US hospitals give drugs to women in labor, then report them to child protective services

In US hospitals, women in labor and babies are tested for drugs, and if the result is positive, it is automatically reported to child protection authorities. However, patients can receive strong drugs during labor from the hands of medical personnel. And then child protection authorities make them out to be "drug addicts" and threaten to take away their children, writes USA Today.

Photo: IStock

Mothers interviewed described being given drugs that are commonly used to relieve pain or in epidurals, to reduce anxiety, or to control blood pressure during a caesarean section.

"Drug Addicts" Against Their Will

Amairani Salinas was pregnant with her fourth child in 2023. At 32 weeks pregnant, doctors at a Texas hospital discovered her baby’s heart wasn’t beating. Preparing the woman for an emergency C-section, they gave her midazolam and a benzodiazepine, a drug commonly used to sedate patients. A day later, the grieving mother was holding her stillborn daughter when a social worker walked into her room to deliver another devastating blow: Salinas had been reported to child protective services. A drug test revealed traces of the benzodiazepine — the same drug staff had given her before taking her into surgery.

Morphine was found in Victoria Villanueva’s first child. Villanueva arrived at an Indiana hospital at 41 weeks to have labor induced. Doctors gave her drugs to ease the pain of contractions. A day later, a social worker told the new mother that the baby’s meconium (first bowel movement) had tested positive for opiates. Now, instead of nursing her baby, Villanueva was shaking with fear that her newborn would be taken away. “I didn’t even know what to do,” she said.

On the subject: Californian Woman Almost Died After Catholic Hospital Refused to Perform Emergency Abortion

What happened to Salinas and Villanueva is far from isolated. Across the country, hospitals are giving certain drugs to women in labor and then reporting them to child welfare authorities when they test positive for drugs, according to an investigation by The Marshall Project and Revea, two independent investigative journalism organizations.

The positive tests are caused by drugs that are prescribed to millions of women in labor each year in the United States. These drugs include morphine or fentanyl for epidurals, anti-anxiety drugs and two blood pressure medications given during C-sections.

During the period of increased surveillance of pregnant women that began after the Roe v. Wade decision (the case that legalized abortion at the federal level. — Approx. Ed.) hospital reports have led to calls to the police and even the removal of children from their parents.

The investigation into this story involved interviews with two dozen patients and health care workers and reviewing hundreds of pages of medical and court records. Some spoke on condition of anonymity because child custody was at stake.

In New York, for example, a drug-free mother lost custody of her children, including her newborn, for five months after testing positive for fentanyl. The woman had been given an epidural. In Oklahoma, when a mother tested positive for meth, sheriff's deputies took her newborn and three other children away. They were kept in foster care for 11 days until a confirmatory test showed that the heartburn medication the hospital had given the patient was the culprit.

By the time Victoria Villanueva was hospitalized in 2017, researchers and doctors had known for years that drugs could easily pass from mother to newborn, causing positive drug tests. Two tests Villanueva took during prenatal visits and another just before she gave birth showed there were no drugs in her system. The morphine she had been given during labor was documented in her medical records. But staffers reported her to the state child protection agency anyway, hospital records show.

Marion General Hospital in Indiana did not respond to requests for comment. Brian Heinemann, a spokesman for the Indiana Department of Children's Services, also declined to comment on Villanueva's case but said the policy had since changed. Drug test results will no longer be used as evidence in child abuse or neglect cases.

Formal approach

Kimberly Walton, a spokeswoman for the Texas health system, declined to answer questions about Salinas' case but said doctors order drug tests if there are concerns about a patient's health and that they are required to "report suspicions."

Hospital drug testing of pregnant women, which began in the 1980s and expanded rapidly during the opioid epidemic, was intended in part to help identify babies who might be experiencing withdrawal symptoms and need additional medical care. Federal law requires hospitals to notify child protective services about such babies. But previous investigations by The Marshall Project and Reveal found that the relatively inexpensive urine tests favored by many hospitals produce false positives and can be misinterpreted. And hospitals themselves have not implemented policies to protect patients from such errors.

In some cases studied by The Marshall Project, doctors and social workers failed to check patients’ medications to find the cause of a positive test. In other cases, providers suspected that a drug they prescribed might be the culprit in a positive test, but reported the patients to authorities anyway.

“Our patients are going to be harmed until we get our act together,” said Dr. Davida Schiff, whose Mass General Brigham hospital chain in New England implemented a new policy this year requiring providers to conduct drug tests on patients with their consent only when medically necessary. The new policy has stopped hospital staff from automatically reporting test results.

A 2022 study at Massachusetts General Hospital found that 91% of women who received fentanyl in an epidural later tested positive for the drug. Other studies have confirmed that mothers can quickly pass the drugs to their babies. A positive drug test in a child “cannot and should not be used to detect fentanyl abuse in mothers,” said Athena Petrides, who conducted the study at Brigham and Women’s Hospital in Boston.

Despite these warnings, hospitals often have no rules requiring providers to check patients’ records to see what drugs they have received before reporting them to authorities. Mandatory reporting laws protect doctors from liability for reports made “in good faith,” even if they turn out to be inaccurate. And toxicologists and doctors say many professionals lack the time and expertise needed to properly interpret drug test results.

“It’s not something that’s typically taught in medical school or even residency,” said Dr. Tricia Wright, an obstetrician-gynecologist and professor at the University of California, San Francisco Medical Center who specializes in substance use disorders during pregnancy. “It’s all up to the people who interpret it.”

Wright helped change the policy at her hospital so that it no longer tests patients for drugs unless it is medically necessary.

In many hospitals, social workers who are responsible for liaising with child welfare agencies are the ones most likely to look into drug test results. Some facilities require social workers to automatically report any positive test, while other facilities first conduct an assessment to determine whether a parent may pose a risk to a child.

But hospital social workers are often overwhelmed, says Kylie Haynes, who runs a program for pregnant women who have used opioids at Vanderbilt University Medical Center. Social workers are typically less trained than doctors and have little understanding of why tests are positive.

"We're not health care providers," said Haynes, herself a licensed social worker. "We can't interpret drug tests."

The timing of tests can also complicate their interpretation. In theory, the best time to collect a urine sample for drug testing is when a patient arrives at the hospital, before they receive medications. But maternity hospitals typically test urine samples taken from a mother’s catheter bag or request a urine sample after the medications have been administered, providers said.

Newborn drug tests complicate matters. While urine tests on the mother can detect potential drug use within days, testing the baby's meconium can detect illicit substances used months ago. Meconium tests are considered the gold standard for newborn drug screening because they can indicate potential drug use early in pregnancy, a possible sign of addiction.

But in some cases, there is no way to determine whether a baby's positive test was caused by a hospital-issued drug or a substance the mother had previously used. Additionally, such tests do not tell providers how much or how often a person has used drugs. For example, if a patient had used drugs in the past but stopped when she realized she was pregnant.

Drugs like morphine and fentanyl led to some patients being suspected of using opioids. Ephedrine and phenylephrine, drugs for low blood pressure commonly given during C-sections, produced false positives for methamphetamine. The Marshall Project also found that women were questioned about positive drug tests after hospitals gave them sedatives like benzodiazepines or barbiturates.

Preying on women in labor instead of protecting children from real dangers

When women test positive for drugs, other aspects of their lives can quickly come under suspicion. Medical conditions or birth complications that could be linked to addiction, such as high blood pressure, placental separation before birth, or preterm labor, are sometimes mistakenly viewed as further evidence that a pregnant patient has been using drugs. Through the lens of a positive drug test, even something as innocuous as missing some prenatal appointments becomes potential evidence that a mother poses a risk to her baby.

In 2023, Salinas was still grieving over her stillborn baby when she learned she would be reported to child protective services. Salinas didn’t know the hospital had given her a benzodiazepine, and she denied taking the drug. She also tested positive for Delta-9, a legal cannabis-derived product she said she bought at a grocery store. (Delta-9 is a legal form of tetrahydracannabinol (THC) derived from industrial hemp that has low levels of psychoactive compounds, but can produce marijuana-like effects in sufficient doses. It’s added to gum, candy, and other products legally sold in stores.) But Salinas soon found herself embroiled in a months-long investigation. She was depressed but still caring for her children.

"I have three other living children. They need to eat. They need to get up for school. They need their mother," Salinas said every time.

Officials closed the case about four months later as “baseless.” But it wasn’t until a year later that Salinas reviewed her medical records with a Marshall Project reporter and discovered the reason for her positive test.

Salinas wondered why child protective services workers weren't spending their time investigating allegations of actual child abuse. "Why are you focusing on good mothers and ignoring cases where children may actually be in danger?"

In recent years, research has shown that drug tests aren’t necessarily the best way to identify someone with a problem—a simple screening questionnaire is just as effective. Leading medical groups advise hospitals to use questionnaires instead of blanket drug tests. But drug testing of women in labor remains common. In at least 27 states, hospitals are required by law to notify child welfare authorities of a positive test. But in no state are health care facilities required to confirm test results before reporting them. Hospitals routinely contact authorities without ordering confirmatory tests or waiting for results.

In 2022 alone, more than 35 babies were reported to child protection authorities without any guarantee that the test results were accurate.

The consequences of a faulty drug test can be especially serious for people with a history of drug addiction. They are unlikely to be believed if they claim that a positive test was caused by a hospital drug.

Lisa Grisham, a nurse in Arizona, recalled the case of a patient in recovery for opioid use disorder who tested positive for fentanyl. The woman insisted that a nurse had given her the drug during labor, even though it was not listed in her hospital records. Grisham, who works at Banner University Medical Center in Tucson as the director of the hospital’s drug-exposed infant program, took over the investigation and eventually tracked down the nurse, who corroborated the patient’s account.

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Victoria Villanueva was just 18 years old, newly married and the mother of her first child. As a child, she had been taught to be honest with medical professionals. So during her hospitalization, Victoria told a nurse that when she was 15, she had experimented a little with drugs like marijuana and acid. But she says she hasn’t used drugs since then.

When she was admitted to the hospital, Villanueva took a drug test, which came back negative. She was then given a drug to induce labor, and contractions began. They were very painful, Villanueva noted. She was relieved when a nurse told her she would be given morphine.

The day after the birth, an investigator from the Indiana Department of Child Services arrived. The hospital told the agency about the mother’s “drug history.” Villanueva was confident that her hospital records would prove she had taken morphine, and she was right. The drug test results even read, “Medications taken during labor may be detected in meconium.”

But even after investigators obtained the hospital records, the young mother said, the agency required her to undergo additional drug tests and allow them to search her home. It was weeks before the case was closed.

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