Imagine that you’re a person working in the healthcare profession…perhaps a nurse or a doctor. And think about what caused you to go to school for all those extra years. Was it the desire to have lots of student debt? Maybe it was working all those hours, especially on weekends and holidays… Or perhaps it was the toll on your social life? Or, maybe, just maybe, it was the desire to help others.
Now consider that you’re working with a difficult population…those who suffer from the disease of addiction. This isn’t a huge leap since about 17% of the population suffers from a substance use disorder (SUD) (SAMHSA). That means that only serving those without SUDs is virtually impossible, despite what the presenting condition is. That is, someone can have diabetes AND an alcohol use disorder, or someone can have a broken bone AND a cocaine use disorder. And they do.
Now think about what being a mandatory reporter means. In Wisconsin, where I live:
“Wisconsin law (48.981(2)) requires that any mandated reporter who has reasonable cause to suspect that a child seen by the person in the course of professional duties has been abused or neglected, or who has reason to believe that a child seen by the person in the course of professional duties has been threatened with abuse or neglect and that abuse or neglect of the child will occur, make a report to county CPS or law enforcement.
“In addition, Wisconsin law (175.32) requires that any mandated reporter who believes in good faith, based on a threat made by an individual seen in the course of professional duties regarding violence in or targeted at a school, that there is a serious and imminent threat to the health or safety of a student or school employee or the public, make a report to law enforcement” (DCF).
And there’s a LONG list of who is mandated to report, which includes physicians, nurses, social workers, therapists, teachers…and on and on. Reporting protects children from additional abuse, which is needed and valued. But what happens when it doesn’t?
When a person is pregnant AND addicted, and a doctor is a mandated reporter, what might happen to the baby before birth? If someone feels as though she’s at risk of having her newborn taken away due to her prenatal substance use, is she absolutely going to get good prenatal care? Unlikely. So, we aren’t really saving THAT baby from future harm, are we?
But what is “prenatal substance use”? Is it medications prescribed by doctors? It may be, as you can read about in my previous blog: https://guidedbyguida.guide/2024/10/03/when-medication-becomes-a-hammer/
Is it cannabis that doctors are suggesting is safe to use and that it reduces morning sickness? Spoiler alert: it does NOT; it actually increases morning sickness, at least according to one study (PubMed).
Is it that other drug, that LEGAL one…alcohol…that then must be safe because society has decided that “legal” equates to “safe”? No, can’t be that one since we know that prenatal alcohol exposure (PAE) is the number one cause of intellectual disability in the United States (DFPS).
And if we believe that addiction is a disease…as we say we do…why are we reporting someone for having that disease? Do doctors and nurses report pregnant women who have lung cancer, since lung cancer could be caused by smoking? What about skin cancer due to tanning? What about stomach or colorectal cancers caused by grilled meat? What about diabetes because mom is eating too many carbs? Ridiculous, right? RIGHT.
But that’s exactly how we address substance use disorders during pregnancy.
Unless we don’t.
Many states don’t have good protocols for testing for substances or they don’t use good testing, relying instead on mom’s urine when baby’s umbilical cord tissue provides so much more robust information in giving baby a head start to health! You can learn more about that at USDTL.com. Too many states decide not to test except when the outcome seems evident, but even then, what are they testing for? We know that cannabis and alcohol are damaging to the developing fetus, but the rub is that these drugs are (mostly) legal, and testing is often for illicit drugs only.
Bottom line, let’s test all babies using umbilical cord tissue. Then we can provide care to those babies who have positive tests – and their moms – making sure they have all the resources they need to prevent future abuse. Because THAT’s how we should be treating diseases, especially one without a cure but with treatment that does work.
Resources
https://dcf.wisconsin.gov/cps/mandatedreporters
https://pubmed.ncbi.nlm.nih.gov/37778699/
https://www.samhsa.gov/newsroom/press-announcements/20231113/hhs-samhsa-release-2022-nsduh-data
Guided by Guida 
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