Substance Abuse in Pregnancy
A pregnant woman addicted to opiates may fear that telling her physician or midwife about her addiction will be met with a judgmental attitude, as well as legal problems. It is common practice for healthcare providers to ask a woman about any substance abuse at her first prenatal visit. These questions are asked so that treatment can be offered, which will greatly improve the health of the woman and her baby. The goal of treatment during pregnancy is not to expect the woman to stop using the drug and suffer the side effects of withdrawal, but rather to replace the drug of addiction with a safe alternative medication.
The use of methadone in opioid-substitution therapy
Opioid-substitution therapy, with a medication such as methadone and suboxone, is prescribed as part of a treatment program that includes counseling and monitoring of how well the woman is responding to the medication, so that adjustments in the dose can be made.
The choice of medication is a decision that is made between the woman, her obstetrician or midwife, and the drug-treatment center physician. Methadone is more commonly used in pregnancy because more research has been done to prove that it is safe for use in pregnancy. A woman does not have to have symptoms of withdrawal from the drug that she is currently using to begin treatment. The methadone dose that she starts with varies, and daily adjustments can be made, depending on the woman’s response to the medication. Some women may take a daily dose of methadone, while others do better with the daily dose split in half, taking it twice a day.
It is common practice to arrange a meeting between the woman and a member of the anesthesia team at the hospital where she plans to have her baby. This meeting will allow the woman to learn about how her pain can be managed during labor. Women who have a history of opioid addiction may respond to pain differently. There are treatment options in place to manage her pain effectively, such as receiving an epidural during labor.
After her baby is born, he or she will be closely monitored by the nursing staff in the nursery for signs of withdrawal symptoms, known as neonatal abstinence syndrome. If the baby demonstrates excessive symptoms of withdrawal of the methadone, there are methods to ease those symptoms. Just as the drug that the woman took before beginning a treatment program crossed the placenta, reaching the baby, the methadone also entered into baby’s circulation, but it is much safer. Mothers on methadone or suboxone are encouraged to breastfeed, as this will lessen the symptoms of withdrawal, because both medications are found in breast milk.
If you are pregnant and suffer from addiction to an opiate substance, talk to your physician or midwife. Their main goal, and reason for asking you about the presence of any substance abuse, is that treatment be offered to you so that you will have a healthy pregnancy, and a healthy baby.