Subutex withdraw

[doularoz]

I was wondering what everyone's experience has been taking care of babies exposed to subutex during pregnancy. We have mothers tell us that they were told by their Dr. that Subutex does not cause withdraw in infants. From what I have read, that is not true. In my experience it most certiantly does cause withdraw. These kids are miserable and stay in NICU for 2-3 weeks. The mothers just can't understand why their baby isn't doing well. Also, how does your unit treat withdraw symptoms. Do your docs give meds? We give the baby a neonatal abstinance score every 4 hours and sometimes medicate with morphine but our Drs. would rather not. It's terrible to watch them scream and not be able to eat. I hate to think that we are not doing everything we can to help them recover as fast as possible. Also, do you ever send these kids home with narcs when the mother obviously has an addiction. Thank you for your imput.

[milksteak]

I dont understand how these girls don't know that their baby may or may not go into withdrawls. I know that a friend of mine had to sign a waiver (with ALL of the possible neonate side effects) while she was pregnant, even before seeing a doctor! Maybe this is only mandated in some states, but I'm not sure.

[phoenix99]

Yes, infants do withdrawal from Subutex, but we don't see it a lot in my area of the country. We have an epidemic of oxycodone withdrawal infants. To me, all withdrawal is an uncomfortable thing to watch.

I am doing research for a combined care unit, where the moms stay with the infants.

I am looking for units like that in the US, but have only found one in Canada.

Any information on combined care units would be appreciated. Thanks

[Lilli2]

Both of my boys were born with no withdrawals I was on this medication because I chose not to be on other pain meds. Both born over 8 lbs and full term no withdrawals no issues . Both are in 95% for growth. I took no more then 4mgs a day and stayed hydrated. I hope this helps. I also breast fed both for three months neither ever had a nas score and ped watched both like a hawk for signs of withdrawal and both never had any.

[dmm1971]

lilli2..if you could, would you be willing to share how long you were on subutex? i am on 2mgs a day for lyme & ra pain. i am 4-6 weeks pregnant and my dr seems to think the trauma of withdrawals would be more harmful than staying on this dose. i am and have been trying to wein for 1 year now and was changed from suboxone to subutex upon finding out i was pregnant. i find that nurses in general have little sympathy for mothers and just a smidge more for the infants born with withdrawals. what was your experience? thank you for sharing both that you are on medication and about your children.

[NicuGal, MSN, RN]

Hi dmm1971, this is a nurse's forum and we can't give advice on your situation. You can private message the poster above you :)

[missmanderz]

Well I've seen very very few if any mother's taking only subutex as prescribed give birth to babies who had withdraws at all. The babies were just as healthy and I myself take subutex and took it throughout my whole pregnancy and I was told it was less harmful than the pain meds I was on for severe lower back and tailbone pain due to car accidents. I thought oh that sounds great, I'll take that if it's safer and better. Well I had no idea it was primarily opiate dependent patients and similar to methadone so I make it a point to never judge another person under any circumstances and I have sympathy for the mother's as well and treat them like Queens under my care. Sometime's that's all they need.. Sometimes all people need is a hug and nobody purposely wants their baby to suffer and I don't know why some parents don't visit their infants that do have withdraw, maybe it's too hard, they feel guilt, I don't know, but i know I would be there everyday and I would feel so bad that I did that and some people deal differently. We need to stop judging and sympathize more and from mother to mother support each other cause we all know how hard the job is, especially for single mothers. BTW my second child was born just as healthy as my first who I took absolutely nothing, not even an tylenol with so yes either doctors need to be more educated or more tests need to be done and correct information given because I think there is a lot of false hype about these meds. I was not told anything about withdraw by my doctor or that it was a concern so I am surprised to hear it as well.

[DebblesRN, ASN, BSN, RN]

We get infants who are exposed to subutex and morphine during pregnancy where I work. BOTH drugs have horrible withdrawls. We have the same problem with the clinic where I live. I'd love to choke the person at the clinic that tells these moms that their baby will be just fine and suffer no withdrawl.

For any baby who has been exposed to opiates, subutex, or methadone, we keep the baby for 7 days for observation and NAS scoring. Our Neos have a sliding scale on NAS scoring--if baby is 5 or less, every 6 hours, 6-8 every 3 hours, 8-10, every hour, 2 scores 10 or greater we call the docs and USUALLY medicate. We primarily give methadone, but have also given morphine.

We do not send babies home on methadone or morphine. They stay with us until they are totally weaned off. We also do not allow breastfeeding. I know that can be controversial, but our Neos will not allow breastfeeding because MOST of our methadone/opiate/subutex moms are non-compliant and unreliable on what, how much, and how often they take it and have poly drug use proven by UDS. So if baby has to stay in our NICU for three months weaning and withdrawing, that is what we do. Yes we have had several babies stay for 3 months.

There is the occasional baby that stays for the seven days and goes home with little to no withdrawl symptoms, but that is extremely rare.

I get very frustrated wih the clinics because I don't understand the reason for keeping people on methadone. I thought that methadone and subutex were there to help get people off of opiates and that eventually the patient is suppsoed to be weaned off the drug. Most of the moms that come in on methadone and subutex in my area have been on it for 5+ years. CRAZY.