For many years, hospitals have proactively tested expectant mothers for drugs. But a growing movement of doctors are advocating for moving away from those policies.
Shoshana Walter recently reported on this for The Marshall Project and joined The Show to discuss.
Full conversation
SHOSHANA WALTER: We've known for years now that there are racial disparities and who is getting drug tested, who's getting selected for drug testing, and what's happening as a result of positive drug tests. And so what we're seeing around the country again and again and again is that Black newborns and Black moms are far more likely than white moms and white newborns to be drug tested, are more likely to be reported to child welfare agencies and more likely to have their children removed once those reports are in.
And oftentimes the tests that hospitals are using have very high false positive rates, up to 50%, very easy to misinterpret.
SAM DINGMAN: Wow, 50%?
WALTER: Yeah, yeah, it's an extremely high percentage. I mean, these tests can trigger positive due to poppy seeds, they can also be triggered positive from medications that the hospital gave patients during child labor, like an epidural. So these test results are highly inaccurate and just very easy to misinterpret.
And so our reporting has found that as a result, there are women getting reported and babies getting reported to child welfare authorities who actually were not exposed to any illicit substances at all.
DINGMAN: Well, just as a kind of case study here to help people understand, I wonder if I could ask you about the anecdote that you shared at the beginning of your piece, and this is a patient of a doctor named Dr. Sharon Ostfeld-Johns.
WALTER: Absolutely. So, Sharon, a few years ago, was seeing a patient at the hospital who'd just given birth. This was a Black mom on Medicaid who have had other kids, and she disclosed to her medical providers that she used marijuana during her pregnancy. As a result of that disclosure, she was reported to child welfare authorities.
Dr. Ostfeld-Jones received this request in response, which is a very common request that medical providers receive all the time from child welfare authorities, and basically she was asked to drug test the newborn to confirm whether or not the newborn had traces of marijuana in its system.
And when she received this request, she, what she described to me was kind of like a crisis of conscience. She knew that potentially by doing this test, her patient could see negative consequences, you know, the agency might decide to remove her newborn, for example. The baby was perfectly healthy. She had no concerns about this mom and her capacity to parent. And so a positive drug test could have made things worse for her patient.
DINGMAN: So, when did this aggressive form of drug testing in hospitals with moms start? What are the origins of this?
WALTER: Hospitals really began to drug test new moms and pregnant patients en masse during the crack cocaine epidemic of the 1980s, when there was a great deal of concern about quote unquote “crack babies” and worries about releasing those babies home to mothers who were just ill-equipped to care for them.
You know, fast forward 20-30 years, we're now in a new drug epidemic, the opioid epidemic, and with exposure to opioids, babies have the added issue of themselves going through withdrawal. So more and more hospitals began to drug test patients, they hadn't been drug testing before to make sure they weren't missing any babies that might go on to exhibit withdrawal symptoms.
And also during that time, federal lawmakers passed a law that began requiring states to require hospitals to notify child welfare authorities any time a baby was born, quote unquote “affected by substance exposure in the womb.”
DINGMAN: One of the quotes that really jumped out at me from your piece, and I wonder if you could expand on it a little bit for us, is from another doctor named Christine Gold, who's a pediatrician at the University of Colorado. She said to you, quote, “Toxicology tests are not parenting tests.”
WALTER: Yeah, it's, such an interesting quote that I think really encompasses an issue with these tests, which is that to the extent that they do identify potential drug use during pregnancy, they don't tell you how many times a parent may have used if that parent has an addiction that is destabilizing and destroying their lives and making them a risk to their children.
DINGMAN: So, at the University of Colorado that we were just talking about as well as Yale New Haven, which we mentioned a moment ago and UMass Memorial. There is this movement away from these tests that we've been talking about and towards some different methodologies. Tell us about those.
WALTER: Yeah, so there's several leading medical groups that really encourage, have encouraged hospitals in the last few years to, instead of relying on automatic drug testing of every pregnant patient to instead use validated screening tools, which are essentially questionnaires that medical providers use with their patients to identify patients who might be at risk of a substance use disorder.
So these questionnaires often include questions about history of drug use, their partner or any family member has had an addiction. They're basically a series of questions that medical providers can use to get to know their patients better.
DINGMAN: Got it. So if I'm hearing you right. a lot of this boils down to spending more time getting to know moms.
WALTER: That's right. You know, it takes longer to have a conversation with the patient than it does to order one of these drug tests. I mean, I think that's why a lot of hospitals are relying on them so heavily.
DINGMAN: And one of the other complicating factors here, if I'm not mistaken, is marijuana is increasingly legal in a lot of states, but it crops up in a lot of these urine tests. And as you point out in your piece, most marijuana only cases do not result in findings of abuse or neglect, right?
WALTER: That's right. Yeah. One of the doctors I spoke with, helped lead some research looking at what happened to families that were reported to child welfare authorities as a result of a marijuana only positive test, and they found that there was no great risk of child abuse or neglect, that most of those cases were not substantiated.
So, a lot of these reports that are being made are not leading to the actual identification of parents who are abusive or neglectful.
DINGMAN: So these doctors that you profile, we mentioned Dr. Sharon Ostfeld-Johns, what is their hope long term?
WALTER: Well, I think, you know, these policies are still very new, so it's going to take a few years to really assess the results of the policy changes, but what she found is that child welfare reports fell by about 50% after they instituted their policy. And they did not find that any, you know, previously unidentified babies were coming in in need of emergency medical treatment.
Prior to Yale New Haven changing their policy, there was some internal concern about, you know, what if we miss babies as a result of, of, of changing this mandatory drug testing policy. But what Dr. Ostfeld-Johns is finding is that they're, they're not missing babies.
DINGMAN: Well, Shoshana Walter is a staff reporter for the Marshall Project and wrote this piece that we've been discussing, which is called “Why Some Doctors Are Pushing to End Routine Drug Testing” during childbirth.
