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Unread 06-13-2015, 02:01 AM   #1
FlyingSparrow
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Default Midwife Birth on Subutex??

Has anyone here had a midwife/birth center birth while on Subs? I'm about 8 weeks, on 2mg to 4mg per day (I just cant seem to keep a steady dose right now, although I took exactly 2mg per day with virtually no problems before I got pregnant). I've been on subs for 5 years, and switched to subutex within two days after finding out I was pregnant.

I have my first appt at a birth center next week. I haven't told them that I'm on any medication yet. I desperately want to deliver at the birth center and not at the hospital. I don't agree with the medicalization of births that fall within the range of normal pregnancies, and for many reasons, I want to avoid the hospital. (I can get more into that if anyone wants me to, but it's not important for the post.)

I understand that there's a chance that my baby would suffer from NAS. I'm really hoping that the don't, obviously, but I've heard horror stories about hospitals scoring normal babies higher on the scale than they really should be, or medicating them for weeks and weeks when it isn't necessary. I also am 100% sure that I want to breastfeed. Because of the important and invaluable benefits of nursing, but also because it could help reduce NAS symptoms and wean the baby off of it slowly (I've heard mixed reviews of this, and have also heard that not much passes through breast milk to babies, but I feel that it would help). I'm really not willing to compromise on nursing.

Has anyone experienced any trouble finding a midwife who will take them? Or has anyone had success? I'm even willing to deliver at the birth center, and then go to the hospital within 12 hours to have my baby evaluated. I don't plan on telling the midwife at my first appt. I wish that I could just not tell them at all, and then monitor my baby myself and bring them in if needed, but I don't feel that is the right thing to do.

My other big concern is that my family doesn't know that I'm on subs, and I really don't want the to find out. I feel guilty about the possibility of my baby suffering NAS, but I honestly don't know if I will ever be ready to go off subs, and i'm not willing to not have children. Please don't judge me over that. Obviously if my baby ends up having to be medicated, I'll have no choice but to tell them, which is really scary to me. I know they will judge me and act like I'm horrible. They have no idea that I was ever an addict, as far as I know. If I can't have a birth center birth, my sister is going to question me so much about why I'm "choosing" not to. I'm really stressed about all of this and I haven't been able to enjoy being pregnant.


Any advice?
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Unread 06-13-2015, 01:41 PM   #2
morphing
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I imagine some experienced women will come along shortly with all kinds of helpful advice. I know I'm a man and cannot fully appreciate the "Venus" side of these things...but, as far as your sister and family goes, this is YOUR pregnancy, and everything should be YOUR decision. You don't have to justify every move and decision you make. If your sister begins asking too many questions, just say, "This is what I've decided will be best for ME and MY baby".

I think you are doing very well with this. You are researching...getting information from experienced individuals...gathering scientific data, etc.

Please keep us posted.

Thanks,
Morphing
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Unread 06-14-2015, 02:33 AM   #3
FlyingSparrow
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Thank you for your response. I know this there really isn't much I can do about it, and that as long as the end result is a happy, healthy baby, than all should be well. But my "birth experience" is also really important to me.

You're right about my sister. I guess she just know's how important to me it is to have a natural and possibly even peaceful birth. And obviously if the baby has to stay in the hospital for any length of time, I'll have to explain to my family. I don't want to have to do that.

I'm trying to put it in the back of my mind. There really isn't anything I can do about it, or anything I can do to make my baby not suffer NAS, other than just try to be as healthy as possible and try not to take too much extra.

Well thank you again for your advice! It was really kind of you to respond.
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Unread 06-14-2015, 06:44 AM   #4
NancyB
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Hi FlyingSparrow, this post might be of interest concerning you having to increase your dose. If you can keep at a steady dose, that would be optimal. The change in dose may also be because you switch to -tex. Many people found that they needed more -tex and the film because of the difference between the film absorption rate and the generic -tex tablet absorption rate. So try not to get hung up on the amount you're taking, it's more important that you feel no withdrawals.

Quote:
Originally Posted by Scarlette_Gemini View Post
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.
Have you checked with any local hospitals to see if they could refer you to a midwife, preferably one specializing in patients on medication-assisted treatment? Would you feel comfortable telling us what part of the country - you don't have to say what city/town, maybe the closest biggest city would help - you're located in case someone knows of one. Please do not feel obligated, anonymity is important.

Nancy
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Unread 06-14-2015, 02:53 PM   #5
morphing
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FlyingSparrow,

What Nancy quoted makes a lot of sense. Since you will be carrying the bloodsupply for two now, it's likely you will need an increase to maintain the same level of buprenorphine in the blood.

I would look for a midwife with experience, like Nancy said.

Thanks,
Morphing
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Unread 06-14-2015, 09:22 PM   #6
FlyingSparrow
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Thank you both.

I'm located in Eastern NH.

I'm thinking of asking my Dr if I can be switched to the larger size subutex pills. He has me on the tiny ones, and I feel that part of the problem is that when I try to break off a tiny piece, it crumbles in my fingers before I can get it into my mouth. So I'm basically putting powder under my tongue, and it seems as though it gets swallowed or just disappears into thin air before I can get it under my tongue.

I knew there would be a strong possibility of needing to increase my dose, but at 8 weeks? That seems very quick.


I'll start calling around to different midwives and birth centers. I could also look into Maine and VT, and maybe even Mass, if I couldn't stay in NH. I did see something when looking online about NH midwifes not taking patients who are "currently suffering from alcohol or substance addiction", but I'm not sure that subutex "counts", because it's a medication that is prescribed to me. I cant imagine that someone who is prescribed to xanax daily, or something similar would have a problem getting a midwife, but sadly many people don't see it that way. I've been avoiding making the calls because I fear the answer. I'll keep you all posted if I do though.
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