Why You Might Be Drug Tested During Labor
“I just need you to sign this, saying that you understand that we will be testing your urine for all medications,” I say, handing the urine specimen cup to my patient who has come in to the hospital.
She looks up at me, confusion in her eyes, but quickly nods her assent.
“Ok, sure,” she mumbles, marking her initials on the cup with a shaky hand.
I initial next to hers and wait while she produces a sample (standard drug testing protocol, right?) and then donning some gloves, quickly seal the specimen up in a bag to be sent down to the lab for testing.
No, I'm not some drug marshall on an addiction floor of the hospital; I'm on the labor and delivery ward.
Drug testing on all women who come in to have a baby is becoming more standard in the labor and delivery ward. For example, at the hospital I worked at, administrators bounced back and forth on what the proper policy of drug testing should be–should they only test at-risk mothers? Should they tell women about it? Could women refuse the drug test?
In the end, it was decided that the right and ethical thing to do was to drug test all women upon admission and to have them sign for complete disclosure, due to the nature of the testing. Although I was surprised that there wasn't more outrage over the testing, most women simply complied without a word.
And the testing definitely brought up results–women you would never guess were using drugs were able to be counseled, and in some rare cases, had their children removed from them after being evaluated by Protective Services.
And although the policy may sound easy enough–test all, no questions asked–it also brings up some ethical concerns, like do women have the right to refuse? What happens if they refuse the test? And what about false positives? (Drug screens are notorious for false positives.)
Myself, I definitely take some offense to the test. Why should my insurance money go to pay for drug testing when I'm not on drugs? And if something as simple as Sudafed could trigger a positive result, warranting an automatic refer all to CPS, could a mother be flagged unfairly forever as an unfit mother?
Currently, the American College of Obstetricians and Gynecologists — although it states that at least 4% of pregnant women report illicit drug use (the number is even higher among teenaged mothers) — does not have an official policy for universal screening for drug use. In fact, despite the staggering cost of this abuse, a number in the billions, it reports several obstacles that prevent tackling the issue of drug use in pregnancy, such as doctors who don't know the rules about reporting the abuse or getting referrals for treatment.
The ACOG recommends that all women receive a verbal or written screening, basically with a nurse or doctor asking them about their drug and drinking habits, but cautions against routine urine screening, stating that “urine drug testing is an adjunct to detect or confirm suspected substance use, but should be performed only with the patient’s consent and in compliance with state laws. Pregnant women must be informed of the potential ramifications of a positive test result, including any mandatory reporting requirements.”
Did you have to have drug testing during your labor?