Pregnancy is a time of great potential for positive change! Here is some helpful information for a healthy pregnancy.
Talk to your provider and discuss all risks and benefits of continuing any medication during pregnancy. Taking medications for opioid use disorder (MOUD) as prescribed during pregnancy has benefits that outweigh the risks. It is important for health care providers and people who are pregnant to work together to manage medical care, including substance use, during pregnancy and after delivery.
The risks associated with quickly stopping opioid use during pregnancy include: preterm labor, fetal distress, or miscarriage. Connection to a substance use disorder treatment provider who is able to prescribe medications for opioid use disorder (MOUD) during pregnancy is essential and recommended as best practice for the care of pregnant women with opioid use disorders.
Pregnant and postpartum people who are struggling with opioid use need to be connected to treatment services that are trauma-informed, inclusive, integrated, utilize a family-based treatment model that places emphasis on the parent-infant dyad, and implements whole-person care addressing the prenatal, physical, psychological, and social components of care. Treatment for pregnant women struggling with opioid use should promote and facilitate family, community, and social support.
Direct services for pregnant people, their newborns and families who need substance use disorder treatment and support:
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Pregnant women with Opioid Use Disorder (OUD) need to be assured that they will receive adequate pain relief during labor and the postpartum period. Prenatal and obstetric providers should discuss and develop a plan for labor and delivery pain control prior to labor beginning.
Breastfeeding is the best source of nutrition for most infants. It can also reduce the risk for certain health conditions for both infants and mothers. All newborns, whether they are showing signs or symptoms of withdrawal or not, need calm, responsive and consistent care that focuses on skin-to-skin contact with the infant’s mother, breastfeeding as soon after birth as possible, and supporting a secure attachment and bond between them and their mother.
In general, breastfeeding is safe for mothers who take methadone or buprenorphine and may reduce clinical signs of NOWS and length of hospital stay, and is a critical foundation in care for the mother-infant dyad. Methadone and buprenorphine are excreted into human milk at low concentrations. The Academy of Breastfeeding Medicine has published consensus breastfeeding guidelines that suggest that breastfeeding should be encouraged if the mother has not had a relapse to use in more that 90 days.
Levels of buprenorphine and methadone are very low in breast milk. Few studies have focused on breastfeeding as an outcome of opioid agonist pharmacotherapy for pregnant women with opioid use disorder (OUD) (Abrahams et al., 2007; Debelak, Morrone, O’Grady, & Jones, 2013; Johnson et al., 2001). Buprenorphine and methadone levels in breast milk are very low when the mother is on pharmacotherapy and pose little risk to infants (Ilett et al., 2012; Jansson et al., 2008a, 2008b, 2016).
The decision to use the combination buprenorphine/naloxone product while breastfeeding is a shared decision, but one that ultimately must be made by the patient once she understands the risks and benefits to herself and her newborn. Available data suggest that naloxone does not affect lactation hormone levels in breastfeeding mothers. The mother’s use of buprenorphine with naloxone is not a reason for discontinuing breastfeeding (Cholst, Wardlaw, Newman, & Frantz, 1984; Johnson, Andrews, Seckl, & Lightman, 1990). Naloxone’s poor bioavailability when taken either sublingually or transmucosally in the buprenorphine/naloxone combination product (Ilett et al., 2012) makes it even less likely to transfer to the neonate via breast milk.
If the new mother returns to substance use, health care team members will have to consider whether to discontinue breastfeeding based on their knowledge of the patient and her access to behavioral and recovery support services. If there is a return to substance use, health care professionals are advised to review the American Academy of Pediatrics (AAP) Breastfeeding and the Use of Human Milk | Pediatrics (Hudak, Tan, & AAP, 2012) and the Academy of Breastfeeding Medicine (ABM) Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015 (Reece-Stremtan, Marinelli, & ABM, 2009, revised 2015).
It may not be necessary to stop breastfeeding after an isolated incident of substance use that is quickly under control. The World Health Organization’s (WHO’s) Guidelines for identification and management of substance use and substance use disorders in pregnancy suggest carefully reviewing the mother’s situation before recommending discontinuation of breastfeeding (WHO, 2014).
Doing these things can help calm your baby:
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Almost every drug and medicine pass from the mother’s bloodstream through the placenta to her unborn infant. Some prescription medications and illicit drugs can cause the unborn infant to become dependent. At birth, the infant continues to need the drug. But because the drug is no longer available, the infant goes through withdrawal. Some drugs and medicines are more likely to cause NAS than others. Opiates are a class of drugs that commonly cause NAS. Some examples of opiates include heroin, methadone, suboxone, Subutex, Vicodin, Percocet, oxycodone, Oxycontin, and codeine.
Pregnant women who use opiates may have infants who develop neonatal abstinence syndrome. Women who have a substance use disorder may also be less likely to get prenatal care. This can increase the chance of complications for both mother and infant.
Symptoms of withdrawal may start as soon as 24 to 48 hours after birth and usually peak by day five, or they may start as late as five to 10 days after birth. Below are the most common symptoms of the NAS. Symptoms may be slightly different for each infant. Symptoms of withdrawal in full-term infants may include:
Premature infants may have a lower risk for withdrawal symptoms or have less severe symptoms.
The signs a newborn might experience, and how severe the signs will be, depend on different factors. Some factors include the type and amount of substance the newborn was exposed to before birth, the last time a substance was used, whether the baby is born full-term or premature, and if the newborn was exposed to other substances before birth, such as alcohol or other medications. Withdrawal among newborns during the first 28 days of life due to long-term exposure to opioids before birth is called neonatal opioid withdrawal syndrome (NOWS). Opioids given at the time of delivery do not cause NOWS. NOWS is under the NAS umbrella and specific to opioid use.
It is important to recognize that NAS is an expected condition that can follow exposure to a substance or medication. A concern for NAS alone should not deter health care providers from prescribing MOUD. Close collaboration with the pediatric care team can help ensure that infants exposed to opioids before birth are monitored for NAS and receive appropriate treatment, as well as be referred to needed services.
The postpartum period can be a stressful time for new parents, and especially parents in recovery. Support for people in treatment for OUD is critical in the postpartum period—a time of adjustments and increased stressors—which may increase the risk for relapse and overdose events. Continued access to health care and linkage to care for substance use disorders and other co-occurring conditions is important. People with OUD during pregnancy should continue MOUD as prescribed in the postpartum period.
The discharge plan for infants treated for neonatal abstinence syndrome (NAS) should include home visitation,child development education and support, attachment-based parenting support, a social work consult, and referrals to health care professionals who are knowledgeable about NAS and are available to the family within their communities.
Any infant who has trouble eating or sleeping, is crying more than expected, or has diarrhea after discharge should be promptly evaluated by their pediatrician. If you need to apply for Arizona Medicaid coverage, or need more information about the coverage and benefits that you have through Arizona Medicaid, please review the AHCCCS Health Plans web page.
If you have Arizona Medicaid health insurance and want or need to find a new health care provider for yourself or your baby, the links below will take you to your plan’s provider search page.
If you or someone you know are seeking help for opioid misuse, abuse or dependence, there are treatment options available in your area.
If you live in Maricopa, Gila, or Pinal Counties:
Mercy Care Member Services: 602-586-1841 or 1-800-624-3879
Mercy Care Crisis Line: 602-222-9444 or 1-800-631-1314
If you live in Apache, Coconino, Mohave, Navajo, or Yavapai Counties:
Care 1st Customer Service: 1-866-560-4042
Care 1st Crisis Line: 877-756-4090
If you live in Cochise, Graham, Greenlee, La Paz, Pima, Santa Cruz, or Yuma Counties:
Arizona Complete Health Customer Service: 1-888-788-4408
Arizona Complete Health Crisis Line: 866-495-6735
Arizona also has four Opioid Treatment that are open 24 hours a day, 7 days a week to provide immediate access to opioid treatment to connect you to ongoing services.
They serve AHCCCS members, individuals with no insurance, and individuals with insurance that may not cover some services like Medication Assisted Treatment or peer support services.
If you or someone you know needs help with opioid misuse, abuse, or dependence please call for help, regardless of your insurance coverage.
Treating opioid misuse, abuse or dependence is a priority for providers who participate in:
These providers offer a range of services, including residential and outpatient treatment, Medication Assisted Treatment, and recovery supports. Call today to find treatment options that are best for you.
If you are experiencing a crisis please dial or text 988, dial 1-844-534-4673 (HOPE), text HOPE to 4HOPE (44673), or chat online.
