Stand Against Hospital Policies that Separate Mothers from their Newborn Babies

Stand Against Hospital Policies that Separate Mothers from their Newborn Babies

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Alabama Cohosh Collaborative started this petition to Crestwood Medical Center

What do heartburn medication, headache medication, and poppy seed bread have in common? All three of these can cause false positives on drug screening tests. These tests are often done on pregnant mothers routinely — a practice known as universal drug screening — in many hospitals when the mothers arrive to deliver their babies. Often mothers are not aware that they are being screened for drug use — and are also not notified of the potential consequences of these drug screens.

News Story: New Mom Fails Drug Test After Eating Poppy Seed Bread

Rebecca Hernandez gave birth three days ago to her second baby, a healthy little boy. Within 4 hours of delivering him, he was separated from her due to a positive result on a drug test administered to her upon hospital admittance at Crestwood Medical Center in Huntsville, Alabama. Rebecca was not aware that her urine was being tested for drugs, though she may have signed a blanket consent form agreeing to the hospital’s standard of medical care. She was also not aware that a positive result of the initial drug screening test would mean that hospital staff would call DHS social workers, leading to her newborn being separated from her as well as her 13 month old also being taken from her custody.

Initial drug screening tests are not infallible and false positives can be caused by eating poppy seeds, — as Rebecca had done the day before giving birth — taking common heartburn medications like Zantac, and taking common cold and headache medications. Confirmation lab tests are able to confirm a positive drug screening with accuracy, but this may take up to a week to process. Babies whose mothers screen positive on initial tests are urine tested after birth, but even a negative test result for a baby can still result in mother and newborn being separated — in Rebecca’s case, her baby’s urine drug test came back negative, but the wheels of DHR were already set in motion and she was still separated from her newborn.

Rebecca has since been reunited with her newborn after her confirmation test came back negative for opioids. 

We want to ensure that birthing patients like Rebecca are not subjected to having their newborns taken from them due to poor hospital policy around drug testing. Her separation from her baby should never have happened and we do not want this situation to ever happen again. 

We are calling for Crestwood Medical Center to change their policy on drug screening in birthing patients. We ask for their screening policy to:

1. Follow ACOG guidelines by eliminating both universal drug screening as well as random drug screening.

2. Clarify protocols around when to contact CPS — CPS should only be notified either if initial drug screen of both mother AND baby is positive, or in the presence of a positive confirmation test.

3. Ensure that informed consent is being acquired from birthing patients before initiating drug screening.

While the opioid epidemic is of great concern, performing universal and random drug screening of pregnant patients can have devastating consequences. False positives can and do happen and the immediate removal of a child from a patient based solely on one quick test performed with little to no informed consent is unconscionable.

A 2017 ACOG Committee Opinion of Opioid Use Disorder in Pregnancy states that “Pregnant women should be informed of the potential ramifications of a positive test result, including any mandatory reporting requirements”  (1). Routinely including a consent for drug screening in a packet of admission paperwork hardly meets the definition of informed consent, especially when the result could mean your child being removed from your custody.

Courts have upheld that providers have no right or obligation to perform prenatal drug testing for alcohol or drug use without a woman’s consent (2). The AMA states that for informed consent “Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care” (3). Certainly signing a consent in a bundle of paperwork or embedded into a general consent to care with no explanation of what it is or the potential consequences does not constitute informed consent. 

In the case of Rebecca Hernandez, we find the real question behind this heartbreaking situation is this: Why did Crestwood Medical Center perform a drug screen on this mother in the first place? She was a patient with no history of prior use or evidence of current illicit drug use and her perinatal care provider had no concern that she was using illicit drugs. 

The fact that Rebecca was drug tested in the first place indicates the presence of either universal or random drug screening on pregnant patients, neither of which are evidence-based practices or are supported by ACOG guidelines. The rush to address opioid use disorder is resulting in policies that not only do not help patients with substance use disorder but also infringe on patient’s rights.

We should be using evidence based guidelines for screening and treatment of substance use disorder in pregnancy. ACOG’s toolkit on State Legislation makes it clear that universal drug screening during pregnancy is not a recommended practice (2) and universal screening also is not required by Alabama state law (4, 5, 6). So why is a hospital implementing this screening practice?

If a hospital is concerned that a newborn is at risk for Neonatal Abstinence Syndrome they can easily test the infant with a urine test before performing maternal drug testing (6). Maternal drug testing with positive results should always be followed by confirmatory testing before referring a patient to CPS (6).

Crestwood’s current policies of maternal drug testing on patients are vague with little to no informed consent. Guidelines for determining which patients are referred to CPS due to positive drug tests are also vague and seemingly subjective. When a policy can result in such devastating consequences shouldn’t a patient have the right to know before soliciting services at that hospital facility? 

Pregnant and birthing patients in Alabama deserve better. We hope that Crestwood Medical Center agrees and will alter their current drug screening policies to reflect evidence-based practices that respect the human rights of birthing people.

 

https://www.acog.org/-/media/Departments/Government-Relations-and-Outreach/NASToolkit.pdf?fbclid=IwAR1aD8QOqtWDrGBdn5XdhDheuo-zFMttwqVW0Fr5G6BCmN3nufrO3VPSfvU


https://www.acog.org/-/media/Departments/Government-Relations-and-Outreach/NASToolkit.pdf


https://www.ama-assn.org/delivering-care/ethics/informed-consent


https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy


https://projects.propublica.org/graphics/maternity-drug-policies-by-state


6 https://store.samhsa.gov/system/files/sma18-5054.pdf

 

 

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