I have had many discussions with a Pain Management physician in our 
area, and what they have done in this here, at least with his patients, 
is work closely with the OB doc through out the pregnancy.  They monitor 
the Mom and the fetus, and then when the baby is born, they slowly bring 
down the dose to the Mom, thus detoxing the babe without any problems.  
The problem I see here is that Mom got pregnant before having her back, 
or whatever other pain issue there is, resolved.  I would have liked to 
have seen Mom off the med (no duh) or on a low dose when she got 
pregnant.  Of course, we can't plan everything....
There seems to be a lot of misconceptions about pain, pain management 
and addiction.  In Oregon, we have to complete 7 hours of Pain 
Management Inservice before renewing our licenses.  It is a new 
requirement as of 2005, and it shall be very interesting to see how this 
all works out.  This case seems as if it would have benefitted from some 
inservice a few months ago.  I hope that in the future, we see red flags 
long before that baby is born, so that in future cases we can keep these 
babies nursing.
Sue Kasten, RN, IBCLC
Dexter, Oregon, USA

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