We know the government is here to help, but the unintended consequences of the Child Abuse Prevention and Treatment Act (CAPTA) may make it one of the lousiest pieces of legislation ever passed – and amended and amended again. It’s like we’re trying to polish a turd.
We know that drug testing is rife with racial bias. Far too many pregnant people of color are tested, despite the majority of drug (including alcohol, of course) users being white. In an effort to help the neonates born to those individuals who have substance use disorders, CAPTA developed some guidelines.
“CAPTA requires states to have policies to identify substance-exposed infants (SEI). Specifically, CAPTA requires that health providers notify Children’s Protective Services (CPS) of all infants identified as affected by substance abuse, withdrawal symptoms resulting from prenatal drug exposure, or a fetal alcohol spectrum disorder (ACF, 2023). While CAPTA does not require states to investigate every report of substance exposure at birth, thirty-seven states and the District of Columbia require clinicians to report prenatal drug use, and forty-three jurisdictions include prenatal substance exposure as part of their definition of maltreatment (Mathematica, 2023). […]
“While CAPTA does not require reporting for substance-exposed infants [SEI], there exists wide variation in how states respond to positive newborn tests. For example, any positive drug test for alcohol or drugs is automatically considered child abuse in Alabama, while withdrawal symptoms or fetal alcohol spectrum disorder are required for California’s definition of substance exposure (Gateway, 2020). Findings from the current study provide compelling evidence that CPS involvement is unnecessary for newborns in which the only concern is a prenatal cannabis exposure as evidenced by a positive newborn test for THC.” (Science S0145213424005684)
I’m not going to pretend to know what the fifty states’ policies are, but I do know that there are likely about fifty different ones. Add to that fact that each and every hospital system also has its own policy about testing, and imagine the number of policies we’d need to wade through.
So CAPTA decided there has to be a way to IDENTIFY substance-exposed infants. And states decide what HAPPENS with that information. And healthcare systems decide how that information is GATHERED. Sure. What could go wrong?
Let me elucidate: if a single hospital’s means of gathering information is simply ASKING a pregnant person if she has used during pregnancy, it’s considerably unlikely that the information will be correct. Studies have shown that simply asking is inaccurate in up to 60% of cases (PMC4713294; Science S089085672300045X). Hospitals decide that testing should happen when a specific set of circumstances occur, those may be a combination of the following, as well as other considerations: lack of prenatal care, history of maternal drug use or agitated/altered mental status in mother; unexplained placental abruption or central nervous system complications in the newborn; symptoms of drug withdrawal in the newborn or other changes in behavioral state (PMC3139193).
That means that if a pregnant person who received prenatal care presents for a birth while not actively impaired and experiences a birth without any special circumstances, no testing is likely to occur. HOWEVER, according to MomBaby.org, “It is estimated that 20% of pregnant women use illicit drugs during pregnancy.” But what about licit drugs, you ask. Yeah, what about them? SO MANY neonates are being underserved because universal testing isn’t occurring.
Unless the proper protocols are used, the information gathered is pointless. Garbage in; garbage out.
Which brings me to the final point: Unless the proper tests are used, the information gathered is also pointless. More garbage in; more garbage out.
Legal doesn’t equate to safe, especially for babies in utero. Prenatal exposure to alcohol is the leading preventable cause of mental retardation in the US. Similarly, prenatal exposure to cannabis has been proven to have dire consequences on the neonate. But many hospital policies don’t test for licit drugs. And even if they did, the test being used isn’t sufficient. Meconium testing is rife with complications. Urine testing – on either the mom or neonate – doesn’t provide a complete picture since alcohol, especially, clears the system so quickly.
Please take heed: universal umbilical cord tissue testing would give neonates the best leg up at birth, and isn’t that what we want for them?
References
https://pmc.ncbi.nlm.nih.gov/articles/PMC3139193/
https://pmc.ncbi.nlm.nih.gov/articles/PMC4713294/
https://www.sciencedirect.com/science/article/pii/S089085672300045X
https://www.sciencedirect.com/science/article/abs/pii/S0145213424005684
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