Hospitals should provide training and resources to staff on racism, implicit bias, and stigma. Pediatrics. 2013;102(11):1060-1066. doi:10.1111/apa.12378, [36] Ilett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. And even if the mothers were lethargic and unresponsive while going through withdrawal, it would still have been possible to breastfeed with proper support. No, Illinois does not require testing over suspicions. There is no simple fix to this problem, given that it involves the political, legal, and healthcare systems. Many of the current laws and regulations that policy makers initially created due to nave political opinion and unfounded bias to serve the War on Drugs need to be changed to provide these opportunities. As for illegal substances like cocaine, marijuana, and methamphetamine (and more) - the mother may not have long-lasting effects on drug use, but the fetus is likely to endure a variety of development problems. 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. doi:10.1542/peds.2015-3113, [16] CDC Tobacco Free. County hospitals that mainly serve lower socioeconomic patients encounter more patients without consistent health care access and those with substance use disorders. [32] For someone who may or may not have access to reliable transportation, traveling to another state might be impossible. For immediate service for employers or individuals call 866-843-4545 or Order Now. "Lawmakers in Tennessee last year increased drug screenings of expectant mothers and passed a law allowing prosecutors to charge a woman with aggravated assault against her unborn baby if she was caught using illicit drugs. Routine urine drug screening is controversial. Ms. F. repeatedly told staff that the only possible explanation for her false positive test was the poppy seed cake that she had eaten for an Easter celebration before entering the hospital. Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016. On the surface, this solution seems like a quick fix. Her daughter, who was exposed to cocaine before birth, had a normal childhood and ended up going to college.[28]. Screening for substance use in all pregnant women is recommended by both the American College of Obstetrics and Gynecology (ACOG) and the American Society of Addiction Medicine (ASAM) in order to provide women and their fetuses and children with the best care during and after pregnancy. Rather than family medicine, OB/GYN, or emergency medicine healthcare workers having to refer their patients to an addiction specialist, they could treat patients with methadone for maintenance or detoxification where they would deliver their baby. I wondered how similar their paths would be and if they would exhibit similar developmental delays in a few years or if their circumstance may follow the cases hyped about in the media of the 1980s and 1990s regarding crack babies. Many of these infants who experienced withdrawal symptoms eventually led normal lives. The law had a sunset provision and expired in 2016. The report is the culmination of more than a year Black women are aboutthree timesas likely to die from a pregnancy-related condition as White women. Our submissions guidelines, requirements, and tips can be found here. Policies Affecting Pregnant Women with Substance Use Disorder . Since 1973, authorities in at least 45 states have sought to prosecute women for exposing their unborn children to drugs. For example, many women with substance use disorder lose custody of their baby or face criminal penalties, including fines and jail time. Further, the law states that it is not illegal for employers to require drug tests from employees who have been or are in a drug rehabilitation program. 102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 HB4116 . However, if an employee tests positive on a random drug test, no action can be taken if it can't be proven the substance was used in the workplace. [4] A History of the Drug War. ASPE. After withdrawal, those struggling with substance use disorder may still have cravings and the likelihood of relapsing remains high without proper medical intervention. [41] It is erroneous to assume that their substance use disorder would disappear after a period without substance use while behind bars. 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. Fifteen states have laws requiring health care workers to report to authorities if they suspect a woman is abusing drugs during pregnancy. II. JAMA Pediatr. In fifteen states, health care workers are required to report to authorities if they suspect a woman is abusing drugs during pregnancy. 2011;33(1):78-87. doi:10.1016/j.ntt.2010.06.005, [28] N, P, R. Crack Babies: Twenty Years Later. 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. 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. The Maternal Lifestyle Study (NCT00059540) was a prospective longitudinal observational study that compared the outcomes of newborns exposed to cocaine in-utero to those without. In 2014, Tennessees legislature passed a Fetal Assault Law, which made it possible to prosecute pregnant women for drug use during pregnancy. [1] NIDA. Crack and motor development of babies living in an assistance shelter. 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. However, the reality is that obtaining an abortion can be challenging due to two significant barriers: accessibility and mandated reporting. https://www.aap.org/en-us/Pages/Default.aspx, handle drug use during pregnancy differently. In addition, a growing number of pregnant women view it as a safe, natural way to treat nausea and . 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. https://nida.nih.gov/publications/research-reports/methamphetamine/what-are-risks-methamphetamine-misuse-during-pregnancy, [18] CDC. Intensive oral hygiene regimens decrease the incidence of gingivitis among pregnant women. Illinois was the first state to extend continuous eligibility for full Medicaid benefits from 60 days to 12 months postpartum. After repeal, the Judge did not want to terminate the respondent's parental rights because of the respondent's "outstanding" rehabilitation efforts. News Chicago Metro/State Poppy seeds caused positive drug test before she gave birth, woman says but hospital wouldn't listen St. Alexius Medical Center reported her to the Department of Children and Family Services, according to a complaint filed with the Illinois Department of Human Rights. 2021 Maternal Morbidity and Mortality Report Summary of 2021 Report 2018 Maternal Morbidity and Mortality Report On October 18, 2018, IDPH released Illinois' first Maternal Morbidity and Mortality Report. 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. [15] Smoking can impede the development of the lungs and brain and lead to preterm deliveries or sudden infant death syndrome. Pregnancy Justice. When drug use is diagnosed or suspected, Illinois requires healthcare workers to report it. Resource lists for women and their families are available inAppendix Aof the report. In Alabama and South Carolina, high courts have interpreted existing child endangerment and chemical endangerment statutes to allow prosecution of drug-using pregnant women and new mothers. SYNOPSIS AS INTRODUCED: . In the days leading up to their placement with a foster family, I saw both newborns go through an uncomfortable drug withdrawal. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 Womens Health Issues Off Publ Jacobs Inst Womens Health. 2019;143(3):e20183801. Exciting advances in HIV treatment and prevention make pregnancy a safe possibility for women living with HIV. No one ever informed her of, nor asked her permission for, a drug test. 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. Pregnancy, Law, Abortion, Opioids, Baby, Alcohol, Substance Use Disorder, Neonatal Abstinence Syndrome, Newborn, Addiction, Medicine, Supreme Court, Roe v Wade, Smoking, Medication Assisted Treatment, Safe Harbor, Development, Mother, States, War on Drugs, Pediatrics, OBGYN, Reproductive Ethics, Bioethics. Yes! In 2014, Tennessee's legislature passed a "Fetal Assault Law," which made it possible to prosecute pregnant women for drug use during pregnancy. 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. This would incentivize people to actively seek medical care, restore the patient-physician relationship, and ensure that they take rehabilitation programs seriously. NPR. Laws Pertaining to Pregnant Women Who Use Drugs 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 judicially defined standard of conduct would have to be met. The flu may also be harmful for a pregnant womans developing baby. [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. 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. Unless otherwise noted, you can republish our stories for free if you follow these rules. 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. Those currently serving sentences in prisons and jails can treat their substance use disorder through medication assisted treatment, cognitive behavioral therapy, and programs like Self Taught Empowerment and Pride (STEP). Published in partnership with Columbia University Libraries. Another proactive approach could be to have medical residency programs register with the Drug Enforcement Administration (DEA) as Narcotic Treatment Programs and incorporate suboxone clinics into their education and rotations. Seasonal Influenza Vaccination Resources for Health Professionals: Infection Control in Health Care Facilities: Clinical Description & Lab Diagnosis of Influenza: Seasonal Flu vaccine information/Vaccine Composition: Materials that can be used to educate patients. Health insurance plans should reimburse for telehealth. 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]. Research shows that obtaining prenatal care, staying connected to the health care system, and being able to speak openly with a physician about drug problems helps improve birth outcomes. 1992;267(3):406-408. doi:10.1001/jama.1992.03480030084043, [24] NICHD Neonatal Research Network. Due to mandatory reporting, they were not confident that physicians would protect them from the law. IDPH remains committed to identifying and reviewing maternal deaths and morbidities and will build upon these findings and recommendations over the coming years. J Urban Health Bull N Y Acad Med. Centers for Disease Control and Prevention. The Global Commission on Drug Policy. Published April 11, 2022. https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm, [17] Abuse NI on D. What are the risks of methamphetamine misuse during pregnancy? Alabama and South Carolina have interpreted existing child endangerment and chemical endangerment statues to all prosecution of drug-using pregnant women. On October 18, 2018, IDPH released Illinois firstMaternal Morbidity and Mortality Report. Laws on drug testing of infants and new mothers vary, but the stakes are always high. However, this is not always a feasible option, as the surrounding states (WV, MO, AR, MI, AL, and GA) also have restrictive laws that either prohibit abortions entirely or ban them after six weeks. 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. Women need accurate information about the importance of practicing good oral health habits throughout their lives as well as about the importance and safety of receiving oral health care during pregnancy. Elizabeth Nolan Brown | 4.23.2021 8:30 AM. Newborns' exposure to drugs: Discrepancies in mandatory reporting States handle drug use during pregnancy differently. Women who reported receiving a provider recommendation for and offer of vaccination, are more than twice as likely to be vaccinated compared with women who received only a recommendation but no offer of vaccination, and six times more likely to be vaccinated compared with women who did not receive a recommendation or an offer for vaccination. Text4Baby Training Center: https://partners.text4baby.org/index.php/get-involved-pg/partners/training-center, Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment Monitoring System, Current Maternal Health Projects and Committees, https://www.cdc.gov/flu/protect/keyfacts.htm, https://www.cdc.gov/flu/protect/vaccine/qa_vacpregnant.htm, https://www.vaccines.gov/who_and_when/pregnant/index.html, https://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html, https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/index.html, http://immunizationforwomen.org/providers/resources/acog-resources/default.php, http://www.midwife.org/Immunization-Resources-for-Providers, https://www.cdc.gov/flu/professionals/antivirals/avrec_ob.htm, https://www.cdc.gov/flu/professionals/vaccination/, https://www.cdc.gov/flu/professionals/infectioncontrol/index.htm, https://www.cdc.gov/flu/professionals/diagnosis/index.htm, https://www.cdc.gov/flu/resource-center/freeresources/index.htm, https://www.cdc.gov/flu/professionals/training/index.htm, https://www.cdc.gov/flu/weekly/fluactivitysurv.htm, https://www.cdc.gov/vaccines/hcp/admin/storage/index.html, https://www.cdc.gov/flu/about/qa/flushot.htm, https://www.cdc.gov/vaccines/ed/patient-ed.html, https://partners.text4baby.org/index.php/get-involved-pg/partners/training-center, Tips for Good Oral Health During Pregnancy, Two Healthy Smiles: Tips to Keep You and Your Baby Healthy, National Maternal & Child Oral Health Resource Center, Resource Highlights: Oral Health During Pregnancy, 2018 Illinois Maternal Morbidity and Mortality Report, Infographic - Overcoming Breastfeeding Challenges, Grant Accountability and Transparency (GATA), receive health care before, during, and after pregnancy and childbirth, receive care for her and her infant that is consistent with generally accepted medical standards, choose a certified nurse midwife or physician as her maternity care professional, choose her birth setting from the full range of birthing options available in her community, leave her maternity care professional and select another if she becomes dissatisfied with her care, receive information about the names of those health care professionals involved in her care, receive information concerning her condition and proposed treatment, be informed if her caregivers wish to enroll her or her infant in a research study, receive information in a language in which she can communicate, receive emotional and physical support during labor and birth, freedom of movement during labor and to give birth in the position of her choice, decide collaboratively with caregivers when she and her baby will leave the birth site for home, be treated with respect at all times before, during, and after pregnancy by her health care professionals, examine and receive a reasonable explanation of her total bill for services. Tennessee is the only state with a statute that specifically makes it a crime to use drugs while pregnant. 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. Introduced 9/3/2021, by Rep. Bob Morgan - Kambium Buckner - Kelly M. Cassidy . . Incidence and Costs of Neonatal Abstinence Syndrome Among Infants with Medicaid: 20042014. There can be no significant change if society continues to view those with substance use disorders as underserving of care. I predict that the increase in opioid and polysubstance use during the pandemic will increase the number of newborns with neonatal abstinence syndrome, thereby significantly increasing the public burden and cost. 1 in 3 women died during the first 2 months postpartum, 1 in 3 women died 2 or more months postpartum. NAS can lead to long-term health and developmental problems such as hearing and vision problems and issues with learning and behavior. 2023, February 15. Illinois state law does not prohibit drug testing. The court of Kane County found the respondent to be an unfit parent and sought to terminate her parental rights to her son when her son was born with cocaine in his system. Creative Commons Attribution 4.0 International License, Voices in Bioethics Podcast (columbia.edu), Creative Commons "Attribution" (CC-BY) License. Punitive policies push pregnant women away from receiving healthcare and prevent them from receiving beneficial interventions. Emphasizing public health measures and adequate medical care can prevent complications and developmental issues in newborns and pregnant women with substance use disorders. Marijuana is the most widely used illegal drug during pregnancy in the U.S., and marijuana use is on the rise among all adult age groups, both sexes, and pregnant women.. This work is licensed under a Creative Commons Attribution 4.0 International License. Universal testing will generate more positive results that require follow-up by the laboratories and patient care teams, as well as may increase referrals to social services and play an increased burden on governmental agencies for relatively low-risk mothers. [17] Opioid use, such as oxycodone, morphine, fentanyl, and heroin, may result in neonatal opioid withdrawal syndrome, in which a newborn may exhibit tremors, irritability, sleeping problems, poor feeding, loose stools, and increased sweating within 72 hours of life. Black women were more likely to die from pregnancy-related medical conditions. 2011;22(2):87-94. doi:10.1016/j.drugpo.2011.02.002, [8] Global Commission on Drug Policy, 2011, [9] Women NA for P. Tennessees Fetal Assault Law: Understanding its impact on marginalized women - New York. By what objective standard could a jury be guided in determining whether a pregnant woman did all that was necessary in order not to breach a legal duty to not interfere with her fetus' separate and independent right to be born whole?". doi:10.1542/peds.2018-3801, [20] Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Due to hormone fluctuations during pregnancy, Oral health during pregnancy is important! Laws about pregnant women and substance abuse questioned Published May 3, 2010. https://www.npr.org/templates/story/story.php?storyId=126478643, [29] Miranda L, Dixon V, September CRP on, 30, 2015. An exception to this is in cases where the mother's life is at risk. 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. National Partnership for Women and Families. The Wisconsin law is especially draconian: A woman can be detained against her will for the duration of her pregnancy, her fetus has its own court-appointed lawyer, she can lose custody of her baby after birth and the proceedings are mostly secret. The Illinois Department of Public Health supports two Maternal Mortality Review Committees, which: Reviews deaths suspected to be medically related to pregnancy. Reviews deaths resulting from homicide, suicide, or drug overdose. Avoid close contact with those who are sick, Avoid touching your eyes, nose or mouthafter you have touched objects that could possibly be contaminated, Clean/disinfect frequently touched surfacesat home, school or work, especially when someone is ill, Eat nutritious foods and drink plenty of fluids. There are ways you and your partner can prevent passing HIV to one another or to your baby. Drug testing pregnant people is a form of medical racism. The Department is excited to announce the launch of a new PrEP Medication Assistance Program. As always,Voices in Bioethics will publish works by leaders in the bioethics field as well as those with perspectives from fields outside of medical ethics and outside the sciences. Their newborns can be taken from them. For example, vouchers for groceries or enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may offset financial burdens and allow a mother to focus on taking care of her child and her recovery. Neurotoxicol Teratol. Risk-based testing may also miss infants exposed to drugs if the policies do not adequately identify and test for probable exposures. . Please try reloading page. 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. Breastfeed Med Off J Acad Breastfeed Med. The two Maternal Mortality Review Committees reviewed 129 maternal deaths that occurred during 2016-2017 to develop the recommendations in the report. Many of these deaths can be avoided, as medical interventions are well known. Here is a survey of state laws. 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. Pediatrics. The results of the investigation determine whether the baby is taken permanently. The report identifies statewide trends in maternal deaths and provides recommendations to help prevent maternal mortality. April 14, 2023. 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. Furthermore, cognitive behavioral therapy can help to identify triggers and teach healthier coping mechanisms to prepare for stressors outside of jail. Those efforts continue under a wide variety of laws even in states where high courts have previously rejected the prosecution approach. A woman can be found guilty of child abuse or neglect in Illinois if the child's blood, urine, or meconium tests positive for drugs at birth. 2012;7:269-274. doi:10.1089/bfm.2011.0096, [37] Pedersen CA, Smedley KL, Leserman J, et al. Access to medical care before, during, and after childbirth is essential to the health and well being of each mother. For more information on antivirals for pregnant and postpartum patients, please visit the CDC: https://www.cdc.gov/flu/professionals/antivirals/avrec_ob.htm. Newborn Drug Screening - Meconium and Umbilical Cord Tissue Neonatal exposure to some drugs during pregnancy can have harmful effects on development and may lead to acute adverse events, including neonatal abstinence syndrome (NAS) and infant mortality. J Addict Med. J Addict Med. The Illinois Perinatal Quality Collaborative is planning a Birth Equity Initiative for birthing hospitals to address bias, racism, and social factors influencing maternal health. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy.