because they worry way to much. I am about 6 weeks pregnant and I am on 4mg of Subutex (Buprenorphine) a day. I take 2mg in the morning and 2mg in the evening. The doctor that prescribes this to me says it is completely safe and he has seen several patients on it with healthy babies. My OB/GYN doctor also says it is safe or "it has to be safe, right". I told him that my doctor that prescribes it told me it is better to take 4mg than try to taper down; which can cause miscarriage. He also said 4mg is a low dose and will be fine.

Naturally, I have done a lot of online reading and I have seen horror stories. Some women say their babies went through withdrawal and had to be given seizure medications. This was a surprise pregnancy for my husband and I but now I do not know if it is safe to continue the pregnancy.... I have no friends to talk to about this and I am so so scared. Please someone help me. Write back. I just need a friend to help me through this that has been there.

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Unread 05-26-2012, 03:55 AM   #40
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Hello smiles1313, I am sorry you are feeling so stressed about this pregnancy. There has been quite a bit of research on the use of subutex during pregnancy and the reports do indicate that the effect on the baby is quite low. My daughter was on subutex throughout her pregnancy and even breast fed and no problems at all. That was her experience. We both did our research and also printed information to give to the hospital nurses at the time as they were not as informed as we thought they should have been, about subutex.

Continue to read the research results that are out there if that will make you feel more confident about all of this. I am sure your dr is being honest when he tells you he has had several patients on subutex and they delivered healthy babies. Research supports his statements. And yes, it is not a good idea to taper during the pregnancy as it can cause miscarriage during certain trimesters. If you feel withdrawals then your baby would too and that is what could cause the miscarry.

As with so many things sometimes we just have to have faith in our drs to guide us correctly. Today we also have an advantage in that we can easily have access to the research that is out there so we can read these things for ourselves.

With any pregnancy there have always been concerns and worries about how our babies will be. We want to do the very best we can while we are pregnant. That is all we can do. Go to the drs and follow directions. No one ever knows what the outcome will be, until the baby is born. Thankfully in this modern age there are many tests and the ultrsounds, etc, that can help us know certain developmental issues, etc, but overall we just have to do what the drs tell us and take care of ourselves the best we can.

With the "horror" stories you have read just keep in mind that there are many variables that affect outcomes-not just that a person was taking subutex as prescribed by a dr. As I said medical professionals are often not informed as to what subutex is and they sometimes assume the baby is going through withdrawals when the baby is just being a "baby" and crying like newborns do. That is why printed information can be helpful so they can see what the research shows.

I am sorry you are so scared. I hope that the more research you read you will feel more comfortable and you will see that when the drs tell you it is safe, it is. Talking to "friends" probably wouldn't help much because if they are not drs and are unfamiliar with subutex they wouldn't be of much help about this subject anyways.

You are doing the right things by talking with your drs about your concerns and also by reading the research. No one can tell anyone that any pregnancy will be successful for many, many reasons. All one can do is take the best care of yourself and follow what the drs advise you to do.

I hope that you will feel better about all of this and not be so scared.

nan
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Unread 06-12-2012, 10:39 AM   #41
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Hi everyone,

I guess I am a selfish forum user, as I only seem to log on when I need support and advice. Sorry 'bout that. I am here in the pregnancy forum as I have recently discovered that my husband and I are expecting our first baby. I am 30 years old and have been on suboxone, then subutex since 6/2009.

My sub doctor has never had a patient on bupe throughout the pregnancy, she says she usually gets the woman to switch to methadone, as more research has been done to ensure a healthy child. My reaction at this was a reflexive "NO!" I must admit that it is because of the extra stigma of methadone that gave me this reaction at first. Upon doing some further amateur research I see that the few studies on the subject are finding that not only is bupe relatively safe, but babies born on it have much fewer symptoms of withdrawls. (Typing that just made me feel sick... Like I am a terrible person, and have no right to have this baby... a former version of myself would have judged myself so harshly, I just know it.)

I am on 2mg of generic subutex, and knowing this is a small to moderate dose eases my mind a bit, but of course I am a wreck about it. I have not even had my first OB appointment yet, that is next Friday... I hope my doctor is compassionate and familiar. To make matters even more stressful by Sub Dr. is retiring- luckily she is hooking us all up with new Doctor's instead of leaving us patients out to the wolves. Hopefully my new sub Dr. will have some experience with pregnancy too.

I'm not even sure what my question is... there is a lot of information here that has helped to ease my mind a bit. Thank you to each and every one of you who has shared a story.
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Unread 06-12-2012, 02:20 PM   #42
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Hi zaney! Congratulations! And don't even think you're a 'selfish forum user'. You're out living life and we're here for support and advice when it's needed - the perfect balance.

I'm glad you said no to the methadone. Like you read, there seems to be so many fewer problems with buprenorphine than with methadone.

Think about printing out the 2010 study published in the New England Journal of Medicine that Tim posted for both your Suboxone and OB doctors to read.
http://www.nejm.org/doi/pdf/10.1056/NEJMoa1005359

You can also refer your Suboxone doctor the PCSS (Physicians' Clinical Support System) Buprenorphine site and she can be in touch with PCSS mentor program and be guided through or just talk or email someone with experience with bupe and pregnancy.
Main site: http://www.pcssb.org/
Mentor link: http://www.pcssb.org/mentors-and-mentees/

Also feel free to start a new thread in the main support forum, it may be seen by more people there.
http://www.addictionsurvivors.org/vb...splay.php?f=47

I hope this helps, this should be a happy time for you, not one full of worries.

It's so nice to 'see' you!!

Nancy
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Unread 01-24-2013, 04:35 PM   #43
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scaredsubmom:

http://www.addictionsurvivors.org/vb...ad.php?t=28220

Quote:
Originally Posted by scaredsubmom View Post
Update ! i am down to 4 mg a day , and my daughter is here she was born on january 23rd at 7:12 she is perfect and shows NO sign if withdrawal and only keeping us for 48 hours just to keep a littl bit of an eye on her just incase but the pedi said that my little girl looks perfect she has past all of her newborn test fine hearing ,ect this is a little short and may not make complete since as i am very very tired from giving birth yesterday and not getting any sleep do to being over anxious lol
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Unread 02-25-2013, 10:02 AM   #44
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Mymiracle's story:

http://www.addictionsurvivors.org/vb...ad.php?t=28470
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Unread 03-26-2013, 02:25 PM   #45
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A Comparison of Buprenorphine + Naloxone to Buprenorphine and Methadone in the Treatment of Opioid Dependence during Pregnancy: Maternal and Neonatal Outcomes

http://www.la-press.com/a-comparison...-article-a3593
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Unread 04-20-2013, 07:29 AM   #46
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CarolinaMommy:

http://www.addictionsurvivors.org/vb...8&postcount=30
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Unread 07-05-2013, 12:20 PM   #47
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Hello, I wanted to share my expierence with pregnancy, birth and my miracle baby while on subutex with hopes that it may help someone in a similar position.
I will start with my hubby and I were trying to get pregnant. In fact, we were spending a ton of $ with a reproductive endocronologist because I suffer from infertility due to stage IV endometerosis. I trusted all of my Drs (RE, OB and sub dr) when they told me that my baby would not have w/d or any problems when born. So I stayed on subutex like all 3 drs told me. I dont want to say that they lied about my baby not having w/d, but maybe they were not educated enough???
We were thrilled when we found out I was expecting. I stayed on my 20mg a day dose the whole 9 months. Yes, 20mg a day. I was told if I tapered that it could cause a miscarriage. I was also told that my baby would be watched closely by nurses after birth, but that he would stay with me the whole time. I delivered at the most expierenced hospital in my area and later found out that they even had a special nursery for babies born whos moms are on methadone or suboxone and are going thru NAS.
My son was born completely healthy at 8lbs 13oz 22 inches long. He was perfect in every way. He came into the world screaming, the most beautiful sound in the world. They laid him on my chest immediately. He stayed there a good 30 mins before the nurse took him to check him over. They then brought him right back to me and he had his 1st bottle. It was amazing. I was then moved up to recovery. Once there I was in for a rude awakening. I was immediately told that my son would have to stay 7 days at the very minimum. If he started having w/d then he would be put on morphine, a very low low dose. The nurses were all very nice though. They did not treat me like a "junkie". They took care of me and my son wonderfully. About 12hrs after delivery I got the news I feared the most. My son was having w/d. I could see him having occasional tremmors while he slept. About 3 hrs later it got worse, he needed morphine. This news hit me so hard because I did not expect it. I was told he wouldnt have w/d. I felt my heart breaking and the guilt was overwhelming. All I could do was cry and cry. I cry now as I type thinking back to that moment. Had I been prepared for this outcome I think I would have handled the news a little better. This is one of the reasons I want to share mine and my sons story with you incase you are pregnant and on suboxone. I do promise that it does have a very happy ending though!
The w/ds started in my son about 12hrs after he was born. The morphine was given orally via a small syringe. They scored him every 4hrs using the Finnghen (sp?) score. If he sneezed he got a point, if he had tremors he got some points, if he didnt sleep he got some points. If he got 3 10's in a day then his dose was increased or it stayed the same. If he didnt get 3 10's in a day then he was decreased. Now my mom and mom in law both said had me and my hubby been scored as a babies we would have been over the 10 a bunch of times and they never took a single med or drug during their pregnancies, but I guess the nurses have to "think the worse" and call these things w/d. There were only about 4 times with in that 4wk period that I thought "maybe that is w/d" all the other times I thought it was just normal newborn stuff. We found out that our stay was going to be long, up to 8wks. So after 7 days at the hospital we went to a place called the childrens home. They were awesome there. It was like a hotel or apartment with nurses and Drs. We had our own room with a phone, tv, crib and bed. Our son got to stay with us and the nurses would come check on him. He did have to spent 6hrs in the upstair nursery a day, but we were there with him. It was really nice because it was the closes thing to being home with my son. My son was dischared at exactly 4wks old. Once home he did not show any signs of w/d or discomfort (except for having reflux, but that is common in alot of babies). My beautiful son is now almost 15 months old. He is smart, funny, loving and ahead in most of his "milestones". Thankfully there were no lasting effects from the whole ordeal. He is as perfect as can be!
Looking back I wouldnt change a thing. I could have lost my miracle son if I would have quit subs cold turkey and it wasnt worth the risk.
I am now tapering and we hope that we are blessed with another miracle when I am off subs. I dont know if my son would have had w/d had I been on a lower dose, say 2mg a day or not. From what the Drs and nurses told me at the childrens home is that the dose usually does not matter. It all depends on how our bodies process the subs. My best friend has her son on 20mgs a day and he was send home after being watched for 7 days. He had no w/d at all. There was another couple who's baby only needed 6 days on meds and went home on the 10th day. So its nearly impossible to say if your baby will have w/d as I have seen and heard both sides.
I wanted to share my story with you so you know what can happen. I recommend talking to the hospital ahead of time to find out how they deal with NAS. Is there a place like the childrens home that you and your baby can go to if your baby has NAS? Be your own advocate and educate yourself the best you can.
Right now my lil miracle is dancing and laughing as I type!
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Unread 02-16-2014, 10:07 AM   #48
texaasdolly
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Reading the story above me opened my eyes. Im so sorry you went through all that but glad ur babey is good now. Must have been a roller coaster of emotions.
I was on this website because it has more information than anywhere else. Obvisouly theres barely any studies on subutex. Right now im on suboxone 8mg 4 in the am and 4 in the pm. I am worried because I am 6 weeks pregnant. I am getting switched to subutex on monday so tomorrow. My doctor's all tell me I will be fine.. when reading stories I find out that not everyone is just fine. I wonder if they tell me that just so ill keep payin them money for appts and medication. I dobt know I am just worried as u all know how it is. I have been on subxone for 2 years and never expected to be pregnant. Now this could be a beautiful thing I know so dont get me wrong I cant wait to have this baby but pray and pray its healthy. My whole family and my bfs family r going to be at that hospital with me how would I ever explain withdrawals
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Unread 09-18-2015, 07:50 AM   #49
Bupe mom2016
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Does anyone know of any good ob/gyn or midwifes in the Hampton roads or Richmond, VIRGINIA area that have experience with subutex or has anyone had a baby in this area while on bupes? Also, if anyone knows of any special delivery programs in my area, that would be great too! I am 5 weeks now, have been in treatment since 2013, and take 4mg/day..my dr. is already aware and has switched me to subutex..I just want an informed doctor for my pregnancy and delivery and for the baby after birth. All of your stories have been inspiring and thanks in advance for any help or direction anyone can offer! :-)
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