This article was printed in partnership with The Marshall Project, a nonprofit information group overlaying the U.S. prison justice system, Reveal and Mother Jones.
Amairani Salinas was 32 weeks pregnant together 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 remedy that workers had administered earlier than wheeling her into surgical procedure.
For Victoria Villanueva, pregnant together 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 advised the brand new mom: The child’s meconium — or first bowel motion — had examined optimistic for opiates. Now, as an alternative of bonding together with her child, Villanueva shook with concern that her new child could possibly be taken away. “I didn’t even know tips on how to perform,” she recalled.
What occurred to Salinas and Villanueva are removed from remoted incidents. Across the nation, hospitals are shelling out medicines to sufferers in labor, solely to report them to youngster welfare authorities once they or their newborns check optimistic for these exact same substances on subsequent drug assessments, an investigation by The Marshall Project and Reveal has discovered.
The optimistic assessments are triggered by medicines routinely prescribed to hundreds of thousands of birthing sufferers within the U.S. yearly. The medicine embody morphine or fentanyl for epidurals or different ache aid, anxiousness medicines, and two totally different blood strain meds prescribed for C-sections.
In a time of increasing surveillance and criminalization of pregnant women because the finish of Roe v. Wade, the hospital stories have prompted calls to the police, youngster welfare investigations and even the removing of youngsters from their dad and mom.
The reporting for this story included interviews with two dozen sufferers and medical professionals, and a evaluate of a whole lot of pages of medical and court docket information. Some spoke about circumstances on situation of anonymity as a result of the custody of youngsters 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 youngsters. They have been held in foster take care of 11 days, till a affirmation check proved that the wrongdoer was a heartburn remedy the hospital had given the affected person.
By the time of Villanueva’s hospital keep in 2017, researchers and docs had recognized for years that medicines can quickly move from mom to child, inflicting optimistic drug check outcomes. Two assessments from Villanueva’s prenatal visits, and one other check completed 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 information. But the workers reported her to the state youngster welfare company anyway, hospital information present.
Marion General Hospital in Indiana didn’t reply to requests for remark. Brian Heinemann, a spokesperson for the Indiana Department of Child Services, declined to touch upon Villanueva’s case, however stated coverage has since modified to make sure that drug display screen outcomes alone will not be used to substantiate an allegation of abuse or neglect.
Kimberly Walton, a spokesperson for the Texas Health Resources system, declined to reply questions on Salinas’ case, however stated that docs order drug assessments if there’s a concern about affected person well being, and that they’re required “to report suspected unlawful drug use that might endanger the well being or security of a kid.”
Hospital drug testing of pregnant girls, which started within the Eighties and unfold quickly through the opioid epidemic, was supposed partially to assist establish infants who may expertise withdrawal signs and wish additional medical care. Federal legislation requires hospitals to alert youngster welfare companies anytime such infants are born. But a previous investigation by The Marshall Project and Reveal discovered that the comparatively cheap, pee-in-a-cup assessments favored by many hospitals are extremely prone to false positives, errors and misinterpretation — and lots of hospitals have didn’t put in place safeguards that may defend sufferers from being reported over defective check outcomes.
In some circumstances examined by The Marshall Project, docs and social employees didn’t evaluate affected person medicines to search out the reason for a optimistic check. In others, suppliers suspected a medicine they prescribed could possibly be the wrongdoer, however reported sufferers to authorities anyway.
“How a lot hurt to birthing individuals are we keen to permit? Our sufferers are being harmed till we are able to get our act collectively,” stated Dr. Davida Schiff, whose hospital community, Mass General Brigham in New England, instituted a brand new coverage this yr that directs suppliers to drug check sufferers, with their consent, solely when medically obligatory. The new coverage additionally halted automated reporting of optimistic check outcomes. Hospitals have a accountability to deal with the testing issues, she stated. “The hospitals are at fault. The clinicians are at fault. Our insurance policies are at fault.”
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The dangers from giving medicines to birthing sufferers after which testing them for illicit substances have been effectively documented. A 2022 study by researchers at Massachusetts General Hospital discovered that 91% of girls given fentanyl of their epidurals examined optimistic for it afterward. Other studies have discovered that moms can shortly move these medicines onto their infants. A child’s optimistic drug check “can not and shouldn’t be used to establish fentanyl drug abuse in moms,” stated Athena Petrides, the lead researcher of one of many research at Brigham and Women’s Hospital in Boston.
Despite these warnings, hospitals usually lack insurance policies requiring suppliers to evaluate a affected person’s information to see what medicines they obtained earlier than reporting them to authorities. Mandatory reporting legal guidelines defend docs from legal responsibility for stories made “in good religion,” even when they change into fallacious. 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 University of California, San Francisco Medical Center who makes a speciality of substance use issues in being pregnant. “It’s all as much as people who make their very own interpretations.” Wright helped change the coverage at her hospital, one of many nation’s main instructing amenities, to direct docs to not drug check sufferers until medically obligatory.
While drug assessments will help pediatricians decide tips on how 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, in order that they have little purpose to dwell on them.
Instead, at many hospitals, it’s social employees — liable for contacting youngster welfare companies — who’re extra possible 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 guardian could be a threat to the infant.
Investigation:She ate a poppy seed salad just before giving birth. Then they took her baby away.
But hospital social employees are sometimes overworked, stated Kylie Haines, who manages a program for pregnant girls with opioid use dysfunction at Vanderbilt University Medical Center, one of many prime maternity instructing 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 will not be thought-about a part of their job.
“We’re not medical suppliers,” stated Haines, a licensed social employee herself. “We can’t interpret drug screens.”
The timing of the assessments may make it difficult to interpret them. In idea, one of the best time to take a urine pattern for drug testing is when a affected person arrives on the hospital, earlier than receiving medicines. But it’s common for hospitals to check urine samples taken from a birthing affected person’s catheter bag, or to request a urine pattern after medicines have already been administered, suppliers stated.
Newborn drug assessments can add one other layer of complexity. While urine assessments can detect potential drug use over a interval of days, testing the infant’s meconium can uncover illicit substances going again months. Meconium assessments are extensively thought-about to be the gold normal for new child drug testing as a result of they will point out potential drug use earlier in being pregnant, a attainable signal of habit.
But in some circumstances, there isn’t any solution to inform whether or not a child’s optimistic check was brought on by a medicine the hospital disbursed or a substance the mom used earlier. Nor do such assessments 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,” stated Schiff. “Which is form of a large number.”
Medications equivalent to morphine or fentanyl have led some sufferers to get flagged as opioid customers. Ephedrine and phenylephrine, medicines for low blood strain which might be generally prescribed throughout C-sections, have induced false positives for meth. The Marshall Project additionally discovered that ladies have been questioned over optimistic drug assessments after hospitals gave them sedatives equivalent to benzodiazepines or barbiturates.
When girls are flagged by a optimistic drug check outcome, different facets of their lives can shortly come beneath suspicion. Medical situations or beginning issues that may be related to habit — equivalent to hypertension, a placenta that separates earlier than beginning or a untimely beginning — might mistakenly be considered as additional proof {that a} pregnant affected person used medicine. Through 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 threat to her child. And sufferers who had traumatic experiences giving beginning might immediately discover themselves beneath risk.
In 2023, Salinas was nonetheless in a haze of grief after delivering her stillborn child when she realized she can be reported to youngster welfare authorities. Salinas had no concept the hospital had given her the benzodiazepine for which she examined optimistic and denied utilizing the remedy. She had additionally examined optimistic for Delta-9, a authorized hemp-derived product, which she stated she had purchased on the grocery retailer. But quickly, Salinas discovered herself beneath a monthslong investigation, attempting to combat off paralyzing melancholy whereas processing her grief and caring for her different youngsters.
“I nonetheless have three stay youngsters. They nonetheless have to eat. They nonetheless have to stand up for college. They nonetheless want their mother,” Salinas recalled pondering as she was being questioned.
Officials closed the case about 4 months later as “unsubstantiated.” But it wasn’t till a yr later that Salinas learn by her medical information with a Marshall Project reporter and found the reason for the optimistic check.
Marissa Gonzales, a spokesperson for the Texas Department of Family and Protective Services, declined to debate Salinas’ case, citing confidentiality legal guidelines.
Salinas stated she puzzled 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 an excellent mother, who hasn’t completed something, as an alternative of a kid who may very well be in peril?”
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In latest years, research have discovered that drug assessments aren’t essentially one of the simplest ways to establish somebody with a substance use downside — a easy screening questionnaire can be efficient. Leading medical teams advise hospitals to make use of questionnaires as an alternative of common drug assessments. But hospital drug testing — and reporting — of labor and supply sufferers stays ubiquitous.
In at the least 27 states, hospitals are required by legislation to alert youngster welfare companies a few optimistic check or a possible publicity to the infant. But not a single state requires hospitals to verify check outcomes earlier than reporting them. Hospitals routinely contact authorities with out ordering affirmation assessments 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 have been reported to youngster welfare authorities as substance-exposed, federal information exhibits, with no assure that the underlying check outcomes have 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 issues throughout being pregnant. “To sluggish it down, or to cease it, takes effort.”
The penalties of a defective drug check could be particularly extreme for individuals with histories of habit, who’re much less prone to be believed once they protest that the optimistic check was brought on by a hospital remedy. In this surroundings, a affected person’s phrase is usually pitted in opposition to 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 lady insisted that one other nurse had given her the remedy throughout labor, although it was not listed in her hospital information. Grisham, the director of a hospital program for substance-exposed infants at Banner University Medical Center in Tucson, took it upon herself to analyze and ultimately tracked down the nurse, who confirmed the affected person’s rationalization.
“It makes me sick to consider all of the mothers which have come by and stated they do not use fentanyl and we don’t imagine them,” Grisham stated.
Villanueva was simply 18, newly married and nonetheless engaged on her GED when she gave beginning to her first child. As a toddler, she had been taught to be trustworthy with medical suppliers. So throughout hospital admission, she advised a nurse that she had briefly experimented with medicine equivalent to marijuana and acid when she was 15 years outdated. She hadn’t used medicine since, she stated.
When she was admitted, Villanueva took a drug check that got here again destructive for any illicit substances — the identical outcome as the 2 drug assessments from her prenatal appointments. Then she obtained medication to induce labor, and her contractions started. They have been so painful, Villanueva recalled, that she was relieved when a nurse advised her she was giving her morphine.
The day after Villanueva gave beginning, an investigator with the Indiana Department of Child Services arrived. The hospital had knowledgeable the company about Villanueva’s “historical past of drug use,” in line with medical information. Without her information, Villanueva stated, the hospital additionally despatched her daughter’s meconium for testing, which discovered the morphine.
Villanueva was sure that her hospital information would show she had obtained morphine, and she or he was proper. The drug check outcomes even said, “Drugs administered throughout labor and supply could also be detected in meconium.”
But even after the investigator obtained the hospital information, Villanueva stated, the company required her to undergo extra drug assessments and permit inspections of her house. Finally, after a number of weeks, the company closed the case, Villanueva recalled.
Only after the investigators have been out of her life did Villanueva really feel that she may lastly experience her child’s beginning and permit herself to be completely happy.
“I couldn’t even actually take pleasure in correctly my youngster being born,” she recalled. “Until after the very fact, once they have been gone.”
The Marshall Project reporters Weihua Li, Andrew Rodriguez Calderón, Nakylah Carter and Catherine Odom contributed to this story.
This article was printed in partnership with The Marshall Project, a nonprofit information group overlaying the U.S. prison justice system, and Reveal and Mother Jones. Sign up for The Marshall Project’s newsletters, and comply with them on Instagram, TikTok, Reddit and Facebook.
