Opioid pain relief during pregnancy.

[tireesix]

If I were to get my pain relief (something like fentanyl patches), do you think this would make me higher risk for my pregnancy and birth, ok, maybe not for me, but for baby. Would it be better for me to birth in a hospital for babies sake?

[kate3]

Narcotics cross the placenta, and fentenyl is strong. There is certainly a risk of opioid withdrawal in the baby with continued use during pregnancy. How severely affected the baby could be would depend on your opioid dose, duration, etc.

If avoiding opiates during pregnancy is not an option I would suggest setting up a consult with a neonatologist or pediatrician that has experience with neonatal addiction. Opiate withdrawal is tough for newborns, and they can be a challange to parent (crying, fussy, poor feeders, poor sleepers). You could have a plan in place to monitor for withdrawal symptoms and decide if the baby needed treatment.

[Jane]

Lots of people use some opiates during pregnancy for a single episode of pain - ie for a gall bladder attack, car accident, broken foot, etc. If you are using opiates for the time of delivery, it should be in the hospital in order to have narcan (opiate antagonist) available if needed. If not at term, but during pregnancy, if you are using them long enough that the baby's development potentially would affected, you'd need more monitoring and checking - perhaps in the high risk environment.

You need to have a long discussion about the risks and benefits with a trusted doctor about your pregnancy and whatever condition is causing you pain.

[CookieMonsterMommy]

I agree-if you're on the opiates near or at delivery, I vote for a hospital birth. Babies with those types of drugs in their blood not only have addiction/dependancy and accompanying withdrawl issues, but those drugs can interfere with normal breathing patterns. All of these may be out of the scope of a home birth, unfortunately.

NOW....if you can wean yourself off these meds (with the observation of a doctor) within a week or more of delivery, I would think a home birth should be fine.

[tireesix]

I have been thinking about it, and I think what I would try to do is simply use the pain relief when I absolutely need it, when its just too much and avoid taking anything from 38 weeks.

I am 12 weeks now,I can bear the thought of no pain relief from 38 weeks to when I deliver, at most that would be a month/5 weeks, thats bearable, but right now, the thought of the next 6 months with my only pain relief being codedine which doesn't actually do much for the pain and givees me rotten gastric problems, is driving me round the bend.

Hang on:
http://www.mothering.com/discussions...8#post11040678

I suffer from Fibromyalgia, at the moment my Fibro is very bad, every where that could hurt, seems to hurt and then I suffer from Ehler Danlos Syndrome Hypermobility type which is causing joint pain. Thanks to relaxin, my joints are worse than usual and I have one shoulder that has popped out for a second time this pregnancy, it does go back in but it aggravates everything and it damn well hurts right now.

Tankyou, this is such a hard decision for me.

[Jane]

Please don't take this the wrong way - but...have you considered antidepressants? There is a lot better safety profile for some of the antidepressants in pregnancy than opiates and there is some evidence (clinical + experience) that messing with brain neurotransmitters can make pain much easier to bear.

I do think your "sometimes" plan has merit. Many women find being without anxiety medications to be anxiety-provoking. But when they are available in low quantities (3-5 a month), they don't need them. It's the "can't have any" that is not bearable. The anxiety (or pain, in your case) IS bearable, most of the time.

A few more random thoughts - have you tried shoving yourself into the mold of a person with normal joints through the use of compression hose, tummy braces, wrist braces, and tight long-sleeve leotards? Apologies if that sounds dreadful with your fibro, sometimes it is helpful for people with EDS. Have you tried the boards at EDNF.org? I bet there are some people who have BTDT with pregnancy and pain.

Are you sleeping? Can you make sure to devote enough hours to your sleep that you actually are sleeping 8 hours of it?
Are you treating any anxiety/hypochondria that you might have?
Do you feel like you have a healthcare team that trusts you and that you trust?

[tireesix]

Unfortunutely, I am banned from anti depressants (SSRIs) due to the way I react to them although I was thinking abouot taking another look at tri cyclics, I had been on ami previously but due to the worry about my reactions, I was taken off of them.

I am sleeping at least 8 hours a day (suffering a lot of fatigue).

Mental health care here is shoddy.

I have been using support things for joints but I am going to get a referral to a physio again.

However, I have a great Doctor, I am willing to try anything she suggests.

I agree with you on the 'can't have any' point. I have been doing my best, bearing up to the pain, taking things one day at a time but this past week has been really bad.

I keep wanting to explain in detail but I can't, its not that I feel anxious right now, I am just in too much pain, just sitting down really hurts so bad. Everything I do is hurting and I am my DHs carer as well as my childrens (my DH has health problems).

Its so hard to explain my current situation (without bursting into tears). I need a few days relief, not just so I can be pain free, but so I can do what needs to be done because I have no family or friends near by who can help me.

I am starting to feel like a really awful person for even considering this.

[Jane]

If you're feeling awful, try googling information on methadone maintenance in pregnancy - there are women who take large, daily doses of methodone. The outcomes are not so bad, considering the societal attitude towards drug use in pregnancy - ie that any at all is TOXIC. I realize you're not shooting for "not so bad" as an outcome, but I suspect your opiate use is not as high as those in methadone programs.

Perhaps you can work out a plan for your pain relief that allows for your individual control. I think that daily opiate and daily sleeping medications would not be ideal. But a combination of some of both those medications, for example, totally off the top of my head, 5 sleeping pills and 10 mild opiates each month would have a lower risk profile while maximizing your quality of life and mental health for all three of your children. I'm not your health care provider, though, so this isn't a real suggestion, but something to bring up with her.

Can you hire in a birth pool for this month? To soak in your living room, weightless and warm for a while? OR have your GP write a script for water physiotherapy?

[tireesix]

Thankyou, I am going to take every thing you said and suggest it to my Doc.

I am going to end up walking in with a gert huge pile of notes.

I might make an earlier appointment for my MW too, I am due to see her in about 3 weeks but I shall see if I can get in to see her sooner depending on what the Doc says, just so we can go over stuff and see if we can get the Ob to see me earlier.

[Jane]

Have you heard/seen your baby yet? It's such a cliche, but sometimes it's a little easier to bear if you've said "hi" to the little one. If not, perhaps that earlier midwife appointment is in order.

One more thought - I am a huge proponent of omega 3 fish oils, for joint lubrication, mental health, and fetal neural development. A month's supply of the enteric coated pills is about $20 (enteric means they pass through the stomach undigested, which means no fishy burps). Helpful amounts range from 1 pill/day to 8 pills per day, depending on which study you look at. I'ver personally split the difference and take the equivilent of 4 pills. They also help me absorb the fat-soluble vitamin D suppliment I need because of my latitude. The vitamin D has vastly helped my arthritis as well. That's totally anectdotal, but it's one of those cheapie things that I consider low risk. Like my folic acid suppliment - one years tablets for $4. I had to be convinced of the omega 3's because it adds to a bunch of money over a year. But the D was a no-brainer (test is $200, pills are $5/two months).

[tireesix]

Yes, I had a scan a week or so a go. It was even more emotional than my first lol. I had come very close to having an abortion this time (this pregnancy I feel like a terrible mother) and when I saw the little critter I felt so guilty but I am feeling more positive about the pregnancy.

I shall sort out some Omega 3.

[BetsyS]

I only took care of one mother who was on fentanyl patches for the majority of her pregnancy. I want to say she had them from weeks 22 until delivery.

Her baby did have withdrawl and had to be in the NICU for a couple of weeks.

I don't think occasional use would have the same affect, but long term fentanyl patches are something that are a really hard decision to make during pregnancy.

[caedmyn]

You've probably already done this, but have you looked into foods that might affect the fibromyalgia? I know gluten can affect it, as well as both naturally and artificially occurring food chemicals. Here's a couple of links on food chemicals--fibromyalgia is mentioned on both sites. www.plantpoisonsandrottenstuff.com www.fedupwithfoodadditives.info

[Jane]

How'd it go?