Around 20% of pregnant people engage in substance use in the U.S. [1] Substance use during pregnancy can cause adverse effects for the fetus, and once born, they can exhibit withdrawal symptoms. [2] If a newborn tests positive for drugs, the consequences can be severe, with family separation and termination of parental rights. [3][4]
Why newborns are drug tested
Newborns are drug tested if there is concern that they might have been exposed to illicit substances during the pregnancy. [2] Individual policies and procedures for newborn drug testing vary between hospitals. [2] Some examples of scenarios that might trigger newborn drug testing include: [2]
- Known maternal substance use.
- No prenatal care.
- Signs of possible withdrawal or unexplained behavioural changes in the newborn.
There is often a discrepancy between self-reporting of substance use and positive drug tests. [5] Neonatal drug testing helps to establish what substances the newborn has been exposed to during pregnancy. These results allow informed medical and legal decisions to be made about the newborn’s ongoing care. [5]
The federal framework: CAPTA and Plans of Safe Care
The Child Abuse Prevention and Treatment Act (CAPTA) is the key federal legislation around newborn drug testing. [6] CAPTA was updated in 2016 and includes the Plan of Safe Care (POSC), which ensures the well-being of infants affected by substance misuse. [6]
Following a positive newborn drug test or if an infant is affected by substance use, such as showing withdrawal symptoms, healthcare providers are required to notify Child Protective Services (CPS). [6] A caseworker will then make a thorough assessment of the infant and family, helping to determine if any maltreatment has happened and what follow-up action is required. [6]
How state laws and hospital policies differ
Newborn drug testing varies considerably across state legal systems and hospital policies. State policies vary from criminalization to public health emphasis. For example, Tennessee criminalizes drug use during pregnancy, while Alabama and South Carolina permit prosecution under existing child endangerment laws. [7] In contrast, some states, including Michigan and Kentucky, do not prosecute drug use in pregnant people and focus more on child welfare and public health approaches. [7]
Hospitals typically use either universal or risk-based testing. Universal screening tests all newborns for drugs, whereas risk-based testing screens only those who meet specific criteria. Universal screening helps to prevent biased protocols, but at an increased cost. Risk-based testing is more common, but it opens the door to prejudice, with Black mothers and newborns being significantly more likely to be subjected to drug testing. [3]Â
There have been cases where newborns have been taken away from their parents after testing positive for a prescription medication with a valid use, for example, opioids for chronic pain. [4] This raises significant ethical concerns regarding newborn drug testing.Â
Potential benefits of newborn drug testing
Early detection of prenatal substance exposure with newborn drug testing allows clinicians to make individualized treatment plans and follow-up care for infants. This early intervention can help minimize the short and long-term effects of substance exposure.
Newborns experiencing withdrawal may require specialized care, so identifying these individuals can allow the appropriate treatment to be initiated sooner. Drug testing can also help identify those who might otherwise be missed, as maternal drug-use disclosure is often unreliable. [2]Â
Risks, harms, and equity concerns
There are several possible risks and harms associated with newborn drug testing. Positive results could occur due to taking prescription or other legitimate medications, which on occasion could even be drugs that were given in labour. [4][7] As mentioned, the data shows a clear inequity with newborn drug testing, with Black families being disproportionately affected. [3]Â
Given that families could be separated based on these results, this is very concerning. As a result, the fear of drug testing is a big deterrent for people engaging in prenatal care, which can have other consequences for the pregnancy. [2]
Consent, rights, and what parents can expect
Despite the importance of newborn drug testing, there are still important ethical considerations. [8] Informed consent remains inconsistent across hospitals and is a controversial topic. Newborn drug testing can sometimes occur without their parents' knowledge or consent if there is sufficient concern from medical professionals, although every effort should be made to gain consent. [9] This can cause parents to feel blindsided by medical professionals, leading to distrust.
Parents should know that medical professionals may want to conduct a drug test for a variety of reasons, and it does not mean they think you are a bad parent. The drug test can be performed on different samples, including the umbilical cord, meconium, or urine. [5]
A positive drug test generally triggers a mandatory report to CPS, which can lead to investigations and potential family separation. Testing results and subsequent reports become part of official records that may affect custody decisions. While parents do generally have the right to refuse a newborn drug test, this is likely to lead to legal action depending on state law.
If you're pregnant and using substances
If you're pregnant and struggling with substance use, seeking help is crucial for both you and your baby’s health. Mothers who wish to stop using substances during pregnancy will require medical assistance to help minimize health risks to themselves and their baby. Many programs offer specialized services for pregnant women, providing individualized treatment plans to help increase the chance of a successful recovery. It's recommended to reach out to a medical or mental health professional as soon as you’re able.Â
Moving toward compassionate policy
There are calls to reform newborn drug testing policies to emphasize treatment over punishment, particularly in view of families being separated unjustly. [4] Current policies are fuelling stigma around substance use in pregnancy, and might be preventing people from accessing the help they need. Policy changes are required to ensure health equity for Black families and eliminate CPS reporting when no concern for child abuse and neglect exists.
