How Doctors React to "Shameful" Confessions

According to ACOG, when doctors discuss these "psychosocial" issues with their patients once each trimester, the incidence of preterm birth and low birth weight goes down by as much as half.

The American College of Obstetricians and Gynecologists (ACOG) urges caregivers to ask women about pregnancy dangers such as alcohol or drug use, smoking and domestic violence and to refer them for assistance and treatment when needed. And for good reason: According to ACOG, when doctors discuss these "psychosocial" issues with their patients once each trimester, the incidence of preterm birth and low birth weight goes down by as much as half.

"I ask specific questions and listen carefully to the answers and ask more in-depth questions when indicated," says Elizabeth Stein, C.N.M., M.P.H., a certified nurse midwife in New York. "When a patient confides in me, I usually say, 'Thank you for letting me know.' Then I offer her some choices, depending on what she has told me."

In some states, illicit drug use during pregnancy is considered a form of child abuse, and caregivers are required to report it to the state's child-protection agency. "Providers must do everything they can to protect the innocent newborn," Stein explains.