When a pregnant person is using opioids-whether prescribed for pain or used as part of an opioid use disorder-there’s no simple answer. It’s not just about stopping. It’s not just about continuing. It’s about stability, safety, and support. The stakes are high: your health, your baby’s health, and the future you’re building together.
Why Opioids During Pregnancy Are a Complex Issue
Opioids include prescription painkillers like oxycodone and hydrocodone, as well as illicit drugs like heroin and fentanyl. When used regularly during pregnancy, they cross the placenta. The baby becomes physically dependent, just like the parent. That doesn’t mean the baby is addicted-it means their body has adapted. And when they’re born, their system has to adjust to life without it.This adjustment can cause Neonatal Opioid Withdrawal Syndrome (NOWS), formerly called Neonatal Abstinence Syndrome (NAS). About 50 to 80% of babies exposed to opioids in the womb will show signs of withdrawal. Symptoms usually start between 48 and 72 hours after birth. They can include:
- High-pitched crying
- Shaking or tremors
- Feeding problems-poor suck, vomiting
- Fast breathing (over 60 breaths per minute)
- Temperature changes (above 37.2°C)
- Loose, frequent stools (more than 3 per hour)
These aren’t just uncomfortable-they can be dangerous. Babies with severe NOWS may need intensive care, IV fluids, or even medication to manage symptoms. But here’s the key point: the best way to prevent the worst outcomes isn’t to quit cold turkey. It’s to get on medication-assisted treatment (MAT).
Medication-Assisted Treatment: The Gold Standard
Major health organizations-including the CDC, the American College of Obstetricians and Gynecologists (ACOG), and the American Society of Addiction Medicine-agree: MAT is the standard of care for opioid use disorder during pregnancy. That means using medications like methadone or buprenorphine to stabilize the parent’s system, reduce cravings, and prevent relapse.Why not just stop? Because quitting opioids abruptly during pregnancy carries serious risks:
- 30-40% higher chance of relapse
- 25-30% risk of preterm labor
- 18-22% risk of fetal distress
- 5-8% risk of miscarriage
Studies show that people on MAT have better outcomes. Babies born to those on methadone or buprenorphine tend to have:
- Higher birth weight (200-300 grams more on average)
- Longer gestation (1-2 extra weeks)
- Better head circumference measurements
And here’s the truth: MAT doesn’t make the baby’s withdrawal disappear-it makes it manageable. And it gives the parent the best shot at staying in care, bonding with their baby, and building a stable life.
Methadone vs. Buprenorphine: What’s the Difference?
Not all MAT is the same. Two main medications are used: methadone and buprenorphine.Methadone is a full opioid agonist. It’s taken daily in a clinic setting. Doses usually start at 10-20 mg and are adjusted up to 60-120 mg daily. It has strong retention rates-70-80% of people stay in treatment after six months. But babies exposed to methadone tend to have more severe withdrawal symptoms. On average, they stay in the hospital 17.6 days and need higher doses of medication to treat NOWS.
Buprenorphine is a partial agonist. It can be prescribed in an office, not just a clinic. Dosing usually starts at 2-4 mg daily and goes up to 8-24 mg. It’s easier to access, and many people prefer it. Babies exposed to buprenorphine often have milder withdrawal symptoms than those exposed to methadone. But about 46% still need medication to treat withdrawal, and hospital stays average 12.3 days.
There’s also a newer option: naltrexone. Unlike methadone or buprenorphine, naltrexone blocks opioids-it doesn’t activate them. In a 2022 study, none of the babies exposed to naltrexone in utero showed signs of withdrawal. Their hospital stays were 3.2 days shorter on average. And 83% of mothers were able to breastfeed without issues.
But here’s the catch: people on naltrexone started prenatal care much later-on average at 28.4 weeks-compared to 19.7 weeks for those on buprenorphine. That suggests naltrexone might be harder to start early, or that people who use it are further along in their recovery journey. More research is needed, but it’s a promising option.
How Babies Are Monitored After Birth
Once the baby is born, monitoring begins immediately. The CDC recommends that all infants exposed to opioids be watched for at least 72 hours. Evaluations happen every 3-4 hours during the first 24 hours, then every 4-6 hours after that.Doctors use tools like the Finnegan Scale to score withdrawal symptoms. But not all hospitals use the same tool. In fact, a 2021 study found 37 different scoring systems across U.S. hospitals. That’s why newer approaches are gaining ground.
The Eat, Sleep, Console model is now used in over 650 hospitals. Instead of focusing on every cry or twitch, providers ask three simple questions:
- Can the baby eat well?
- Can the baby sleep for at least an hour at a time?
- Can the baby be consoled with cuddling or swaddling?
If the answer is yes to all three, the baby doesn’t need medication-no matter what the Finnegan score says. Hospitals using this method report 30-40% fewer babies needing drugs to treat withdrawal.
What About Breastfeeding?
Breastfeeding is safe-and encouraged-for most people on methadone or buprenorphine. The amount of medication that passes into breast milk is very low. In fact, breastfeeding can help calm the baby and reduce withdrawal symptoms.For those on naltrexone, breastfeeding is also safe. No drug transfer has been detected in breast milk. One mother shared: “I breastfed my baby from day one. He slept through the night at three weeks. No meds. No stress.”
The biggest barrier isn’t safety-it’s stigma. Many people are told not to breastfeed, even when it’s safe. Others feel judged by nurses or doctors. If you’re planning to breastfeed, ask your provider for written guidance. Bring it with you to the hospital.
Real Stories, Real Challenges
Behind every statistic is a person. On parenting forums, mothers share what it’s really like:One woman, “NewMomInRecovery,” described her baby scoring a 12 on the Finnegan scale at 48 hours. “I thought I’d done everything right. But watching him tremble, unable to feed… I felt like I failed.” Her baby needed morphine for 14 days.
Another, “SobrietyWarrior99,” said buprenorphine kept her alive through pregnancy-but her baby needed 19 days of treatment. “I was proud I stayed clean. But I didn’t know how hard it would be for him.”
Then there’s “RecoveryMom2022,” who used naltrexone. “My baby was calm. We went home in two days. No meds. No NICU. I cried when they said he was fine.”
Common themes? Anxiety about scoring systems. Fear of being judged. Guilt. And hope-because recovery is possible.
Barriers to Care
Getting help isn’t easy. Only 45% of U.S. hospitals have standardized protocols for treating opioid use disorder in pregnancy. In rural areas, it’s worse-only 28% offer on-site MAT. Many clinics don’t have addiction specialists on staff. Insurance doesn’t always cover it. And stigma still runs deep.There’s also the issue of timing. The best outcomes happen when MAT starts early-ideally at the first prenatal visit, around 8-12 weeks. But many people don’t seek care until later. That’s why programs that connect prenatal care with addiction services are so vital.
The 2020 SUPPORT Act required Medicaid to cover MAT for pregnant people. But as of 2023, only 32 states fully complied. That means access depends on where you live.
What’s New in 2025?
In 2023, the FDA approved Brixadi, a once-weekly extended-release form of buprenorphine. Early data shows 89% of pregnant people stayed in treatment for 24 weeks-compared to 76% with daily pills. That’s a big deal. Fewer missed doses. Fewer clinic visits. More stability.The American Academy of Pediatrics now says: try non-drug care first. Two hours of skin-to-skin contact, quiet rooms, swaddling, and feeding before reaching for medication.
The NIH’s HEALing Communities Study is testing integrated care models in 67 areas. Early results show a 22% drop in NOWS severity when prenatal care, MAT, and mental health services are all connected.
And it’s not just about drugs. Housing instability affects 47% of pregnant women with opioid use disorder. Food insecurity. Lack of transportation. Trauma. These aren’t side notes-they’re part of the treatment plan.
What You Need to Do
If you’re pregnant and using opioids:- Don’t wait. Talk to your OB-GYN or midwife-even if you’re scared.
- Ask about MAT. Methadone, buprenorphine, or naltrexone are options.
- Find a provider who understands addiction medicine. You deserve care without shame.
- Plan for postpartum support. Recovery doesn’t end at birth.
- Know your rights. You have the right to breastfeeding support, mental health care, and non-judgmental care.
If you’re a provider, partner, or family member:
- Listen without judgment.
- Help connect them to MAT programs.
- Advocate for standardized protocols in your hospital.
- Support breastfeeding and family bonding.
This isn’t about perfection. It’s about progress. It’s about staying alive. It’s about giving your baby the best start-even if your path wasn’t easy.
Is it safe to take methadone or buprenorphine while pregnant?
Yes. Methadone and buprenorphine are the standard of care for opioid use disorder during pregnancy. They reduce the risk of miscarriage, preterm birth, and fetal distress. Babies born to mothers on these medications have higher birth weights and longer gestations. The goal isn’t to avoid all exposure-it’s to ensure stable, controlled exposure so the baby doesn’t go through sudden withdrawal.
Can I breastfeed if I’m on MAT?
Yes, breastfeeding is safe and encouraged for most people on methadone or buprenorphine. The amount of medication passed through breast milk is very low and can actually help reduce withdrawal symptoms in the baby. For those on naltrexone, no drug transfer has been detected. Always discuss your plan with your provider, but don’t be discouraged from breastfeeding-it’s one of the best things you can do for your baby’s recovery.
Will my baby definitely have withdrawal symptoms?
Not all babies will. About 50-80% of infants exposed to opioids in utero show signs of withdrawal, but the severity varies. Babies exposed to naltrexone have shown 0% incidence of withdrawal in studies. With MAT, symptoms are usually milder and more predictable. Even when withdrawal happens, it’s treatable. Many babies go home without medication if they’re fed, held, and comforted properly.
What’s the difference between NAS and NOWS?
They’re the same condition. NAS (Neonatal Abstinence Syndrome) was the older term. NOWS (Neonatal Opioid Withdrawal Syndrome) is the newer, more accurate term because it specifies opioids as the cause. The American Academy of Pediatrics now uses NOWS in its guidelines to reflect that the issue is opioid-specific withdrawal, not general substance withdrawal.
Why is naltrexone not used more often during pregnancy?
Naltrexone blocks opioids instead of replacing them, so it doesn’t cause dependence. Babies exposed to it show no withdrawal symptoms. But it’s harder to start during active addiction because it can trigger withdrawal if taken too soon after last opioid use. Most people who use it have already gone through detox, which often happens later in pregnancy. That’s why it’s less common-but it’s a powerful tool for those ready for it.
How can I find a provider who supports MAT during pregnancy?
Call your local health department or state substance use agency. Many states have directories of providers who specialize in maternal addiction care. Look for clinics that offer integrated services-obstetrics, addiction medicine, and mental health all in one place. If you’re in a rural area, telehealth options are expanding. Don’t accept dismissal. You deserve compassionate, evidence-based care.
