[mjegan59]

This is a hard question to ask, but i was recently on a vacation with my wofe's family and learned that her sister in law who is 7.5 months pregnant has been taking a high dose of Ultram and a small dose of vicodin during her entire pregnancy. In fact, i learned that she has been addicted to these drugs for the last 12 years and did not stop during her pregnancy. She has a prescription from her drug-pusher doctor (sorry docs) for as many as 12 ultram per day (i don't know the dose or the possible dosing for Ultram so i don't konw how much this equals, let's say for argument's sake that 12 ultram = 300 mg per day). The vicodin is sporadic because she buys it off prescription. She has not told her OB about the drug use. She has not told her family physician she is pregnant. she has not told anyone that she is buying meds off prescription.

OK, a couple of questions because i am starting to feel like the only moderately sane person in the family and i need to know how to counsel at this point.
1. What are the possible effects on the unborn child from this cocktail of drugs?
2. At this point she is 7.5 months pregnant and is worried that the baby will show signs of withdrawal upon his birth, so she is trying to taper off the meds now (without a lot of success). Would it be better for the baby for her to taper off now so the baby has withdrawals in utero or would it be better to have the baby to undergo withdrawals with medical care ex utero? note: i assume that there are withdrawals from these drugs.
3. My sister in law is a decently high functioning educated person who is extremely embarassed that she is still addicted. So much so that she refuses to tell her doctors for fear that they will come down hard on her. She has also hidden this from my brother-in-law throughout the entire pregnancy. Now that i know, do i have any obligation to inform either of these people (her OB was my wife's OB during her recent pregnancy)?

Thank you for any answers you can give.

[peanut30]

Oh my goodness. What a situation. Well, the baby will go through withdrawls weather she does it now or later. I can't remember where I heard this but I've heard that it's really dangerous to go through withdrawls while the baby is still inside. From what I've heard Ultram is not a very strong opiate and since she is only taking vicodin occasionally the baby should be fine. I heard a story of a woman who was pregnant and lost her legs in a tragic accident and she was on the strongest pain medicaton, morphine. Her baby was fine. The baby will probably cry a lot and not seep too well the first few weeks but the main effects of the drug will be gone in a matter of time. Unless the mother od's she should be okay. You can always call a hospital or look in your phone book for dial a nurse and they will be able to help you with all of your questions.

As for telling your brother in law or the doctor that's a moral delimma. If you tell you risk having your wife's family be upset with you. Since it's her family she should be the one to address the situation. Is your wife's mother in her life? Maybe it would be good if your wife talked to her mother about her sister (or sister in law) and they can figure out a plan of action as a family. Maybe she needs an intervention or a little push to tell her ob herself so that she can get on safe dose until the baby is born. Usually when people tell others about thier addictions it's a cry for help. She needs support right now and she needs people she can trust. I know when I was taking vicodin all the time, if someone upset me the first thing I wanted to do was take more pills to feel better, to numb out. That's just me but us addicts tend to think alike.

Good luck and God Bless

[mjegan59]

Thank you for your response. It does ease my mind a bit. I have suggested to my wife that she tell my brother in law or that if that's too hard she and her mom do it. It's a challenge because hers is a family in which there are a number of addiction issues and no one, except my wife, is really immune (she gets to be the co-dependent instead!!!). I think it makes matters worse that my brother in law went through rehab for his own drug addictions and has stayed completely clean for two years. the baby was the restart for them. I will just keep my prayers going their way.

[MaisieC]

Yikes, that's a bad situation. Ultram is a complex drug, and I honestly don't know what the effect on the baby might be. I would NOT, however, conclude that the baby will be fine. You need more information.

How did you learn about her current drug use? Did she tell you? This is a tough one, but I don't believe in covering up for addicts, and now that there is another (innocent) life involved the stakes are even higher. I think you are morally obliged to make sure this information got to the people who need it, in order to protect that baby. If she told you herself about her problem, I think the best thing to do would be to tell her that if she doesn't tell her doctors and her husband what she's doing, you will have to do it for her. It will be awkward and she will likely be mad at you, but she can't be allowed to endanger her baby simply because she can't or won't deal with her addiction. So I guess I'd try approaching her first, and give her an ultimatum. If she doesn't do it, I would go ahead and call the doctor myself.

Sorry you're in such a difficult position. I think you need to be guided by what's best for the baby.

Good luck with this!

Maisie

[mjegan59]

My sister in law did not exactly tell me, but the situation, as i mentioned is a bit complex. It's a semi-open secret in her family, one that had been kept from me since i am fairly new to the family. My sister in law left the vacation early and i found out because my wife told me she had run out of pills. I asked more detailed questions then and realized that the use of ultram and vicodin was pretty serious (i was aware that there had been some dependency before the pregnancy, but i assumed that a) it was small because she is pretty high functioning and b) she had stopped because she was pregnant). I admit to being relatively naive about drug addiction (my family drinks to cover its pain - and i knew my sister in law was never a drinker).

The biggest issue now is the health of the baby. Frankly, i think we all have to live with our own actions and my sister in law has had an enormous string of "bad luck" which i now have started to understand is a product of her addiction. But that's not for me to judge in any way (I hope she gets well!). My main concern is for the innocent in all this. That's why i was wondering a) the effect on the fetus during pregnancy and b) whether its better for the baby if she goes off while he's in utero or if she should let the medical staff be there to take care of him when he is born.

The third issue is obviously the interpersonal one. i am very proud of my brother in law for going to rehab and staying clean. See, he was addicted to meth - a "dirty" drug - while his wife was on pain pills - a "clean" drug (this is the logic of the family not mine!). I think he should know, but even if she doesn't tell him, the OB should know so he can give her good counsel. The ultimatum idea is a good one, but i think my wife will have to have that conversation with her sister rather then me. She has been avoiding the issue for a long time, but with good info about the dangers maybe she will take the next steps.

[peanut30]

You definitely need to have your wife deal with this. It's her family. I've read lots about the effect of Opiates on the body and it affects the brain's central nervous system. The child will have withdrawls but it most likely wont die. You can always call a hospital like I said and talk to a physician or have your wife call the OB and ask a "hypothetical" question since thie OB's are the same Dr. All medical information is confidential and I don't know if it's legal to talk to someon's Dr. about them with out thier permission. If you give your sister in law an ultimatum you should have your wife do it. What blows my mind is that she wasn't drug tested! All pregnant women are drug tested by their OB now.


I found this information on http://drugsafetysite.com/tramadol/
In a 1997 case report, a male infant developed withdrawal symptoms between 24 and 48 hours after birth (13). Symptoms consisted of trembling, tachypnea, tachycardia, hypertonic muscle tone, signs of tetany when touched, and a single mild convulsion. The mother admitted to taking tramadol 300 mg/day for 4 years. The infant was treated with diazepam and/or phenobarbital for 13 days until the symptoms had fully resolved. No long-term follow-up of the infant was reported. The authors concluded that the estimated elimination half-life of 36 hours was consistent with the course of the withdrawal syndrome (13).

I hope this helps. You are such a compassionate person for caring about this precious child. I truely hope and pray the baby will be okay and that your family will be able to heal from this and grow stronger. Keep us posted on what happens, okay?

[MaisieC]

Wow, peanut, that's a horrible story! That poor little baby! It just breaks my heart to read that.

mj, I think it's a good idea for your wife to have the conversation. I don't mean to sound harsh here, but she needs to DO it rather than avoiding the issue. It shouldn't depend on getting the right information off the internet, and you guys really don't need to figure out whether it's better for your sister-in-law to detox now or have the new baby go through withdrawals as a newborn. That's not your call; it's the doctors'. If you read somewhere on the internet that it was better to wait for after the birth, would you really decide to remain silent about what is being done to this baby right now? I understand you want information, but there is really NO information that will excuse turning a blind eye to this situation. As I say, I don't mean to be harsh, but it's frankly really alarming what is going on. I hope you'll be able to act as quickly as possible to help the baby.

Good luck and God bless.

[Robert_325]

The OBGYN needs to know about this immediately. She will NOT be the first opiate dependent patient the dr has ever dealt with I guarantee. They work through this problem all the time. But it's a very serious issue. The dr needs to know immediately for the sake of that little baby. Let us know how it goes. God bless.

[mjegan59]

Thank you all for your good advice. I talked to my wife who has agreed to talk to her sister and mom about this and if she can't get any traction, to talk to her sister's OB. In my heart, I knew this was the right course but having you guys give me some back up on the issue was very important for me in talking it over with her. I will keep you posted on the results and next steps.

[Anneleise]

Originally Posted by mjegan59

This is a hard question to ask, but i was recently on a vacation with my wofe's family and learned that her sister in law who is 7.5 months pregnant has been taking a high dose of Ultram and a small dose of vicodin during her entire pregnancy. In fact, i learned that she has been addicted to these drugs for the last 12 years and did not stop during her pregnancy. She has a prescription from her drug-pusher doctor (sorry docs) for as many as 12 ultram per day (i don't know the dose or the possible dosing for Ultram so i don't konw how much this equals, let's say for argument's sake that 12 ultram = 300 mg per day). The vicodin is sporadic because she buys it off prescription. She has not told her OB about the drug use. She has not told her family physician she is pregnant. she has not told anyone that she is buying meds off prescription.

OK, a couple of questions because i am starting to feel like the only moderately sane person in the family and i need to know how to counsel at this point.
1. What are the possible effects on the unborn child from this cocktail of drugs?
2. At this point she is 7.5 months pregnant and is worried that the baby will show signs of withdrawal upon his birth, so she is trying to taper off the meds now (without a lot of success). Would it be better for the baby for her to taper off now so the baby has withdrawals in utero or would it be better to have the baby to undergo withdrawals with medical care ex utero? note: i assume that there are withdrawals from these drugs.
3. My sister in law is a decently high functioning educated person who is extremely embarassed that she is still addicted. So much so that she refuses to tell her doctors for fear that they will come down hard on her. She has also hidden this from my brother-in-law throughout the entire pregnancy. Now that i know, do i have any obligation to inform either of these people (her OB was my wife's OB during her recent pregnancy)?

Thank you for any answers you can give.

Hello, im anneleise and wanted to offer you some reassurance on your sister in law! I have been on norco ( same thing as vicodin, but 5 mg stronger) my entire pregnancy. My ob knows this and so does my family doctor. I was on 6 ultram a day, but quit that easily. I have severe back pain, that's what i take it for. It sounds like your sis in law will be fine, and so will her baby. Actually, the vicodin is frequently prescribed during pregancy as opposed to otc's, such as ibuprofen and aspirin. The ultram is less safe, but is not known to cause withdrawal or birth defects in the newborn! The vicodin may cause mild withdrawal, but if she can keep it down to 2 7.5 mg a day, the baby will have little to NO withdrawal and certainly no birth defects. From my experience, the vicodin is better to take as opposed to ultram, however, like I said, there are NO KNOWN BIRTH DEFECTS OR WITHDRAWAL IN THE BABY ASSOCIATED WITH THAT DRUG. If your sis is addicted and does not want to tell her doctors, she is not putting the baby or herself in danger at this point, if she is in fact taking the dosage you think she is and if she is successful at weening herself off, it would be best you did not tell her doctors, in my opinion. If you were to tell them instead of her, child protective services might step in and in my experience and opinion, that is NOT necessary at this point! Let her deal with it and seek help other ways. To answer your other question, she is on such a low dose, believe it or not, that any withdrawals she experiences while still pregnant will NOT harm the fetus, and it would be better, if she doesn't want her doctors to know, to get off these meds while pregnant, just do it slowly. There is always a chance she will be drug tested, and if she does not have a prescription, this could mean trouble. But if she has a script, it would be better. I hope i helped some, there is much misconception on the dangers of these medications during pregnancy. of course, it would be better if her doctors knew, BUT if she is not comfortable telling them, it is okay. I have done alot of research and talked extensively to my doctors, including my obgyn about my medications, and i feel confident in saying you don't have to worry about her, as you stated the medications and dosages she is on will not cause birth defects or withdrawals in her baby. I hope she gets help for her addiction, if she really is addicted and does not have legitimate pain. I have scoliosis and various other things and go to a pain management clinic. Please don't worry so much and if she is weening herself off successfully, worry even less! Her baby is fine, in my opinion. Good luck to both of you and please feel free to contact me yourself, or if your sis in law wants any advice! I am not a doctor, but like i said, i have talked extensively with my obgyn about the exact same medications. Hope this helps! God bless

[mjegan59]

Hi,

Thank you and everyone who poseted replies to my original message. My sister in law delivered a healthy baby about three weeks ago. he was a bit under 6 pounds, not big but majorly underweight or anything. While the baby was/is fine, my sister in law was not. she hemorraged three separate times and ended up needing three units of blood. I finally called her doctor and told him about the ultram (which he didn't konw about) because no one else would and because i was not sure if there were any secondary effects that impacted blood clotting or something like that. He was very reassuring and said that the likelier cause of the hemmoraging was that she was taking aspirin for a headache (probably from withdrawals from the ultram). My sis-in-law is now doing much better and the baby is, as i said, very healthy. i still feel bad about telling her doctor but i decided that it was the right thing to do given the complications and my lack of knowledge about ultram and vicodin. that was a very tough call and in many ways i feel bad that i didn't say something sooner. on the other hand, i agree with annaleisse that getting CPS involved would not have been right. i am grateful that the baby and my sis in law seem to be doing well now. it was touch and go there for a little while (and probably unrelated to the medications she was taking).

[Anneleise]

Originally Posted by mjegan59

Hi,

Thank you and everyone who poseted replies to my original message. My sister in law delivered a healthy baby about three weeks ago. he was a bit under 6 pounds, not big but majorly underweight or anything. While the baby was/is fine, my sister in law was not. she hemorraged three separate times and ended up needing three units of blood. I finally called her doctor and told him about the ultram (which he didn't konw about) because no one else would and because i was not sure if there were any secondary effects that impacted blood clotting or something like that. He was very reassuring and said that the likelier cause of the hemmoraging was that she was taking aspirin for a headache (probably from withdrawals from the ultram). My sis-in-law is now doing much better and the baby is, as i said, very healthy. i still feel bad about telling her doctor but i decided that it was the right thing to do given the complications and my lack of knowledge about ultram and vicodin. that was a very tough call and in many ways i feel bad that i didn't say something sooner. on the other hand, i agree with annaleisse that getting CPS involved would not have been right. i am grateful that the baby and my sis in law seem to be doing well now. it was touch and go there for a little while (and probably unrelated to the medications she was taking).

I am so happy everything more or less worked out okay! you know, to tell you the truth I probably would have done the same thing on calling her doc if she was hemoraging, and I would have felt bad about it as well, but im glad everything worked out okay! How is your sis-in-law doing with the whole addiction thing? I hope all is well with that and hope she is able to enjoy the baby in spite of it!
God bless,
Anneleise