You and your family may be worried about your opioid use disorder (OUD) during pregnancy and what may happen to your baby.
We answer some frequently asked questions about OUD, pregnancy, breastfeeding and infant care to help you learn how to best care for you and your baby both during and after pregnancy.
Methadone and Buprenorphine During Pregnancy
Some people may want to “detox” as a way to stop using heroin or pain medicines. Sadly, studies have shown that most people start using again by a month after “detox.” Therefore, most doctors treat OUD in pregnant patients with either methadone or buprenorphine. These are long-acting opioid medicines that may improve the health of you and your baby during pregnancy.
Is it safe to take methadone or buprenorphine (Subutex) during pregnancy?
In the right doses, both methadone and buprenorphine can stop withdrawal and reduce cravings. Treatment during pregnancy with either medicine makes it more likely that your baby will grow normally and not come too early.
If you have an opioid addiction, your baby can show signs of withdrawal known as Neonatal Abstinence Syndrome (NAS). These withdrawal signs in babies can also occur if you take methadone or buprenorphine.
Talk with your doctor about the benefits versus the risks of taking these medicines to learn if using methadone or buprenorphine during pregnancy is right for you.
Is methadone or buprenorphine a better medicine for me in pregnancy?
If you are interested in taking a long-acting opioid medicine such as methadone or buprenorphine during pregnancy, talk with your doctor. They will discuss which one is best for you and take into account the medicine’s availability near your home.
If you are already taking methadone or buprenorphine when you become pregnant, your doctor will likely advise you to stay on the same medicine.
How can I get started on methadone or buprenorphine?
In some communities, there are programs that offer care to those who are pregnant and need methadone or buprenorphine. These programs may offer prenatal care and substance use counseling along with the medicines.
Methadone may be given out only by certain clinics, while your doctor may be able to administer buprenorphine if they have special training.
It may be best to start these medicines while going to addiction treatment.
What is the best dose of methadone or buprenorphine during and after pregnancy?
There is no one “best” dose of either methadone or buprenorphine in pregnancy. You should take the dose that is right for you.
The right dose for you:
- will prevent withdrawal without making you too tired. If your dose makes you sleepy, discuss with your care team.
- depends on how your body uses the medicine.
- may need to be changed during pregnancy.
A baby’s NAS symptoms do not seem to be tied to the dose of medicine. After birth, your medicine dose may need to change as your body returns to normal. This can take a few months after birth.
Birth, Breastfeeding, and Infant Care with Opioid use Disorder
How should I get ready for the birth of my baby?
If you have opioid use disorder and are pregnant, you should take the following steps:
- Choose a doctor or midwife and hospital with experience in methadone and buprenorphine during labor and birth.
- Find out if you can tour the hospital before your baby is born.
- Find out if you can meet with the baby’s doctor at the hospital before the baby is born to learn about how the baby will be watched for NAS.
- Ask your doctor or midwife about pregnancy and parenting support programs.
- Select a place for your baby to receive health care when you go home. You may be able to meet the care team before the baby is born.
What can I do about pain during and after birth?
If you have opioid use disorder, your usual daily methadone or buprenorphine does will not treat your pain during or after birth.
Discuss pain and make a plan with your doctor during prenatal care appointments. When you go into labor, talk with your care team about how to best manage your pain.
It is important to let your Labor and Delivery care team know that you are taking methadone or buprenorphine. Some pain medicines should not be given because they can cause withdrawal symptoms if used with methadone or buprenorphine. Your care team will also help you manage pain after giving birth.
I am pregnant and have opioid use disorder, will child protective services be called?
If you have opioid use disorder, you and your baby may get tested for drugs and alcohol at birth. This might include tests for methadone and buprenorphine.
Having a positive test will mean child protective services will want to make a Plan of Safe Care for you and your family. Please talk to your care team about the child protection laws in your state.
How does opioid withdrawal affect the baby after birth?
After you give birth, your baby no longer gets buprenorphine and methadone from your blood. Your baby may develop NAS – drug withdrawal.
Each baby shows withdrawal differently. The following are some of the most common signs in opioid exposed babies:
- Tremors or shakes
- Frequent yawning
- Poor feeding/sucking
- Sleep problems
- Stuffy nose
- Fever Sneezing
- Tight muscles
- Loose stool (poop)
These signs may happen from birth to days after birth and can last days, weeks, or months.
Your baby may need medicine to feel better, and may be watched for five days in the hospital to see if medicine will be needed. The medicine will be decreased over time, until the symptoms have stopped.
Make sure your baby is seen by a doctor when they go home to check for possible long-term problems.
Can I breastfeed if I am taking methadone or buprenorphine?
Yes, you may be able to breastfeed if you are taking methadone or buprenorphine. Breastfeeding is usually safe and encouraged if you are taking these medicines, however it is not safe if you have HIV or use street drugs.
Only very small amounts of the medicines get into the baby’s blood and may help lessen the symptoms of NAS.
How will having a newborn affect my drug use recovery?
Having a baby can be a stressful. There are steps you can take to help remain in recovery from opioid use disorder, including the following:
- Be sure to continue counseling and use parenting programs.
- Do not stop your opioid medicine too quickly or too soon. This increases the risk of starting drug abuse again.
- It is important to discuss your medicines with your recovery care team.
If you have opioid use disorder and are pregnant or have recently given birth, we are here to help.