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Federal Regulations take it a step further. In recognition of the high
risk of relapse associated with a history of opioid addiction, Federal
Regulations allow admission of any pregnant woman who is currently
physically dependent on opioids OR who has a history of dependence
and is at risk of relapse even if she is not currently physically
dependent
Informed Consent for the Use of Methadone in Pregnancy
Many pregnant women are anxious about taking medication during
pregnancy. They feel particularly guilty about taking methadone
because it makes them feel better, and they are worried that the
medication will harm the baby. In addition, they do not want the baby
to experience methadone withdrawal at birth. Sometimes the situation
is complicated by a significant other, extended family member or
friend who does not know the woman is on methadone or may not
know that the woman has a history of opioid addiction at all or that she
was using during the pregnancy. The woman is terrified that the
details will become known at the time of delivery, either because
someone observes her taking her methadone dose or because the baby
has to stay in the hospital longer for observation or treatment of
neonatal abstinence.
It is vitally important for a pregnant woman being advised to start
methadone maintenance to understand the benefits and risks of this
treatment and to be able to discuss her concerns with the prescribing
physician. Often multiple discussions are necessary over the course of
the pregnancy to provide reassurance regarding the safety of
methadone during pregnancy and the necessity of a therapeutic dose to
ensure the best possible outcome for mother and baby.
Methadone Maintenance Treatment is voluntary and is only started
after the patient gives written informed consent. Women are also
asked to provide written consent for the Methadone Physician to
coordinate with the Prenatal Care Provider and Pediatrician. Ongoing
work with a counselor helps the woman to plan for delivery and to
deal with family and friends around this issue.
