Mass General Brigham in Boston, one of the most highly respected hospital systems in the country, announced changes to its perinatal reporting policy in April as part of a broader effort to eliminate practices that might “unwittingly perpetuate structural racism.” Provided the baby isn’t in imminent danger, Mass General will now conduct toxicology testing only with written consent from the pregnant patient and will only report positive results to child welfare authorities if clinicians determine the baby is suffering or in imminent danger. Similar changes are happening within other states and hospital systems, which have updated their policies on drug testing for pregnant women and newborns, aiming to better support patients’ treatment and recovery from substance use disorder and combat racial disparities in testing and reporting, Stateline reports. One impetus for the shift is research showing that Black pregnant women are more likely to be drug tested and long-standing disparities in how Black and Indigenous families are treated by child-welfare agencies.
Under federal law, medical professionals must notify child protective agencies when an infant has been affected by the mother’s substance use, including alcohol use. But federal law doesn’t define “affected,” and testing and reporting policies vary from state to state and even from hospital to hospital. The federal rules, which were updated in 2016 in response to the opioid epidemic, also emphasize that substance abuse on its own doesn’t constitute child abuse. Instead, states are required to develop their own “plans of safe care” to promote the long-term health of the newborn and the mother. But hospitals and clinicians are often confused about their own state laws, said Joelle Puccio, director of education at the Academy of Perinatal Harm Reduction, which provides information to pregnant women and parents who use drugs. “What actually happens is always more punitive, more surveillance than what is actually required by the law, and it always falls more heavily on Indigenous, Black and other families of color,” said Puccio, who has worked as a registered nurse in perinatal and neonatal intensive care for two decades.
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