Hospitals Gave Ladies Medicines Throughout Childbirth—Then Reported Them for Utilizing Illicit Medication

This text was printed in partnership with The Marshall Mission, a nonprofit information group masking the US felony justice system.

Amairani Salinas was 32 weeks pregnant along with her fourth youngster in 2023 when docs at a Texas hospital found that her child now not had a heartbeat. As they prepped her for an emergency cesarean part, they gave her midazolam, a benzodiazepine generally prescribed to maintain sufferers calm. A day later, the grieving mom was cradling her stillborn daughter when a social employee stopped by her room to ship one other devastating blow: Salinas was being reported to youngster welfare authorities. A drug check had turned up traces of benzodiazepine—the very medicine that workers had administered earlier than wheeling her into surgical procedure. 

For Victoria Villanueva, pregnant along with her first youngster, the drug detected in her child’s system was morphine. Villanueva had arrived at an Indiana hospital at 41 weeks to have her labor induced. To ease the ache of her contractions, docs gave her narcotics. A day later, a social employee instructed the brand new mom, the child’s meconium—or first bowel motion—had examined optimistic for opiates. Now, as a substitute of bonding along with her child, Villanueva shook with concern that her new child could possibly be taken away. “I didn’t even know easy methods to operate,” she recalled.

What occurred to Salinas and Villanueva are removed from remoted incidents. Throughout the nation, hospitals are meting out drugs to sufferers in labor, solely to report them to youngster welfare authorities after they or their newborns check optimistic for those self same substances on subsequent drug exams, an investigation by The Marshall Mission and Reveal has discovered. 

The optimistic exams are triggered by drugs routinely prescribed to thousands and thousands of birthing sufferers in the US yearly. The medicine embrace morphine or fentanyl for epidurals or different ache reduction, nervousness drugs, and two totally different blood strain meds prescribed for C-sections.

In a time of growing surveillance and criminalization of pregnant girls because the finish of Roe v. Wade, the hospital studies have prompted calls to police, youngster welfare investigations, and even the elimination of kids from their dad and mom.

The reporting for this story included interviews with two dozen sufferers and medical professionals and a evaluation of lots of of pages of medical and court docket data. Some spoke about circumstances on situation of anonymity as a result of the custody of kids is at stake. 

In New York, a mom with no historical past of drug use misplaced custody of her toddler and new child for 5 months after she examined optimistic for fentanyl that the hospital had given her in her epidural. In Oklahoma, when a mom examined optimistic for meth, sheriff’s deputies eliminated her new child and three different kids. They had been held in foster look after 11 days, till a affirmation check proved that the offender was a heartburn medicine the hospital had given the affected person. 

By the point of Villanueva’s hospital keep in 2017, researchers and docs had recognized for years that drugs can quickly cross from mom to child, inflicting optimistic drug check outcomes. Two exams from Villanueva’s prenatal visits and one other check carried out proper earlier than she went into labor all confirmed the mom had no medicine in her system. The morphine given to Villanueva for her contractions was documented in her medical data. However the workers reported her to the state youngster welfare company anyway, hospital data present.

Marion Basic Hospital in Indiana didn’t reply to requests for remark. Brian Heinemann, a spokesperson for the Indiana Division of Youngster Providers, declined to touch upon Villanueva’s case however stated coverage has since modified to make sure that drug display screen outcomes alone are usually not used to substantiate an allegation of abuse or neglect. 

Kimberly Walton, a spokesperson for the Texas Well being Assets system, declined to reply questions on Salinas’ case however stated that docs order drug exams if there’s a concern about affected person well being and that they’re required “to report suspected unlawful drug use that would endanger the well being or security of a kid.” 

Hospital drug testing of pregnant girls, which started within the Eighties and unfold quickly in the course of the opioid epidemic, was supposed partly to assist determine infants who would possibly expertise withdrawal signs and wish further medical care. Federal regulation requires hospitals to alert youngster welfare companies anytime such infants are born. However a earlier investigation by The Marshall Mission and Reveal discovered that the comparatively cheap pee-in-a-cup exams favored by many hospitals are extremely vulnerable to false positives, errors, and misinterpretation—and lots of hospitals have didn’t put in place safeguards that will shield sufferers from being reported over defective check outcomes. 

In some circumstances examined by The Marshall Mission, docs and social employees didn’t evaluation affected person drugs to search out the reason for a optimistic check. In others, suppliers suspected a medicine they prescribed could possibly be the offender however reported sufferers to authorities anyway.

“How a lot hurt to birthing individuals are we prepared to permit? Our sufferers are being harmed till we are able to get our act collectively,” stated Dr. Davida Schiff, whose hospital community, Mass Basic Brigham in New England, instituted a brand new coverage this 12 months that directs suppliers to drug check sufferers, with their consent, solely when medically obligatory. The brand new coverage additionally halted automated reporting of optimistic check outcomes. Hospitals have a duty to deal with the testing issues, she stated. “The hospitals are at fault. The clinicians are at fault. Our insurance policies are at fault.”

The dangers from giving drugs to birthing sufferers after which testing them for illicit substances have been nicely documented. A 2022 research by researchers at Massachusetts Basic Hospital discovered that 91 p.c of ladies given fentanyl of their epidurals examined optimistic for it afterward. Different research have discovered that moms can shortly cross these drugs on to their infants. A child’s optimistic drug check “can not and shouldn’t be used to determine fentanyl drug abuse in moms,” stated Athena Petrides, the lead researcher of one of many research at Brigham and Ladies’s Hospital in Boston. 

Regardless of these warnings, hospitals usually lack insurance policies requiring suppliers to evaluation a affected person’s data to see what drugs they obtained earlier than reporting them to authorities. Obligatory reporting legal guidelines shield docs from legal responsibility for studies made “in good religion,” even when they change into mistaken. And toxicologists and docs say many docs lack the time and experience wanted to adequately interpret drug check outcomes. 

“It’s not one thing routinely taught in medical college and even residency,” stated Dr. Tricia Wright, an OB-GYN and professor at College of California, San Francisco Medical Middle who makes a speciality of substance use problems in being pregnant. “It’s all as much as people, who make their very own interpretations.” In 2021, Wright helped change the coverage at her hospital, one of many nation’s main educating amenities, to direct docs to not drug check sufferers until medically obligatory. 

Whereas drug exams might help pediatricians decide easy methods to deal with an toddler who might expertise withdrawal signs, many OB-GYNs say that optimistic drug check outcomes don’t typically inform the mom’s medical care, so that they have little motive to dwell on them.

As an alternative, at many hospitals, it’s social employees—liable for contacting youngster welfare companies—who’re extra probably to concentrate to drug check outcomes. Some hospitals require social employees to mechanically file a report for any optimistic check, whereas different amenities first carry out an evaluation to find out whether or not a mum or dad is perhaps a danger to the child.

However hospital social employees are sometimes overworked, stated Kylie Haines, who manages a program for pregnant girls with opioid use dysfunction at Vanderbilt College Medical Middle, one of many high maternity educating hospitals within the nation. Social employees typically have even much less coaching than docs on drug testing and little authority to query check outcomes, she stated. Investigating the reason for a optimistic drug check shouldn’t be thought-about a part of their job.

“We’re not medical suppliers,” stated Haines, a licensed social employee herself. “We are able to’t interpret drug screens.”

The timing of the exams also can make it difficult to interpret them. In principle, the most effective time to take a urine pattern for drug testing is when a affected person arrives on the hospital, earlier than receiving drugs. However it is not uncommon for hospitals to check urine samples taken from a birthing affected person’s catheter bag or to request a urine pattern after drugs have already been administered, suppliers stated.

New child drug exams can add one other layer of complexity. Whereas urine exams can detect potential drug use over a interval of days, testing the child’s meconium can uncover illicit substances going again months. Meconium exams are broadly thought-about to be the gold normal for new child drug testing as a result of they’ll point out potential drug use earlier in being pregnant, a attainable signal of dependancy.

However in some circumstances, there isn’t a technique to inform whether or not a child’s optimistic check was brought on by a medicine the hospital allotted or a substance the mom used earlier. Nor do such exams inform suppliers how a lot or how often an individual might have used medicine—for instance, if a affected person used substances previously however stopped when she realized she was pregnant. “You truly don’t know,” Schiff stated, “which is form of a large number.”

Medicines corresponding to morphine or fentanyl have led some sufferers to get flagged as opioid customers. Ephedrine and phenylephrine, drugs for low blood strain which can be generally prescribed throughout C-sections, have induced false positives for meth. The Marshall Mission additionally discovered that ladies had been questioned over optimistic drug exams after hospitals gave them sedatives corresponding to benzodiazepines or barbiturates.

When girls are flagged by a optimistic drug check end result, different points of their lives can shortly come below suspicion. Medical situations or start problems that may be related to dependancy—corresponding to hypertension, a placenta that separates earlier than start, or a untimely start—might mistakenly be considered as additional proof {that a} pregnant affected person used medicine. By way of the lens of a optimistic drug check, even one thing as innocuous as lacking some prenatal appointments turns into potential proof {that a} mom is a danger to her child. And sufferers who had traumatic experiences giving start might all of the sudden discover themselves below risk.

In 2023, Salinas was nonetheless in a haze of grief after delivering her stillborn child when she realized she could be reported to youngster welfare authorities. Salinas had no thought the hospital had given her the benzodiazepine for which she examined optimistic and denied utilizing the medicine. She had additionally examined optimistic for Delta-9, a authorized hemp-derived product, which she stated she had purchased on the grocery retailer. However quickly, Salinas discovered herself below a monthslong investigation, making an attempt to combat off paralyzing melancholy whereas processing her grief and caring for her different kids.

“I nonetheless have three stay kids. They nonetheless have to eat. They nonetheless have to stand up for varsity. They nonetheless want their mother,” Salinas recalled pondering as she was being questioned.

Officers closed the case about 4 months later as “unsubstantiated.” Nevertheless it wasn’t till a 12 months later that Salinas learn by means of her medical data with a Marshall Mission reporter and found the reason for the optimistic check.

Marissa Gonzales, a spokesperson for the Texas Division of Household and Protecting Providers, declined to debate Salinas’ case, citing confidentiality legal guidelines. 

Salinas stated she questioned why youngster welfare employees weren’t spending their time investigating allegations of precise youngster abuse. “Why are you giving your consideration to this one that’s mother, who hasn’t carried out something, as a substitute of a kid who may very well be in peril?”

In recent times, research have discovered that drug exams aren’t essentially one of the best ways to determine somebody with a substance use downside—a easy screening questionnaire can be efficient. Main medical teams advise hospitals to make use of questionnaires as a substitute of common drug exams. However hospital drug testing—and reporting—of labor and supply sufferers stays ubiquitous.

In not less than 27 states, hospitals are required by regulation to alert youngster welfare companies a couple of optimistic check or a possible publicity to the child. However not a single state requires hospitals to substantiate check outcomes earlier than reporting them. Hospitals routinely contact authorities with out ordering affirmation exams or ready to obtain the outcomes.

Not each state explicitly requires reporting a optimistic check, however many hospitals achieve this anyway. In 2022 alone, greater than 35,000 infants had been reported to youngster welfare authorities as substance-exposed, federal knowledge reveals, with no assure that the underlying check outcomes had been correct. 

“The system is primed for a report,” stated Dr. Mishka Terplan, an OB-GYN in Maryland and a number one researcher on substance use problems throughout being pregnant. “To sluggish it down, or to cease it, takes effort.”

The implications of a defective drug check could be particularly extreme for individuals with histories of dependancy, who’re much less more likely to be believed after they protest that the optimistic check was brought on by a hospital medicine. On this setting, a affected person’s phrase is commonly pitted towards a single drug check, and it’s as much as a person physician, nurse, or social employee to resolve whether or not to ferret out the reality. 

Lisa Grisham, a nurse in Arizona, recalled the case of a affected person in restoration for opioid use dysfunction who examined optimistic for fentanyl. The girl insisted that one other nurse had given her the medicine throughout labor, though it was not listed in her hospital data. Grisham, the director of a hospital program for substance-exposed infants at Banner College Medical Middle in Tucson, took it upon herself to research and ultimately tracked down the nurse, who confirmed the affected person’s clarification.

“It makes me sick to consider all of the mothers which have come by means of and stated they don’t use fentanyl and we don’t consider them,” Grisham stated.

Villanueva was 18, newly married, and nonetheless engaged on her GED when she gave start to her first child. As a toddler, she had been taught to be trustworthy with medical suppliers. So throughout hospital admission, she instructed a nurse that she had briefly experimented with medicine corresponding to marijuana and acid when she was 15. She hadn’t used medicine since, she stated. 

When she was admitted, Villanueva took a drug check that got here again damaging for any illicit substances—the identical end result as the 2 drug exams from her prenatal appointments. Then she obtained medication to induce labor, and her contractions started. They had been so painful, Villanueva recalled, that she was relieved when a nurse instructed her she was giving her morphine.

The day after Villanueva gave start, an investigator with the Indiana Division of Youngster Providers arrived. The hospital had knowledgeable the company about Villanueva’s “historical past of drug use,” in line with medical data. With out her data, Villanueva stated, the hospital additionally despatched her daughter’s meconium for testing, which discovered the morphine.

Villanueva was sure that her hospital data would show she had obtained morphine, and he or she was proper. The drug check outcomes even said, “Medication administered throughout labor and supply could also be detected in meconium.”

However even after the investigator obtained the hospital data, Villanueva stated, the company required her to undergo extra drug exams and permit inspections of her house. Lastly, after a number of weeks, the company closed the case, Villanueva recalled.

Solely after the investigators had been out of her life did Villanueva really feel that she might lastly experience her child’s start and permit herself to be glad. 

“I couldn’t even actually take pleasure in correctly my youngster being born,” she recalled. “Till after the very fact, after they had been gone.”

The Marshall Mission reporters Weihua Li, Andrew Rodriguez Calderón, Nakylah Carter, and Catherine Odom contributed to this story.

Join The Marshall Mission’s newsletters and comply with them on Instagram, TikTok, Reddit, and Fb.

Associated