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program, and remind the patient to follow-up with the Ob/Gyn
physician for post-partum care and contraception.

The methadone physician evaluates the appropriateness of the
methadone dose fairly soon after delivery. Some women will
experience sedation as their body returns to the non-pregnant state.
This can happen quickly in some women and more slowly in others.
Early detection of sedation and dose adjustment is essential to ensure
that the mother is able to care for her infant.

Post-partum depression in a woman with a history of addiction puts
her at risk of relapse. It also may impair maternal-infant bonding,
interfere with parenting and rob a woman of the enjoyment associated
with caring for a new baby. Many depressed women do not recognize
that the symptoms they are experiencing are due to depression, so they
may not seek medical evaluation and treatment. Educating women
before delivery about post-partum depression may be helpful. Prompt
diagnosis and treatment is essential.

The methadone physician and program counselors make an effort to
stay in contact with women after delivery and encourage them to
return to program as soon as reasonably possible. Caring for a new
baby can be overwhelming and getting organized to get out of the
house with the baby is challenging. However mothers in recovery are
particularly vulnerable to relapse at this time, so the support of the
treatment program is vital.

What About Methadone Withdrawal After Delivery?

Discontinuation of methadone treatment after delivery is medically
contraindicated because it almost inevitably results in relapse to daily
illicit opioid use. As reported by Ball and Ross in 1991, the relapse
rate is 80% within the first year of withdrawal. Methadone
Maintenance Treatment is effective long-term medical treatment for
the chronic disease of opioid addiction.

The post-partum period is a difficult time for any woman because of
the intense demands of a newborn at a time when she is physically