Hospitals Give Pain Control Drugs to Women During Childbirth, Then Report Them for Illicit Drug Use
- by Natasha Hobley
- Published
- Bioethics
Fentanyl and other drugs administered by health care professionals during childbirth can show up in toxicology reports done on the mother or baby. Not only can this presence be shocking to mothers who do not realize the drugs have the ability to cross the placenta to reach their babies, but many women are being reported to child welfare authorities because of it.1
The drugs often given to women in labor and birth include morphine or fentanyl found in epidurals or other pain relief medications, anxiety medications, and two different blood pressure medications given during C-sections. These medications are routinely prescribed to millions of birthing women per year.1 It is estimated that roughly 83 percent of women receive at least one type of medication during birth.2
Ninety-one Percent of Women Given Epidurals Test Positive for Fentanyl
The risks of giving medications to birthing women and then testing them for illicit drug use has been well documented,3 but many hospitals have not put policies in place to protect mothers who experience it. One 2022 study by researchers at Massachusetts General Hospital in Boston found that 91 percent of women given fentanyl-containing epidurals tested positive for the drug after giving birth. Other studies have found that mothers can quickly pass the medications onto their babies.1
Health Care Providers Required to Report Suspected Substance Abuse
Mandatory state reporting laws require hospitals to alert child welfare agencies anytime babies are born who seem to be affected by substance abuse. In some cases, doctors and social workers failed to review patient medical records to determine if the cause could have been medically induced. In other cases, providers suspected the medication that was prescribed to be the reason for the positive test but reported the patients anyway.
Doctors who report these cases of positive tests for pain control drugs are protected from liability for reports made “in good faith,” even when they turn out to be wrong. But often, the damage has already been done with cases being opened against innocent mothers and in the worse of scenarios, babies and other children are removed from the home of mothers after false accusations of illicit drug use.
At many hospitals, it is the responsibility of social workers to contact child welfare agencies. While some hospitals require social workers to automatically file a report for any positive test, others first perform an assessment to determine whether the baby may be at risk by remaining in the care of the parents.
Unreliable Testing Methods and Outcomes Commonly Used
Meconium tests are widely considered the gold standard for newborn drug testing, but this route of testing can uncover illicit substances from months prior. These widely used tests cannot tell a provider whether the drug presence is from a prescribed medication or a substance a mother used earlier in pregnancy, nor do they tell quantity or frequency of use of the substance. In addition, an investigation done by The Marshall Project and Reveal found that the typical urine-in-a-cup tests favored by many hospitals and often given to mothers are highly susceptible to false positives and misinterpretation.1
While most hospitals don’t have policies in place to protect women in these circumstances, others have instituted policies to do just that. Last year, Mass General Brigham in Boston instituted a policy that directed providers to test their patients only with their consent and only when medically necessary.
“Our patients are being harmed,” stated Davida Schiff, MD of Mass General Brigham. “The hospitals are at fault. The clinicians are at fault. Our policies are at fault.”1
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