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Toxicology Testing at Delivery

Drug screening at delivery is recommended for pregnant women with
a history of addiction. The results provide information that may
impact the medical management of the mother and child. Testing also
provides documentation of the woman’s status at delivery, which may
assist with decisions regarding the custody of the child. A positive
drug-screening test at delivery (particularly a term and therefore
anticipated delivery) is a red flag for a more serious addiction
problem. It may indicate that drug use is beyond the woman’s ability
to control, meaning that a more intensive level of care is needed.

Pain Management

Labor, delivery and the post-partum period often involve significant
amounts of pain. Opioid dependent persons are more sensitive to pain;
this is a neurological reality. When taken once/day, methadone does
not provide pain relief. Additional medications will be needed for pain
management. Untreated pain may trigger cravings or relapse in a
person with a history of addiction. For mild pain, Acetaminophen or
Ibuprofen will often be adequate. For moderate to severe pain, short-
acting opioids will be needed on top of the regular dose of methadone.
Because of higher tolerance to opioids, addicted patients often need
doses at the upper end of the therapeutic range to experience pain
relief. Discharge pain medications should be prescribed if pain is
anticipated (after C/S or traumatic vaginal delivery). Caution should
be used about the quantity of medication sent home and availability of
refills. A few days supply with the availability of a refill or two on
specified dates to cover the anticipated painful period may be
advisable. The prescribing physician will bring patients in for
evaluation if refills are requested beyond the anticipated period.

Breastfeeding While on Methadone Maintenance

Breastfeeding has many known advantages for mother and baby and
should be encouraged provided there is no contraindication.
Methadone is not a contraindication as negligible amounts of