Can prenatal patients be induced and maintained while pregnant and following delivery in community settings without specialty addiction medicine services?
The provision of safe care through the prenatal and postnatal period is more dependent on the clarity transparency of the protocol used, and the monitoring applied to validate compliance, than it is to the degree of specialty care available. If the provider managing the opioid use disorder is not also managing the pregnancy, it is critical that the pregnant patient be receiving pre-natal services from a qualified obstetrician or family medicine physician.
What is the most important difference between perinatal care of a patient and care delivered to women who are not pregnant?
The context of pregnancy frequently creates an atmosphere of motivation to change behavior. However, in the case of newly discovered pregnancy, the dynamics of caring for only one of the two people involved with the conception can undermine progress of the pregnant partner. Seeing the entire household as contributors to success frequently requires engaging multiple household members.
Should buprenorphine be weaned in anticipation of delivery?
There is no data to suggest that reduction of dose prior to delivery will reduce the frequency of Neonatal Abstinence Syndrome. ON the other hand, a motivated patient who wishes to reduce their dose should always be allowed to make that decision. Frequently volume of distribution changes during pregnancy result in a need for increased dose to reduce cravings, but when a patient declares that the dose is not necessary to control cravings and asks to reduce the dose, there is no discrete data to suggest that this should be refused.
