Methadone and NAS- from a mom's perspective - page 2
I have been reading over some posts on the topic on this forum today and wanted to start a thread to address several topics. I realize some of the posts I read were several years old and that the... Read More
Dec 17, '13 by Sunshine_I recently had a baby born to me while I was taking subutex. I didn't plan on getting pregnant. I was about to detox of my replacement therapy of suboxone. Alas, that was not to be. My baby needed no withdrawal medicine at all, we breastfed, and would have been out of the hospital by the mandatory 5 day stay, but stayed an extra day for jaundice treatment under the bilirubin light. I stayed with my son constantly. I knew that many people on replacement therapy don't try very hard, and I wanted to be a good example for hospital staff to remember about how some parents do care, and not every recovering addict is a monster. The roommate I had after moving to the observation floor didn't have a parent, period. I heard from staff that dhhs took away parental rights because of illegal drugs in the mother's system that weren't monitored or prescribed. That baby had been there for over a month. And was still being detoxed. My baby never scored higher than a seven, and by the fourth day was scoring zeros. The staff said it was because I did breastfeed. I still am, and love my bonding time with my baby while still on leave from my job. It can be done right.
Dec 17, '13 by Sunshine_The fact that the mother quit replacement therapy while pregnant is to me, more dangerous for the unborn child than the mother, and completely irresponsible. That child could have died before it had a chance to live. Every doctor I have spoken with, and all the research I have done would recommend stabilizing replacement therapy as opposed to quitting cold turkey. That was a long shot, my friend, amd could've had detrimental effects.
Apr 23, '15 by GidgetHershNow, being a mother on methadone the response of some of these nurses is disturbing. As a heads up, not all methadone babies even required detox, my daughter didn't... Now, my child wouldn't go to the breast, I tried endlessly and I'm still currently trying 14 weeks postpartum... But I am exclusively pumping breast milk for my daughter and I fully intend to till I can no longer. The nurses where I had my daughter, well, they were nothing like the nurses I've seen on here... They were very understanding to me and my husband... My daughter was also in a well baby nursery and hardly left my side... Now when I was discharged, it was going to be a blizzard, they told me to go home, where I continued pumping, I called every hour on the hour, and they seemed bothered by that, sorry but I actually want to know how she's doing, well they ran out of breast milk, my daughter became restless, refusing to eat formula, she was then inconsolable in there eyes... I call the next hour being told, she scored an 8 on her chart and if she scored two more she would be given morphine... Now me and my husband, both on the clinic, we get weekly take homes, jumped in the car and flew to her bed side breast milk in hand... Our little girl heard our voices and stopped crying immediately... My husband made her bottle and she devoured it! 1 hour later, devoured a second bottle, and Her next score was a 4... Then a 3... My baby missed her mommy and daddy and also wanted mommy's milk... I had one nurse that was very impatient and said "she's gonna need a ******* feeding tube if u can't make her eat!" Now, my recovery is very important to me and my husband, but being healthy and mentally able to take care of my child is what's important to me, so if I must be on this medication till when I feel sturdy enough to stand on my own, so be it... Now, my daughter came home, no methadone needed and no morphine... Nothing but mommy's milk in her system! I understand not a lot of moms and dads would rush to there detoxing child in a snow storm even if the baby isn't detoxing most parents wouldn't... When I heard morphine was gonna be given to her though, I ran... My baby is my world and nothing will ever harm her if I'm alive! To think judgement would be casted on me just for being on methadone is disgusting... I only left her for maybe 8 hours but ran back, then I stayed with her till she would be discharged making sure nothing changed... I kangarooed her till her discharge papers were signed... Cps came to our home, they took photos to show there supervisor how prepared we were for our daughter and the mountain of diapers we had in her beautiful nursery and they immediately closed the case... Her visiting nurse came from the hospital, saw us twice and closed her case, we currently have a preventive worker who comes once a week, drops off a few things to read and leaves cause she said we are an open and closed case, she's keeping it open for the minimum amount of time, which was suppose to be 6 months but she's making it 4... Now, my daughter came home a week after I had her, I was on 140mgs of methadone... I know my case is rare, the doctors and nurses said so themselves... But I took care of myself very well prenatal and my baby was planned and loved! My husband and me have been together 9 years, and just because we are on methadone shouldn't mean we can't start a family... I couldn't see my life without my baby! The first time her pediatrician saw her, he told me if I didn't tell him she was born on methadone he wouldn't have even known... Also as I asked if this would have an effect on her he told me "mom, dad, let it go,it's over, she got past it, don't think about it..." Now, my point to letting this out, and joining this site simply to say this (II'll probably never use this again) is to say, not all methadone parents are heartless low life's... I used heroin 3 months with my husband, we got scared of the withdrawal and someone said to get on a clinic... Now I'm scared to get off... Heroin wasn't my thing, I moved in with a girl who wanted us hooked to support her habit... People can be awful... Now my situation may not be average but I'm sure there r moms out there that are the same... Now I'm gonna get back to pumping milk for my baby, climb into bed with my husband who's a manager and works 60 hours a weeks and is on methadone and my little 14 week old baby who co sleeps with us, and is currently beige kangarooed by daddy and we baby wear when we go out... Our daughter is very loved and well taken care of... I'm a stay at home mom who exclusively pumps... And I'm disgusted by some of the "nurses" on here... U guys would discourage any methadone mom who even came in with the best of intentions... Gross...
Apr 23, '15 by NicuGal, MSN, RNThis is also a very old thread, things have changed since its start.
You may be the exception. In the past few years there has been better education, improved scoring. And putting a baby on morphine is not always a bad thing. But I seriously doubt a nurse said "******* feeding tube to you. And please don't co-sleep. And this is a nursing forum, so unless you are a nurse, have cared for many many many drug addicted kids who aren't lucky enough to have good parents, then don't judge us.
Apr 23, '15 by TiffyRN, ASN, BSN, RNTo GigdetHersh (if she ever appears again) and in defense of NICU nurses everywhere who witness some of the worst atrocities imaginable. . .
Took me a little, but I went through this 5 year old thread to gather all the "gross" comments that "disgusted her. There a couple that are a tad harsh. Most only relate their experiences in pretty neutral terms considering what they have experienced.
I would add that I don't agree with some of the stronger opinions here but felt that GidgetHersh's accusation was overwhelmingly unfounded from the previous postings.
Quote from babyNP.I would say that in my limited (18 months) of nursing in a NICU, either the NAS infants haven't had a parent at the bedside ever or the parent was too abusive towards staff and had to be escorted by security.Quote from SteveNNPI honestly admit that I have harbored feelings of resentment toward mothers of NAS babies. Who wouldn't feel resentment when a mother gives birth to a horribly miserable infant in the throes of NAS due to illicit drug use? or got pregnant while on methadone? It's not my job to feel bad for mom. My job is to take care of baby.
It's usually mom's 5th or 6th child, all in foster care, and all exposed to drugs. It is heartwrenching. They are so miserable. Sweating, crying, shaking....all you want to do is make them feel better.
Your situation is unique... the majority of moms with NAS babies, in my opinion, have in becoming pregnant while ingesting a neurotoxic, illegal (in most cases) substance... lost the right to direct the care of their baby. Call me "anti-family centered care" or whatever, but that's what I believe.Quote from TiffyRNI understand your pregnancy was unplanned, but when we see moms coming back for their 3rd NAS infant. . . And I've personally held 2 of her babies. . . And mom has never weaned her personal dose (in 4yrs). Maybe being compassionate for the mom is more than my brain can wrap itself around.Quote from littleneoRN
The mothers who are as committed to breastfeeding as you are in the minority, MMT or not. You are a dream parent in my book, but there's a reason why that's a dream. It's not my everyday reality.Quote from BabyLadyThe OP is a one-in-a-million Mom.
I have never seen an NAS kid with a mother who breast fed it...we can't even get them to bring clothes for the baby half the time or to be available to hold the infant for the endless hours of screaming.
Most of them blame the formula for their baby's vomiting and diarrhea....despite every nurse on every shift reminding them that it's a part of NAS.
Most of these mothers feel that we neglect the baby's because we cannot hold them constantly when they are screaming...they don't seem to understand that staffing does not permit us to do this, as we have other babies to care for, however, we tell them they are welcome to come hold them or authorize family members to come.
Sometimes the level of expectations of these mothers is not reasonable....I am blessed with the fact that they know that the withdrawal symptoms are part of the process...however, you have this handful of mothers that "demand" that we 'stop their kid" from crying and trembling and accuse us, as nurses, of neglecting their baby or not caring about it.Quote from JoryI am a nurse that gave these mothers every benefit of a doubt, but I have learned, the subutex, methadone and suboxone mothers came in two varieties:
1. The regretful
2. The entitled...we all know who these mothers are. They don't want to get better. I am going to discuss the former.
While I don't feel that the majority of mothers who are on replacement therapy get pregnant on purpose, I do feel that they don't full realize that all they have done is substitute one Schedule II drug for another. The taxpayers, IN MOST cases, pay for this twice. They pay not only for the therapy but most of these people don't work. Therefore, we are paying for that too. Very rarely did I ever see these babies admitted to the NICU that had regular insurance, it was always a state policy.
Therefore, it's important to know that if you are in a replacement therapy program that an addict HAS NOT RECOVERED. As long as you are in the program, the addiction continues. However, the mentality is that they 'cured' and they are NOT!!!!!
I have never, in my life, ran into someone that said, "Oh, I USED TO BE in a program, but now I am completely drug free."
They are in the programs for one, two, three years, even longer. Instead of going down in dosages, they go up. I believe very strongly that addicts that need help should get help. However, I believe one year should be the limit for these programs. That is plenty of time. I believe that the so-called drug testing in these programs is lax...mainly because I can count on one hand with fingers left over of how many times I saw a mother that was in a replacement therapy program that didn't test positive for other substances.
Opiate addiction is a choice. Less than 1% of all addicts are addicted because of routine pain medications...but to ask any of them they'll tell you the story about the surgery, broken limb, etc...that lead to their addiction.
I don't agree with breastfeeding an NAS baby. A baby that is going through withdrawal is more concerned about the pain/nausea/vomiting/severe diarrhea/bleeding diaper rash stopping than the bonding. These babies are forced to go through WHAT THEIR MOTHERS WON'T. When the replacement therapy is done with these babies, they don't need to be exposed to more drugs NO MATTER HOW LITTLE is in the breast milk. They don't need to be exposed on and on on any level.
I am so glad that they changed the policy here...if you test positive for an illegal substance or any opiate, you are not permitted to breastfeed while your baby is in the hospital, period. Mom can do whatever she wants after the baby goes home.
Apr 23, '15 by TiffyRN, ASN, BSN, RNSince this is a thread started in 2010, I would like to update the changes I am seeing in our unit in treating infants with NAS. For one thing, we are seeing far fewer of these infants and I'm told this is from an effort that is starting in the general nursery. They are stepping up efforts to carefully monitor these infants for 4-5 days even if mom goes home. The mother/baby nurses are extensively educating the mothers of infants at risk on comfort measures. Breastfeeding is strongly encouraged in cases of legally obtained medications such as methadone & subutex. Non-pharmacological measures are the preferred treatment. Only those infants started on methadone are admitted to the NICU. These infants are kept in 2 baby assignments. If possible they are paired only with the infants that require non-extended cares (stable cpaps on all OG feeds).
We have several nurses who have volunteered to take thse infants as much as possible. They are strong breastfeeding advocates. The length of these infants stay seems directly negatively correlated to the number of hours the mothers spend at the bedside. More hours mom present = shorter NICU stay. We have just opened up some private rooms and anticipate using them for these infants IF their mothers are willing to stay with them extensively. If they are not willing, we will care for the infants in the regular NICU where there are more hands on deck to hold the infants as they withdraw.
And that breastmilk absolutely helps. We do have our hands tied in some situations. If mom has tested positive for non-prescribed medications, we cannot allow breastmilk. And that's not the nurses being "gross" or disgusting. That's us following the orders and rules in our unit that keep us employed and caring for these poor suffering kids.
May 18, '15 by Jory, ADN, BSN, MSNI live in one of the highest drug concentration areas in the country and the NICU here keeps between 8 and 10 NAS babies on any given day. We have heard it all, seen it all.
Birth control fails, that is a given, at least you were on it and tried.
However, the only problem I have with these treatment programs is that they are teaching patients (both men and women) that they are "clean". They are not. That is not a stigma, that is a cold hard fact. I do not believe that life-long support is necessary and understand that the majority of research that claims that it is ok, comes from the very physicians that stands to profit from these arrangements.
Breastfeeding...yes, it's recommended, but if I was that mother I wouldn't and I'll tell you why. In the hospital the baby is detoxed and the dose is specific. WE KNOW how much the baby is getting. We don't know, how much is in that breast milk. I strongly feel that there is more drug in breastmilk than what research is claiming. They allow mothers to breastfeed here that are positive for other drugs, even illegal ones. All we are doing is discharging an infant that is not drug free if it is breastfeeding and the longer it is breastfed, the longer the drug exposure. That cannot be healthy.
A friend of mine that is a 4th grade school teacher said that drug-exposed infants are the #1 concern in schools over any other social issue. Sometimes the problem doesn't manifest itself until years later.
Once a woman is pregnant, you have to manage that. It would be cruel to do otherwise. However, once an infant is born there are tons of choices. This is the one time where I do not agree that "breast is best".
May 18, '15 by karnicurnc, MSN, APRN, CNSWe encourage consistent breastfeeding if the mother can produce a UDS that is negative for street drugs. Most of these mothers are not able to maintain a supply because they do not visit and therefore breastfeed often enough, so in a few days it becomes a moot point.
Jun 8, '15 by Jory, ADN, BSN, MSNThey don't drug test them here after they are discharged. The mothers here know they are under the eye of child protective services and the sooner they get the baby home the better. So some breastfeed to keep the scores lower so they can get the baby home. But the kid isn't drug free.
Aug 25, '15 by keuka8, BSN, RNI work in a level III NICU and have seen quite a few NAS babies. They all break my heart. I don't judge the moms, my main concern is caring for their baby. I have come across some great parents, but the majority are either misinformed or in denial. I have a very hard time with parents who want to refuse morphine for their baby who is obviously in withdrawal. That I will never understand. One of our MDs asked a mom recently if she had ever gone through withdrawal and the mom said yes, it was awful. Well, that is what you are putting your child through. I will support your choice to breastfeed or formula feed, to sit at the bedside all day or go home and take care of your other children. I have not walked in your shoes and therefore cannot judge you for the choices you have had to make. Unless the choice you are trying to make is to withhold pain medication for your baby. That is something I will never understand.
Apr 2 by LOVINGmethadonemommyI say this respectively, but I am about to deliver and been on methadone for 9 years- my husband and I will be amazing parents. I'm terrified about my baby going through NAS! We are blessed to be involved with a nonjudgmental and highly experienced hospital. You should not judge! We aren't all crazy heroin addicts who are putting ourselves before our babies. I wanted to wean right when I found out I was expecting, however, my MFM specialist said it would be way too risky. Almost a guaranteed recipe for miscarriage or still birth! I have bi-weekly biophysical profiles and my baby is strong and healthy, because I have done everything right, and everything I could do to have a healthy pregnancy being on MMT. You have the right to express your opinion, and I'm glad you put baby first. But please don't assume all moms on methadone are bad-- it's simply NOT the case. Thank God I have so many advocates and a huge support group. I have been clean since March 23rd, 2007. (OxyContin aka The Devil). And I will be weaning off methadone for GOOD as soon as my baby is born. I also have the right to my own opinion and I'm so glad I won't have to worry about judgement and stigma from nurses like you!
Apr 2 by Magsulfate, BSNQuote from LOVINGmethadonemommyI don't understand why ANYONE would need methadone for 9 years. Someone please explain. Thanks.I say this respectively, but I am about to deliver and been on methadone for 9 years- my husband and I will be amazing parents. I'm terrified about my baby going through NAS! We are blessed to be involved with a nonjudgmental and highly experienced hospital. You should not judge! We aren't all crazy heroin addicts who are putting ourselves before our babies. I wanted to wean right when I found out I was expecting, however, my MFM specialist said it would be way too risky. Almost a guaranteed recipe for miscarriage or still birth! I have bi-weekly biophysical profiles and my baby is strong and healthy, because I have done everything right, and everything I could do to have a healthy pregnancy being on MMT. You have the right to express your opinion, and I'm glad you put baby first. But please don't assume all moms on methadone are bad-- it's simply NOT the case. Thank God I have so many advocates and a huge support group. I have been clean since March 23rd, 2007. (OxyContin aka The Devil). And I will be weaning off methadone for GOOD as soon as my baby is born. I also have the right to my own opinion and I'm so glad I won't have to worry about judgement and stigma from nurses like you!