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Handbook Centre for Addiction
and Mental Health

Chapter 7 - Women, family and methadone

Methadone Maintenance Treatment: Client Handbook

In this chapter:

Birth control

If you’ve been using heroin, OxyContin or other opioids, you may have stopped having your period, and think that you can’t get pregnant. Then again, if you’ve stopped having your period, you may be pregnant. If you’re not sure, get a pregnancy test from a doctor, pharmacist or community health centre.

If you’re not pregnant, and you are sexually active, use birth control. If you begin to use less opioids, or if you begin to take methadone, your period will likely start up again, and your chances of getting pregnant will increase. Use birth control. It’s best if you wait until you’re ready to give up drugs entirely before you get pregnant.

Pregnancy

If you are pregnant, and you are still using opioids, call your doctor and ask to begin methadone maintenance as soon as possible. The short cycle of the high and the recurring threshold of withdrawal is the most immediate threat to your baby. Withdrawal causes the uterus to contract, and may bring on miscarriage or premature birth. Methadone maintenance is safe for the baby, it keeps you free of withdrawal, and gives you a chance to take care of yourself.

If you are pregnant, you may want to take a good look at your options. If you think you want to keep your baby, consider how you’ll live, what support you’ll have and if you’re ready for the responsibility. Another option is to carry the baby through pregnancy, and offer it for adoption. Healthy babies are in high demand. Another option is abortion. Keep in mind that if you decide to terminate the pregnancy, it is safest and easiest in the first 12 weeks of pregnancy. If you put off the decision, you will no longer have the choice.

Pregnant women beginning methadone maintenance are encouraged to stay in hospital while making the change from their opioid of choice to methadone. This usually takes a few days, but may be less, or may be more.

Once on methadone, you should feel relief from the physical drug cravings. You’ll be more likely to eat better, smoke less or not at all, and avoid alcohol and other drugs. You can be like any other pregnant woman, enjoy the extra attention, and prepare to welcome the new life you have begun.

If you plan to keep your baby once it is born, you may be asked to reassure the children’s aid that you have stopped using drugs, and are settled and ready to be a mother. Look to your doctor and counsellor for help in dealing with the children’s aid.

“When I found out I was pregnant, I was convinced, and everyone else was convinced, I could not get clean and take care of myself and have the baby. The doctor said to me, ‘You can do this,’ and he made me believe that I could.

“I was worried that the baby would have withdrawals when she was born, but all she had were some tremors. I held her and she was okay. I breastfed her and that was great, no problems. They kept her in the hospital for five days and I stayed with her. When the children’s aid came in to the hospital and saw how I’d bonded with the baby, they backed off and closed my file.

“She’s two years old now and she’s fantastic. I was scared and worried what the methadone might do to her, but she’s just fine: she started walking at only nine months, and she’s smart. The pregnancy happened at just the right time, it saved me from the whole addiction thing, it showed me what I could do.” — Roxanne, 26, on methadone three years.

Infant withdrawal

Some babies born to mothers on methadone will go through withdrawal after birth. This usually begins a few days after birth, but symptoms could arise two to four weeks after birth and may last several weeks or months. Infants in withdrawal may be cranky, not eat or sleep well, or have a fever, vomiting, trembling and occasionally seizures. Infants going through withdrawal must be closely watched in hospital, depending on how well the baby is doing. If the symptoms are severe, your baby may be medicated to ease the withdrawal. Never give methadone to your baby. Even a small amount can be enough to kill a baby. Let your doctor manage the baby’s withdrawal.

While it is not known for certain what long-term effects the exposure to methadone may have on your baby, babies born to mothers on methadone usually do as well as other babies, and have a much greater chance at doing well than babies born to mothers on heroin or other opioids. Taking methadone while pregnant will not result in any deformities or disease in the baby.

Breastfeeding

Women on low doses of methadone who are not HIV positive are encouraged to breastfeed. Women who are hepatitis C positive are usually able to breastfeed, but should check with their doctor.

The benefits of breastfeeding are felt to outweigh the effect of the tiny amount of methadone that enters the breast milk. Once the baby is three to six months old, and is drinking large amounts of breast milk, he or she is also getting larger amounts of methadone. For this reason the baby should either be weaned at this time, or the mother should stop taking methadone. (Mothers should only stop methadone if they are sure this will not lead to a return to drug use.) If you feel that you want to wean your baby because of methadone exposure, talk to your doctor. Your doctor should be able to give you advice about when you should begin weaning and about the risks and benefits of continuing to breastfeed.

Child protection services

Taking care of kids can be a tough job even when everything is going well, and when things are rough, it can be overwhelming. Every mother needs support, but not every mother gets as much support as she needs. Ideally, the role of your children’s aid society (CAS) is to give you a hand when you need help caring for your child, and to provide access to training in parenting skills. If you are having trouble coping with parenthood on top of other struggles, talk to your counsellor about it. You may need the support of the CAS.

Most CAS caseworkers are more interested in seeing your child enjoy and benefit from your care than in taking him or her away from you. They want to see you provide a healthy, loving and secure home for your child. Unfortunately, not all caseworkers are well informed about methadone treatment. They may make assumptions about you based on your history of drug use. Dealing with the CAS can be confusing. Again, look to your doctor or counsellor for help.

In some communities there are special programs offering services for mothers in recovery. The support and practical help they provide can make a difference in day-to-day life for you and your children. Ask your local CAS if such a program is available in your area.

If you continue to use drugs, your CAS caseworker will question your ability to care for your child. Taking good care of a child demands alertness, attention, patience and good judgment. Drugs can affect all these qualities. Using drugs doesn’t necessarily make you a bad parent, but it does make it harder to be a good parent.

“Methadone saved my life, and it saved my baby too. When I found out I was pregnant, I tried to go cold turkey, but I couldn’t take it and it turned out it was killing the baby. I came to the clinic here, and right away they put me on methadone.

“I was clean when the baby was born, and I stayed that way, but the children’s aid came into the hospital and they said, we’re going to apprehend the baby for three months. I was living in a shelter and I had it set up to stay in a shelter that was for moms and babies but they wouldn’t let me take him. They had my other two kids too, they got them when I was in jail. I wanted to get them back.

“It was hard, I had to prove myself, but after a few months I got my own apartment and I got the baby, and eventually I got my other two kids back. The baby’s five now, and he’s one smart cookie. Methadone saved us.” — Valerie, 35, on methadone six years.

Menopause

Women approaching menopause on methadone face the same concerns and decisions to make as women not on methadone. The only exception to this rule may be if you experience profuse sweating, which can be a side-effect of methadone. The sweating, in combination with the hot flashes common to women going through menopause, can make you feel pretty droopy. Your doctor may be able to suggest steps you can take to deal with some of the discomfort (for example, hormone replacement therapy or other treatments).

Methadone Maintenance Treatment: Client Handbook

Methadone myths and realities

  1. Methadone and other options
  2. Learning about methadone
  3. Going on methadone
  4. Living with methadone
  5. Methadone and other drugs
  6. Counselling and other services
  7. Women, family and methadone
  8. Looking ahead on methadone

Resources

CAMH Switchboard 416-535-8501
CAMH General Information Toronto: 416-595-6111 Toll Free: 1-800-463-6273
Connex Ontario Help Lines
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1001 Queen St. W
Toronto, ON
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Russell St.
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Toronto, ON
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College St.
250 College St.
Toronto, ON
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