Suboxone is generally considered safe to take during pregnancy, and both the American College of Obstetricians and Gynecologists (ACOG) and the American Society of Addiction Medicine (ASAM) recommend medication-assisted treatment, including buprenorphine, for opioid use disorder during pregnancy. The risks of untreated opioid use disorder are significantly greater than the risks associated with staying on medication. That said, the naloxone component in Suboxone has historically raised questions, and there are real considerations around dosing, delivery, and what to expect for your baby after birth.
Why Staying on Medication Is Safer Than Stopping
Untreated opioid use disorder during pregnancy carries serious risks. The repeated daily cycle of opioid use and withdrawal creates fetal distress that directly harms placental function. This can lead to intrauterine growth restriction, placental abruption, preterm delivery, and low birth weight. More severe outcomes include fetal convulsions, intrauterine meconium passage, and fetal death.
Stopping opioids abruptly during pregnancy is not recommended either, because sudden withdrawal can trigger many of these same complications. Medication-assisted treatment stabilizes both your body and the fetal environment, eliminating the dangerous highs and lows that come with active opioid use or repeated withdrawal episodes.
The Naloxone Question
Suboxone contains two ingredients: buprenorphine (the opioid that treats withdrawal and cravings) and naloxone (an opioid blocker added to discourage misuse by injection). For years, doctors preferred prescribing buprenorphine alone during pregnancy because there wasn’t enough data to confirm that the naloxone component was safe for a developing fetus.
That concern has softened considerably. When Suboxone is taken as directed, dissolved under the tongue, naloxone has very low bioavailability. It barely enters the bloodstream and doesn’t produce any meaningful opioid-blocking effect. Health Canada has already removed pregnancy as a contraindication for buprenorphine/naloxone, and a growing body of evidence supports its use during pregnancy. Many providers now feel comfortable keeping patients on the combination product rather than switching to buprenorphine alone, especially when the switch itself could introduce instability.
Your Dose Will Likely Need to Change
Pregnancy changes the way your body processes buprenorphine. The liver enzyme primarily responsible for breaking down the drug increases its activity by about 35% in the second trimester and 38% in the third. At the same time, your blood volume rises dramatically, up to 50% above pre-pregnancy levels by the third trimester. Together, these changes mean less of the drug stays in your system at any given time.
The FDA specifically notes that dosage increases are often needed during pregnancy, even for patients who were stable on their dose before becoming pregnant. If you start feeling withdrawal symptoms or stronger cravings as your pregnancy progresses, that’s a pharmacological reality, not a sign of failure. Some women split their dose into three or four smaller doses throughout the day rather than taking it once or twice, which can help maintain more consistent levels. In one treatment program, 68% of pregnant patients chose this approach to better manage symptoms.
What to Expect for Your Baby After Birth
Babies exposed to buprenorphine in the womb can develop neonatal opioid withdrawal syndrome, sometimes called neonatal abstinence syndrome. This means the baby may show signs of withdrawal after birth, including irritability, tremors, feeding difficulties, and disrupted sleep. Not every exposed infant develops symptoms severe enough to need treatment, but your baby will be monitored in the hospital using a standardized scoring system that rates withdrawal severity.
When treatment is necessary, the outcomes for buprenorphine-exposed infants tend to be favorable compared to other opioid exposures. In a key clinical trial published in the New England Journal of Medicine, infants who needed treatment had a median hospital stay of about 21 days, compared to 33 days for infants treated with the standard approach. The median duration of medication treatment was 15 days versus 28 days. Only about 15% of buprenorphine-exposed infants in the study needed additional medication beyond the primary treatment.
These numbers can feel alarming, but it helps to understand that this withdrawal is temporary and treatable. Hospital teams experienced with neonatal withdrawal know how to keep your baby comfortable while symptoms resolve.
Pain Management During Labor and Delivery
One practical concern many women on Suboxone have is whether they’ll be able to get adequate pain relief during labor. Because buprenorphine partially blocks opioid receptors, standard pain medications may be less effective. Epidurals work through a different mechanism and remain a good option. In studies of women maintained on buprenorphine, the majority received epidurals during delivery.
After delivery, routine pain management protocols using anti-inflammatory medications and combination pain relievers are generally effective, though most opioid-dependent patients need higher than typical doses for adequate relief. Pain control needs to be individualized, so make sure your delivery team knows about your Suboxone use well in advance.
Breastfeeding on Suboxone
Breastfeeding while taking Suboxone is generally encouraged. The amount of buprenorphine that passes into breast milk is very small. In studies of women taking doses between 12 mg and 20 mg of buprenorphine daily, the concentrations found in breast milk were measured in micrograms per liter, which are trace amounts. When researchers tested the blood of breastfed infants at two weeks old, buprenorphine was either undetectable or below measurable levels.
Breastfeeding may actually benefit babies with neonatal withdrawal by providing comfort, promoting bonding, and delivering small amounts of buprenorphine that can ease the transition. Both the skin-to-skin contact and the nutritional benefits of breast milk support recovery during this period.
After Delivery: Dose Readjustment
Just as your dose likely increased during pregnancy, it will probably need to come back down in the weeks after delivery. The physiological changes that sped up drug metabolism reverse in the postpartum period. Your provider should monitor you closely during this time, since a dose that was appropriate at 36 weeks of pregnancy could become too high once your body returns to its pre-pregnancy state. This is a period when close communication with your treatment team matters most.