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  1. #1
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    Default Suboxone/subutex/opioid replacement/pain management/depression

    Hi everyone. I'm currently 8 weeks pregnant, due 18/9/16, with surprise baby no.5 after what will be a 9 1/2 year gap.
    Since I had my last 4 children (about 5 yrs ago) became dependant on otc codeine meds for neck pain and migraines. Once I realised that I had become dependant I saw a GP and started on Suboxone.
    I've suffered depression on and off and to various degrees since I was 13 also and I am taking Prestiq 200mg/day.
    I would like to connect with others who are also taking pain meds and worried about the baby withdrawing after delivery. Or are worried about being judged by staff for being on opiate replacement. Or have found that the recommendation to change from Suboxone to Subutex difficult for some reason (despite never having morning sickness before in any other pregnancy or this one, the subutex has caused me nausea and vomiting for up to three hours after each dose).
    Other worries of mine include the potential for sertonin syndrome caused by my antidepressant when combined with other medications; the fact that I worked as a registered nurse and student midwife at my local public hospital in both special care and maternity and don't want to be judged by old collegues when I give birth; I hope to have the baby at home and I worry that I will not be considered low risk due to my medications; and, medical stuff aside, I wonder what it will be like having a baby after so long - kind of feels like starting over even though I have the same husband and my children are all still at home (DS 14, DS 12, DS 11 & DD 9 by the time I have this baby). Just to add a bit to the story my hubby already had 2 × DDs who will be 19 and 22 by September - yes, he will be a father of 7 later this year! We are both quite overwhelmed by it all...
    I hope that I have posted in the most appropriate place. I might also add this to introductions.
    Looking forward to joining you all :-)
    SS.

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    Hi. I'm not sure what "Bump" means... in this context anyway???

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    Bump = someone trying to help you get a response. Any comments brings your post back up/higher in the todays/recent post so more people will see it.

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    It's not my area of expertise by any means, but withdrawal for baby would be my biggest concern. I know you're only 8 weeks, so I would ask for an early appt at your booking in hospital. They can put into place additional supports for you (regardless of planning a home birth, you will need to be booked in somewhere). They can link you in with specialist support like an obstetrician who specialises in drug/alcohol issues, specialist midwives for the same reason, social worker, plus a paediatrician/neonatologist to talk to during the pregnancy. Depending on the likelihood/risk of withdrawal it may be recommended that you deliver in hospital as baby will likely have to be on a scoring system called the Finnegans score. This will help you and the midwives/nurses know if baby is showing any signs of withdrawal. Some of our babies who are withdrawing from drugs (whether they be legal or illegal) require medication such as morphine to help with their withdrawal. I personally wouldn't be planning a home birth until you've spoken to the experts about your individual circumstances. It is difficult when you have worked in the hospital you will deliver at. Is there any option for delivery elsewhere? Despite patient confidentiality, it can be tricky when people know you if they see your name on the pt bed list etc. In saying that, you are still afforded your right to privacy and it should not affect your care or treatment, both as a patient and as a staff member. You could also ask that only those directly involved in yours or your baby's care get a full handover. The rest would be minimal info ie that you've had a vaginal birth, and you're in for a 3 day stay due to potential withdrawal from antidepressants. No one else needs to know about the previous addiction unless they are directly caring for you/baby - although ward manger/shift team leader would also need to know. They can try to plan for the same midwives to look after you during your stay to reduce the amount of people privy to your history. What you have to try to focus on is that you've done nothing wrong. The moment you realised there was a problem you did something about it. Also, do you have any risk factors obstetrically from your previous pregnancies/deliveries? This may impact your ability to find a midwife who is happy to care for you at home if there are any risk factors that may impact safe care at delivery. Being baby no 5 is already an increased risk of a PPH so anything else may make you too high risk. Best of luck.

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    Default Thanks:-D

    Hi, thanks for your advice and support. I had not checked in for a while because I thought my post had been made a while ago and nobody had replied.
    In the meantime I have found a midwife who has visiting privileges at the base hospital. If I need to deliver in hospital then she is able to care for me there also. She meets with the OBs and other midwives at the base and gets advice re risk factors etc. The OBs are not thrilled with me planning a home birth but I have made it very clear that I have no intention of denying my baby medical care if it's necessary after the birth. I know that there is an approximately 50/50 chance that my baby will suffer withdrawal and need to be monitored in hospital but I probably will be able to admit the baby to childrens ward rather than SCN where I have less history with staff. I also have the option of going to the private hospital as we have health insurance.
    The beautiful midwife I have found is happy to help monitor the baby at home after birth and she only lives around the corner from me so she said she would be able to visit often and won't charge extra for home visits.
    If I was in hospital my baby would room-in with me and I would be taught and supported in scoring my baby on the finnigans scale. I also have some experience with this from my years as an RN working in SCN. I honestly feel that - as long as everything else is going well and we are both healthy - that my baby's best chance of avoiding withdrawal is for me to be as calm and stress free as possible during and after the birth. Breastfeeding will help protect bub from withdrawal and being comfortable plays a big part in sucessful breastfeeding, so I do think that being at home will help with that. I am definitely the type of person who worries excessively about what people think or might say about me and despite having no previous issues as a maternity patient at the public hospital, I just know that I will feel stressed and under the microscope if I am admitted to the ward and/or my baby is admitted to SCN. This way, even if it becomes necessary for the baby to go into hospital, we can be together in a private room (probably) in paediatrics where I am allowed to stay 24/7 rather than if bub was in SCN where it is one wide open space. It is a lovely unit but there is no privacy and because they mostly deal with premmies and sick babies they are extremely routine based and less comfortable with demand feeding etc. I can almost predict that I will have difficulty feeding as it hasn't gone particularly smoothly before, and I believe that my letdown and supply will be affected if I am uncomfortable, stressed and not able to demand feed. Then that will increase the chance of bub withdrawing causing me more stress and guilt and making bub irritable and less likely to feed well.
    I suppose I am being a little bit negative and probably shouldn't be anticipating things that may not happen. There is always a chance that something happens that causes me and/or baby to be admitted to hospital and that the best place for bub is SCN, and I need to prepare myself for that in a more positive way. I truly do think that the staff in maternity/ SCN are the best people to care for my child in some circumstances, and I know they are extremely committed and qualified. However, if everything goes smoothly and according to plan with the pregnancy and birth then I hope that I am able to feed my beautiful healthy baby, have plenty of skin to skin time and bonding time, be able to monitor him or her at home with the assistance of my midwife and ultimately give bub the best chance of avoiding withdrawal entirely. If bub does need to go to hospital then I will stay with them in kids ward where I can have some privacy and space to continue with feeding and bonding while they are monitored or treated. In these circumstances I know that whatever happens I will have done all I can do myself to minimise the impact of my medication on the baby and give him or her the best possible start.
    I am definitely open to all suggestions and thoughts about my plan. I want to make sure that I have considered everything.
    Thanks everyone:-)
    SubSim.


 

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