I. Misconception One: Mothers with Substance Use Disorder Can Get an Abortion. If found guilty, pregnant women could face up to 15 years in prison and lose custody of their child. April 14, 2023. J Pediatr. Published December 14, 2020. https://www.pregnancyjusticeus.org/tennessees-fetal-assault-law-understanding-its-impact-on-marginalized-women/, [10] Roberts SCM, Nuru-Jeter A. Womens perspectives on screening for alcohol and drug use in prenatal care. 2020 May/Jun;14(3):185-192. doi: 10.1097/ADM.0000000000000562. No, Illinois does not require testing over suspicions. Alcohol Clin Exp Res. [41] Association APH. In Illinois, substance abuse is not a crime. Despite this, routine oral health care is often avoided or postponed for the duration of pregnancy. After withdrawal, those struggling with substance use disorder may still have cravings and the likelihood of relapsing remains high without proper medical intervention. Laws on. Exciting advances in HIV treatment and prevention make pregnancy a safe possibility for women living with HIV. Because they did not have a family member who could help, the family was forced to pay a stranger to be in their home for hours when the husband was away at work. 2020;174(2):200-202. doi:10.1001/jamapediatrics.2019.4791, [22] Ghose R, Forati AM, Mantsch JR. Impact of the COVID-19 Pandemic on Opioid Overdose Deaths: a Spatiotemporal Analysis. Intensive oral hygiene regimens decrease the incidence of gingivitis among pregnant women. Across the country, hundreds of pregnant women and new mothers have been accused of child abuse or other crimes when they or their newborns tested positive for controlled substances. Providers should ensure all women are discharged from the hospital with an early postpartum visit within three weeks of pregnancy. This testing approach, however, may be perceived as unfairly profiling mothers, exposing the institution to legal issues. Our pieces cover all aspects of bioethics from clinical to philosophical, addressing timeless ethical dilemmas as well as current challenges. Online only: Report finds most U.S. inmates suffer from substance abuse or addiction. [5], Despite being in effect for over four decades, the War on Drugs failed to achieve its intended goals. 2020 Addiction Now. ACOG recommends testing be performed only with the patients consent and a positive test not be a deterrent to care, a disqualifier for coverage under publicly-funded programs, or the sole factor in determining family separation. States need to enact laws that protect these women from being reported to authorities. They can face . Many different definitions of maternal mortality are used to track and analyze deaths in different contexts, but Illinois uses the following standard definitions from the Centers for Disease Control and Prevention (CDC): Pregnancy-Associated Death- the death of a woman during pregnancy or within one year of the end of a pregnancy from any cause. [41] It is erroneous to assume that their substance use disorder would disappear after a period without substance use while behind bars. Medication assisted treatment under the supervision of medical professionals can help inmates achieve and maintain sobriety in a healthy and safe way. The newborns I observed during my pediatrics rotation probably could have benefited from breastfeeding rather than bottle feeding and being passed around from one nurse to the next. Most babies with NAS get treatment in the hospital after birth and typically get better within a few days or weeks. Hospitals are more likely to give drug tests to Black women delivering babies than white women, regardless of the mother's history of substance use, suggests a new study of a . For immediate service for employers or individuals call 866-843-4545 or Order Now. The Illinois Department of Public Health supports two Maternal Mortality Review Committees, which: Reviews deaths suspected to be medically related to pregnancy. 1992;267(3):406-408. doi:10.1001/jama.1992.03480030084043, [24] NICHD Neonatal Research Network. Tobacco use1.8 to 2.8 times greater risk. During this time, a DCFS agent and another state employee came regularly to Ms. F.s home to check in on her and the baby. The Department is excited to announce the launch of a new PrEP Medication Assistance Program. [37] Removing an infant from their mothers care immediately after birth would result in the loss of all these positive benefits for both the mother and her newborn. These results are for the calendar year 2018 births. The report identifies statewide trends in maternal deaths and provides recommendations to help prevent maternal mortality. Acta Paediatr. In 1914, Congress enacted the Harrison Narcotics Tax Act to target the recreational use of drugs such as morphine and opium. Neonatal abstinence syndrome (NAS) is itself a treatable and transient condition, and a growing body of literature confirms that one of the most effective treatments for NAS is keeping the newborn and mother together in a soothing environment while encouraging skin-to-skin contact and breastfeeding. Two modes of testing are available: umbilical cord tissue and meconium. Tennessee is the only state with a statute that specifically makes it a crime to use drugs while pregnant. Text4baby is a free mobile health information service for pregnant women and new parents with infants under the age of 1 year. Just a few feet away from his room, behind the nurses station, were the two newborns feeling the same withdrawal symptoms that this teenager likely experienced in the first few hours of his life. NAS is a group of conditions caused when a baby is exposed to certain drugs in the womb, most often opioids, and is withdrawn from those drugs after birth. 19 states have either created or funded drug treatment programs specifically targeted to those who are pregnant, and 17 states and the District of Columbia provide pregnant people with priority access to state-funded drug treatment programs. Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. Drug Policy Alliance. At the hospital, I witnessed Child Protective Services removing two newborns with neonatal abstinence syndrome from their mothers custody. . National Advocates for Pregnant Women (NAPW) and the ACLU of Illinois filed a charge against St. Alexius Medical Center for a discriminatory, non-consensual drug test against a first-time mother, Ms. F., before she went into labor. The court found that because the act of birth had not yet occurred, the fetus is not legally considered a child. Committee members aimed to gain a better understanding of the causes of maternal mortality, to develop statewide recommendations to prevent future maternal mortalities, and to determine whether the deaths were pregnancy-associated (occurring within one year due to any cause) or pregnancy-related (occurring within one year due to pregnancy). If a woman cannot take care of herself, one might wonder how she can take care of another human being. Flu is more likely to cause severe illness in pregnant women than in women who are not pregnant. Antiviral treatment should be initiated as early as possible because studies show that treatment initiated early (i.e., within 48 hours of illness onset) is more likely to provide benefit. Excessive alcohol consumption can result in fetal alcohol syndrome, characterized by growth deficiency, facial structure abnormalities, and a wide range of neurological deficiencies. [3], The War on Drugs was a government-led initiative launched in 1970 by President Richard M. Nixon with the aim of curtailing illegal drug use, distribution, and trade by imposing harsher prison sentences and punishments. [1] These punitive measures may cause patients to lose trust in their physicians, ultimately leading to high-risk pregnancies without prenatal care, untreated substance misuse, and potential lifelong disabilities for their newborns. [15] Smoking can impede the development of the lungs and brain and lead to preterm deliveries or sudden infant death syndrome. Smoking During Pregnancy. The Centers for Disease Prevention and Control (CDC), the American College of Obstetricians and Gynecologists, the American College of Nurse Midwives, and the American Academy of Family Physicians have not changed their recommendations and all continue to recommend flu vaccination for pregnant women. Distributed through Columbia Universitys Academic Commons. [20] In 2020, the CDC published a paper that showed an increase in hospital costs from $316 million in 2012 to $572.7 million in 2016. Misconception Two: Mothers with SUD are Not Fit to Care for Children. For many women, motherhood is a rewarding experience. maternal attitudes and experiences before, during, and shortly after pregnancy. Access to medical care before, during, and after childbirth is essential to the health and well being of each mother. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156
However, they said states could define and protect potential human lives as long as there are "important legitimate reasons." During his hospitalization, he was so violent towards healthcare providers that security had to intervene. Centers for Disease Control and Prevention. February 3, 2022 CHICAGO - On January 28, 2022, National Advocates for Pregnant Women (NAPW) and the ACLU of Illinois filed a charge of discrimination against Saint Alexius hospital with the Illinois Department of Human Rights for a discriminatory, non-consensual drug test of a first-time mother, Ms. F., before she went into labor. Efforts to inform health professionals about the connection between oral health and overall health during pregnancy should focus on effectively disseminating strategies that translate evidence-based guidelines into clinical practice, with the ultimate goal of improving oral-systemic health among women and children. Yet doctors and nurses brushed off her explanation and whispered stigmatizing comments about her positive test result while preparing her for cesarean surgery on April 6, 2021. Appointment reminders and an immunization tracker can be used to support a woman in getting the vaccines she needs for herself during pregnancy and for her new baby. Of the 41 responding states, 33 reported covering all three. Punitive policies push pregnant women away from receiving healthcare and prevent them from receiving beneficial interventions. Exciting advances in HIV treatment and prevention make pregnancy a safe possibility for women living with HIV. [16] Stimulants like methamphetamine can also cause preterm delivery, delayed motor development, attention impairments, and a wide range of cognitive and behavioral issues. 2013;102(11):1060-1066. doi:10.1111/apa.12378, [36] Ilett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. The Maternal Lifestyle Study (MLS): effects of prenatal cocaine and/or opiate exposure on auditory brain response at one month. Routine urine drug screening is controversial. Meconium the traditional specimen to detect and document drug use during pregnancy, while umbilical cord tissue is relatively new for testing. Photo by 14825144 Alita Xander | Dreamstime.com. Those efforts continue under a wide variety of laws even in states where high courts have previously rejected the prosecution approach. National Institute on Drug Abuse. Centers for Disease Control and Prevention. NAS can lead to long-term health and developmental problems such as hearing and vision problems and issues with learning and behavior. The Pennsylvania Supreme Court ruled in 2018 that prenatal exposure to substances does not constitute child abuse under the state's Child Protective Services Laws. To progress as a society, physicians and interprofessional teams must work together to truly understand the needs of patients with substance use disorders and provide support from prenatal to postnatal care. Published January 17, 2018. http://archives.nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition, DO Candidate, Touro University California. No one ever informed her of, nor asked her permission for, a drug test. In Minnesota and North Dakota, a test is required if drug-related complications occur at birth. Flu vaccination has been shown to protect pregnant women from flu illness. J Addict Med. ACOG recommends testing be performed only with the patient's consent and a positive test not be a deterrent to care, a disqualifier for coverage under publicly-funded programs, or the sole factor in determining family separation. All papers must be analytical, highlighting a problem with the status quo, addressing a controversy, or offering new frameworks and analysis. From December 2017 through March 2019, a 12-question marijuana and drug use supplement was added to the PRAMS survey. The Centers for Disease Prevention and Control (CDC), the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse Midwives (ACNM), and the American Academy of Family Physicians (AAFP) recommend flu shots for all women who are or will be pregnant during the flu season, as it has been shown to help protect both the mother and the baby for several months from the flu. https://www.aap.org/en-us/Pages/Default.aspx, handle drug use during pregnancy differently. Most risk is found among the heaviest smokers, Any stimulant, marijuana, or prescription. 10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people. Risk-based testing may also miss infants exposed to drugs if the policies do not adequately identify and test for probable exposures. His past psychiatric disorders included attention deficit disorder, conduct disorder, major depressive disorder, anxiety disorder, disruptive mood dysregulation disorder, intellectual developmental disorder, and more. They can lose custody of their other children. The report is the culmination of more than a year of work done by two IDPH committees, the Maternal Mortality Review Committee (MMRC), established in 2000, and the Maternal Mortality Review Committee for Violent Deaths (MMRC-V), established in 2015. After being arrested 50 times within five years, she went through STEP: Self-Taught Empowerment and Pride, a public program that allowed her to complete her GED and provided guidance and encouragement for a more meaningful life during her time in jail. drug testing policy, random drug testing policy, or a : 24: drug-free workplace policy or from disciplining an employee : 25: Office of Assistant Secretary for Planning and Evaluation. Maternal morbidity refers to any pregnancy or delivery complication, which may be minor or severe. All content published from 2020 onward is subject to a Creative Commons "Attribution" (CC-BY) License unless otherwise noted. For example, Virginia considers substance use during pregnancy child abuse and mandates that healthcare providers report it. [40] Drug Related Crime Statistics [2023]: Offenses Involving Drug Use. Int J Drug Policy. They probably would have cried less and suffered fewer withdrawal symptoms had they been given the opportunity to breastfeed. [2], As a medical student, I have observed the importance of a rehabilitative approach to addiction medicine. For many women, treatment of oral disease during pregnancy is particularly important because dental insurance may only be available to them during pregnancy or up to 2 months postpartum. IDPH is funding local organizations to increase the number of women receiving well-woman exams. Pregnancy Justice. [27], While I have witnessed this behavior in the teenage patient during my pediatrics rotation, not all newborns with intrauterine drug exposure are inevitably bound to have psychiatric and behavioral issues later in life. ACOG states, "Urine drug testing has also been used to detect or confirm suspected substance use, but should be performed only with the patient's consent and in compliance with state laws." However, newborn infants may be tested without the mother's consent. Therefore, under the CPSL, a mother who was addicted to substances . The report is the culmination of more than a year Whether these studies will lead to stricter regulations and punishments on pregnant women is highly debatable. Dentists who are knowledgeable about periodontal disease are more likely to counsel their patients who are pregnant about periodontal health. Fifteen states have laws requiring health care workers to report to authorities if they suspect a woman is abusing drugs during pregnancy. If found guilty, pregnant women could face up to 15 years in prison and lose custody of their child. [14], Nonetheless, many studies have demonstrated that drug use during pregnancy can adversely impact fetal development. The estimated prevalence of maternal drug use during pregnancy is based on maternal self-report but is likely an underestimate because of known underreporting by pregnant women. The results of the investigation determine whether the baby is taken permanently. [30] So far, laws are not associated with a decrease in the misuse of drugs during pregnancy. Health outcomes during pregnancy and the postpartum period occur across a continuum. During 2018, a total of 2,175 recent mothers were sampled and Though premature, her baby was born healthy and had no symptoms of withdrawal.. [29] With opioid and polysubstance use on the rise, the efficacy of laws that result in punitive measures seems questionable. Drug testing pregnant patients exists in this unstandardized and unregulated context. The Problem of Prenatal Cocaine Exposure: A Rush to Judgment. The subcommittees have started reviewing 2016 maternal deaths in an effort to identify changing trends and areas for statewide improvement with the ultimate goal of preventing maternal mortality. doi:10.1542/peds.2017-3520, [21] Strahan AE, Guy GP Jr, Bohm M, Frey M, Ko JY. Pregnant women with low incomes and those who are Hispanic have higher rates of tooth decay than those with higher incomes and those who are white, respectively. There is no indication that preventive or restorative oral health treatment during any trimester of pregnancy can harm the mother or the developing fetus. https://drugpolicy.org/issues/brief-history-drug-war, [5] The Harrison Narcotic Act (1914) https://www.druglibrary.org/Schaffer/library/studies/cu/cu8.html, [6] The War on Drugs. Appointment reminders and an immunization tracker can be used to support a woman in getting the vaccines she needs for herself during pregnancy and for her new baby. Centers for Disease Control and Prevention. Throughout his hospital course, it was difficult for me to converse with him, and I left every interview with him feeling lost in terms of providing an adequate short- and long-term assessment of his psychological and medical requirements. No, substance abuse during pregnancy is not grounds for civil commitment. It only takes 15 minutes for water-soluble alcohol to get to the fetus and make the fetus' blood alcohol content that of the mothers. Click here to learn more about flu vaccine safety and pregnancy: The Centers for Disease Control and Prevention (CDC, 2017) Flu Vaccine Safety and Pregnancy. [42], V. Medical Education: Narcotic Treatment Programs and Suboxone Clinics. Incentivizing pregnant women with substance use disorder to safely address their chronic health issues is essential for minimizing negative short-term and long-term outcomes for women and their newborns. Unfortunately, many believe mothers with substance use disorder cannot adequately care for their children. [3] All stories have been fictionalized and anonymized. This approach requires an open mind and supportive perspective, recognizing that substance use disorder is truly a medical condition that requires just as much attention as any other medical diagnosis. Yu, C. (2023). Illinois was the first state to extend continuous eligibility for full Medicaid benefits from 60 days to 12 months postpartum. Infants exposed to drugs prenatally have an increased risk of complications, stillbirth, and life-altering developmental disabilities. In three states Minnesota, South Dakota and Wisconsin women who use drugs during pregnancy can be involuntarily committed to a treatment program. Treatment decisions, especially those involving empiric treatments, should be informed by knowledge of influenza activity in the community. Fetal Alcohol Spectrum Disorders. During the two years this law was in effect, officials arrested 124 women. Future interventions should focus on improving the oral health knowledge of dentists and other health professionals about the importance of comprehensive oral health care, including periodontal treatment when needed, for all pregnant women. [9] The fear that this law instilled in pregnant women with substance use disorder can still be seen across the US today. At one county hospital where I recently worked, there has been a dramatic increase in newborns with neonatal abstinence syndrome born to mothers with untreated substance use disorders during pregnancy. 2015;136(5):e20153113. 2010;40(3):E11-E11. Monitor, Analyze, and Communicate Trends. On the surface, this solution seems like a quick fix. Drug testing pregnant people is a form of medical racism. Pregnancy Justice and ACLU of Illinois File Human Rights Complaint on Behalf Of New Mother Who Endured Non-Consensual and Discriminatory Drug Testing, Reporting to DCFS Because of Poppy Seed Consumption - New York | Pregnancy Justice Illinois newborn drug testing laws mandate cases to be reported to the Department of Children and Family Services (DCFS) and the Department of Public Health (DPH), where an investigation will begin. A.R., Respondent-Appellant, Newborns' exposure to drugs: Discrepancies in mandatory reporting, Laws about pregnant women and substance abuse questioned, Laws Pertaining to Pregnant Women Who Use Drugs, How States Handle Drug Use During Pregnancy, Substance Use While Pregnant and Breastfeeding, The Illinois Supreme Court calls it "legal fiction" that the fetus "is a separate legal person hostileto the woman. [38] Medication-assisted treatment with methadone or buprenorphine is the first line treatment option and should be available to all pregnant women regardless of their ability to pay for medical care.[39]. Yet I felt for the new mothers and realized that heart-wrenching custody loss is not the best approach. Illinois state law does not prohibit drug testing. This would incentivize people to actively seek medical care, restore the patient-physician relationship, and ensure that they take rehabilitation programs seriously. [19] The AAP found that the cost of neonatal abstinence syndrome covered by Medicaid increased from $65.4 million to $462 million from 2004 to 2014. Black women were more likely to die from pregnancy-related medical conditions. Introduced 9/3/2021, by Rep. Bob Morgan - Kambium Buckner - Kelly M. Cassidy . Many pregnant women with substance use disorders stated that they feared testing positive for drugs. Black women are aboutthree timesas likely to die from a pregnancy-related condition as White women. St. Alexius staff drew Ms. F.s blood and gathered her urine, which she assumed was for reasons related to her preeclampsia. The Healthcare worker must report drug abuse and direct you to Drug & Alcohol Detox & Rehabilitation Centers For Pregnant Women. It is recommended, however, that every facility that provides newborn care establish their own testing protocols, including establishing unbiased guidelines to identify those who should be tested. For more information on antivirals for pregnant and postpartum patients, please visit the CDC: https://www.cdc.gov/flu/professionals/antivirals/avrec_ob.htm. The charge alleges that Saint Alexiuss practice of drug testing pregnant women without their knowledge or consent and in the absence of a medical justification discriminated against Ms. F. on the basis of sex and pregnancy. Rather than policing and criminalizing substance use, pregnant women should get the appropriate care they need and deserve. Oral health is essential to overall health in the prenatal period. Pregnant People with Substance Use Disorders Need Treatment, Not Criminalization. It must be asked, by what judicially defined standard would a mother have her every act or omission while pregnant subjected to State scrutiny? Substance Use While Pregnant and Breastfeeding. Society needs to change from the mindset of tackling a problem after it occurs to taking a proactive approach by addressing upstream factors, thereby preventing those problems from occurring in the first place. Recognizing that many drug policies were of political opinion, it called for drug policies that were grounded in scientific evidence, health, security, and human rights.[8]. Her daughter, who was exposed to cocaine before birth, had a normal childhood and ended up going to college.[28]. Emphasizing public health measures and adequate medical care can prevent complications and developmental issues in newborns and pregnant women with substance use disorders. When drug use is diagnosed or suspected, Illinois requires healthcare workers to report it. The law had a sunset provision and expired in 2016. Published May 3, 2010. https://www.npr.org/templates/story/story.php?storyId=126478643, [29] Miranda L, Dixon V, September CRP on, 30, 2015. For example, many women with substance use disorder lose custody of their baby or face criminal penalties, including fines and jail time. Although the number of people sentenced to state prisons for drug related crimes has been declining, it is still alarming that there were 171,300 sentencings in 2019. How States Handle Drug Use During Pregnancy IDPH will continue to support the Maternal Mortality Review Committees and will use new data tools to look at social and community factors influencing maternal health. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants with Medicaid: 20042014. This practice arose out of the failed War on Drugs, which advanced a narrative that cast suspicion on people of color and resulted in federal laws to ostensibly provide drug treatment to pregnant women. The Illinois Department of Human Services is piloting the Illinois Families in Recovery program for pregnant and postpartum women with substance use disorders in central Illinois. Without resources or means, these restrictive laws have made it incredibly difficult to obtain the medical care they need. Reviews deaths resulting from homicide, suicide, or drug overdose. [40] Only 11 percent of the 65 percent of our nations inmates with substance use disorder receive treatment, implying that the other 89 percent were left without much-needed support to overcome their addiction. For others it is a time of ill health and sometimes even death. On April 29, 2021, IDPH released Illinois' second Maternal Morbidity and Mortality Report. While a recent study found an increased risk of miscarriage in the 28 days after vaccination for women vaccinated early in pregnancy with a specific flu vaccine two years in a row, the study has been criticized for including a very small sample size. However, a fetus cannot metabolize the alcohol to get it out of its system like the mother. County hospitals that mainly serve lower socioeconomic patients encounter more patients without consistent health care access and those with substance use disorders. Nevertheless, hospital staff told Ms. F. that they were reporting the matter to DCFS. A charge of discrimination was filed with the Illinois Department of Human Rights on Ms. F.s behalf. There can be no significant change if society continues to view those with substance use disorders as underserving of care. To promote continuity of care, health officials could include financial incentives to motivate new mothers to go to follow-up appointments. On October 18, 2018, IDPH released Illinois firstMaternal Morbidity and Mortality Report. Exposure to maternal drug use during pregnancy may lead to adverse effects such as poor neonatal development and acute adverse effects such as infant mortality and neonatal abstinence syndrome (NAS). Please also see our Voices in Bioethics Podcast (columbia.edu) where we interview thought leaders with an eye to projecting personal stories as well as addressing professional ethical dilemmas. There are ways you and your partner can prevent passing HIV to one another or to your baby. All rights reserved. Policies Affecting Pregnant Women with Substance Use Disorder . Published on September, 30, 2015. Pregnancy-Related Death- The death of a woman during pregnancy or within one year of the end of a pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. Identification of newborns exposed to illicit substances can alert the practitioner to problems one might encounter in the delivery room and nursery, such as intoxication, withdrawal syndromes, and long-term needs for exposed neonates. NPR. Multiple studies have shown that women who receive the flu shot during pregnancy. Published July 27, 2021. https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html, [35] Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjark L, Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. There should be advocation for legislative change, not by providing an opinion but by highlighting the facts and conclusions of scientific studies grounded in scientific evidence, health, security, and human rights. ", "a judicially defined standard of conduct would have to be met. Montana, for example, passed a law in 2019 that provides women with substance use disorders safe harbor from prosecution if they seek treatment for their condition. Pregnant women with substance use disorder require treatment that is arguably for the benefit of both the mother and the fetus. An exception to this is in cases where the mother's life is at risk. Pediatrics. Severe complications are rare, with a relatively small number of women experiencing the most severe complication: death. III. And his attitude toward his foster parents was so volatile that we were never sure if having them visit was comforting or agitating.
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