We often get referrals from OB/GYN or Maternal Fetal Medicine specialists regarding opioid medication management in the pregnant patient. The best practice is not to start these medications while the patient is pregnant, however these patients have often been started on these medications by an outside clinic and we are charged with managing these cases. The delicate balance lies in weaning the medications versus avoiding withdrawal. If the medications are abruptly discontinued, the mother and fetus are put in danger of pre-term labor and all the consequences that come along with this. If the mother is allowed to continue on high doses of opioid medications, the baby is put in danger of breathing problems and withdrawal after delivery. This may result in serious complications, leading to a stay in the Neonatal Intensive Care Unit for the baby.
Our strategy involves avoiding withdrawal in the mother, by slowly weaning opoid medications, utilizing small decreases in medication over time. Our goal is to minimize the overall dose of opioid medications by the third trimester. When done in a slow controlled fashion, we are able to minimize risk to both the mother and the baby. When slow controlled weaning is performed over a period of weeks and months, the mother will not feel the discomfort typically associated with aggressive weaning or abrupt discontinuation. By utilizing a careful and controlled approach, we are able to care for the mother and baby in the safest way possible.