Giving birth soon

Will my baby withdraw? Is my baby addicted? Can I have an epidural on Suboxone? Will buprenorphine hurt my baby? Can I breast feed on Suboxone? What medication-assisted treatment is best?
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AshBaker91
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Giving birth soon

Post by AshBaker91 » Sun Dec 08, 2019 10:07 am

Hey everyone, I know it’s been a while since I’ve posted or even come to the forum but I’ve been extremely busy with getting everything ready for our baby, I’ve also been caring for my grandmother daily who has advanced dementia & cannot care for herself. My grandmothers issue is a whole other topic in itself that I will get into another time, but for now I thought I’d give an update as to how I’m doing & what’s been happening.

So I’ve been on 16 mgs of buprenorphine for the past 5-6 months now & I am currently 38 weeks pregnant (technically 37+6, tomorrow will be 38 weeks) so baby could decide to come earthside at anytime. I’m nervous/anxious as ever about giving birth & the pain that comes with it. I’m also nervous about CPS getting involved because I am a buprenorphine patient. My OB/GYN told me that because I am on buprenorphine that I will have a case worker regardless. I have been honest and open about everything in my life in this pregnancy with both my primary caregiver and OB/GYN as I don’t want any problems. Hopefully everything goes well & there are no issues. Anyways just wanted to update & say hello, hope everyone is well! :)

-Ash

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Re: Giving birth soon

Post by jennjenn » Mon Dec 09, 2019 1:45 am

Hey Ashlee! Oh my goodness how time flies, it seems like yesterday you told us you were expecting! You are really down to the wire now! So close. I always went to full term with my 3...... to 40 weeks exactly or a little past. But some go at exactly where you’re at so I’m so glad you’re prepared.

It’s normal to be nervous, I’d be really worried about you if you weren’t nervous honestly. You will do good though and you’re healthy so nothing to freak out about. If you get the epidural (I cannot remember if you said you were or not) you’ll be good to go. If you don’t then you’ll still be fine.

Try not to worry so much about this case worker thing, you have done everything right so I’m sure it’s just procedure or whatever. Babies are born all the time with mothers that take buprenorphine. Please keep us updated and I want to hear your story from beginning to past the hospital stay because so many mothers in your shoes need to hear your journey! You have the opportunity to educate more expectant mothers out there in your position. So please try to keep us updated, I know you’ll be busy busy with a new precious baby but I hope you can pop in and out every so often!

Good luck and remember that you’re doing everything right!
Jennifer

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Re: Giving birth soon

Post by suboxdoc » Mon Dec 09, 2019 8:33 am

Thanks for stopping by - and good luck with the delivery. I'm surprised that they will automatically open a CPS case. You must live in an area where they have lots of time on their hands!

Hopefully you'll sail through the delivery. Buprenorphine won't impact anything unless you need a c-section. In that case, the anesthesiologists and nurses should give you a higher dose of narcotic after the surgery. The one mistake docs make the most is when they fail to give a large-enough dose of a single opioid, and instead give sub-therapeutic doses of several opioids. The right approach is to give one opioid - IV dilaudid in the recovery room, or oral oxycodone when you're eating and drinking again - and to give about 3 times more than they do in someone who isn't on buprenorphine (about 15 mg oxycodone).

Good luck!

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Re: Giving birth soon

Post by PremierHealth » Wed Dec 11, 2019 8:58 am

I've referred so many of my pregnant patients to my affiliated hospital that CPS no longer gets involved. Instead, they treat my patients as moms who are doing everything to be successful. However, I've found that not all hospitals in my city behave the same. So, I will share the advice I give my patients who have to use another hospital in town.

I would recommend that you be prepared. Have your addiction specialist write a letter about your compliance with treatment. If beneficial, include the last year or so of your urine drug screen results. This should show that you are responsible. Be very nice to the staff and the CPS worker. You want your kindness to be a lasting impression. Lastly, I've asked my patients to be ambassadors for the recovered community. I've asked them to speak freely about their previous addictions and how life has completely changed ever since treatment. People have preconceived ideas about addiction that are often wrong. So, don't be afraid to educate those who are treating you poorly.

I would add one thing to your anesthesia care if you have a c-section. Ask the anesthesiologist to perform a TAP block at the end of your surgery. This involves 2 injections with the purpose of numbing the incision for up to 24 hours. I've found that some anesthesiologists will see a request for higher doses of opioids as drug seeking (which it is not) and the TAP block as a benign request that can further help with pain management. What Suboxdoc said is correct; you will need 3 times the dose and hopefully your anesthesiologist will be experienced and comfortable with adjusting your medications.

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Re: Giving birth soon

Post by AshBaker91 » Wed Dec 11, 2019 9:13 am

Hey Jenn & Suboxdoc,


Firstly, I want to add that yes I’m extremely nervous to as what will happen. The thought of CPS opening a case against me simply because I take a prescription medication is just bogus in all honesty. I was told that they will more than likely come to my home & “inspect” our way of living, the cleanliness of or household, our lifestyle, etc. I find it to be quite insulting! But whatever I have to do to ensure my baby comes home with my husband & I... we will do. No questions asked. I’m also nervous about my family finding out about my prescription for buprenorphine, for several reasons (I won’t get into them, but to put it simply, they just don’t need to know). Thirdly, I’m concerned about pain control & what will happen in that department. I’ve never experienced childbirth before as this is my first pregnancy/first time I’ve ever had a baby so I am not sure of what to expect. There will probably be a lot of pain involved but I would like to try and go as far as I can possibly go without any sort of medication. My OB/GYN said that because of the buprenorphine, she doesn’t know exactly if an epidural would work because buprenorphine is an opiate blocker. Either way, I’m sure I will be okay. Just need to be ready for anything & prepare as much as I can. My due date is on the 23rd of this month, when I seen my OB/GYN yesterday, we did our final ultrasound & she estimated the baby’s weight to be 7 pounds and 2 ounces. If we go full term, baby is expected to gain atleast another ounce or so... we will see. Just hoping for a healthy/happy baby & a successful, smooth painless as possible birth! Thanks for your inputs!

-Ash

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Re: Giving birth soon

Post by suboxdoc » Wed Dec 11, 2019 12:51 pm

You can educate your OB about epidurals (as I wrote in the other anesthesia posts, I am boarded in anesthesia and did hundreds of epidurals over 13 years). Labor epidurals mostly rely on local anesthetics - bupivicaine, ropivicaine,lidocaine, etc - to provide pain relief. Pain fibers have a smaller diameter than nerves carrying touch and motor control, so a low dose of local anesthetic will impact pain with relative sparing of other functions. Buprenorphine has absolutely NO impact on local anesthetics.

Sometimes, opioids are added to epidurals. Opioids are not necessary, and I often avoided them because of the side effects they cause - such as severe itching during and after labor. Opioids are partially blocked by buprenorphine, so buprenorphine will reduce that portion of the epidural - and also those side effects. In fact, a small dose of IV or IM buprenorphine can be used to TREAT the itching caused by epidural opioids.

In the 1990's we tried a new technique where we gave a small dose of fentanyl into the CSF using a spinal technique. That allowed patients to walk around, because there was no local anesthetic. But it only lasted 2 hours, and had a high incidence of side effects (itching, nausea, and spinal headache). So it isn't used that much anymore.

Epidurals and spinals are often used for C-sections. Buprenorphine does not interfere with that in any way. But when an epidural is used, morphine is sometimes injected after the surgery, before the epidural is removed, to provide post-op pain relief. That also has side effects (itching, nausea, and inability to urinate) that can be relieved with buprenorphine.

If I can answer any questions for you, feel free to email me at admin@addictionremission.com . I'll answer, time permitting.

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Re: Giving birth soon

Post by AshBaker91 » Thu Dec 12, 2019 9:25 am

Premier Health-

Thanks so much for your input, I appreciate your advice & will definitely take you up on what you said about having my PCP write a document explaining how I’ve been doing within the last year in regards to my sobriety and drug testing. As far as my birth plan goes, I have every intention of having a natural birth. However, if something were to happen where I could not deliver my baby naturally & a cesarean section is required, I will definitely be discussing post op pain control with my doctor. For CPS & the staff at the maternity ward, I was actually planning on bringing in some baked goods (I’m an avid cook/baker) like cookies, brownies, etc for everyone! I will do my best to educate those biased against mothers prescribed buprenorphine while pregnant & will be as kind as one can be. Will they come to my home to see our way of living? What else do I need to expect going into this? Again thanks for your input!

Suboxdoc- Thanks for educating me on what to expect with getting an epidural & how buprenorphine really doesn’t have too much of an effect on how they work. I would like to try and hold out as much as I can until I cannot bear the pain any longer before I get an epidural- if I will need one at all that is. But knowing myself & how I’m a giant chicken with pain, I will more than likely take an epidural. You’ve given me a lot to think about & I really appreciate all of the knowledge you have provided me with. Thanks again!


-Ash

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Re: Giving birth soon

Post by PremierHealth » Thu Dec 12, 2019 10:55 pm

Surprisingly, when CPS came to visit moms, everything ended when the patients showed them their bottle of legally acquired suboxone and asked them to verify the prescriptions on the state's Prescription Monitoring Program website. The social workers were no longer interested in talking further and they never visited the homes. I think home visits are only appropriate when there is concern for ongoing neglect. This may be different in your state.

I think bringing goodies is an excellent idea. Thank everybody. I had a patient do so much educating, and talked so freely about her prior addiction that the housekeeper overhearing her admitted to being a former addict. Then the nurse revealed that her husband was a current addict and started asking how she could get him help. It was surprising how kindness and candor can be such an ice breaker.

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Re: Giving birth soon

Post by Amy-Work In Progress » Sat Dec 14, 2019 11:27 am

Ashlee, I am so thrilled for you!! Please keep us informed about how you and baby are doing!

It is normal to be nervous, like Jenn said. Just remember that anytime you can start breathing deeply and slowly, you will be helping to bring yourself out of that anxious state to where your rational thinking can take control. No one, when they are elevated into a state of anxiety, can apply rational thinking to a situation because you are in "fight, flight or freeze" mode. It's only when you can calm yourself that you will be able to think your way through a problem. Use intentional, slowed breathing to help yourself when anxiety overcomes you.

I wish you so well! My thoughts and prayers will be with you during this time.

Amy
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Re: Giving birth soon

Post by AshBaker91 » Tue Dec 24, 2019 7:59 pm

Hey everyone!

So I’m currently one day past my due date & baby hasn’t given off even the slightest sign that she’s ready to come into the world... on top of all of that, I caught a nasty flu which totally sucks!

So as far as the CPS thing goes- I’m really worried about it but at the same time I know that because I have a valid prescription, & according to the Michigan guidelines of CPS & babies born with substances in their system, there really isn’t a reason for CPS to open a case against me. Yet my OB still says that I will be assigned a caseworker. I suppose a lot of it will have to do with how the staff at the maternity ward in the hospital sees everything. Anyways, it is what it is. I’d be lying if I said that I wasn’t worried though. My 40 week appointment is this Friday & if I haven’t gone into labor before then, I will either make an appointment to be induced or have a membrane sweep done to hopefully jumpstart labor.

Hope everyone is enjoying their Christmas, happy holidays!

-Ash

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Re: Giving birth soon

Post by suboxdoc » Wed Dec 25, 2019 10:01 pm

Good luck Ash, and hang in there. My opinion mattered more ten years ago than it does now, and there were often nice responses when readers here had me send a letter to their area CPS office. Now, most CPS agencies have a better understanding of opioid use and buprenorphine treatments.

But if I can be of help, send me an IM. I suspect most people at CPS agencies would see it as annoying if some guy on the internet offered up his opinion... but if you or anyone reading this is ever dealing with an open-minded person who is seeking more information, I'd be happy to speak with the person.

Hopefully baby will make it before January first so that you get the tax deduction... good luck!

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Re: Giving birth soon

Post by AshBaker91 » Thu Dec 26, 2019 1:13 am

SuboxDoc-

I really appreciate how you are so caring for our community, & I wish that all doctors able to prescribe buprenorphine had the knowledge/area of expertise/care that you possess. So thank you for that! However everything happens, I haven’t broken any laws nor have I went against a doctors orders. If CPS gets involved, then fine. I just want to be able to take my baby home & not have to deal with any issues. I will be compliant/receptive to whatever they ask of me.

So i do have another question, there’s a good chance that I will run out of my medication either while in the hospital or will be recovering at home from giving birth- my next appointment to refill my buprenorphine prescription is January 2nd. If I’m unable to make it that day because I’m in the hospital or whatever, how will I be able to get my prescription? I pay 100 dollars for every visit once a month & then my insurance covers the cost of the actual medication. But if I’m in the hospital, I’m wondering how that whole thing works? Should I taper back so I have a few extra to last me until I’m able to make it to my next appointment? I apologize for the bombardment of questions I just don’t know what to expect. But I am starting to have a feeling that my baby girl will be born in early January or maybe even New Years Eve/Day!

Thanks again for taking the time to answer my questions.


-Ash

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Re: Giving birth soon

Post by PremierHealth » Fri Dec 27, 2019 10:46 am

You have several potential options. Of course, I would recommend that you contact your Suboxone doctor to discuss the dilemma you face. He or she may have a plan for you.

If your Suboxone doctor allows this, you may have your ObGyn prescribe 3 days worth of your prescription. The DEA allows for this under the 3 Day Rule. https://www.naabt.org/documents/Three-day-rule.pdf In addition, you could begin a taper just to stretch your remaining pills until your follow up. Of course, you can provide your Suboxone doctor the proof of your admission, hospital drug testing, and see if he/she will prescribe enough buprenorphine until your next visit.

In my practice, I would prescribe enough medications until their next visit or conduct a telemedicine appointment. The majority of Suboxone doctors understand that circumstances arise that may hinder a follow-up and they usually accommodate the patients.

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Re: Giving birth soon

Post by AshBaker91 » Sat Dec 28, 2019 10:38 am

Thanks Premier Health-

I will do that this coming Monday when the office is open. I did however bring up the whole issue I had with CPS getting involved & being assigned a caseworker because of my prescription with buprenorphine. My OB was so informing & very assuring that she said the case worker actually works within the hospital (she knew her by name) & said that she was wonderful. She just wants to make sure that I have all that I need, baby’s needs are met & that we’re okay. She actually gave me a hug because I was so upset at the fact that there was even a slim chance my baby could be taken from me. But she said that due to the fact I’ve been so forth coming and honest about my past & prescription for buprenorphine from the very beginning, I really face no problems. I also lack a criminal record, have never had children before & have a stable marriage/home life and lifestyle, there is no problem. In other words, my “case” will be dismissed. I was unbelievably relieved.

Today I am 40 weeks and 5 days pregnant. I made an induction date for January 3rd (I know it’s still a little ways away) but I wanna give my baby a chance to come on her own naturally & this is her official eviction notice haha. I will update in the next few days or whenever she decides to make her earth-side debut!

Thanks Premier Health- you’ve been very helpful & I appreciate your advice. :)

-Ash

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Re: Giving birth soon

Post by rule62 » Sat Dec 28, 2019 12:45 pm

How are you feeling with having the flu? Being pregnant especially late stage must be horrible combined with feeling ill. I HATE the flu! Just got over it myself but got lucky it didn't last very long. Same as last year. I get a flu shot but still end up getting a short lived version of it. A day and half of no eating and just sleeping. Still, not as bad as it could have been. Hope your is gone by now too.

My son was a late one too. They induced labor but he was too big for my small wife so she ended up having a C-section. Felt bad for her but seeing my son born was the best day of my life. A natural high no drug can mimic.

It is so nice having you back with us Ashley. We all hope you stay with the forum for the long term.

Holding our breath until we hear the news.
Don't take yourself so damn seriously

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Re: Giving birth soon

Post by AshBaker91 » Sun Dec 29, 2019 6:41 pm

Hey Rule!!! :)

Having the flu has been the most miserable feeling ever! Not being able to sleep as is due to being heavily pregnant is hard enough, then having horrible congestion in both my sinuses & chest has been even worse! The other day I lost my voice completely & couldn’t talk, indeed it was awful. But with lots of tea with lemon & hot showers for breathing in humidity, I am almost completely healed. Just hoping that by the time my baby decides to come I will be fine.

I am afraid that I just may end up having to have a c section if my baby is too big. At 38 weeks, my baby was already weighing in at 7 lbs 2 oz. Tomorrow I will be 41 weeks & with baby gaining anywhere from 1/2 lb to 3/4 lb a week, she will probably be a big girl. My family keeps asking me why I haven’t induced by now but I was still holding out hope that my girl would decide to come on her own naturally. I’m starting to realize that this isn’t gonna happen :/ but atleast I know this Friday is our deadline & no matter what happens, we will have a baby within a week!

So good to hear from you, Rule! Hope you’re doing well & all is good on your end!

-Ash

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