Drugs During Pregnancy

10.22.10: What happens when a drug screen is positive?


I read an article yesterday in Time magazine titled: Eating Poppy Seeds in Pregnancy, An Ill Advised Habit. It was about a woman in Pennsylvania who tested positive for opiates while in the hospital having her baby. Apparently, she’d eaten a poppy seed bagel that morning. Three days later, Child Protective Services took her baby away to foster care. The baby was returned to the mother after the ACLU intervened, saying the hospital and county workers neglected to thoroughly investigate before taking the baby.

How did this happen? I’m wondering that myself. My question is: Why did the hospital test this woman? Do they test all their patients or did this particular patient raise red flags? Did she give permission to be tested? A 2001 Supreme Court ruling states mothers can’t be tested without their informed consent. Babies, however, can, if there’s a clinical reason.

Many obstetricians do drug screening as part of their prenatal lab workups. They lay it out there as part of the routine for everyone. Mothers have the right to say no but declining sends a message that could be misinterpreted. That message might be: “I don’t do drugs and I don’t want to pay for unnecessary testing.” Or, it might be: “I don’t want you to know about the joint (pill, line, shot, etc.) I smoked.”

Some obstetricians don’t do drug testing unless its mandated by Child Protective Services (CPS) because it opens a big can of worms. It puts their patient under uncomfortable scrutiny and compromises their doctor-patient relationship. Your doctor is supposed to be your partner, not your persecutor. A positive drug screen means they have to bring social authorities into their relationship. Since we don’t treat all drugs with the same consequences and don’t have counseling or treatment facilities for everyone who tests positive, some doctors just prefer not to get into it.

What makes a hospital decide to test a mother in labor? There are certain guidelines, including when a patient has had no prenatal care, extremely late care (after 20 weeks) or fewer than five prenatal visits. We test if CPS tells us to. That’s usually because that patient already has an open file and is being evaluated to determine if they’re appropriate parents. We test patients who’ve had a positive test during pregnancy, a history of drug abuse or if they come in acting intoxicated. Mothers have the right to refuse, but we have to document that refusal which can look just as bad on her record as a positive test.

What happens if the test comes back positive? That depends on what it tests positive for. If it’s positive for opiates, but she’s taken legally prescribed Vicodin before testing, it doesn’t carry the same weight as an opiate-positive test without a prescription. If though, it comes back positive for methamphetamines (or many other drugs), we have to report it to social services and CPS. They decide what to do next. Sometimes, (especially if it’s positive for marijuana), all they do is tell the patient not to do it anymore. Sometimes, they add the drug test to their file with other issues like a history of drug abuse, child neglect or violence in the home. They may take the baby to foster care or place it with another family member until a court ruling is made. It’s rare that anyone gets arrested and if they do, it’s not usually just because of that one drug screening.

Most hospitals drug screen babies (even without parental consent) when they meet specific medical criteria. We need to know if a baby is going through withdrawal, or if his seizures are caused by cocaine exposure. Ironically, plenty of babies are born addicted to cigarettes and nicotine. Withdrawal is tough on them but CPS doesn’t get involved with that drug.

In a perfect world, all babies would be born to perfect mothers in perfect families under perfect conditions. As soon as the pregnancy test turned positive, nothing but joy, healthy food and pristine living would follow. Mothers are human. They make mistakes; sometimes really dumb mistakes. They have tough lives and do things they shouldn’t. Are they weak? Some are, but not all mothers who test positive are bad mothers. Some just need support.

It’s easy to be judgmental about mothers who use drugs. Many are reckless and irresponsible, but many are living with poverty, abuse, ignorance, minimal education, anxiety, depression, oppression, and addiction. Some live with so much stress they can’t take it without help. They self-medicate to ease their pain even though they know they shouldn’t.

I’ve taken care of countless women who’ve messed up somehow (who among us hasn’t). I spend a couple shifts getting to know them. Usually, I like them. I understand them. I don’t condone their mistakes, but they’re women. They’re mothers. Some are seriously damaged, make really poor choices, have so few resources or live under such horrendous circumstances that they can’t raise a child. And still, she’s a woman, a mother. She’s human. In a perfect world, we’d reach out to that woman, take her pain away and support her to be a good mother. But if that can’t be; let’s be compassionate.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.