What are the risks of taking prescription opioids during pregnancy. How can pregnant women safely manage pain without harming their baby. What treatment options are available for opioid use disorder in pregnancy.

Understanding Prescription Opioids and Their Use in Pregnancy

Prescription opioids are powerful painkillers commonly prescribed for severe pain following injuries, surgeries, or dental procedures. They include medications like codeine, morphine, and oxycodone. While effective for pain relief, opioids can pose significant risks when used during pregnancy.

Are all prescription opioids equally risky during pregnancy? The level of risk can vary depending on the specific opioid, dosage, and duration of use. However, all opioids have the potential to cross the placenta and affect fetal development. Common prescription opioids include:

• Hydrocodone (Vicodin, Norco)
• Oxycodone (OxyContin, Percocet)
• Codeine
• Morphine
• Fentanyl
• Tramadol

Can over-the-counter medications contain opioids? Some over-the-counter cough medicines may contain codeine, an opioid. It’s crucial to carefully read labels and consult with a healthcare provider before taking any medication during pregnancy.

Potential Risks of Opioid Use During Pregnancy

Taking prescription opioids during pregnancy can lead to serious complications for both the mother and developing baby. Understanding these risks is essential for making informed decisions about pain management during pregnancy.

How do opioids affect fetal development? Opioids can cross the placenta and impact various aspects of fetal growth and development. Potential risks include:

• Premature birth
• Low birth weight
• Birth defects
• Stillbirth
• Neonatal abstinence syndrome (NAS)

What is neonatal abstinence syndrome (NAS)? NAS is a condition where newborns experience withdrawal symptoms due to exposure to opioids in the womb. Symptoms may include irritability, tremors, feeding difficulties, and respiratory problems. NAS can occur even when opioids are taken exactly as prescribed by a healthcare provider.

Safe Pain Management Strategies During Pregnancy

Managing pain effectively during pregnancy while minimizing risks to the developing baby requires careful consideration and medical guidance. There are several alternative approaches that pregnant women can explore with their healthcare providers.

How can pregnant women safely manage pain without opioids? Some safer alternatives include:

• Acetaminophen (under medical supervision)
• Physical therapy
• Acupuncture
• Massage therapy
• Heat or cold therapy
• Relaxation techniques

Is it safe to stop taking opioids abruptly during pregnancy? Suddenly discontinuing opioid use can be dangerous for both the mother and baby. It’s crucial to work with a healthcare provider to develop a safe tapering plan if opioid use needs to be reduced or discontinued.

Opioid Use Disorder and Pregnancy

Opioid use disorder (OUD) is a complex medical condition that requires specialized care during pregnancy. Understanding the signs of OUD and available treatment options is crucial for ensuring the health and safety of both mother and baby.

How is opioid use disorder diagnosed in pregnant women? Healthcare providers assess various factors, including:

• Taking larger amounts of opioids than prescribed
• Inability to cut down or control opioid use
• Spending significant time obtaining, using, or recovering from opioids
• Experiencing strong cravings for opioids
• Continuing use despite negative consequences

What treatment options are available for pregnant women with opioid use disorder? Treatment typically involves a combination of medication-assisted treatment (MAT) and behavioral therapy. MAT options may include buprenorphine or methadone, which can help manage withdrawal symptoms and cravings while reducing risks to the developing baby.

Preconception Planning and Opioid Use

For women taking prescription opioids who are planning to become pregnant, preconception planning is essential. This involves working closely with healthcare providers to assess the risks and benefits of continued opioid use and explore alternative pain management strategies.

How should women prepare for pregnancy if they’re currently taking opioids? Important steps include:

• Scheduling a preconception checkup
• Discussing all medications, including opioids, with a healthcare provider
• Exploring safer pain management alternatives
• Using effective birth control until opioid use is addressed
• Developing a plan for tapering off opioids if appropriate

Can women safely conceive while taking prescription opioids? While it’s generally recommended to avoid opioid use during pregnancy, some women may need to continue taking them for chronic pain conditions. In these cases, working closely with healthcare providers to minimize risks and optimize maternal and fetal health is crucial.

Communicating with Healthcare Providers About Opioid Use

Open and honest communication with healthcare providers is essential for ensuring safe and effective pain management during pregnancy. This includes discussing all medications, including prescription opioids, over-the-counter drugs, and supplements.

What information should pregnant women share with their healthcare providers about opioid use? Important details to discuss include:

• All current medications and dosages
• Reasons for opioid use
• Duration of opioid use
• Any attempts to stop or reduce opioid use
• Concerns about pain management during pregnancy

How often should pregnant women discuss their medication use with healthcare providers? Medication use should be reviewed at each prenatal visit, as needs and risks may change throughout pregnancy. Any new prescriptions or changes in pain levels should be promptly discussed with the healthcare team.

Neonatal Care and Follow-up for Opioid-Exposed Infants

Infants exposed to opioids during pregnancy may require specialized care after birth. Understanding what to expect and the importance of ongoing follow-up can help ensure the best possible outcomes for both mother and baby.

What type of care do opioid-exposed newborns typically receive? Care may include:

• Close monitoring for signs of neonatal abstinence syndrome (NAS)
• Supportive care, such as swaddling and low-stimulation environments
• Pharmacological treatment for severe NAS symptoms
• Extended hospital stays if needed
• Breastfeeding support (if appropriate and approved by healthcare providers)

How long do opioid-exposed infants need follow-up care? The duration of follow-up care can vary depending on the individual case. However, regular check-ups to monitor growth, development, and any potential long-term effects are typically recommended throughout infancy and early childhood.

Additional Considerations for Opioid Use in Pregnancy

Beyond the immediate risks and management strategies, there are several other important factors to consider regarding opioid use during pregnancy.

How does opioid use impact breastfeeding? Many opioids can pass into breast milk, potentially affecting the nursing infant. Women who are taking opioids should discuss the risks and benefits of breastfeeding with their healthcare providers. In some cases, breastfeeding may still be possible with careful monitoring and guidance.

Are there long-term effects of prenatal opioid exposure on child development? Research in this area is ongoing, but some studies suggest that prenatal opioid exposure may be associated with:

• Developmental delays
• Behavioral issues
• Cognitive impairments
• Increased risk of future substance use disorders

However, it’s important to note that many factors, including prenatal care, postnatal environment, and access to early intervention services, can influence long-term outcomes.

Support Systems and Resources for Pregnant Women Using Opioids

Addressing opioid use during pregnancy can be challenging, but numerous support systems and resources are available to help women navigate this complex issue.

Where can pregnant women find support for opioid use issues? Valuable resources include:

• Specialized prenatal clinics for women with substance use disorders
• Addiction counseling services
• Peer support groups
• Social work services
• Mental health professionals
• National hotlines for substance use and pregnancy

How can partners and family members support pregnant women dealing with opioid use? Supportive actions may include:

• Encouraging open communication with healthcare providers
• Attending prenatal appointments together
• Learning about opioid use disorder and treatment options
• Providing emotional support without judgment
• Creating a safe, stress-reducing environment at home
• Participating in family therapy or support groups

Legal and Ethical Considerations Surrounding Opioid Use in Pregnancy

The intersection of opioid use, pregnancy, and the legal system raises complex ethical and policy questions that vary by jurisdiction.

How do laws regarding substance use during pregnancy impact prenatal care? Some key considerations include:

• Mandatory reporting laws in some states
• Potential involvement of child protective services
• Fear of legal consequences deterring women from seeking prenatal care
• Ethical debates surrounding the rights of the mother versus the fetus
• Efforts to prioritize treatment over punitive measures

What steps are being taken to improve care for pregnant women with opioid use disorder? Many healthcare systems and policymakers are working to:

• Increase access to medication-assisted treatment
• Develop comprehensive care models that address medical, psychological, and social needs
• Reduce stigma associated with opioid use during pregnancy
• Improve coordination between prenatal care, addiction treatment, and pediatric services
• Advocate for policies that support treatment rather than criminalization

These efforts aim to improve outcomes for both mothers and babies affected by opioid use during pregnancy.

Preventing Opioid Misuse and Addiction

While addressing opioid use during pregnancy is crucial, preventing misuse and addiction in the first place is equally important. Healthcare providers and patients can work together to minimize risks associated with opioid prescriptions.

How can healthcare providers help prevent opioid misuse? Strategies include:

• Carefully assessing the need for opioid prescriptions
• Exploring non-opioid pain management options first
• Prescribing the lowest effective dose for the shortest necessary duration
• Educating patients about proper use, storage, and disposal of opioids
• Monitoring patients closely for signs of misuse or addiction
• Utilizing prescription drug monitoring programs

What can individuals do to reduce their risk of opioid addiction? Important steps include:

• Following prescribed dosages exactly
• Never sharing prescription opioids with others
• Storing medications securely
• Disposing of unused medications properly
• Discussing concerns about pain management with healthcare providers
• Being aware of personal risk factors for addiction

Advancing Research on Opioid Use in Pregnancy

Ongoing research is crucial for improving our understanding of opioid use during pregnancy and developing more effective prevention and treatment strategies.

What are some current areas of research regarding opioids and pregnancy? Key topics include:

• Long-term outcomes for children with prenatal opioid exposure
• Optimal medication-assisted treatment protocols for pregnant women
• Genetic factors influencing neonatal abstinence syndrome severity
• Novel non-opioid pain management approaches for use during pregnancy
• Effectiveness of integrated care models for pregnant women with opioid use disorder

How can pregnant women contribute to advancing research in this field? Opportunities may include:

• Participating in clinical trials (when deemed safe and appropriate)
• Sharing experiences through qualitative research studies
• Consenting to long-term follow-up studies for opioid-exposed children
• Advocating for increased funding and attention to this important area of research

By continuing to expand our knowledge base, we can work towards developing more effective strategies for addressing opioid use during pregnancy and improving outcomes for mothers and babies alike.

Prescription opioids during pregnancy | March of Dimes

Prescription opioids are painkillers often used for pain after an injury, surgery or dental work. They include codeine, morphine and oxycodone.

If you take opioids during pregnancy, they may cause serious problems for your baby, like premature birth and drug withdrawal called NAS.

Even if you use an opioid exactly like your health care provider says to, it still may cause NAS in your baby.

Don’t stop taking an opioid without talking to your provider first. Quitting suddenly can cause severe problems for your baby. 

If you’re not pregnant and taking an opioid, use effective birth control until you’re no longer taking the medicine.

Download our English and Spanish health action sheets on opioids and pregnancy.

What are prescription opioids?

Prescription opioids are painkillers (medicine used to relieve pain) your health care provider may prescribe if you’ve been injured or had surgery or dental work. They’re sometimes used to treat a cough or diarrhea. A prescription medicine is one your provider says you can take to treat a health condition. You need a prescription (order for medicine) from your health care provider to get the medicine. Opioids are some of the most common medicines prescribed for pregnant women.

Taking opioids during pregnancy can cause serious problems for your baby. If you’re pregnant or thinking about getting pregnant and taking an opioid, tell your health care provider. You may be able to change to a medicine that’s safer for your baby. You and your provider can weigh the benefits and risks of medicine you take, like opioids, to give you the healthiest possible pregnancy.

These are prescription opioids and some of their common brand names. A brand name is the name given to a product by the company that makes it. 

• Buprenorphine (Belbuca®, Buprenex®, Butrans®, Probuphine®)
• Codeine
• Fentanyl (Actiq®, Duragesic®, Sublimaze®)
• Hydrocodone (Lorcet®, Lortab®, Norco®, Vicodin®)
• Hydromophone (Dalaudid®, Exalgo®)
• Meperidine (Demerol®)
• Methadone (Dolophine®, Methadose®)
• Morphine (Astramorph®, Avinza®, Duramorph®, Roxanol®)
• Oxycodone (OxyContin®, Percodan®, Percocet®)
• Oxymorphone (Opana®)
• Tramadol (ConZip®, Ryzolt®, Ultram®)

There are many other brands of opioids, so if you’re taking any medicine you think may be an opioid or combined with an opioid, tell your provider. For example, some cough medicines contain the opioid codeine.

The illegal drug heroin is an opioid. Fentanyl and other prescription opioids are being made and sold illegally. When used illegally, fentanyl sold on the street often is mixed with heroin or cocaine, which makes it extremely dangerous.

Why are opioids dangerous?

It may be hard for some people to stop using opioids because along with relieving pain, they release chemicals in the brain that can make you feel calm and intensely happy (also called euphoria). Drug addiction is a brain condition that makes you use drugs, even if they’re harmful to you. Addiction affects your self-control and your ability to stop taking a drug. Most people who take prescription opioids can stop using them without getting addicted to them. But using them regularly can make you dependent on them, even if you use them as directed by your provider.

At a preconception checkup before pregnancy or at your first prenatal care checkup, your provider asks you questions about your health. Tell your provider about any health conditions you have and any medicines you take. This includes prescription medicine, over-the-counter (also called OTC) medicines, herbal products and supplements. If you take medicine to treat a medical condition, you may need to switch to medicine that’s safer for your baby. Or your provider may recommend different kinds of treatment that don’t use medicine. And if you need help to quit using addictive drugs, your provider can help you find a treatment program.

When your health care provider gives you a prescription for medicine, he tells you exactly how much to take, how often to take it and how long to take it. If you’re pregnant and using prescription opioids, take them exactly as your provider tells you to. Tell your provider about any opioid or other drug you take, even if it’s prescribed by another provider. If you go to a provider who prescribes you an opioid, make sure she knows you’re pregnant. 

 When you take any prescription medicine:

• Don’t take more than your provider says you can take.
• Don’t take it with alcohol or other drugs.
• Don’t use someone else’s prescription drugs.

What is opioid use disorder?

Addiction to opioids is called an opioid use disorder. You may have an opioid use disorder if:

• You take more opioids than your provider says you can take.
• You have cravings (a strong desire) for an opioid.
• You feel like you can’t stop taking opioids or reduce the amount you take.
• You need more opioids to get the same effect.
• You have problems at home, work or school caused by taking opioids.
• You spend time getting and using opioids.
• You feel sick when you stop using opioids or reduce the amount you take.

If you have opioid use disorder, you’re at risk for overdose. This is when you take too much of a drug. Overdose can slow or stop your breathing. It can cause you to pass out and even die. If you’re using opioids and have any of these signs and symptoms of overdose, call your provider or 911:

• Blurred vision
• Cold, clammy skin
• Feeling dizzy, faint or very sleepy
• Feeling sick to your stomach
• Loose, floppy muscles
• Slowed or trouble breathing or a slow heartbeat

If you have opioid use disorder and you share needles with other drug users, you’re at risk for infections like hepatitis and HIV. Hepatitis is a virus that attacks the liver. HIV stands for human immunodeficiency virus. HIV attacks the body’s immune system that usually helps protect you from infections. You can pass infections like these to your baby during pregnancy. 

If you have opioid use disorder, you may have trouble taking care of yourself during pregnancy. For example, you may miss your prenatal care checkups and not make healthy choices for you and your baby. You’re also at risk for overdose and for mental health conditions, like depression. Depression is a medical condition that causes feelings of sadness and a loss of interest in things you like to do. It can affect how you feel, think and act and can interfere with your daily life. It needs treatment to get better.

Can opioids cause problems during pregnancy and after birth?

Yes. Using opioids during pregnancy can affect your health and your baby’s health. If you’re not pregnant and you’re using opioids, use effective birth control until you’re ready to get pregnant. This can help prevent complications when you do get pregnant. Possible complications linked to opioid use during pregnancy may include:

Birth defects. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops or how the body works. Birth defects associated with opioid use during pregnancy include:

• Congenital heart defects. These conditions can affect the shape of a baby’s heart, how it works or both.
• Gastroschesis. This is a birth defect of a baby’s belly in which the intestines stick outside the body through a hole beside the belly button.
• Glaucoma. This is a group of eye conditions that damage the optic nerve. If untreated, glaucoma can cause blindness.
• Neural tube defects (also called NTDs). These are birth defects of the brain, spine and spinal cord. Spina bifida is the most common NTD.

Miscarriage or stillbirth. Miscarriage is the death of a baby in the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby in the womb after 20 weeks of pregnancy.

Neonatal abstinence syndrome (also called NAS). NAS is when a baby is exposed to a drug in the womb before birth and goes through withdrawal from the drug after birth. NAS is most often caused when a woman takes opioids during pregnancy. NAS can cause serious problems for a baby, like being born too small and having breathing problems. Even if you use an opioid exactly as your health care provider tells you to, it may cause NAS in your baby. So tell your prenatal care provider about any opioid you take, even if it’s prescribed to you by another health care provider. If another health care provider prescribes you an opioid, make sure she knows you’re pregnant.

Placental abruption. This is a serious condition in which the placenta separates from the wall of the uterus (womb) before birth. If this happens, your baby may not get enough oxygen and nutrients in the womb. And you may have serious bleeding. The placenta grows in your uterus and supplies the baby with food and oxygen through the umbilical cord.

Preeclampsia. This is a serious condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs and symptoms of preeclampsia include having protein in the urine, changes in vision and severe headaches. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy.

Preterm labor and premature birth. This is labor and birth that happen too early, before 37 weeks of pregnancy. Babies born this early may have more health problems at birth and later in life than babies born full term. Opioids also can cause premature rupture of membranes (also called PROM). This is when the sac around a baby breaks before a woman goes into labor.

Problems with your baby’s growth. These include:

• Fetal growth restriction (also called growth-restricted, small for gestational age and small for date). This is when a baby doesn’t gain the weight she should before birth.
• Low birthweight. This is when a baby is born weighing less than 5 pounds, 8 ounces.

Sudden infant death syndrome (also called SIDS). This is the unexplained death of a baby younger than 1 year old. SIDS usually happens when a baby is sleeping. Babies born to mothers who use opioids are at increased risk for SIDS.

How is opioid use disorder treated during pregnancy?

Treatment for opioid use disorder during pregnancy may include:

Opioid replacement therapy, including medication-assisted therapy (also called MAT) or opioid-assisted therapy (also called OAT). For these treatments, your provider prescribes you long-acting opioids, like methadone or buprenorphine, that you take during pregnancy and after your baby is born. Long-acting means the opioids stay in your body for a long time. Methadone and buprenorphine help reduce your need for opioids in a way that’s safe for you and your baby. They don’t make you feel happy or calm the way some opioids do. These medicines can help reduce your baby’s risk for premature birth and growth problems. Your baby may have some withdrawal symptoms after birth.

If you’re in MAT, talk to your provider about a medicine called naloxone (brand name Narcan®). Naloxone helps stop the harmful effects of opioids, and it can save your life if you have an opioid overdose. With your provider’s OK, it’s safe to use during pregnancy in small doses. Your provider may prescribe it as a nasal spray or a shot. If you’re using naloxone, keep it with you at all times. Your provider can show you and your family how to use it if you have signs or symptoms of an overdose.

Behavioral therapy (also called counseling). Your provider may recommend that you meet with a counselor by yourself, with a group or both. Counseling can help you change your feelings about drugs and help you develop healthy life skills. It also helps you learn how to avoid or manage situations that may make you likely to relapse. Relapse is when you go back to using a drug after trying to quit using it. People who get drug counseling are less likely to relapse than people who don’t get counseling.

Is it safe to suddenly quit taking opioids during pregnancy?

No. Quitting suddenly (also called going cold turkey) during pregnancy can cause severe problems for your baby, including death. If you’re pregnant and taking opioids, don’t go cold turkey. Talk to your provider about safe ways to stop taking opioids.

If you’re breastfeeding, is it safe to take opioids?

Breastfeeding is good for both you and your baby. It helps you bond with your baby, and your breast milk helps build your baby’s immunity to protect her from infections. If you baby has NAS, breastfeeding may help make her withdrawal less severe so she needs less medicine and can leave the hospital sooner.

If you’re using prescription opioids for pain relief with your provider’s supervision, you can breastfeed depending on the medicine you take. Some opioids can cause life-threatening problems for your baby. Make sure the provider who prescribes you the opioid knows you’re breastfeeding, and take the medicine exactly as our provider tells you to. Talk to your provider about switching to a safer pain reliever if you take:

• Codeine or medicines that contain codeine
• Hydrocodone
• Meperidine
• Oxycodone
• Tramadol

Pain relievers like ibuprofen (Advil®) or acetaminophen (Tylenol®) are safe to use when breastfeeding.

If you’re in MAT or OAT, you can breastfeed your baby if:

• Your health is stable and you’re no longer abusing opioids or using street drugs, like cocaine or marijuana.
• You don’t have HIV.
• Your MAT or OAT program is supervised and your treatment is closely monitored.
• You have social support from friends and family throughout your treatment.
• Your baby continues to gain weight as you breastfeed.  

Are you at risk forhaving problems with opioids?

We don’t know why some people have problems when they try to stop using opioids and others can stop using them without problems. We do know that some things make you more likely than others tohave problems with opioids. These are called risk factors. Having a risk factor doesn’t mean for sure that you’llhave these problems. But it may increase your chances. Risk factors for addiction include:

• A family history of problems with drugs. These problems are more common in some families. Tell your provider if you have a parent, brother or sister who’s had a problem with drugs or alcohol. Fill out the March of Dimes family health history form to record health information about your family and share the form with your provider.
• A mental health condition. Pregnant women with opioid use disorder often have a mental health condition, like anxiety, depression or post-traumatic stress disorder (also called PTSD). Anxiety is strong feelings of worry or fear, and depression is strong feelings of sadness. These feelings last for a long time and interfere with your daily life. PTSD can happen if you’ve experienced a shocking, scary or dangerous event, like a disaster, rape, abuse or the sudden death of a loved one. People with PTSD may have serious anxiety, flashbacks, nightmares or physical responses (like sweating or a racing heartbeat) when reminded of the event. Tell your provider if you have or think you have a mental health condition, like anxiety, depression or PTSD.
• Peer pressure. If your friends or people around you use drugs, you’re more likely to use drugs and have problems with them.
• Taking drugs that are highly addictive, like opioids

Where can you get help to stop abusing prescription drugs, including opioids?

If you need help to stop abusing prescription drugs, talk to your health care provider, use the Substance Abuse Treatment Services Facility Locator or call (800) 662-4357.

More information

• Food and Drug Administration
• Mother to Baby
• Treating for Two

Last reviewed: June, 2019

See also: Neonatal abstinence syndrome (NAS), Preventing NAS in your baby infographic, Caring for a baby with NAS infographic

Pregnancy and Opioids: MedlinePlus

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Many women need to take medicines while they are pregnant. But not all medicines are safe during pregnancy. Many medicines carry risks for you, your baby, or both. Opioids, especially when misused, can cause problems for you and your baby while you are pregnant.

What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some health care providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your health care provider. However, opioid dependence, addiction, and overdose are still potential risks. These risks increase when these medicines are misused. Misuse means you are not taking the medicines according to your provider’s instructions, you are using them to get high, or you are taking someone else’s opioids.

What are the risks of taking opioids during pregnancy?

Taking opioids during pregnancy can cause problems for you and your baby. The possible risks include:

• Neonatal abstinence syndrome (NAS) – withdrawal symptoms (irritability, seizures, vomiting, diarrhea, fever, and poor feeding) in newborns
• Neural tube defects – birth defects of the brain, spine, or spinal cord
• Congenital heart defects – problems with the structure of the baby’s heart
• Gastroschisis – a birth defect of the baby’s abdomen, where the intestines stick outside of the body through a hole beside the belly button
• Loss of the baby, either miscarriage (before 20 weeks of pregnancy) or stillbirth (after 20 or more weeks)
• Preterm delivery – a birth before 37 weeks
• Stunted growth, leading to low birthweight

Some women need to take opioid pain medicine while they are pregnant. If your health care provider suggests that you take opioids during pregnancy, you should first discuss the risks and benefits. Then if you both decide that you need to take the opioids, you should work together to try to minimize the risks. Some of the ways to do this include:

• Taking them for the shortest time possible
• Taking the lowest dose that will help you
• Carefully following your provider’s instructions for taking the medicines
• Contacting your provider if you have side effects
• Going to all your follow-up appointments

If I am already taking opioids and I become pregnant, what should I do?

If you have been taking opioids and you become pregnant, contact your health care provider. You should not stop taking the opioids on your own. If you suddenly stop taking opioids, it could cause severe health problems for you or your baby. In some cases, stopping suddenly during pregnancy may be more harmful than taking the medicines.

Can I breastfeed while taking opioids?

Many women who regularly take opioid medicines can breastfeed. It depends on which medicine you are taking. Check with your health care provider before breastfeeding.

There are some women who should not breastfeed, such as those who have HIV or take illegal drugs.

What are the treatments for opioid use disorders in pregnancy?

If you are pregnant and have an opioid use disorder, do not stop taking opioids suddenly. Instead, see your health care provider so you can get help. The treatment for opioid use disorder is medication-assisted therapy (MAT). MAT includes medicine and counseling:

• Medicine can reduce your cravings and withdrawal symptoms. For pregnant women, health care providers use either buprenorphine or methadone.
• Counseling, including behavioral therapies, which can help you
• Change your attitudes and behaviors related to drug use
• Build healthy life skills
• Continue taking your medicine and getting prenatal care

• About Opioid Use during Pregnancy

  (Centers for Disease Control and Prevention)

  Also in Spanish

• Pregnancy and Opioid Pain Medications

  (Centers for Disease Control and Prevention)

  – PDF

  Also in Spanish

• Prescription Opioids during Pregnancy

  (March of Dimes Foundation)

• Treating Opioid Use Disorder during Pregnancy

  (National Institute on Drug Abuse)

  Also in Spanish

• Heroin and Pregnancy

  (March of Dimes Foundation)

  Also in Spanish

• Data and Statistics About Opioid Use During Pregnancy

  (Centers for Disease Control and Prevention)

• What Treatment Is Available for Pregnant Mothers and Their Babies?

  (National Institute on Drug Abuse)

• ClinicalTrials. gov: Pregnancy and Opioids

  (National Institutes of Health)

• Article: Caring for people and their babies in the opioid crisis.

• Article: Doula engagement and maternal opioid use disorder (OUD): Experiences of women…

• Article: Opioid Use Disorder and Perinatal Outcomes.

• Pregnancy and Opioids — see more articles

• Neonatal abstinence syndrome

  (Medical Encyclopedia)

  Also in Spanish

• Pregnancy and Opioid Pain Medications

  (Centers for Disease Control and Prevention)

  – PDF

  Also in Spanish

American mink.

Pregnancy and rearing

Preparation for the rut

The main condition for proper preparation for the rut is full feeding of the animals and their proper maintenance. The period of preparation for the rut is characterized by the development of the genital organs. By this time, the minks should be in good condition so that preparations for the new breeding season are not delayed.

Adult females after the end of lactation, especially if they have raised large litters, are emaciated. In order to continue preparing for the rut normally, they are given an increased diet for 10-15 days. When the fatness of the females becomes normal, they are transferred to the diet adopted during the preparation for the rut.

During the preparation for the rut, it is necessary to monitor the state of health and the course of the molting of animals. On January 1, replacement young animals are transferred to the main herd, in addition, a marketable herd is left in the amount of 5% of the main herd. In February, the minks of the main herd are tested for plasmacytosis, animals with a positive reaction are culled and slaughtered.

It is necessary to control the fatness of animals, since obesity or malnutrition is undesirable, both of which are bad for the results of the reproduction of animals.

Minks are weighed before feeding on a children’s or trade scale, which is installed on a cableway platform or on a portable table. It is more convenient for three or four workers to do this. Moving along the shed, one of them catches the animals in portable cages, another weighs them, the third releases the weighed animals and checks that the cages are well closed, and the fourth records the weighing data in a log.

Animal fatness can be determined by eye and with the help of the weight index, that is, the ratio of the mass of the animal to the length of its body. Animals are measured with a centimeter tape from the tip of the nose to the root of the tail. The fatness of all animals in the breeding farm and animals of the control groups in the commercial farm is determined monthly.

During January-February, the fatness of females should be brought to factory standards. All females are weighed on January 1, February 1 and March 1. It is believed that females give good reproduction results with indices before the rut of 23-27. Studies have shown that among overly well-fed animals, the number of unsuccessful puppies increases – more stillborn and weak puppies, which often die before registration.

During the period of preparation for the rut of breeding animals, fur breeders should carefully monitor them and regulate their feeding, increasing or decreasing portions of feed depending on the fatness of the animal, and also ensure that there is always clean water in the drinkers.

Deviations from the normal state (animal refusal to feed, poor stool consistency, lethargy, slow shedding of the hairline, etc.) are noted on a stencil hung on the house. With the onset of damp cool weather, the houses must be insulated to prevent colds in minks. To do this, use a litter of hay, shavings, etc.

Particular attention should be paid to the good preparation of young females and males for the rut. This period in them coincides with the final formation of the body, which requires an increased amount of nutrients compared to adult animals. Well, if on January 1, the average weight of young animals does not differ from the weight of adult animals.

Importation of breeding animals and their seating should be completed as soon as possible, preferably in November. Changing the conditions of keeping and feeding at a later time can adversely affect the course of the rut.

During the preparation for the rut, workers carefully check the cages in which the breeding animals will be kept. Faulty cells must be repaired. Veterinary activities are carried out on the farm: cages are disinfected, etc. It is necessary to check the animals by sex, as there are times when a male is mistakenly placed in a cage instead of a female. They look through the stencils for adult breeding animals, fill in the stencils for the first years. After the livestock specialist draws up a pairing plan in the male stencil, the cell numbers and serial numbers of the females attached to each male are recorded. The numbers of backup males are also supplied in the stencil, that is, those males that, by their qualities, can replace the main one; the relevant information about the males is entered into the stencils of the females.

At the end of February, before the start of the rut, the condition of the testes of males should be checked. As it turned out, about 4% of males do not fertilize females, some of these males actively and well cover them, but females do not become pregnant. Check the testicles by probing. One or both testicles may not be palpable or may be smaller than normal. Animals with poorly developed testicles are not allowed to breed.

Rutting

Before mating, the female has estrus and hunting. Estrus is a period of sexual arousal of the beast. Hunting is part of estrus, which is characterized by the female’s readiness to mate. By changing the external genital organs – the genital loop (vulva) – determine the readiness of the female for mating.

The first signs of the onset of the rut in minks are noted in February. At this time, females and males show interest in each other and can mate. You finish the rutting season in the first days of April, but at this time there can only be separate matings. Minks show the greatest sexual activity from March 5 to March 20, when the maximum number of eggs matures in females.

Rutting starts usually from March 1-5. Experiments have shown that females covered in February and, again, in early March, often do not fertilize, so the rut should not begin before March.

Minks during estrus have 3-4 periods of hunting. The hunting period is repeated most often after 7-10 days, hunting continues for 1-2 days.

Breeding females and males are usually kept separately. At the beginning of the rut, the male and female are placed in pairs daily or every other day. The presence or absence of hunting is determined by the behavior of animals. When the female is not hunting, the minks are hostile to each other, fights arise between them. In this case, the animals should be seated. A female in heat does not resist when the male tries to mate. Mink mating lasts an average of 30-40 minutes, but there are also short (2-3 minutes) and very long (up to 2-3 hours) mating. Experiments show that interruption of coitus after 10-20 minutes leads to a decrease in the yield of puppies. The interruption of very long matings does not affect the fertility of females.

It may happen that the female is in heat, but the male assigned to her cannot cover her. In this case, the female should be placed with another male, an understudy. They catch and carry minks during the rutting period by hand or using portable cages. Together with the female, her stencil is necessarily transferred. The date of each landing of the female to the male is recorded in the male’s stencil, the date of mating is circled. As a rule, during the “descent” of pairs, the female is transferred to the cage to the male. In some farms, females are transported using carts or a cableway.

In the stencil, females must mark the number of the male who mated the female and the date of mating. Replanting is carried out in the morning, 30-40 minutes after feeding, and in the afternoon. A male can cover two or three females per day.

Minks are seated differently depending on the rutting method. Females attached to him are planted next to the male. Females are planted in turn to the male assigned to them. If the female is not in heat, another one sitting in the next cage is placed next to the male. With this method of rutting, the fur breeder walks around the shed, observing the behavior of the pairs.

Sometimes all the males are placed in the center of the shed and the females are kept separately. The fur breeder places one of the females assigned to each male and observes their behavior. In the event of a fight or prolonged inattention of animals to each other, the female is seated and another is planted in her place.

During the bush rut, self-understudies, similar in their qualities, sit in a group of 5-7 heads, and females attached to them – in cages located nearby and on the opposite side of the shed.

The so-called pipe rutting method is also used in mink breeding. Its essence lies in the fact that six cells along the aft passage are connected by a pipe made of a regular mesh. The cross section of the pipe is 15×15 cm. In the house of each cell, a hole (manhole) is made leading to the pipe, which can be closed with a metal valve. A male is placed in one of the cages, and the females assigned to him are placed in the other five.

During the rut, the breeder opens the valve and releases the male into the pipe, and then, one by one, opens the valves of the houses in which the females are. If the female is in heat, then mating occurs. After mating, the male and female are herded into their own house. If the female does not come to hunt, she is closed in the house, and another is allowed to the male.

On a number of farms, the breeder pairs up half of the males and females every day, and works with the other half the next day (“intermittent rut”).

The concentration of males in one place of the shed allows the worker to simultaneously control the behavior of all pairs, but the delivery of females to males, especially from distant cages, requires a lot of time and labor.

The dispersed placement of males inside the shed reduces the labor and time costs for carrying females, but makes it difficult to control the behavior of animals.

With a pipe rutting system, the need to capture and transfer females is eliminated, and the worker focuses on observing the animals.

After mating, a fight may occur between the animals, so they should be seated. The male is given a rest for 1.5-2 hours, and then he can again be planted with the females. It happens that part of the females or all, covered by one male, remain without offspring, so a number of farms have organized a test for the activity of the male’s sperm. It is controlled several times during the rut, as some males at the beginning of the rut, while others at the end of the rut, may increase the number of inactive sperm.

Provoked ovulation in minks. It is provoked by mating, but occurs only if the follicles have reached the stage of maturity. A proper mink mating system is very important. It should ensure full ovulation in females and maintain the viability of sperm in her genital tract by the time of ovulation of the egg.

Previously, a number of mating systems existed in mink breeding. Thus, the females were placed with the male every day or every other day during the entire rutting period, regardless of whether there was mating, or after mating – on the second day, and then on the 7-10th and 14-15th. At present, the following system is considered the most rational: the descent of pairs begins on March 3-5, the females are covered once, 7 days after the first mating, that is, in the second period of the hunt, the females are blocked, and preferably two days in a row. After this, mating is stopped – the female is considered fertilized.

Females mated for the first time after 16 March are mated on the second or fourth day. Experience has shown that one covering of females entails an increase in the number of omissions.

A rutting method has been developed based on the timing of the females’ heat and covering them in one heat period. The first ovulation in females is caused without mating – by injection of 10-20 units of gonadotropic hormone. 7-8 days after the injection, the females are placed next to the males for mating for two days in a row. Six females are assigned to one male, which are treated with a hormone from March 3 to March 7 (two females every other day). The output of puppies under such a system is not reduced.

It is very important that the females are covered by the male to which each of them is assigned. Compliance with the mating plan contributes to the improvement of the herd, helps to get good offspring. Coverage by an occasional male may adversely affect the quality of the offspring. Puppies may develop a combination of undesirable traits from their parents. If the female and male are closely related, ugly puppies may appear among the offspring or the female’s fertility will decrease. From crossing two colored minks, sometimes even close or identical in color, puppies of a standard dark brown color can appear. When pairing, the livestock specialist takes into account the qualities of the parents and their family ties, so you should not violate the selection options he has chosen.

It is necessary to avoid covering the female with different males. In each period of the hunt, the female ovulates, that is, leaves the ovaries, several eggs, so she can give birth to both males, while it is not possible to establish which of them is the father of the puppies. However, at the end of the rut, when the risk of missing females, covered once due to poor sperm production of the male, increases, overlapping by different males can be resorted to. All puppies obtained in this case are considered commercial.

Most of the time during the rut is spent by the breeder catching animals, transferring females to the male’s cage and back, observing the behavior of pairs, recording in stencils, checking the male’s sperm, etc. Until April 1, all uncovered females of the commercial herd are slaughtered.

Pregnancy and breeding of minks

The gestation period of minks is 36-80 days from the first coat. Differences in terms depend on the duration of the latent period – the period when the eggs lie freely in the horns of the uterus, without attaching. Early-coated females have a longer pregnancy than late-coated ones. Most females covered at the height of the rut whelp on the 50-54th day after the first mating.

The duration of pregnancy depends to some extent on the size of the litter. On average, in infertile females, bringing one or two puppies, it is longer (50-55 days), than in more prolific females – 5-11 puppies (47-48 days).

The maintenance and care of females during this period should ensure the normal development of the fetus.

Pregnant females remain without offspring for a number of reasons. Abortion can be caused by the disease of the female, the presence of low-quality products in the feed, a lack of vitamins, poor living conditions, and rough handling. The fact that an abortion has occurred is indicated by the presence in the cell, house or under the cell of the remains of the fetus and traces of blood. The female is depressed, refuses to feed. Early abortion is difficult to establish.

Females may remain without offspring as a result of untimely mating. In this case, their eggs ovulate before mating or much later, after the death of the sperm. The reason may be the inferiority of the male sperm or the abnormal structure of the female genital organs. Often, emptying is the result of death and resorption of the fetus. In different farms, the number of females without offspring ranges from 5-8 to 20% or more.

Pregnancy in minks is difficult to determine by appearance. 10-15 days before whelping, the belly of females increases, they move carefully, in pregnant females earlier than non-pregnant ones, molting begins on the muzzle. When caring for them during this period, it is necessary to regularly change the litter, provide water, monitor their behavior and eating food.

Mink whelps in houses, so the houses should be prepared for whelping. They are thoroughly cleaned and filled with dry bedding. As bedding, you can use hay, straw of awnless cereals, soft shavings.

In the future, it is necessary to systematically inspect the houses. Smoke and, if necessary, change soiled bedding. The amount of litter should be adjusted depending on the breeding area and weather conditions. In the case of an early warm spring, less is required, and in cold weather, more.

Mink whelping is active, in a relatively short time. Due to the presence of a latent stage, the timing of whelping is not related to the timing of coverage, and it is difficult to predict them. Most females mate in the second half of April – the first decade of May.

Preparing for whelping is best done for all females at the same time and completed 5-6 days before the expected whelping date.

Mink puppies are born blind, deaf, fat mass 9-12g, length 5-8 cm. On the ground, they can freeze, they can be dragged by birds. Therefore, under the mesh floor, pallets are strengthened or mats are placed on the floor. They can be different: from plywood, fine mesh or burlap.

Females whelp at different times, but more often at night and in the morning. You learn about whelping by the behavior of the female. She does not leave the house, where the squeak of puppies is heard. If the birth went well and everything is fine in the house, the squeak quickly stops, a long drawn-out squeak indicates trouble in the litter.

Weaning may produce weak or dead puppies. Inspect puppies as early as possible, usually on whelping day. It is better to do this during feeding, when the female goes to the paddock of the cage, at other times the female can be carefully driven out of the house and the entrance to it can be blocked with a valve. On examination, pay attention to the condition of the female, puppies, as well as the sanitary condition of the house. If you find dirt or dampness in it, you need to change the litter. Each puppy should be taken in hand so as not to miss the weak.

In a litter, minks can have from 1 to 10-16 puppies, more often 5-9. They are born naked, on the surface of the body they have only separate tips of guard hairs. Normal puppies lie in a pile, they are warm and dry. If the puppies are wet, cold and scattered around the house, then there is some kind of trouble in the litter and emergency measures must be taken.

The puppies are counted and the dead are removed from the house. The litter may be large, some of the puppies may be weak. It is recommended to wean several puppies from a large litter, as the female will not be able to provide them all with milk. More than 7-8 puppies are usually not left under the female. The puppies are placed with dairy females with less than five puppies. Weak ones, who are lagging behind in growth compared to littermates, are also removed. Nurse’s puppies should not be larger than those being planted.

Nursing females usually accept puppies well from another mother. Having driven the female out for a walk, one or more puppies are placed in the house among the rest. If the female does not leave the house, it is not worth disturbing the puppy, you can put it at the entrance to the house. Hearing the puppy squeak, she herself drags him inside. Before moving away from the cage, the fur breeder needs to make sure that the female has taken the puppy to the house.

The number of puppies taken from her, their gender, the date of jigging, the number of the female nurse, the puppy’s mark must be noted in the mother’s stencil. Similar information is entered into the nurse’s stencil. The tip of the ear cut off with scissors can serve as a mark for puppies. Minks easily tolerate this operation.

During the whelping period, duty is set on the farm. The attendant walks around the territory, observing the behavior of whelping and whelping females, listens to the squeak of puppies, determines their state of health.

During the whelping period, in addition to caring for animals and feeding them, the fur breeder regularly inspects females and young animals. Having timely identified weak and low-milk females, as well as weak and sick puppies, he places the puppies with other mothers, takes sick animals for treatment, writes down the results of whelping and moving animals in stencils and in a notebook.

Rearing of suckling young animals

Young animals are registered and arrive on the tenth day after their birth. When registering, the number of puppies and their gender are set. The breeder must constantly monitor the condition of females and offspring. The female may have little milk. The reason may be the heredity of the animal, its poor health, poor feeding.

Even if the female is in a normal condition, some of the puppies may be stunted or die. Therefore, it is necessary to look at the litters and take measures to preserve the young and females: organize treatment, improve the diet, start additional feeding, put weak puppies to the wet nurse, etc.

Mink puppies are covered with hair at the age of 3-4 days, at the age of one month, males weigh -170-200 g, females – 150-180 g (Fig. 1 9). The eyes of the Norchs open on the 30th-32nd day, they begin to hear on the 25th day, the teeth erupt on the 16th-26th day.

In the first one and a half to two weeks of life, puppies are always in the house and eat only mother’s milk. The females eat the puppies’ feces, so during this period the house is relatively clean. From 18-20 days of age, the female begins to carry food to the nest, and even blind puppies try to eat it. Young animals at this time begin to be taught to feed, so they improve the food intended for females.

When accustoming puppies to feeding, food is placed in the house. When the puppies start eating food, the females no longer eat their feces. The house can be dirty, so you need to change the bedding more often. The amount of bedding in the house is regulated depending on the weather. On warm days, it should be reduced, in hot weather, completely removed.

The period from the 20th to the 40th day of lactation is very responsible. Mink females can lose their appetite, they carry most of the food to puppies, even if they have food in the house, and as a result they become very depleted, which can cause their death. Therefore, it is necessary to constantly monitor the condition of the females.

In the stencil, females during the period of rearing offspring make marks on the quality of puppies (good, weak), on mortality, jigging and replanting puppies. Much of this information is then transferred to the production log and taken into account when selecting females and young animals for the tribe.

Cultivation of transplanted young animals

Young growth is planted at 40-45 days of age. From females that have lost a lot of weight, prone to exhaustion – on the 32-35th day. Jigging is carried out with litter, using carts and special boxes, each of which is designed for 4-5 litters.

After juveniles are deposited, the main herd animals are regrouped, females culled based on the results of breeding are concentrated in one place.

In a number of farms, puppies are kept as a litter after weaning and after some time they are seated in pairs. It is believed that in this case, puppies are less bored without a mother. Usually, puppies are immediately put into a cage two by two in opposite-sex (male and female) or same-sex (two females or two males) pairs. Young animals left for the tribe after the first stage of selection (from the time of birth to jigging of puppies), and young animals intended for slaughter, are planted in different sheds or different places in one shed, and feed the puppies in the paddock.

Before the start of planting, clean, wash and disinfect all cages and houses in the shed intended for keeping young animals. The litter is laid so that the young can go out into the hole. During jigging, a stencil prepared in advance for each animal is hung on the cage. When jigging, it is necessary to identify the placed puppies by the label and assign them the appropriate numbers. If there is no firm certainty about which puppy is planted and which are born by this female, the use of young animals from this litter for the tribe is not allowed. The origin of each breeding puppy should not be in doubt. Puppies from different litters can be placed in one cage during jigging, if one of them is female, the other is male, otherwise the origin of the puppies cannot be established.

As a rule, puppies set in pairs get along well. Pugnacious couples must be seated to avoid injury. Aggressiveness or significantly better development in one of the puppies can lead to malnutrition and stunting in the other.

Until August, young animals are fed twice a day. Food is placed on the mesh ceiling of the cage near the entrance to the house. Minks grow very quickly, and by the age of five months they reach the size of adult animals. To control the development of young animals, weighing should be carried out monthly. Not all herd animals are weighed, but control groups, and before feeding.

It is necessary to control the development of animals separately by sex. Studies have shown that at birth the mass of males and females is almost the same, at the age of one month, males weigh about 9%, and at the age of six months – 80-100% more than females. So, standard black, dark brown, pastel, soklopastel, palomino, silver-blue and white by the end of growth weigh 200-300 g more than minks of other types. Minks grow especially intensively until September, and then their growth rate decreases significantly.

At the beginning of August, the puppies finish their summer hair growth and start laying their winter hair. The endocrine and reproductive systems are developing. At this time, it is important to monitor the fatness of the animal, since underfeeding can affect the course of molting, winter pubescence of animals, and the formation of the reproductive ability of the young animals left for the tribe. From the second half of August, young animals are preliminarily selected for the tribe, taking into account the development, physique of animals and their pubescence.

Starting from September, the course of molting should be carefully observed, especially during the autumn culling, as the course of molting reflects the state of health of the animal and its readiness for reproduction. On October 15, all replacement young animals are weighed.

During the growth of winter hairs it is very important to keep the house clean. With the onset of cold weather, animals must be provided with good bedding. This helps to keep the pubescence clean, especially in colored minks, to avoid colds.

The care of young stock is no different from the care of adult animals: they are regularly fed, watered, and their cages are cleaned. On hot days, special attention is paid to drinking. Minks do not tolerate high temperatures well, so on hot days I open the wooden lid of the house so that air circulates in it. In addition, they monitor the presence of water in the drinkers, sometimes water the sheds and the ground around them. Failure to take precautions can lead to heat stroke and death of minks.

At the end of October – beginning of November, young animals are assessed and the final selection of breeding animals is carried out. Slaughter begins November 8-10. First, white minks and minks assigned to the blue group are slaughtered, then the minks of the brown group and standard minks. A delay in slaughter leads to a deterioration in the quality of the skins: undesirable tones appear, especially in the color of colored minks, their hair becomes dull, the number of animals with defects in the pubescence structure increases, primarily with thinning hair on the abdomen.

The maturation of the skins of individual animals varies significantly, therefore, in order to obtain the best quality skins, slaughter begins after an individual inspection of the animals. Minks intended for slaughter are not fed; slaughter is carried out in the morning. Then the remaining animals are fed and watered. During the slaughter period, it is important to properly organize work on the farm. Slaughter must be carried out in a short time. To do this, they resort to freezing carcasses or skins that have been removed but not processed. Many fur farmers during this period are involved in the processing of furs.

At the same time, breeding animals require a lot of attention. Deterioration of maintenance can affect their reproduction, lead to diseases and mortality, especially among young animals.

Life expectancy and pregnancy of different animal species

Animal species	Attainable age	Estimated duration of pregnancy (months)
Elephants	120-200	20.5
Horses	40-50	11
Donkeys	40-50	12-13
Zebras	22	11.5-12.5
Cows	20-25	9
Single humped camels	40-50	12-13
Sheep	10-15	5
Goats	12-15	5
Mountain goats	20-25	6-7
Reindeer	30	8-9
Chamois	15-16	9-10
Lani	20	8
Reindeer	16	8
Moose	20	9
Wild boar	20-30	4
Domestic pigs	20-30	4
Hippos	40-50	7-8
Rhinos	40-45	17-18
Dogs	10-15 (20)	2 (58-63 days)
Wolves	10	2
Foxes	10	2
Domestic cats	9-10	2 (50-58 days)
Lions	20-25	3. Leave a Reply Cancel reply Your email address will not be published. Required fields are marked * Comment * Name * Email * Website