What to Expect at the Hospital
Most pregnant women wonder what will happen at the hospital. In this section we will answer these questions for you. These questions are based on hospitals in Maine. If you don't live in Maine, talk to the staff at your clinic and have them help you to find out which hospital in your area has the most experience working with babies whose mom's are in methadone treatment. Once you find that out, you'll want to ask the hospital staff the questions that are on this page and any other questions you may have about what to expect at the hospital.
If you are from a hospital and want to share information about your policies and information that pertains to pregnant women in methadone treatment, please email Katie to discuss posting your information or adding a link to your facility.
- How long will my baby be in the hospital?
- Will I receive my methadone dose there?
- What should I do about pain management?
- What will my baby experience?
- Will “the state” (Department of Health and Human Services) be involved?
How long will my baby be in the hospital?
If you live in Maine, do your best to get to Maine Medical Center (MMC) in Portland or Eastern Maine Medical Center (EMMC) in Bangor. If you cannot safely get to one of these hospitals on your own go to the nearest hospital and have them transport you. Both MMC and EMMC have significant experience providing care to newborns whose mothers are in methadone treatment programs.
The length of time at the hospital is different from baby to baby. The hospital will want to keep your baby for observation to look for any signs of withdrawal. It may take a few days for your baby to show any signs, so some hospitals will want to obverse your baby for up to seven days. There are certain medications that may be given to your baby to help them if they show withdrawal symptoms. Some of these medications your baby will be weaned from before they leave the hospital. Because of this, you should plan for your baby to stay at least 3 weeks.
Will I receive my methadone there?
Once you arrive at MMC you will be admitted to the labor and delivery wing. The medical staff there will contact the clinic to verify your dose of methadone and you can expect to get your medication there while you are a patient. If you have take-home medication (methadone that the clinic prepares for you to take at home), you will be expected to bring all medication back to the clinic for the days you received your medication in the hospital. Make sure to talk to your counselor about this issue well before your due date.
Once you are discharged from the hospital (even if your baby is still a patient there) you will not receive your medication from the hospital and will be expected to attend the clinic for your methadone.
When you leave the hospital make sure you ask for your discharge summary and a list of all medications and when you were given them. Bring this back to the clinic with you. It’s important to give this information to the nurses so they know your last dose of methadone and any medications you were given that may show up in a drug test.
One more thing about your dose- after women give birth they often need to decrease their dose. After a day or so, you might feel groggy or sedated 3-6 hours after you take your methadone. This might be an indication you need to have your dose decreased. Make sure to speak with someone at the hospital and at your clinic if you think you may need you dose decreased.
What should I do about pain management?
This can be a really complicated issue, especially if you have had an addiction or problems with pain medication (OxyContin, oxycodone, percocet, Vicodin, etc). Talk to your prenatal provider about what your options are and work with your substance abuse counselor to help prevent relapse or misuse of medications. Women who are newer in recovery may not feel that they are able to manage their own medication and feel more comfortable only taking medication while they are a patient at the hospital.
What will my baby experience?
When your baby is born she or he will go to the newborn nursery. Both you and your baby may have a drug screen. Your baby is likely to have a meconium screen to look for drug exposure.
Meconium is your baby’s first bowel movement and can detect drug exposure from your second trimester of the pregnancy right through to delivery.
Your baby may not experience withdrawal from methadone until 5-7 days after birth. On average, 60%-90% of babies born to mothers who are in MMT will show withdrawal signs.
A baby has withdrawals just like adults do, including (but not limited to):
- Loose stools
- Yawning
- Poor sleeping
- Sweating
- Fever
- Sneezing
- Seizures
- Tremors
The NICU
If your baby shows signs of withdrawal he/she might be moved to an area called the NICU, Neonatal Intensive Care Unit. Currently, many of the babies who have been born to moms in methadone treatment are going to the Barbara Bush Children's Hospital at MMC.
There are things you can do to help ease withdrawal symptoms! Try soothing your baby by having skin-to-skin contact with them in a quiet room with dim lights.
The baby will be assessed with the Neonatal Abstinence Scoring System (NAS), which was developed by Loretta P. Finnegan, MD. The NAS states what withdrawals are and what score the baby should receive based on how severe the symptoms are. Nurses will observe your baby and will make a record of any withdrawal symptoms on the NAS scoring sheet. Your baby will be assessed about every 3 hours.
The nurses know when to start giving your baby medication by the scores from the NAS. If your baby scores 8 or greater for 3 assessments in a row, or 12 or greater for 2 assessments in a row the nurses may give your baby medication to help lessen the withdrawal symptoms.
Your baby may seem distressed, but medication may help reduce feelings of discomfort. Your baby will be tapered off the medication, which may happen before you leave the hospital or you may be given medication to give the baby at home.
Some hospitals use phenobarbital and diluted tincture of opium (DTO). Others may use morphine or methadone. Make sure you ask the hospital about what they use to treat withdrawal symptoms. Be an informed mom! Also, even if you think your baby is having withdrawal symptoms you should not give them any prescription medications that have not been prescribed for them.
Will DHHS be involved?
In Maine, there is a law that states if a baby is born affected by substance use—legal or illegal—the Department of Health and Human Services (DHHS) will be contacted by hospital staff.
DHHS will investigate, determine if the baby is affected, determine if there is abuse or neglect, and work with you to develop a plan for safe care. If abuse or neglect is found further steps will be taken by DHHS.
DHHS social workers are looking for ‘red flags’ alerting them that your home may not be safe for the newborn, including drug use by you or people who are living with you.
If anyone in your home is still using, you may want to encourage them to stop using and/or seek treatment. If your partner or someone in your home is using and wants help ask your counselor for referrals or recommendations.
You can expect a public health nurse (or other social service provider) to come to your home and assess the safety of the environment. They will determine if your home is safe and free from abuse and neglect.
They will often make suggestions that they think will support you and your family. DHHS does not want take your baby away from you. As social workers, it’s their job to make sure the baby is going to be raised in a safe and healthy home with supportive caregivers.
This is an excellent time to communicate with your counselor so they can help you talk to DHHS. DHHS has the ability to see your treatment records, so we encourage you to be honest with them.
The level of DHHS involvement is different from family to family. Your experience with DHHS may be drastically different than that of your friends, family, or other patients from the clinic.