Methadone and Pregnancy - Should You Take Methadone While Pregnant
Methadone and Pregnancy
I have wanted to write about this for a very long time, but I was worried about the community response to it. In the end, I have decided that the need of the people who are searching for answers, outweighs the opinions of the people who disagree with this treatment.
I understand that everyone has very strong, and very different, opinions about methadone during pregnancy. Also, that each person will cling to that opinion because of the deep seeded belief system that it originates from. I'm not trying to personally offend anyone by writing this. I"m not promoting methadone during pregnancy. I'm simply putting the information out their based on research and personal experience.
So with all emotions put aside, let's look at the most commonly asked questions and worries about using methadone maintenance treatment while pregnant.
What is Methadone?
Methadone is an opioid medication that is commonly used to treat addiction to other opiates. It blocks the euphoric feeling that addicts crave, by working in parts of the brain and spinal cord.
It is sometimes used to treat chronic pain, but is more well known for its use in treating substance abuse addictions. When given in correct amounts, it is immensely effective at decreasing withdrawal symptoms and gradually weaning a person off opiates.
Most people have a negative impression about methadone because it is in the same classification of medication as most of the substances being abused by addicts. They generally believe that addicts are just trading one addiction for another, and possibly getting it for free.
In some ways they are not wrong, you are trading one type of addiction for another, but there are countless reasons why Methadone is the better (and safer) choice.
How Does Methadone Work?
Substance abuse is just as much a mental addiction as it is a physical one. Long term users find themselves stuck in a cycle of having to find ways to get their fix, looking for someone to buy from, and the act of using. This is their entire day to day life, and once they get their fix, they are already thinking about how to get the next one.
After a while, a person doesn't need the drug to get high, they need the substance to function as a normal person. Without it they are very sick and cannot even go about daily tasks without their fix. This is why opiate addiction is such a powerful addiction, a person feels a desperate need to have the medication, and will do almost anything to get it. It is impossible to live a healthy, and normal life, like this.
Methadone works because it gives a person back their humanity. It allows them to feel normal enough to go back to a healthy daily routine, get a job, have healthy relationships, and take care of a family, without the fear of withdrawals. They no longer have to spend their days chasing a substance just to feel normal again.
Why Not Quit Without Methadone?
Two people go to a party where they are both given an opiate for the first time, and they both take it. Over the next week they both continue to use opiates recreationally for the feel good "high" it gives them. After a week, person A decided that, while it was fun, it's not for them and walks away from opiates. Person B continues to use and becomes a long term addict. Why can two different people respond to the same medication in very different ways?
The answer to that lays in some very technical language, but the simple answer is that a person who has an addictive personality has a different brain, then someone who does not have an addictive personality. Substance abuse has been classified as a disease, and while some do not believe that is true, there is scientific proof that an addict has differences in their brain that make them more prone to addiction.
The point of all this is, if you have an addictive personality, the chances of being able to quit cold turkey, and then stay clean afterwards, are very slim. You could probably get through the worst of the withdrawals, and may even go months without using, but you are statistically more likely to relapse then someone who used methadone to help them quit.
Quitting cold turkey sounds like an ideal situation. You lock yourself in a room for a week and come out clean and ready to change your life. However, your life is not changed and then you have to start the long journey to rebuild your life, all the while battling the mental withdrawals. It can be done, and there are people who have successfully gotten clean by themselves without methadone, but the majority of people will continue to fail without some form of outside intervention.
Quitting Cold Turkey While Pregnant
There are several reasons why a person might find themselves pregnant while addicted to opiates. Aside from abusing prescription medications, many people are given them on a monthly basis by a doctor. Finding out you are pregnant in the midst of an addiction is a very heartbreaking and scary feeling. You do not want to harm your baby, but you don't know what to do. So what should you do?
The answer to that is personal, and each mother will have to answer it for themselves. However, there are two prominent choices a person could make. Quit cold turkey, or begin medication maintenance with Methadone or Buprenorphine (Subutex).
The common misconception about quitting cold turkey is that your baby could die from withdrawals inside the womb. While this absolutely is a possibility, most miscarriages are actually caused from the uterus contracting because of the mothers withdrawal symptoms. Quitting on your own without medication to ease these symptoms, puts your unborn child at a higher risk of death.
The general public has such a strong aversion to Methadone that women are afraid they will be judged harshly if they choose to utilize this medication. The fact of the matter is, your baby is at risk either way. Quitting cold turkey has more disadvantages then it has advantages, and their is a higher risk of miscarriage. If you do choose to quit cold turkey, talk to a health care provider first.
Taking Methadone While Pregnant
If Methadone works so well, why dose anyone have a problem with it? Simply put, they feel addicts are using Methadone as an excuse to continue using, and selfishly putting their child through a situation they were afraid to go through.
This is probably true in a small percentage of women, but they should not set the standard for everyone. No one can truly understand the impossible nature of a decision such as this, until you have been forced to make it.
You know you have an addiction, and you probably did not get pregnant on purpose, but you are so you now have to make a choice. You can quit cold turkey and possibly miscarry, or take methadone and your baby will probably have withdrawals. What an impossible situation to find yourself in.
There is really no way to prove with any certainty the effects that Methadone has on an unborn fetus. There are too many unknown factors that play a part because of the nature of addiction. Addicts generally do not eat right, have exposed themselves to unsafe situations, use other substances besides opiates, and have abused their bodies for years. Who is to say they would have a perfectly healthy baby anyways?
The problem is that everyone is so quick to blame Methadone for problems that may have occurred even without the medication present in the mothers daily life. A baby is born to a Mom on methadone, the baby has a low birth weight, it must be because of methadone! Or it may be because she did not eat right during her pregnancy, and if she smoked that could have been the cause as well. The point is there are too many unknowns to accurately pinpoint methadone as the cause of prenatal problems.
However, some of the risks associated with taking Methadone while pregnant are low birth weight, small head size, vision problems, developmental issues, and withdrawal symptoms. Most babies born with size or weight issues will fall within the normal range as they grow older.
A lot of people will say there is no conclusive proof associated with methadone and pregnancy because it has not been tested long enough. Methadone has been used for over forty years in both pregnant and non pregnant addicts, there is plenty of scientific proof.
Methadone Vs Continued Addiction While Pregnant
Using On The Streets
Using Methadone Maintanance Treatment
A woman may be sharing needles or other paraphernalia to inject/use their drugs
You are no longer using needles, straws, or other forms of paraphernalia thus eliminating the risk of contracting diseases
You are putting yourself in dangerous situations when you meet your dealer or using
You no longer have any reason to be in shady neighborhoods or dangerous areas
Drug deals can sometimes go wrong and people get hurt or killed when caught in the middle
You are not putting yourself in dangerous situations any longer
People usually surround themselves with other addicts and use together
You can begin to cut unhealthy people out of your life
Addicts have to find ways to get their fix such as stealing, prostitution, and other unsafe practices
You do not have to do unsavory actions to obtain your medication
It is hard to keep a job when dealing with the highs and lows of addiction
You can start working and being a good employee
Addicts tend to sell everything they own, be homeless, and have nothing
You can start rebuilding your life because you have money and a job
People usually ignore their health and basic needs while in active addiction
You may notice yourself paying more attention to basic hygiene and your overall health
When you spend everything on drugs their is very little left over for food, drinks, and medications
You can start eating more healthy, drinking and taking care of your nutrition
Addicts rarely have money for toothpaste, toilet paper, and shampoo
You will have household items and be able to take better care of yourself
Overall when in active addiction nothing else matters except for being "high"
When you don't have to worry about getting "high", you can begin putting the pieces of your life back into place and become an important member of society
Will My Baby Have Withdrawls if I Use Methadone During Pregnancy
Unfortunately, yes your child could be born with NAS (Neonatal Abstinence Syndrome), which refers to a group of symptoms your baby could experience. Withdrawal is every addicts worst fear, and they will go to great lengths to avoid it, so you can understand why no one would want their newborn to go through it. The terrible reality is that sometimes there really is no better option.
A newborns symptoms depend on the mothers history, how much medication the baby was exposed to, how long the baby was exposed to it, at what point in the pregnancy the exposure began, what other types of substances the mom was using, and which kind of medication maintenance treatment the mother chose. For some reason, babies born prematurely do not show as many symptoms of withdrawals as a full term infant. There are numerous things that come into play, and some newborns show no signs at all, while other have a very hard time.
When Will My Baby Show Signs Of Withdrawls
It depends on the type of medication or substance that they have been exposed to. If a mother is still using heroin, the child could show signs in the first couple days. Methadone has a longer half life so it could take up to a week before withdrawal symptoms manifest themselves.
There are many factors that need to be taken into consideration, what type of medication was taken, when the last dose was taken, how high of a dose it was, or was the baby full term or premature.
The quick answer is that you could begin to see signs as early as twenty-four hours after birth and as late as ten days. If no symptoms have been observed within the first five to ten days, you are most likely in the clear.
What Kind Of Withdrawal Symptoms Will my Baby Have if I Take Methadone While Pregnant
When a child is born to a Mother on methadone, that child will automatically be monitored for signs of withdrawals. Nurses will keep a close eye out for a certain number of symptom with the most common ones being:
- Hyperactive Reflexes - is your baby startled easily when you talk to them or touch them?
- Sleeping patterns - does your newborn sleep as much as they should, or seem to have trouble sleeping for more then a few minutes at a time?
- Crying - are they crying a normal amount and what do their cries sound like, they watch for high-pitched cries that seem to come from nowhere the most.
- Flexibility or Muscle tone - is it hard to gently pull your child's arm away from their body, or if you do pull it away do they immediately pull it close to their body again?
- Irritability - are your newborns cries inconsolable or do they seem frustrated
- Stuffy Nose
- Eating Patterns - if they are uninterested in food or won't eat a lot
- Mottled skin tone
What Will Happen if my Baby has Withdrawls
When a child is born to a women taking Methadone they will be kept and observed for a required amount of time. In most cases it is five days, and if the child does well they will be allowed to go home.
Their symptoms will usually be monitored by both the hospital staff and the parents, who will then follow a standard scoring system. A list of symptoms will be provided and each symptom will have a number assigned to it. The more severe symptoms will have higher numbers, and less severe will have lower numbers. At the end of the day the numbers from each symptom that was observed will be added up to a total for that day, and if your child continuously scores high they may begin treatment.
Hospitals where their nurses are overwhelmed, or caring for a high number of patients, may really rely on the parents to relay information about what symptoms they observed. It is tempting to lie about the less severe symptoms so that you can take your child home, but it does no good to your baby if you lie!
You may feel guilt or shame while at the hospital with your child, and you will probably run into some nurses with judgment's, but you need to remember that you made the best of a bad situation, and don't let them pursued you to do anything you do not feel comfortable doing.
What if my Baby has Severe Withdrawls from Methadone
In the event that your baby does score high numbers, or shows severe signs of withdrawals, a doctor will come to you to discuss treatment options. Depending on what signs and symptoms your baby is showing, they may want to put your child on medication.
If your newborn is having a hard time relaxing or is showing moderate signs of withdrawals, they may put them on something to relax them. In some cases a muscle relaxer or benzodiazepin may be given.
For more serious withdrawals they may prescribe a very low dose of Methadone. They will start by dosing them quickly to get them comfortable, and then slowly bring them down off it with a taper routine. This could prolong your stay at the hospital for weeks, depending on the severity of the symptoms.
You are the parent and you are the only one who knows what is best for your child. However, keep in mind that a doctor would not want to put a newborn back onto Methadone unless they thought it to be absolutely necessary to do so.
If you feel your child is being unfairly scored, or scored for things that were normal occurrences, you can absolutely hold off on treatment. If you are unwilling because you feel guilt about your child being on Methadone, or are worried about what others will think, that is unfair to your child. Just be sure to really think hard about why you are making each choice, and be sure you are making them for the right reasons, your child.
Side Effects of Methadone
All medication has side effects and Methadone is no different. Withdrawals are one of the most common side effects of methadone and those were listed above. Low birth weight and undersized heads were also a mentioned side effect, and that usually does not follow a child into later years.
There have been reports of behavioral or physiological problems in a handful of children born addicted to Methadone, but it cannot be sure if that developed as a side effect of methadone or something else.
Children who have been exposed to Methadone have an increased chance of developing jaundice and are at higher risk of sudden infant death syndrome. Again though, it is hard to pinpoint Methadone as the cause of this since it only happens in a few of the children and not all, and children who have not been exposed are also at risk.
The general side effects (according to Rxlist) of methadone are as follows:
- Sleep Problems
- Dry Mouth
- Loss of Appetite
- Decreased Sex Drive
- Difficulty having an orgasm
Severe side effects that you should immediately seek medical attention for are as followed:
- Shallow Breathing
- Chest Pain
- Fast or Pounding Heartbeat
- Any Trouble Breathing
- Being Lightheaded