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woman to fulfill these treatment goals before delivery in an
outpatient setting.

Perinatal Drug Treatment

Perinatal Drug Treatment Programs are designed to address logistical
barriers and often include supports like onsite childcare, transportation
to and from program and onsite court approved parenting classes.
Perinatal programs often include a more prominent medical
component to address the numerous health issues associated with
addiction. The medical piece would include screening and referrals at
admission (medical, dental, public health nursing), weekly urine drug
testing, regular visits with the physician at the methadone clinic and
coordination between the methadone physician and Prenatal Care
Providers and Pediatricians.

Medical Management of Methadone Maintenance During
Pregnancy

The principles of induction described earlier in this document apply to
pregnant women. Because of the unique risks posed by untreated
withdrawal during pregnancy, a pregnant patient may be asked to
remain onsite for observation longer on the first day or to return to the
program later in the day for evaluation. Either of these will allow the
admitting physician to assess the patient when the medication is
peaking in her system.

If symptoms of withdrawal persist, an additional dose can be given on
the first day of treatment. Early in treatment, a pregnant patient may
meet with the methadone doctor daily to every few days to assess the
methadone dose. Promptly and safely stabilizing the methadone dose
is vital. Withdrawal needs to be completely suppressed to minimize
risk to the fetus. The dose must be sufficient to support complete
abstinence. Sedation must be avoided as it results in fetal sedation,
which could result in a newborn that has low blood pressure, low heart
rate and respiratory suppression.