I know nothing about medical law, but I hope they can do something like this. They essentially treated her like a criminal and clearly caused a lot of emotional damage.
That's the point exactly. What a weirdly unsatisfying ending. All this emotional trauma over a false positive.
It also really underscores an extremely critical question with society: When the system is inflexible, and uncaring, what recourse do you have when it fails you? Imagine the hopelessness, the bleak future, of the world turning its back on you because of a mistake. I can only imagine this is what it's like to be falsely convicted of a crime... or failing a drug test that you shouldn't have failed.
I think there's even a lesson for us technical folks here: When the systems we design are too automated, and too rigid, we are removing all compassion. Now if the system is "perfect" there's no problem, but even Google hasn't been able to completely perfect their systems. People still become the victim of false DMCA takedowns, etc.
I guess at the end of the day, the moral is to "Remember the person."
Here's the thing, it isn't just automated systems. Large institutions do the same thing. People have less and less of the full picture and act more and more as a component of the system.
In this case it appears that the social worker had enough of the full picture to inject some measure of sanity, but I really wonder if the nurses understood the statistics related to the tests well enough to treat her like shit over them.
No I'm not. Honestly I'm astonished that people are calling for a lawsuit. What happened? Some nurses gave her a disapproving look? Someone made an appointment with cps that was later cancelled? So what? I'd be more sympathetic if CPS actually took the child away, but they didn't. The hospital clearly acted unprofessionally, but that is hardly grounds for a lawsuit.
1. High levels of cortisol (stress hormone) are known to affect development.
2. Mother-child bonding is facilitated by the oxytocin rush at delivery and was probably disrupted by the aggressive response of the "care" providers.
3. A cascade of hormonal shifts at delivery probably make women much more susceptible to emotional stressors.
4. Care providers that cannot do math (e.g., understand a false positive rate or mg per kg of a drug) should be held liable so that the system can correct.
5. Class action lawsuits are often successful with much less clarity of harm.
Are you making an argument that distress and psychological harm aren't a form of "damage"? They added some fairly traumatic experiences to an already stressful time in these peoples' lives without sufficient cause. You're trying to say that the little things (glances, the temporary threat of CPS taking away the newborn, being told more than once not to breastfeed your child, being described as a "combative patient" just for doing what's best for the child) don't add up to a big thing. I don't think you understand the stresses involved in this situation.
Maybe a lawsuit is going too far, especially if this incident isn't in some permanent CPS record. But if it is, the hospital has them set up for some serious problems down the road.
From the sounds of it, the reason people are calling for a lawsuit is the typical War On Drugs approach: Without reasonable suspicion, they did a field test (known to be faulty). Without probable cause or any corroborating evidence, they falsely accused her of a crime. They then treated her as guilty until proven innocent (which violates our social standards of morality). And they topped it off by threatening violence in the form of kidnapping her newborn baby.
That's quite a bit more than merely unprofessional. Something like a stray sarcastic comment or slightly distasteful joke might be unprofessional. This sort of behavior, on the other hand, quite possibly should be illegal and should have consequences.
This has nothing to do with the war on drugs. She wasn't drug tested by a police officer going door-to-door in the hospital. The hospital administered a medical test to determine risks that the newborn would potentially face. You don't need probable cause to administer a medical test. Furthermore, i bet the mother could have refused the drug test with no consequences.
Nonsense. Do you think if instead she had happened to test positive for strep throat, the results would have been the same? It is absolutely about the war on drugs mentality.
Yes, because that would actually be fucking useful.
I almost want to flag this post off the front page due to how goddamned useless that article is. And the thing is? It's actually pretty decently written. It was engaging enough to finish reading it.
Or rather, not finish reading it: there is at least two paragraphs left that have not been published. Was it a lab fuckup? The inhaler (which also indicates a lab fuckup, since they should have looked at her medical records to deal with known false positives)? Is she going to sue for mental distress, malpractice, whatever?
What the hell.
Edit: Oh, and like half the HN community are asthmatics and are on inhalers. Can one of us be whisked off by the government for lab fuckups? Can this go on our permanent record due to their incompetence?
And as for that woman, can she get this expunged off her record? Once you're tagged by CPS, unless you deal with them with a firm hand, they love to fuck up children's lives.
Disclaimer: I grew up in Maine, I've seen repeatedly what CPS has done to families due to their incompetence, I have no reason to think that CPS in other states are any better.
If you're a parent, and you care about your child, treat the CPS like a terrorist threat. Do not talk to them unless you're with your lawyer, do not answer their questions, and teach your child the same. Their job is to make you guilty to justify their budget, not protect children.
Your issue with the article is half the point of the article. All that emotional trauma with a hurried apology and no explanation.
The point is that when "the system" is too uncaring, these are the kinds of consequences. A false positive from a mediocre field test caused this woman no end of grief. The takeaway is that when we, as engineers, design systems, we have to remember edge cases like these, we need to remember the person.
When your automated spam detection system flags an account, are you going to outright lock/delete it with extreme prejudice, or are you going to allow the account owner some recourse, and a chance to explain themselves to a real human?
I think this article highlights some huge problems with systems that have too much confidence in their tests / checks. Definitely a useful story for all of us to know.
> ... when we, as engineers, design systems, we have to remember edge cases like these, we need to remember the person.
Well said.
I'll only add that this concern needs to extend all the way back to the initial decision to start designing a system. Technology can have a large impact on people simply by existing; it's worth taking the time to consider what that impact will be and how it will affect people, even the edge cases.
This is becoming increasingly important as the effects of technology start to reverberate through the foundations of society. This makes the popular attitude of only considering the technology increasingly irresponsible; there is "No Neutral Ground in a Burning World"[1].
No, it isn't a solution. It's also telling that hospital shootings and other violence are on the rise. When hospitals foster an adversarial relationship with their patients they shouldn't be at all surprised that this is what happens.
Then again, this is par for the course in the drug war.
One day I got a call at work from an ex. "What's up?" "You need to come home, we need to talk."
I duly do.
"So I went to the doctor earlier today. Had an issue. They swabbed me and told me I have an STD. So they did a full STD and blood test, we'll see how that goes. In the mean time, who did you cheat on me with?"
"Uh, nobody."
Back and forth, arguing etc. Me insisting I'll go get tested.
Doctor rings back the next day. "Looking again under the scope, not an STD, just a yeast infection."
Relationship relief.
A month later, call from the clinic: "So about this bill for $290 for a full workup and testing, can you pay that today."
No. Not a chance. You not only misread a test, you gave my girlfriend factually inaccurate information that you -knew- was going to be controversial, and on the strength of that told her "if it wasn't you, you really need to get fully tested if you don't know where he's been".
I'm willing to bet that the hospital didn't even provide that information.
Drug tests are not a "magical black box", there's a process that goes on. And they aren't always right. They usually first start off with immunoassay test on the urine which attempts to measure substances in urine through the use of antibodies. These are "okay" tests -- not bad per se, but they are definitely subject to a wide variety of false positives (http://jat.oxfordjournals.org/content/38/7/387.full). The reported false positive rate I can Google is all over the map, but I've seen articles suggesting as high as 10% (http://www.webmd.com/news/20100528/drug-tests-often-trigger-...).
Drug testing uses these first because they are quick and relatively cheap. The gold standard, however, is GCMS testing. Very accurate, but expensive and time consuming. I assume that's the test performed in the article that took three weeks to resolve the false positive to the negative.
Assuming the story as reported is true, I'm a little bit peeved that there was a de facto assumption by the nurses that the test was correct. The meth / amphetamine test in particular seems to be one of the more problematic immunoassays in the literature in that it false-positives with all sorts of prescriptions, along with some non-prescription drugs (http://www.medscape.com/viewarticle/726897_2). 90% correct is not correct enough in my opinion when it comes to messing with people's children by threatening CPS.
They should have had the social worker come and explain things to her (false positives happen, the send away test is far more accurate, we aren't going to come and take your baby)
"Accurate" is too broad a term. The hospital test was likely very accurate, it was just optimized for sensitivity (being sure to catch it if it's there, at the expense of false positives), rather than specificity (being able to have a high degree of confidence that a positive test is true, at the expense of a higher false negative rate).
It is _very_ common in medicine to use a very sensitive test to screen for conditions, and then cross check any positives with a more specific test (which is what should have been done in this case, prior to taking any action).
Q: What do the percentages mean in methamphetamine "d" and "l" isomer test results?
A: In order to help determine whether a methamphetamine positive may be due to an illicit source, it is helpful to determine the percentage of "d" isomer. For example, following an individual's use of Vick's Vapor Inhaler, the expected result would be 100% "l" methamphetamine. However, there is a possibility that trace amounts of "d" isomer may be present in the quantitative analysis. Laboratory guidelines have been established to allow for trace presence of the "d" isomer. If the laboratory report indicates more than 80% "l" methamphetamine, the results are consistent with Vick's Vapor Inhaler use. If the laboratory reports more than 20% "d" methamphetamine present, the result indicates the use of "d" methamphetamine other than the inhaler. Illegally produced methamphetamine and amphetamine may contain mixtures of "d" and "l" isomers. LabCorp recommends use of a medical review officer (MRO) to review all non-negative test results.1
Yeah, the article mentioned that the husband was trying to show them articles talking about inhalers causing false positives but no one cared.
It is a weird situation because on one hand, they should trust the actual tests over the word of someone who has a motive to lie if they were actually on the stubstance. However, on the other hand tests are super inaccurate sometimes and treating people like a criminal before a confirmation is just wrong.
>Yeah, the article mentioned that the husband was trying to show them articles talking about inhalers causing false positives but no one cared.
i'll go on a limp here (as fortunately has never had any even close to such experience) and speculate that may be he should have called a lawyer. Especially considering that in bunch of states it is a crime of endangering child or something like this.
Interestingly, tthe amphetamines were originally developed as anti-asthma and decongestants, and this continued for many decades. Some of the early amphetamine abuse epidemics centered around inhalers; you'd crack them open to take the amphetamine powder, or soak them, or otherwise process them after countermeasures were taken. (See _On Speed: The Many Lives of Amphetamine_.) At least one testing lab says salbutamol will cause false positives: http://www.phamatech.com/pdf/01-24-07%20Cross-Reactivity.pdf
Everybody going into situation with possible drug test should carry a printed copy like just in glove compartment with car insurance to avoid (or at least to clearly understand where it stems from) such "false positive" experience.
I visit my sister at work sometimes, a nurse who looks after drug addled premature babies at a big hospital... it is heart wrenching to see those little people hooked up to morphine lines because they were born addicts to useless parents.
I am sorry she went through that, it is very unfortunate that statistically some tests will come back with false positives. Arguing that they should have treated her different is much like arguing babies should not to be vaccinated because there is a very slight statistical chance they might have a bad reaction.
I don't disagree. Would you tell a disabled parent they're useless? One with MS? Or one with cystic fibrosis? Probably not. Mental illness is no different.
Whether you want to parent, and how much you're able to parent, are completely different states.
I believe that "truly useless" parents are a minority compared to the cohort of parents who have mental illness issues in general.
My mother was an abusive alcoholic who abandoned our family because she couldn't get the help she needed. She wasn't a bad person, just someone who couldn't get the medical and counseling services needed to cope with previous life experiences that enabled her addiction.
No need to be sorry! My issue with the US medical/insurance complex. I do; she's disabled and I support her in her old age. While it doesn't change the past, she's apologized for not being able to get the help she needed and for how she behaved.
Have to give people the benefit of the doubt. To hold onto the coal of anger only burns yourself.
My mother is an alcoholic, my father was a meth addict. I'm curious why you decided to help her in her old age? If it's not to personal of course. My thoughts are If they didn't wish to help me when I was at my most vulnerable why have any concern for them? I've always felt that turnabout is fair play.
I am not the OP, but my guess is s/he benefits more from it than the parent does. As the old adage says ...
"Anger/hate/unforgiveness is like drinking poison, expecting the other person to die."
Please understand I am not judging you at all. To be honest I don't know if I would look after an abusive parent or spouse. I would like to say I would ... but truth be told I don't know.
What I do know forgiveness is a wonderful thing, and the forgiver gets way more out of it than the person who is forgiven. So much pain and conflict in this world is stems from humankinds seemingly innate inability to forgive, sometimes even after centuries have passed.
Edit: I don't know why you were downvoted and don't think you should have. If it helps, my posts in this thread have been heavily downvoted.
Too bad I can't downvote you because downvoting isn't about a comment disagreeing with your opinion, it's about a comment not adding anything to the discussion.
If a test has a non trivial false positive rate, then a positive must not be treated as a true one without further analysis. Innocent until proven guilty, not the other way around.
It's not about innocent or guilt. CPS wasn't called. If a test is positive then they take certain precautions. The baby tested negative but she was treated like positive.
Yet arrests can be made, and bail denied, before a trial if there is reasonable suspicion that the defendant is a danger to other human beings. And in this case, the positive test result was certainly enough for reasonable suspicion. Everyone acted professionally, the baby was not taken away, the freedom to breastfeed was not taken away. Even if the (statistical) test should have taken whether a person is known to use an asthma inhaler into (greater?) account in its prior distribution, that doesn't change the procedure here, just the number of people it might apply to.
Asthma inhalers, poppy seed muffins, whatever. If the false positive rate is even just 1% or .1%, then the results must automatically be treated with suspicion and the dignity of the accused shouldn't be infringed on (e.g. You tested positive, it could be false, we'll need to run some more tests).
> All three days, the nurses are reluctant to hand over the baby, saying my actions are irresponsible.
> Every shift change, two nurses stand by my bed and inform another two nurses of my status as a combative patient. “This woman tested positive for methamphetamine,”
This does not strike me as very professional. The medical staff should have considered the possibility of a false positive, and given the mother the benefit of the doubt when she said she wasn't taking methamphetamine. Telling the mother that she shouldn't breastfeed and that CPS have been called, while not stopping her from breastfeeding (presumably they have no legal power) is the worst of both worlds: increase stress/worry (which is something the child would pick up on), draw everyone's focus away from the actual birth and the child, while simultaneously allowing her to potentially pass this, presumably harmful, drug to the child. Madness.
The child has a human right to a family life with its parent. That right should only be interfered with in extraordinary circumstances. Drug addiction sometimes meets that level. But that drug addiction needs to be proved.
Subjecting the family to un-needed intervention causes harm to those children. And it causes harm to the children that do need intervention, because child protection social workers are made busier dealing with cases that they need not deal with.
What benefit is there to harass and increase the stress levels of the patient? If the mother test positive, that itself justify additional tests of the child and the breast milk, without the need to accuse the patient first. The first priority in a hospital should be the health of the patients, and only onces that is ensured should the hospital accuse the patient and bring up secondary concerns like CPS.
Something that was missing in this story was the lack of dialog between the hospital staff and patient. False positives is possible, so why not send a trained psychiatrist at a positive? They can talk to the patient and check if the result make sense, and if nothing else, start address issues such as postpartum depression.
Do you know what's worse than an infant being hooked up to a morphine drip?
A spontaneously aborted fetus because the stress of withdrawal during pregnancy was too much for the mother's body.
If an addict becomes pregnant and seeks treatment (which during pregnancy would likely consist of continued dosage of an opioid in the form of methadone) then there is the risk that she will give birth to an opioid dependent infant (or not - it's only something on the order of 1/3rd of infants born to mothers who use opioids who suffer from NAS).
But yes...treat the parent as subhuman. Rip the infant away from its mother. To punish the mother because she's bad.
Nevermind the fact that there has been a strong link demonstrated by neonatal bonding between mother and infant and lower rates of NAS as well as overall better outcomes for the child.
Yes, I know, that was what I meant and tried to express in a semi-funny way.
I fully realize that the ellipsis is a code point/glyph/character/whatever in its own right, and that the rendering of it using three periods is not correct.
The existance of that rendering is what makes the proper one seem "fancy", from some points of view.
What's so scary about CPS? She should have called her doctor/gyna and prepared to lawyer up, especially if she knew she didn't do drugs. Being treated like crap after birth tho must have been tough.
If you have a kid its one of the most terrifying things on the planet. I am a father and I can't even imagine a mom with all those hormones going and someone saying that to her.
CPS has basically unlimited power to take the kid for any contrived reason they can imagine BEFORE it goes through any kind of court... all based on their perceived notion of 'what's best' for the child.
And if you don't believe in raising your kid the same way THEY want you to, watch out...
> CPS has basically unlimited power to take the kid for any contrived reason they can imagine BEFORE it goes through any kind of court... all based on their perceived notion of 'what's best' for the child.
This is 100% absolutely false, but it's a misconception CPS agents love to abuse. CPS is NOT a law enforcement agency. If they want to remove a child from a house, they need to have the police and judge's order to do so. In fact, they can only enter your house with your permission or with a warrant with police present. However, some of their worse agents thrive on threatening parents with child removal.
If you ever, ever get wind of CPS coming to visit you, consult a lawyer, and record any conversations you have with them (on your property). You need to stand up to them. Source: I've been through this. Fortunately, the person I worked with understood she was entering a hostile environment.
I've been an EMT for 15 years, in 3 states. I've reported suspicions, as required. I've also seen CPS take kids. All it takes to get a judge's 'order' is a phone call. cops at least need to present something before getting a warrant.
CPS is like the police. In general, a large number of the agents are decent people who are trying to do what's best for the children. However, you will get some agents that tend to be over zealous and will abuse their position to threaten and force the parents into submission, under the assumed auspices of taking away the children. Most people who deal with CPS tend to be poor and do not realize a CPS agent is not a law enforcement agent, and thus need a warrant and police to take away children.
> A part of me recognizes the hospital is acting in the interests of my child. But even if I were a drug user, does that justify turning delivery into something criminal? At what point do the rights of my child outweigh my own?
rights to have a "birth experience" according to a wishlist, possibly at the expense of the child? At more or less every point I would assume.
That, and the right to not be treated like a criminal, not be tested without consent, and not be stressed out for weeks over fear of her baby being taken away.
I think most arguments for abortion rely heavily on the right of the mother to bodily autonomy. That is, once the baby is delivered, those arguments fall apart. Breastfeeding your child because you want the "experience" is completely different.
Thats the idea. Bankrupt the shitty institutions that are careless or make too many mistakes and let the good ones grow. Kind of like performance reviews we get in the industry (not to say they aren't flawed but still)
> Lawsuit against the hospital thats what the lady needs to do.
On what grounds? She failed a drug test and the hospital are mandatory reporters, I'd see the case instantly thrown out, and we only got her own side of the story.
I'm not a lawyer (obviously), but from her side of the story seems like they knew she wasn't a meth user, yet she was treated with disdain anyway. Medical professionals can't treat you like a piece of garbage, I'm sure a good lawyer will know how to spin it.
> from her side of the story seems like they knew she wasn't a meth user
I've no idea where you read that from. Her only accounts are that the nurses changing shifts warn their followers she's tested positive, that they repeatedly warned her about the breastfeeding risks and that the social worker doesn't believe she's a user, that's about it.
> I'm sure a good lawyer will know how to spin it.
And I'm sure even a bad lawyer would know how to dismantle that.
Every medical professional worth their salt knows that tests are not binary - there is a possibility of false positives. They sent her for another test where results would come in two to three weeks, but that doesn't excuse them treating her unprofessionally. I recall there was a case where the guy was getting a colonoscopy or something along those lines and the doctors and nurses were making derogatory comments about him while performing the procedure (he wasn't completely under), he managed to sue and win some money.
> My doula rubs lavender essential oil on my temples, and my husband plays “Push It,” the Spotify playlist I created for labor and delivery. I have a photo of Beyoncé propped up on the over-bed table, because if anything can inspire me, it’s Queen Bey.
You are speaking for others - which is basically what the article is about. Judgment sucks and it's much easier than speaking your own truths - for example, do you have children and/or gone through birth?
How is this "Speaking for others"? OP provided their perspective in comments. You having a different perspective is valid and is not threatened by the point of view of OP.
That's speaking for the child. Speaking for someone else's feelings besides your own is speaking for others. And, it's not a perspective either, it's an opinion how someone else would feel in the situation, which is NOT a different perspective you can hold, given you aren't the other person.
Let me state right out I don't think this person deserved such treatment, and basic critical thinking and cross-checking the prescription for the inhaler (which surely should've been a phone call away?) in theory absolves the issue. It's just, well, personal experience leads me to be wary of medical care, not simply hit autopilot and think things will turn out great. It can from time to time! But, hey, this kind of story is an excellent caution...this is why it's very, very important to pester the ever loving dogsh!t out of your health-care provider to have every single detail prepared in your file before going into - essentially - the custody of a medical facility.
No matter how many times it might seem stupid for me to reiterate that with my condition I can't have any blood thinners - no Aspirin specifically - I simply don't trust anybody new with being, well, competent enough to make the connection themselves. I police what goes into my body with pretty good results. I go out of my way, time and again, to discuss my specific treatment needs and precautions. Granted, not everything is in my control, but the things I can monitor, I do try to get a handle on.
Something similar happened to us. When she was 4 years old, our daughter had a string of unexplained severe seizures over the course of 8 hours or so, and she too tested positive for methamphetamine at the hospital.
What made it especially bad was the fact that my daughter was in the middle of a medical emergency, and the staff at the hospital were wasting time on a ludicrous "meth" hypothesis.
I understand why it was ludicrous from your perspective. It was not, however, ludicrous for them to spend time ruling it out.
New onset seizures (particularly a string of seizures) are unusual for a kid. Methamphetamine causes seizures. There are ways a child could have been exposed to meth that a parent wouldn't know about (another caretaker left it lying around, a preschool friend brought it in for "show and tell" and no one noticed, etc...). It was prudent on their part to consider it as a possible cause of your daughter's seizures. A positive meth test for a seizure patient (of any age) would certainly raise my index of suspicion enough to thoroughly explore the possibility of intentional or accidental ingestion.
I totally get why you would perceive them as "wasting time" (and obviously I wasn't there, it's entirely possible they were), but it's very likely they were running down all the other "normal" differential diagnoses in parallel.
You're vastly overestimating the average competence and concern that most human beings have when doing their jobs.
I've seen multiple instances with family members where the doctor's dumbass hypothesis absolutely did not match the symptoms, but they persisted in trying the worthless treatment anyway. Took 'em months to find and start treating the slightly rare form of cancer. Bring on the diagnostic computers, I say.
I know a lot of ER docs (I assume this story took place in an ER). Some are better than others, but I can't think of any that I wouldn't consider "above average" relative to "most human beings".
I'll absolutely agree with you in terms of primary care docs... As someone who routinely transports patients out of doctor's offices when the doc is in over their head, there is a _much_ broader variation in competency...
Sorry, I forgot that this is HN, where the default mode of discussion is "how dare they". :)
I'm not outraged that it happened. But: we obviously knew for a fact that methamphetamine exposure was not involved in her seizures. We did, however, have to deal with ER staff entertaining it as their primary hypothesis. That was frustrating, and, in hindsight: indeed a waste of time.
I think the only real problem I have here is that whatever test they use to detect meth, it obviously falses a lot.
(Her seizures were idiopathic and never repeated; our working theory is that it was a reaction to a benzocaine medication she got a day earlier.)
She wasn't "treated like a criminal" because she tested positive to a preliminary test. She was treated like a criminal because she insisted on breastfeeding her baby despite several positive test results.
I think the mature thing to do would be to wait for the 2 week test to come back and not breastfeed your child in the meantime. Even if you know you haven't done meth, I would think the risk that you somehow have been exposed to meth should outweigh the desire to breastfeed.
The hospital is more concerned about the health of the baby than the desire of a new mother to validate their motherhood by breastfeeding. Seems okay to me.
>She wasn't "treated like a criminal" because she tested positive to a preliminary test. She was treated like a criminal because she insisted on breastfeeding her baby despite several positive test results.
She was treated like a criminal before giving birth, though.
>you somehow have been exposed to meth
How exactly do you get exposed to meth?
>than the desire of a new mother to validate their motherhood by breastfeeding
You're reading an awful lot into her desire to breastfeed her child.
If she did not breastfeed for the first 2 weeks it's unlikely she'd be able to start suddenly, her milk might simply have dried up. My wife wasn't able to breastfeed 1 of our 5 children and this alone caused her a degree of post-natal depression through feeling guility (no depression with the other 4).
I suspect you're male and don't have children, talk to mothers about the importance of breast feeding to them, you'll find this isn't a subject to be logical over.
Pump and dump is an option, so that mom keeps lactating, but not foolproof. The baby needs to learn how to latch on and if they are given a bottle for 2 weeks will likely refuse to breastfeed (e.g. baby turns into a frustrated screaming terror while mom sobs). But the more important point is the emotional and hormonal impact of breastfeeding on the mom, and health benefits of breastfeeding for the baby.
Breastfeeding is monumentally important for some mothers. Mom has every right to insist on breastfeeding even in the face of a test she knows to be a false positive.
Their listed benefits of breastfeeding include resisting illness, lower % of SIDS, a correlation to higher cognitive function, and lower occurrence of other diseases. They then list benefits of formula, which all amount to convenience for the parents. Then they say don't feel guilty either way.
The higher correlations to health benefits are the closest to birth, with nearly all sources recommending breastfeeding for at least the 1st six months, if possible.
I don't know. If I was confident I wasn't exposed (the article said they were very careful, and were certain it was a false positive), I might go with breastfeeding in that case as well.
> The hospital is more concerned about the health of the baby than the desire of a new mother to validate their motherhood by breastfeeding. Seems okay to me.
That has to be one of the most idiotic things I have ever seen written on this site.
If she didn't do meth then she should nurse. What possible reason is there not to? Some mythical exposure to meth? What in the world are you talking about?
Have you ever even seen a baby? Have you seen one nurse? I suspect you have not, or you would not write such incredibly stupid things.
> I would mention lawyers and lawsuits a lot more during the visit in this hospital and definitely sue them with a 500 pages long claim.
That would be idiotic, nonsensical and a very good way to make current and future interactions even worse. Hospitals are mandatory reporters, if they don't report suspicious situations (such as a pregnant mother failing a drug test) they're on the hook for it, and they must prepare for a possible NAS case which is anything but fun, or a walk in the park.
And despite the completely one-sided report, it looks like much of the antipathy came from her insisting on her "experience" and on e.g. breastfeeding the child.
the issue isn't the mandatory reporting. The issue was the way they treated here AFTER the two known-to-be-spurious tests, neither of which were blood draws which are vastly more accurate.
So, yes, a lawsuit would be in order (IMO). I wouldn't ask for a huge payday, but at the very least that they clean up their testing procedures and follow protocols.
> The issue was the way they treated here AFTER the two known-to-be-spurious tests
The tests were not known to be spurious by the hospital.
> neither of which were blood draws which are vastly more accurate.
Blood draws tests are also much longer (that's the 2~3 weeks test whose results they got afterwards).
> I wouldn't ask for a huge payday
Not that you'd get any even if you did.
> at the very least that they clean up their testing procedures and follow protocols.
Is there any protocol you know them to not have followed?
Keeping in mind that the one account we have is the one-sided version of the parents, consider the hospital's point of view: what they have is an expectant mother who has twice failed a drug test and thus a NAS risk, a nearly DOA newborn from emergency C-section and the possibly drug-addicted mother thereafter insists on breastfeeding.
They do. And the balance of probabilities is that the urinalysis is more likely than not to be accurate (I don't know percentages). So as a mandated reporter, they did what they could.
They gave multiple chances for retests. The results were consistent.
A blood test four weeks prior to delivery would be a good start, but still leaves a window.
There are two suboptimal possibilities at that point:
1) err on the side of the mother, who has failed (incorrectly as it may be) multiple drug tests and allow her to breastfeed her child, or
2) err on the side of the child, who is exhibiting symptoms that could point to NAS, bradycardia and the like, who is delivered by emergency C-section (so she would not have had the bonding experience immediately post partum, as it was, anyway)
They did know the failure mode.
They evaluated.
They held off on calling CPS. They allowed contact after the baby's urinalysis.
There is no negligence here. The father showing by their own words anecdotal forum posts and such is not reason for the hospital to say "Well, what do we know, here you go".
I think the real issue is that they're administering a test with an apparently high false positive rate and then using that as a basis for depriving both child and mother of interaction and making an already difficult process much worse. I find the hospital's conduct reprehensible if they knew or should have known that a false positive was eminently possible, if not likely based on some OTC drug the mother may have taken. I myself would file a lawsuit for negligence and intentional infliction of emotional distress, which would likely make it past a motion to dismiss and result in a settlement. And yes, I work on high stakes lawsuits for a living.
This is interesting because I'm a nurse and I deal with people who occasionally test positive for methamphetamine.
We've found that many of these people take Zantac (aka ranitidine, used for acid reflux). This hasn't been studied since 1991[0] but it probably should be again, given increasing rates of meth use.
I wish the author had given the name of her prescription inhaler- Vick's Vapor inhaler has been shown to test positive but albuterol and other steroid inhalers are more common.
Cross-reactivity studies don't seem to be published often but searching for albuterol + 'cross reactivity' shows some drug tests are cross reactive with albuterol and some aren't.
Damn, Zantac is the only thing that has made my third trimester bearable. I'm wondering if this is a serious enough risk that I should stop taking it as my due date approaches. May ask my midwife at my next visit.
I do think kids should be allowed to roam, but as a cyclist I'm not convinced that being allowed to ride without a helmet is a crucial formative experience. It's not a trade-off, it's just irresponsible.
As a road cyclist I say sure, it's not sane to ride at an average of 40kph (25mph) without a helmet. However, as a commuter cyclist I say nonsense! Where I live almost everybody 8 to 80 years old rides without a helmet -- just little kids do because they're still learning -- for a simple reason, no one rides faster than 20kph. Cycling should be about being free and having fun. A helmet sends the opposite message which is not good when you want people to cycle instead of driving their lives away.
A helmet won't make any difference when riding a bike into a hunk of steel; you will get badly hurt or killed depending on your speed. In that case your only defense is to ride as far away as possible of car doors, don't count on the person getting out the car looking in the mirror before opening the door. Focus your attention on what's happening in front of you, and enjoy your ride.
> A helmet won't make any difference when riding a bike into a hunk of steel; you will get badly hurt or killed depending on your speed.
That's a straw man. Helmet advocates do not imagine them as some sort of invincible armor. They obviously will not keep you from being injured in a serious accident. What they do is reduce your chance of being killed. The large majority of fatal bicycle accidents involve head injuries. (One source: http://www.rospa.com/road-safety/advice/pedal-cyclists/facts...) I would rather be in traction than dead.
I agree that children cannot be wrapped in cotton wool; they should be allowed to roam without supervision and make their own mistakes, even if that does slightly increase their risk of injury or death. But getting a bike helmet for your kid does not restrict their mobility or their ability to learn. It has no downsides, only upsides.
You've made the choice not to wear a helmet; if you ride safely, in a safe area, the extra risk is probably quite small, and if you believe it's a fair trade-off for a little extra comfort, that's your prerogative as an adult. But don't pretend that wanting to feel the wind in your hair is taking a moral stand.
I am sorry, but it's not. Being car doored is the type of incident where a helmet won't make any difference. For a simple reason, the cyclist hits a car door with his upper or lower body, not with his head [0].
> But don't pretend that wanting to feel the wind in your hair is taking a moral stand.
Your words, not mine -- as most of your post by the way. However, there is value in not arriving to your destination sweating or stinking (i.e. going to a meeting, social event, etc). In cases like that it's perfectly fine not to wear a helmet as long as the rider is aware of the risk, and adapts his/her riding style to this situation. Mostly everybody does it in Europe and we're all fine.
> I am sorry, but it's not. Being car doored is the type of incident where a helmet won't make any difference. For a simple reason, the cyclist hits a car door with his upper or lower body, not with his head [0].
Yeah, and then you go flying and your head hits the ground, or a lamp post, or another car. Not always, but often enough.
Head injuries are pretty common in car-pedestrian or car-cyclist accidents even though the average car is much lower than the average head. Collisions don't end at the moment of impact.
Yeah, I know that. Yet, by then most of the energy has already been dissipated by the primary hit. After that the rider usually ends lying down on the middle of the street under the risk of being run over by another car. Again, a helmet won't make any difference there.
I get it, you're advocating for people's safety -- that's noble. But, sometimes you have to live and let it die. In other words, you have to respect people's choices, or move to a nanny state and stop judging the people that decided not to live under the same rules as you.
Happened to me as a teenager; wasn't wearing a helmet - they didn't exist back then. Turns out teenagers roll quite well. Fortunately the bus I rolled across in front of stopped pretty quickly, but I doubt a helmet would have made much difference if it didn't. I was fine; the car door on the other hand was rather bent, as was my front wheel. Ever since, I've been assertive and left a wide gap when passing parked cars, no matter what traffic is passing me.
Biking amongst traffic on roads requires skill, knowledge of biking laws, good situational awareness, knowing how to posture and when to take the lane to protect yourself.
Oh, and a bit of luck that the people next to you in their steel cages aren't homicidal towards bicyclists.
> No offense, but that's what will happen when poorly educated riders bike in the door zone.
What do you propose a well-educated rider should do, when all the bike lanes are in the door zone and bikes are legally required to stay in the bike lane?
> Oh, and a bit of luck that the people next to you in their steel cages aren't homicidal towards bicyclists.
"What do you propose a well-educated rider should do, when all the bike lanes are in the door zone and bikes are legally required to stay in the bike lane?"
Well that's the usual poor planning I see in America. Sharrows or "share the road" signs are much better than many of the dedicated bike lanes I've seen here.
First, find another route, if possible. Second, start going to your city's public meetings and/or complain to the city about the clear danger that poorly planned bike lanes inflicts upon the public. Learn the law specific to bicycles for your area and get involved with a bike advocacy group if you really care.
As far as helmets go, I like to keep my brains intact, so I wear one, and have the abrasions on an old helmet to prove it. Front tire blowout and dumping at 45 KPH downhill on a recumbent was an experience that could have been worse sans helmet. That said, a pound of plastic and foam can only do so much for you. Good luck!
All my friends did that too. It was the norm in the 80s when I was growing up. To my recollection, any deaths or serious injuries from it were somewhere between rare and non-existent. That's not survivor bias.
I have no doubt that a study would find there were more then than there are now, but things don't exist in isolation. We make trades for everything.
For example, we've traded relatively rare (and usually treatable) skin cancer for more widespread sunlight deprivation and Vitamin D deficiency that's implicated in a number of different conditions. I don't think this was a good trade, personally.
In this case we've traded our kids' childhoods and parents' exercise of discretion--this is part of their life cycle too, keep in mind--for what I'm quite convinced is a minimal increase in safety. Mandatory bicycle helmets? Sure, if it stopped there. But we've gotten way more paranoid than that. I don't think that's a good trade either.
Sorry to be negative, but I'm not sure I understand what I should be outraged about. She tested positive for meth. The hospital advised her on all the things they probably advise to everyone else in that situation, they tested the baby for meth (came back negative), and they did an additional, more thorough test later (came back negative), and finally mom and dad are off to be parents. CPS was never even involved. I guess the article is about how a few nurses were mean and made her feel sad, because not much else seemed to happen.
If you really want to feel injustice and helplessness, why not try getting arrested for something you didn't do. Spend a few nights in jail, and deal with police, lawyers, judges, lose your job and friends because of it, find yourself on a bunch of lists you've never been on before, etc. That's what "being crushed by a system" is like.
Maybe she just left out from the story, but why didn't she say "But I didn't take any meth! I didn't even drink any alcohol! After a miscarriage I'd never do anything like that! Is it possible that the test is wrong?"
Had they been certain the test was right, CPS would have been hovering over the birthing bed and the parents would have risked carting to a cell. That's not what happened.
Doctors are like cops in that they're used to being lied to, particularly by drug users. Telling a doctor "I didn't take meth" when he has a positive test result is likely to mean exactly nothing unless you have a long term existing doctor-patient relationship.
This is a big part of why homebirth is gaining popularity. It's just family and maybe a midwife. Nobody is going to do a meth test. The doors don't lock you inside, unable to escape without permission. (that security is NOT to protect the baby from strangers; it's so CPS can take your baby)
Also: There is no need to drive madly to the hospital. There will be no incentive to keep you for exactly how long your insurance will pay, nor to perform surgery. You get to sleep in your own bed, without constant beeping and light from the hallway. You can have as many visitors as you want. You will never be separated from your baby, not even for a moment. You won't be treated like a potential criminal. You get respect.
And if there's trouble and the kid[0] dies[1] you can just say that was "their journey" and wash your hands from it. Hell, you might even "get respect" and praises for having killed your kid, go you.
But hey, CPS didn't get to take your kid[2], so there's that.
[0] or the mother, or both
[1] which is anything but rare, even in the UK under obstetric care[3]
> The risk of dying on the day of birth (0.43 per 1000, or 430 micromorts) exceeds that of any other average day of life until the 92nd year.
and matches the risks of major surgery. Homebirth, especially with completely unqualified midwives (which is the rule in the US) is almost an order of magnitude more risky[4].
That's just an ignorant response. There are plenty of board-certified midwives, birthing centers, etc. Importantly, a great deal of risk can be ascertained before labor, and like any other medical procedure you're either a good candidate for non-hospital birth or you're not.
It depends heavily on the quality of the midwife and how well they can recognize complications. If they miss something (which very likely would turn from from a required test in a hospital), by the time the baby has stopped breathing, it might be too late to save them.
"Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P=0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth." [1]
"Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs 0.32 per 1000; P < .001). Midwife home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27 per 1000; P < .001) and midwife home births of women with a first birth (2.19 per 1000; RR, 6.74 vs 0.33 per 1000; P < .001) had significantly higher risks of total neonatal mortality than deliveries by hospital midwives. In midwife home births, neonatal mortality for first births was twice that of subsequent births (2.19 vs 0.96 per 1000; P < .001). Similar results were observed for early neonatal mortality. The excess total neonatal mortality for midwife home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births." [2]
Rounding up your first statistic slightly, that's a difference of two severe incidents per thousand births. That's a reasonably big risk factor in absolute terms, but small enough that it's not unreasonable to take in order to get other things that you care about.
Like, these are "am I willing to make this tradeoff" numbers similar to choosing to drive to work daily, rather than "fuck no, go to the hospital" numbers.
Midwives don't sell themselves on the increases risks, they talk about the (largely) cosmetic benefits of home birth.
Look up earlier in the thread for my comment, but anecdotally, almost every parent that I have told my story to has changed their opinion on home birth vs. hospital birth.
If you're talking about certified nurse midwives (CNMs), yes. If you mean certified professional midwives (CPMs), no. I liked this NYT piece on the subject, "Why is American Home Birth So Dangerous?": http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-amer...
It's an educated and sourced one, as opposed to your flippant comment.
> There are plenty of board-certified midwives
Not only are there plenty of midwives which are not that, how meaningful board accreditations are depends strongly on the board, CNMs are true professionals[0], CPMs are pointless layabouts.
> birthing centers
The comment I was replying to was about homebirth.
Birthing scenters are usually professionally staffed, attendant to hospitals, carrying necessary emergency materials and will immediately transfer to their linked hospital in case of complications. And good birth centers will plain refuse at-risk patients and direct them to hospitals.
> Importantly, a great deal of risk can be ascertained before labor
Which is already included in the statistics above.
[0] and even with CNMs homebirth mortality is significantly higher than hospital birth.
There are some very nice birthing centers that are not associated with hospitals.
From what I've seen, hospital-associated ones are bait-and-switch. If you show up early, then you take longer than allowed and they transfer you to the regular hospital. If you show up late, then they also transfer you!!! (this shockingly lame excuse was actually used on a friend) Clearly, there is a purposely narrow window because the hospital makes more money if you end up in the regular hospital area.
I find it strange that you think homebirth midwives don't carry necessary emergency materials. Just considering the obviously visible example, every one I've seen lugs around an oxygen tank.
If you have to deliberately compare to the worst case scenario "with completely unqualified midwives" to try to make your point, then it is not a good point.
True. Though as an EMS provider, I'll definitely say that I've run the gamut of calls to midwifes/birthing centers/home births from "completely competent professional I'd have no issue managing my partner's birth" to "I really need to call the DOH after this". Situations where, upon handing us a cyanotic baby with severely deficient APGAR score (https://en.wikipedia.org/wiki/Apgar_score) the midwife's primary care was 'respect for the process and the environment', wanting us to take off boots and "try not to be too loud or overactive".
If you've already been handed the baby, your boots should be on their way to the emergency room as fast as your truck can go. It really isn't right how you people turn every call into an excuse for searching without a warrant. Unrelated stuff going on in the home or birth center is none of your business.
I am describing a situation where the midwife/ doula was MORE CONCERNED with maintaining a "positive and serene energy in the birthing space" (her words) than she was about what we would do to take care of a critically ill neonate.
I can assure you, my methodology on such a call is not to "stay and play" but to "stabilize, ideally while transporting". Let alone a fishing trip. To wit, I could not care less what else is going on in the home, be it legal or illegal, unless it directly affects the care I am or need to provide. My reference to DOH was not a "fishing trip", but in regards to a provider who, in my professional opinion, was being actively negligent in caring for what was their patient, until transferred to me.
I don't see any reference to 'searching'. It is very standard practice for a healthcare provider to give a verbal report when handing over care of a patient, even (_especially_) in a critical setting.
You realize paramedics are qualified in neonatal resuscitation, right? While "scoop and run" is absolutely the right thing to do in some cases, if I'm handed a blue baby, I'm going to spend some time in stable, well lit environment getting an airway established. The sooner that happens, the better the baby's outcome is going to be (and it's much harder to do bouncing down the road in the back of an ambulance).
> If you have to deliberately compare to the worst case scenario
What in god's name are you talking about? Infant mortality is the one primary risk of childbirth and the primary measure of perinatal and neonatal care alongside maternal mortality, the risk of the child dying is the very first thing you compare when talking about childbirth.
> with completely unqualified midwives
And that is a very common risk in the US because most states don't require any formation (let alone certification) to call yourself a midwife.
I was very clear, I do not see how you could genuinely be confused.
>And that is a very common risk in the US
It is not a risk, it is a choice. You don't call up the midwife store and say "send me a midwife" and hope for the best. You choose one. People can choose one that is trained and certified.
The baby's heart rate dropped during contractions, as monitored by the hospital equipment. The mother was put on oxygen to help. Later, they chose to do an emergency C-section because the heart rate dropped too low.
In a hospital, all that was easy to access. If this had been a home birth, it may have been catastrophic.
Driving to the hospital and not being in your own home is an unfortunate reality. We do not live in hospitals.
Disrespect, misalignment of insurance incentives, and inflexible criminal treatment are all bad things. But their damage is amplified because the alternative - homebirth - lacks the medical advantages of being in a hospital. Draconian policies like this literally kill children at the margins.
"The baby's heart rate dropped during contractions, as monitored by the hospital equipment."
That's about as reliable as:
"The dog moved funny, indicating it found drugs, so we have to search your car."
(it's totally normal for the heart rate to drop)
The sad reality is that the facility for C-section is not financially viable unless you use it on a regular basis. There is an incentive to use it. When used, it is profitable.
Doctors who push back on profitability find themselves replaced.
In any case, those who have trouble at home can get emergency C-sections. Since prepping takes time anyway, there is no added delay if you call ahead. Situations where mere minutes matter are rare to the point of being pretty much non-existent.
A baby's heartrate (as measured by either an external transducer, or a probe hooked into the baby's scalp) is an objective measurement. Comparing it to the completely subjective "signaling" of a police dog is absolutely absurd.
Much of the 'prepping' requires the mother to be present (administration of anesthesia, monitoring, etc). The prep of the OR is generally done in parallel with those tasks. If it takes you 30 minutes to the to the hospital, you are delaying a c-section by at least 30 minutes.
Additionally, measure that can be taken to reduce fetal stress (while waiting for the OR to be prepped, in the event that is delayed) are _much_ easier to accomplish in a hospital, rather than in a car, or the back of an ambulance.
it is also there to prevent unmonitored/uncontrolled access to babies. Prevent things like babies being mixed up. Aides taking wrong child for testing etc.
> It's not to protect the baby, thefts of children (etc) are rarer than lightning strikes.
Maternity ward infant abduction is an ongoing thing, though now fairly rare (and even more rarely successful, with dozens of attempts stopped within the ward for each successful abduction) because of the security measures that have been instituted by hospitals in the last few decades.
But that's a success of the security measures, not an indicator that they aren't necessary.
If this happens on a regular basis and people find out about it, people will stop going to the hospital to give birth, raising the rate of mortality and complications for infants and mothers.
Anyone who has a basic understanding of Bayes' Theorem can tell you that testing all new mothers for X (where X is relatively rare among new mothers) will lead to a large number of false positives even if the test has high specificity and sensitivity, simply because the prior probability for X is so low.
Which is why they did a second test, tested the baby, and did a third test.
More screwed up is the fact that it took weeks to get the correct result, and that innocent people have to live in fear of CPS coming and taking away their newborn.
I have had to deal with CPS in behalf of family members more than once and I have come to the conclusion that there is no group more terrifying than one that was supposed to protect children and has turned into something entirely different.
people will stop going to the hospital to give birth, raising the rate of mortality and complications for infants and mothers.
According to Healthcare Triage, home births have an overall lower risk of complications. It's only in the cases of things going spectacularly wrong that being in the hospital helps.
It fits with my view of things: If there's something really broken, go to the hospital to get it fixed. However, if you're fine, you're better off avoiding the place. (Do get checkups from a doctor you have a good relationship with.)
When it comes to having a baby, things can go from "perfectly normal" to "spectacularly wrong" in a (literal) heartbeat. The vast majority of the time, that doesn't happen, but when it does, I'd rather be down the hall from an OR, rather than a 20 minute ambulance ride away...
I've heard the same statistic. I wonder where it comes from.
Also, the overall chance of pregnancy with unprotected sex involving a man and a woman of childbearing age is 1 in 4. So, would you engage in such sex knowing that there was a 1 in 40 chance it would lead directly to your own death? (Or your partners? Bees be Krayton!)
I wonder if that's where some of our cognitive biases around risk come from? It benefits our genes that we're cavalier about certain kinds of risk.
The first number you give is wildly inaccurate. It rises to about 35% in the +/-1 day window around ovulation, with lower probability during a wider weeklong window, and very near 0 for the rest of the menstrual cycle. I'm fairly sure the actual compounded odds of conception from procreative sex at a random point in the woman's cycle is much closer to 1 in 1000.
Also unprotected sex does not necessarily equal procreative sex, which I realize is a somewhat controversial statement, but nonetheless true.
It's really a matter of semantics, not science. Either party could be incapable of providing the needed input. But also yes, to address the controversiality, the withdrawal method, used perfectly, is a 96% effective [0] contraceptive method vs. 98% for condoms used perfectly [1]. Obviously the prerequisites for perfect use are different and YMMV.
I knew that when I posted it. When I posted it, I thought I had clearly indicated it, but looking at it again, that must have been forgotten before it could be enacted. My intention was to play with the two wildly inaccurate figures together.
So what if 1/200 times your baby was saved by being closer to the doctors...
but 1/180 times your baby got a Staph Infection they would not have gotten at home and died?
The numbers are obviously bogus, but there are dangers to anyplace you choose to give birth... As long as people are well informed, seems they should be able to choose their own adventure.
Except the numbers that aren't bogus seem to suggest that birthing at home can be much more dangerous for mothers and children. I'm not saying that there's no room for improvement at the hospital, there always will be, but when we don't use fake numbers your point doesn't hold water. I'll refer to another user's comment in this article's thread for the citation.
Walking is much more dangerous than being carried in a litter, yet we let people do it all the time.
Drinking a hot beverage is much more dangerous than drinking a cold beverage.
Life is full of dangers and risks. Why should birth be any different?
I could post many stories of people who had their first kid in a hospital and had a horrible experience, ends up getting a C section when not really needed, etc (See american C-section rates vs European for example). Then they chose to have a kid at home and had a 100x better experience and a more healthy baby (due to lack of C section and all the problems that leads to).
What's bad about anti-vaxxers isn't that they weigh relative risks and make a decision. What's bad is that they spread wildly inaccurate information about what those risks are, which causes people to make faulty decisions that increase the risks for others in the community.
What you are doing here, is glossing over the underlying logic and falsely reasoning by resemblances. I find this sort of false reasoning flat-out stupid. It needs to be called out so others do not imitate it. (Which is a more meaningful resemblance to anti-vaxxers your comment is exhibiting.)
> It's only in the cases of things going spectacularly wrong that being in the hospital helps.
Yep. My wife had a perfectly normal pregnancy, and everything went perfectly until something went spectacularly wrong. When my daughter was born, and didn't breath on her own for the first 3 minutes. If she hadn't been in a hospital, it would have gone down as still born. She was in the hospital, immediately received resuscitation and numerous other treatments which maintained her blood oxygen level sufficient to prevent brain damage, and now at the age of 4 is ahead of every developmental measure.
"It's only in the case of things going spectacularly wrong" that any risk mitigation activity actually provides value, and in every other case is essentially worthless. YMMV, but I tell everyone I can the story of my daughter whenever they talk about home birth.
I agree with the larger sentiment, but don't be so quick, it's a game of chance even when shit happens.
One of my daughters too didn't breathe when she was born. The midwives grew very very ernest very very quickly, and the little child was rushed off to hospital in an ambulance. All went fine. I was a little shaky that first night.
Life is a game of chance, but we make our own luck (beyond what we are born with) by making sensible decisions, taking measured chances, and knowing when to admit we are out of our depth.
Yes, midwives (in some jurisdictions) are trained, qualified practitioners. That said, they are not equipped to deal with many, many complications other than by calling an ambulance and hoping for the best.
Choosing to have my daughter born in a hospital instead of a home birth was most likely the difference between having a healthy baby girl and something in the range of severe mental handicap to stillbirth.
Having a child is a huge risk and investment (by every measure, emotionally, financially, socially, economically, etc). Why would you risk having a stillborn child, life with a mentally or physically handicapped child (this is not a shot against handicapped children - it's a shot against people who refuse to apply critical thinking skills to emotionally charged high risk decisions) so that you can satisfy some foolish ideal that being born at home is better than being born around people who have trained for much of their adult lives to keep your kid alive in its first few days?
It ranks right up there with the foolish parents who refuse to vaccinate children against common ailments or choose naturopathy or homeopathy because of "toxic western medicine".
Not really. Watch the Healthcare Triage video. The odds kind of wash out. You're very highly emotionally affected by your own anecdotal case, but that would be a particularly potent example of Survivor Bias.
Unfortunately I can't seem to find it but I read a story recently about a couple who lost their newborn during a home birth. The twist was that they were minutes away from a top NICU with an ambulance standing by. They were told that if they had given birth in the hospital, their child would have lived. The father was basically saying that the reassurance of having an ambulance standing by is illusory and if something goes wrong you want to be inside the hospital, not an ambulance ride away.
This is exactly what happened with our daughter. She had severe MAS at birth and was not breathing. It took a team of 4 working on her non-stop to keep her alive. After several hours of this they had to medivac her to another hospital that could do ECMO. She promptly went on life support and 11 days later, after her lungs were functional, she was able to come off the ECMO machine. Today she's a happy and super smart 3-year old. I have zero doubt that a home birth would have resulted in either death or severe mental impairment do to oxygen deprivation. I also tell every person I can about my daughter. I understand the desire of home birth, but not availing yourself of available modern emergency medical facilities during child birth is horribly irresponsible.
EDIT: And for the record, there was zero prior indication that something was wrong. The first sign was when the water broke and was green.
I'm curious, in my region (greater Seattle area) almost all the hospitals have birthing centers that are attached to the hospital, but aren't "the hospital." They are nicely appointed rooms with birthing beds, baths, exercise balls, bars etc. They have hidden doors that can "transform" the room in to a hospital room at a moments notice, and if needed the NICU is down the hall. We needed the NICU once, so I was glad for the option.
Is this not commonplace in the larger hospital markets (where I would assume most HN'ers live)?
> According to Healthcare Triage, home births have an overall lower risk of complications. It's only in the cases of things going spectacularly wrong that being in the hospital helps.
"Complications" is a broad categories and includes many things that may not lead to adverse outcomes if managed appropriately, and which hospitals may be more prepared to manage.
According to this study of Oregon births in the NEJM, planned out-of-hospital births studied have substantially higher rates of infant death and neonatal seizures than planned in-hospital births (and these results are, per the study, in line with other studies of out-of-hospital vs. in-hospital births.)
That's not true at all. If the actual incidence is low, then the false positive rate will be higher (not the overall positive rate, the _false_ positive rate).
Dr Carroll's Healthcare Triage series has been linked elsewhere in the thread, but there are a couple videos that are relevant to this discussion (namely, how Bayes' theorem applies to medical testing, and why the prevalence in the population matters (or, more accurately, the probability that the patient has the disease/drug in the first place, which is heavily influenced by the prevalence))
I am familiar with Bayes' theorem. It just doesn't apply in this situation. False positives are a function of the testing method, not a prior probability. If you wanted to know how likely your positive result is to be true, you would use the theorem.
The probability of a false positive result = probability of not doing meth * probability of getting a positive test result while not doing meth. P(+ ∩ M') = P(M') * P(+|M').
That pretty clearly depends on the prior probability, P(M).
You are calculating the probability for a randomly selected individual of the test to have been given a false positive result. That is different from the test's false positive rate, which is just P(+|M') [Where I assume M' represents that the subject had not used meth.]
It doesn't matter what the prior probability is of a random person having used meth (or whatever you are testing for); it only matters how likely it is that someone who has not used meth will be given a positive result.
Say you have a test that determines, with some non-perfect level of accuracy, if a person is or has been president of the USA.
If that test is performed only on women, the false positive rate will be 100% regardless of accuracy. All positive results would be false positives.
If the test is preformed on any man leaving or entering the oval office, then the false positive rate will likely be significantly less then 100%, as there will be a president tested multiple times in that group, and when we test positive on him, it's not a false positive.
If we test the population at large, most positive results are going to be false positives, simply because we're unlikely to actually have a former president get tested. But in theory the false positive rate could be slightly less then 100% if we got lucky.
As the probability of an actual occurrence in the test group drops to zero, the rate of false positives approaches 100%, regardless of the accuracy of the testing method.
I think we are talking about slightly different meanings of false positive rate.
I think you might be talking about the rate relative to all positive trials. I think I am talking about the rate relative to all trials that don't meet the conditions of the test.
So, you survey 100 women and your test tells me that 10 of them have been president, I say that your test has an observed false positive rate of 10%.
You’re correct in regards to terminology; apparently what I was describing is more related to the terms “positive/negative predictive value.” Your definition of false positive rate is the correct one. But I believe my argument is still valid.
If we test a group comprised of only former presidents, all positives must be true positives. So our false positive rate will be 0% while our female test set has been observed to have a false positive rate of 10%. This illustrates that the sample set effects the observed false positive rate.
As the rate of occurrence of what we are testing for approaches 100% in the sample set, the false positive rate drops to zero. Inversely, as the incidence of what we are testing for in a (sufficiently large) sample set decreases from 100%, the false positive rate will eventually increase to some non-zero percentage unless the test is perfect.
So if we only test meth addicts for meth, our false positive rate will be lower then if we test the population at large.
I think that is true, but we can still distinguish between the false positive rate of the testing mechanism vs. the false positive rate of a particular series of tests (where this would depend, somewhat, in the underlying distribution). I'm not sure what the correct terminology is for this distinction, but I still don't believe Bayes' Theorem would come into play.
The drug test is relevant to providing care to the mother. In the case of a delivery, I think it is reasonable to consider the results of the test while providing care for the child.
It's obviously a thorny question, but what should a facility that treats children do when it notices a conflict between the interests of the child and the interests of the parent? It's clearly going to happen.
Drug testing around childbirth is a wreck and needs to be seriously looked into...
My second son was premature... when we were in the NICU... there was a lady there, whos child was born premature because the taxi she was riding in from the airport was involved in an accident. She came from california... where her gyno was pro-mj, and she used MJ to manage her Hyperemesis gravidarum... so its in her system, clearly... but this is Texas... so even though her doc recommended it, not only was her child in the NICU, but when he got out, he didnt get to go home with her... because of stupid laws that pay no mind to actual scientific evidence...
I think this piece captures brilliantly the emotional and psychological toll that rote and thoughtless application of harsh procedures and mindless judgment can be wrought on people by an uncaring system.
When my daughter was conceived her mother was addicted to opiates. We were both in a bad place. I was just out of a relationship with someone with Borderline Personality Disorder and she was coming out of her own abusive relationship. Needless to say this wasn't how either of us had envisioned conception.
But her pregnancy was a strong motivator to turn things around. But addiction isn't something you can just switch of. Especially something like an opioid. It is extremely dangerous to the fetus for the mother to detox during pregnancy. Miscarriage is common. But that doesn't mean that treatment isn't an option. That treatment is, however, most commonly something like opioid maintenance in the form of methadone.
Methadone is still an opioid (although longer acting and "harder to abuse"). It still comes with the same risk of NAS. But that risk is actually fairly low. In researching the risks around my daughter's birth I came to find that only about 1/3rd of all babies born to opiate addicted women suffered NAS, and the greatest correlation was tied to usage of multiple illicit substances (say opioids and amphetamines together)
So we dedicated ourselves to having a healthy pregnancy and a healthy baby and she started methadone maintenance at a local clinic.
In the end my daughter was born four weeks premature (premature birth is actual common in opioid addicts). The author of this story did an excellent job of capturing how the atmosphere changed as soon as it was discovered that my wife was under a maintenance dose of methadone. The derisive judgment. The loathing in the eyes of the nurses. That was a very new experience for me.
And the procedures and policies described in the article are actually in many ways detrimental to and harmful to the outcome for the infant.
Opportunities for bonding should be encouraged. And at least in the case of opiates it has been found that breastfeeding decreases the risk of NAS and should be encouraged (opiate concentration in breastmilk of a woman using opiates is measured in micrograms, far below the threshold to affect the infant, but the simple skin on skin contact and intimacy seems to make all the difference).
My daughter did not suffer from NAS and after three days of observation we were discharged when it was clear her lungs were fine and she was not going to suffer withdrawals. Thankfully the attitudes of the nurses changed within about the first day. I suppose we weren't typical of "addict" parents...but I can say that being on the receiving end of that sort of experience...the only effect is going to be to push addicts further down a hole with even less chance of being healthy, functional parents.
Sometimes I think that the HN crowd is less prone to very non-scientific biases than the general public, or a place where I'm less likely to see people throwing around things that sound like facts that are mostly psuedo-science. Then threads like this happen.
> My doula rubs lavender essential oil on my temples, and my husband plays “Push It,” the Spotify playlist I created for labor and delivery. I have a photo of Beyoncé propped up on the over-bed table, because if anything can inspire me, it’s Queen Bey. Also on the table is my birth plan, which is kind of like a wish list for delivery. That includes modest requests, like keeping the door to my room closed, as well as more imperative things, like, “Please delay all routine procedures on the baby until after the bonding and breastfeeding period.”
> The bulk of my produce was organic, my drinking water purified through a reverse-osmosis system. I used clove oil on a persistent toothache instead of visiting the dentist, because I didn’t want any anesthetic to pass through my body and into the placenta. During all 42 weeks, the hardest drugs that entered my body were prenatal vitamins and puffs from my prescription asthma inhaler.
"But... I'm white! I'm middle-class! I have a doula! It's patently absurd that these nurses could think I did drugs! Just look at me! What do you mean that's exactly what a drug user would say?"
From her point of view she's a perfect mommy, but as far as the nurses and doctors know, she's just somebody who showed up pregnant with meth in her system and an unlicensed hippie who's smearing lavender oil around the place.
249 comments
[ 4.9 ms ] story [ 285 ms ] threadArguably, the only thing they did without consent was drug test the child, but I bet they consented. She consented to her own drug tests. All of them.
It also really underscores an extremely critical question with society: When the system is inflexible, and uncaring, what recourse do you have when it fails you? Imagine the hopelessness, the bleak future, of the world turning its back on you because of a mistake. I can only imagine this is what it's like to be falsely convicted of a crime... or failing a drug test that you shouldn't have failed.
I think there's even a lesson for us technical folks here: When the systems we design are too automated, and too rigid, we are removing all compassion. Now if the system is "perfect" there's no problem, but even Google hasn't been able to completely perfect their systems. People still become the victim of false DMCA takedowns, etc.
I guess at the end of the day, the moral is to "Remember the person."
In this case it appears that the social worker had enough of the full picture to inject some measure of sanity, but I really wonder if the nurses understood the statistics related to the tests well enough to treat her like shit over them.
Maybe a lawsuit is going too far, especially if this incident isn't in some permanent CPS record. But if it is, the hospital has them set up for some serious problems down the road.
That's quite a bit more than merely unprofessional. Something like a stray sarcastic comment or slightly distasteful joke might be unprofessional. This sort of behavior, on the other hand, quite possibly should be illegal and should have consequences.
Previously: https://news.ycombinator.com/item?id=10883282
murica!!
You know what else causes a positive test? Using meth. They got a positive, they followed up with further testing to clarify.
I almost want to flag this post off the front page due to how goddamned useless that article is. And the thing is? It's actually pretty decently written. It was engaging enough to finish reading it.
Or rather, not finish reading it: there is at least two paragraphs left that have not been published. Was it a lab fuckup? The inhaler (which also indicates a lab fuckup, since they should have looked at her medical records to deal with known false positives)? Is she going to sue for mental distress, malpractice, whatever?
What the hell.
Edit: Oh, and like half the HN community are asthmatics and are on inhalers. Can one of us be whisked off by the government for lab fuckups? Can this go on our permanent record due to their incompetence?
And as for that woman, can she get this expunged off her record? Once you're tagged by CPS, unless you deal with them with a firm hand, they love to fuck up children's lives.
Disclaimer: I grew up in Maine, I've seen repeatedly what CPS has done to families due to their incompetence, I have no reason to think that CPS in other states are any better.
If you're a parent, and you care about your child, treat the CPS like a terrorist threat. Do not talk to them unless you're with your lawyer, do not answer their questions, and teach your child the same. Their job is to make you guilty to justify their budget, not protect children.
I added the link on the root level.
The point is that when "the system" is too uncaring, these are the kinds of consequences. A false positive from a mediocre field test caused this woman no end of grief. The takeaway is that when we, as engineers, design systems, we have to remember edge cases like these, we need to remember the person.
When your automated spam detection system flags an account, are you going to outright lock/delete it with extreme prejudice, or are you going to allow the account owner some recourse, and a chance to explain themselves to a real human?
I think this article highlights some huge problems with systems that have too much confidence in their tests / checks. Definitely a useful story for all of us to know.
Well said.
I'll only add that this concern needs to extend all the way back to the initial decision to start designing a system. Technology can have a large impact on people simply by existing; it's worth taking the time to consider what that impact will be and how it will affect people, even the edge cases.
This is becoming increasingly important as the effects of technology start to reverberate through the foundations of society. This makes the popular attitude of only considering the technology increasingly irresponsible; there is "No Neutral Ground in a Burning World"[1].
[1] https://media.ccc.de/v/30C3_-_5491_-_en_-_saal_1_-_201312272...
If just reading about it frustrates you this much, imagine how the mother must have felt.
Ring ring, hello, so you're not on drugs after all, have a nice day, bye.
This is how the system apologizes, and it's not humane.
And no, throwing lawyers at the problem is not a solution.
Then again, this is par for the course in the drug war.
One day I got a call at work from an ex. "What's up?" "You need to come home, we need to talk."
I duly do.
"So I went to the doctor earlier today. Had an issue. They swabbed me and told me I have an STD. So they did a full STD and blood test, we'll see how that goes. In the mean time, who did you cheat on me with?"
"Uh, nobody."
Back and forth, arguing etc. Me insisting I'll go get tested.
Doctor rings back the next day. "Looking again under the scope, not an STD, just a yeast infection."
Relationship relief.
A month later, call from the clinic: "So about this bill for $290 for a full workup and testing, can you pay that today."
No. Not a chance. You not only misread a test, you gave my girlfriend factually inaccurate information that you -knew- was going to be controversial, and on the strength of that told her "if it wasn't you, you really need to get fully tested if you don't know where he's been".
And then send me the bill? No.
Drug tests are not a "magical black box", there's a process that goes on. And they aren't always right. They usually first start off with immunoassay test on the urine which attempts to measure substances in urine through the use of antibodies. These are "okay" tests -- not bad per se, but they are definitely subject to a wide variety of false positives (http://jat.oxfordjournals.org/content/38/7/387.full). The reported false positive rate I can Google is all over the map, but I've seen articles suggesting as high as 10% (http://www.webmd.com/news/20100528/drug-tests-often-trigger-...).
Drug testing uses these first because they are quick and relatively cheap. The gold standard, however, is GCMS testing. Very accurate, but expensive and time consuming. I assume that's the test performed in the article that took three weeks to resolve the false positive to the negative.
Assuming the story as reported is true, I'm a little bit peeved that there was a de facto assumption by the nurses that the test was correct. The meth / amphetamine test in particular seems to be one of the more problematic immunoassays in the literature in that it false-positives with all sorts of prescriptions, along with some non-prescription drugs (http://www.medscape.com/viewarticle/726897_2). 90% correct is not correct enough in my opinion when it comes to messing with people's children by threatening CPS.
It's most likely the inhaler but how is she supposed to know exactly what caused the hospital tests to fail? She's not a technician.
It is _very_ common in medicine to use a very sensitive test to screen for conditions, and then cross check any positives with a more specific test (which is what should have been done in this case, prior to taking any action).
It can cause a positive meth test (thank you Google):
https://www.labcorp.com/wps/portal/!ut/p/c1/04_SB8K8xLLM9MSS...
Q: What do the percentages mean in methamphetamine "d" and "l" isomer test results? A: In order to help determine whether a methamphetamine positive may be due to an illicit source, it is helpful to determine the percentage of "d" isomer. For example, following an individual's use of Vick's Vapor Inhaler, the expected result would be 100% "l" methamphetamine. However, there is a possibility that trace amounts of "d" isomer may be present in the quantitative analysis. Laboratory guidelines have been established to allow for trace presence of the "d" isomer. If the laboratory report indicates more than 80% "l" methamphetamine, the results are consistent with Vick's Vapor Inhaler use. If the laboratory reports more than 20% "d" methamphetamine present, the result indicates the use of "d" methamphetamine other than the inhaler. Illegally produced methamphetamine and amphetamine may contain mixtures of "d" and "l" isomers. LabCorp recommends use of a medical review officer (MRO) to review all non-negative test results.1
https://en.wikipedia.org/wiki/Levomethamphetamine
She was using an albuterol inhaler. It's prescription only and operates on the lung passages.
https://en.wikipedia.org/wiki/Salbutamol
But this leads to the obvious question: can Salbutamol confuse the drug test?
Google seems to say yes to several chemicals that look similar (both the chain and the name), but not getting a direct hit.
It is a weird situation because on one hand, they should trust the actual tests over the word of someone who has a motive to lie if they were actually on the stubstance. However, on the other hand tests are super inaccurate sometimes and treating people like a criminal before a confirmation is just wrong.
i'll go on a limp here (as fortunately has never had any even close to such experience) and speculate that may be he should have called a lawyer. Especially considering that in bunch of states it is a crime of endangering child or something like this.
Everybody going into situation with possible drug test should carry a printed copy like just in glove compartment with car insurance to avoid (or at least to clearly understand where it stems from) such "false positive" experience.
I am sorry she went through that, it is very unfortunate that statistically some tests will come back with false positives. Arguing that they should have treated her different is much like arguing babies should not to be vaccinated because there is a very slight statistical chance they might have a bad reaction.
There are no useless parents, only parents who need help.
Whether you want to parent, and how much you're able to parent, are completely different states.
You honestly belive all parents, even child abusing parents are just good parents that need a little help?
My mother was an abusive alcoholic who abandoned our family because she couldn't get the help she needed. She wasn't a bad person, just someone who couldn't get the medical and counseling services needed to cope with previous life experiences that enabled her addiction.
Have to give people the benefit of the doubt. To hold onto the coal of anger only burns yourself.
I am not the OP, but my guess is s/he benefits more from it than the parent does. As the old adage says ...
"Anger/hate/unforgiveness is like drinking poison, expecting the other person to die."
Please understand I am not judging you at all. To be honest I don't know if I would look after an abusive parent or spouse. I would like to say I would ... but truth be told I don't know.
What I do know forgiveness is a wonderful thing, and the forgiver gets way more out of it than the person who is forgiven. So much pain and conflict in this world is stems from humankinds seemingly innate inability to forgive, sometimes even after centuries have passed.
Edit: I don't know why you were downvoted and don't think you should have. If it helps, my posts in this thread have been heavily downvoted.
Also upvoted both of you FWIW.
Compassion, and peace with the way life occurs. I hope you find peace one day as well.
> All three days, the nurses are reluctant to hand over the baby, saying my actions are irresponsible.
> Every shift change, two nurses stand by my bed and inform another two nurses of my status as a combative patient. “This woman tested positive for methamphetamine,”
This does not strike me as very professional. The medical staff should have considered the possibility of a false positive, and given the mother the benefit of the doubt when she said she wasn't taking methamphetamine. Telling the mother that she shouldn't breastfeed and that CPS have been called, while not stopping her from breastfeeding (presumably they have no legal power) is the worst of both worlds: increase stress/worry (which is something the child would pick up on), draw everyone's focus away from the actual birth and the child, while simultaneously allowing her to potentially pass this, presumably harmful, drug to the child. Madness.
Subjecting the family to un-needed intervention causes harm to those children. And it causes harm to the children that do need intervention, because child protection social workers are made busier dealing with cases that they need not deal with.
Something that was missing in this story was the lack of dialog between the hospital staff and patient. False positives is possible, so why not send a trained psychiatrist at a positive? They can talk to the patient and check if the result make sense, and if nothing else, start address issues such as postpartum depression.
Like looking out for a newborn by discussing with the mother the ramifications of breastfeeding in light of multiple failed tests?
A spontaneously aborted fetus because the stress of withdrawal during pregnancy was too much for the mother's body.
If an addict becomes pregnant and seeks treatment (which during pregnancy would likely consist of continued dosage of an opioid in the form of methadone) then there is the risk that she will give birth to an opioid dependent infant (or not - it's only something on the order of 1/3rd of infants born to mothers who use opioids who suffer from NAS).
But yes...treat the parent as subhuman. Rip the infant away from its mother. To punish the mother because she's bad.
Nevermind the fact that there has been a strong link demonstrated by neonatal bonding between mother and infant and lower rates of NAS as well as overall better outcomes for the child.
HN appears to support Unicode://news.ycombinator.com/item?id=9105273
I fully realize that the ellipsis is a code point/glyph/character/whatever in its own right, and that the rendering of it using three periods is not correct.
The existance of that rendering is what makes the proper one seem "fancy", from some points of view.
Also, one should never explain jokes I guess.
And if you don't believe in raising your kid the same way THEY want you to, watch out...
http://www.usatoday.com/story/news/nation/2015/04/13/parents...
http://insider.foxnews.com/2015/06/14/florida-parents-charge...
This is 100% absolutely false, but it's a misconception CPS agents love to abuse. CPS is NOT a law enforcement agency. If they want to remove a child from a house, they need to have the police and judge's order to do so. In fact, they can only enter your house with your permission or with a warrant with police present. However, some of their worse agents thrive on threatening parents with child removal.
If you ever, ever get wind of CPS coming to visit you, consult a lawyer, and record any conversations you have with them (on your property). You need to stand up to them. Source: I've been through this. Fortunately, the person I worked with understood she was entering a hostile environment.
CPS is like the police. In general, a large number of the agents are decent people who are trying to do what's best for the children. However, you will get some agents that tend to be over zealous and will abuse their position to threaten and force the parents into submission, under the assumed auspices of taking away the children. Most people who deal with CPS tend to be poor and do not realize a CPS agent is not a law enforcement agent, and thus need a warrant and police to take away children.
rights to have a "birth experience" according to a wishlist, possibly at the expense of the child? At more or less every point I would assume.
OK, it's UnitedHealthcare® if you want silly capitalization.
On what grounds? She failed a drug test and the hospital are mandatory reporters, I'd see the case instantly thrown out, and we only got her own side of the story.
I've no idea where you read that from. Her only accounts are that the nurses changing shifts warn their followers she's tested positive, that they repeatedly warned her about the breastfeeding risks and that the social worker doesn't believe she's a user, that's about it.
> I'm sure a good lawyer will know how to spin it.
And I'm sure even a bad lawyer would know how to dismantle that.
The nurses at shift change noted that she had failed two urinalyses. That is a statement of fact, not a derogatory assassination of character.
That poor, poor child.
That's speaking for the child. Speaking for someone else's feelings besides your own is speaking for others. And, it's not a perspective either, it's an opinion how someone else would feel in the situation, which is NOT a different perspective you can hold, given you aren't the other person.
Stick to what you know, is the basic lesson.
No matter how many times it might seem stupid for me to reiterate that with my condition I can't have any blood thinners - no Aspirin specifically - I simply don't trust anybody new with being, well, competent enough to make the connection themselves. I police what goes into my body with pretty good results. I go out of my way, time and again, to discuss my specific treatment needs and precautions. Granted, not everything is in my control, but the things I can monitor, I do try to get a handle on.
What made it especially bad was the fact that my daughter was in the middle of a medical emergency, and the staff at the hospital were wasting time on a ludicrous "meth" hypothesis.
New onset seizures (particularly a string of seizures) are unusual for a kid. Methamphetamine causes seizures. There are ways a child could have been exposed to meth that a parent wouldn't know about (another caretaker left it lying around, a preschool friend brought it in for "show and tell" and no one noticed, etc...). It was prudent on their part to consider it as a possible cause of your daughter's seizures. A positive meth test for a seizure patient (of any age) would certainly raise my index of suspicion enough to thoroughly explore the possibility of intentional or accidental ingestion.
I totally get why you would perceive them as "wasting time" (and obviously I wasn't there, it's entirely possible they were), but it's very likely they were running down all the other "normal" differential diagnoses in parallel.
I've seen multiple instances with family members where the doctor's dumbass hypothesis absolutely did not match the symptoms, but they persisted in trying the worthless treatment anyway. Took 'em months to find and start treating the slightly rare form of cancer. Bring on the diagnostic computers, I say.
I'll absolutely agree with you in terms of primary care docs... As someone who routinely transports patients out of doctor's offices when the doc is in over their head, there is a _much_ broader variation in competency...
I'm not outraged that it happened. But: we obviously knew for a fact that methamphetamine exposure was not involved in her seizures. We did, however, have to deal with ER staff entertaining it as their primary hypothesis. That was frustrating, and, in hindsight: indeed a waste of time.
I think the only real problem I have here is that whatever test they use to detect meth, it obviously falses a lot.
(Her seizures were idiopathic and never repeated; our working theory is that it was a reaction to a benzocaine medication she got a day earlier.)
I think the mature thing to do would be to wait for the 2 week test to come back and not breastfeed your child in the meantime. Even if you know you haven't done meth, I would think the risk that you somehow have been exposed to meth should outweigh the desire to breastfeed.
The hospital is more concerned about the health of the baby than the desire of a new mother to validate their motherhood by breastfeeding. Seems okay to me.
She was treated like a criminal before giving birth, though.
>you somehow have been exposed to meth
How exactly do you get exposed to meth?
>than the desire of a new mother to validate their motherhood by breastfeeding
You're reading an awful lot into her desire to breastfeed her child.
I suspect you're male and don't have children, talk to mothers about the importance of breast feeding to them, you'll find this isn't a subject to be logical over.
Breastfeeding is monumentally important for some mothers. Mom has every right to insist on breastfeeding even in the face of a test she knows to be a false positive.
Their listed benefits of breastfeeding include resisting illness, lower % of SIDS, a correlation to higher cognitive function, and lower occurrence of other diseases. They then list benefits of formula, which all amount to convenience for the parents. Then they say don't feel guilty either way.
The higher correlations to health benefits are the closest to birth, with nearly all sources recommending breastfeeding for at least the 1st six months, if possible.
I don't know. If I was confident I wasn't exposed (the article said they were very careful, and were certain it was a false positive), I might go with breastfeeding in that case as well.
http://www.webmd.com/baby/breastfeeding-vs-formula-feeding
> The hospital is more concerned about the health of the baby than the desire of a new mother to validate their motherhood by breastfeeding. Seems okay to me.
That has to be one of the most idiotic things I have ever seen written on this site.
If she didn't do meth then she should nurse. What possible reason is there not to? Some mythical exposure to meth? What in the world are you talking about?
Have you ever even seen a baby? Have you seen one nurse? I suspect you have not, or you would not write such incredibly stupid things.
It's fighting law with law. If they were draw a sword, I would draw mine too.
That would be idiotic, nonsensical and a very good way to make current and future interactions even worse. Hospitals are mandatory reporters, if they don't report suspicious situations (such as a pregnant mother failing a drug test) they're on the hook for it, and they must prepare for a possible NAS case which is anything but fun, or a walk in the park.
And despite the completely one-sided report, it looks like much of the antipathy came from her insisting on her "experience" and on e.g. breastfeeding the child.
So, yes, a lawsuit would be in order (IMO). I wouldn't ask for a huge payday, but at the very least that they clean up their testing procedures and follow protocols.
The tests were not known to be spurious by the hospital.
> neither of which were blood draws which are vastly more accurate.
Blood draws tests are also much longer (that's the 2~3 weeks test whose results they got afterwards).
> I wouldn't ask for a huge payday
Not that you'd get any even if you did.
> at the very least that they clean up their testing procedures and follow protocols.
Is there any protocol you know them to not have followed?
Keeping in mind that the one account we have is the one-sided version of the parents, consider the hospital's point of view: what they have is an expectant mother who has twice failed a drug test and thus a NAS risk, a nearly DOA newborn from emergency C-section and the possibly drug-addicted mother thereafter insists on breastfeeding.
Then the hospital is negligent. It is their responsibility to know the failure modes of any technology they use.
They gave multiple chances for retests. The results were consistent.
A blood test four weeks prior to delivery would be a good start, but still leaves a window.
There are two suboptimal possibilities at that point:
1) err on the side of the mother, who has failed (incorrectly as it may be) multiple drug tests and allow her to breastfeed her child, or
2) err on the side of the child, who is exhibiting symptoms that could point to NAS, bradycardia and the like, who is delivered by emergency C-section (so she would not have had the bonding experience immediately post partum, as it was, anyway)
They did know the failure mode.
They evaluated.
They held off on calling CPS. They allowed contact after the baby's urinalysis.
There is no negligence here. The father showing by their own words anecdotal forum posts and such is not reason for the hospital to say "Well, what do we know, here you go".
You mean by sending away for a more accurate test which cleared things up?
We've found that many of these people take Zantac (aka ranitidine, used for acid reflux). This hasn't been studied since 1991[0] but it probably should be again, given increasing rates of meth use.
I wish the author had given the name of her prescription inhaler- Vick's Vapor inhaler has been shown to test positive but albuterol and other steroid inhalers are more common.
[0] http://www.ncbi.nlm.nih.gov/pubmed/2051743
My husband scrolls through pages of information about albuterol inhalers and drug tests. He shows his phone to every nurse who steps foot in the room.
Cross-reactivity studies don't seem to be published often but searching for albuterol + 'cross reactivity' shows some drug tests are cross reactive with albuterol and some aren't.
I rode a bike without a helmet
I played outside, by my self, and would sometimes go MILES from my house.
We did stupid stuff, with fire, fireworks and the like.
My parents left me home alone after school, I was a latch key kid.
Today, the police would bring my kids home and I would get a visit from CPS for any of these things.
Welcome to having children in the new millennium.
Maybe we should stick kids in suits of armor Faraday cages too, just in case lightning strikes.
About 50% of all New York bike accidents, according to the article Jean_Claude linked.
> Maybe we should stick kids in suits of armor Faraday cages too, just in case lightning strikes.
I'm just baffled by all the people who think putting a helmet on is onerous and restrictive and destroys the experience of cycling. Why?
That's a straw man. Helmet advocates do not imagine them as some sort of invincible armor. They obviously will not keep you from being injured in a serious accident. What they do is reduce your chance of being killed. The large majority of fatal bicycle accidents involve head injuries. (One source: http://www.rospa.com/road-safety/advice/pedal-cyclists/facts...) I would rather be in traction than dead.
I agree that children cannot be wrapped in cotton wool; they should be allowed to roam without supervision and make their own mistakes, even if that does slightly increase their risk of injury or death. But getting a bike helmet for your kid does not restrict their mobility or their ability to learn. It has no downsides, only upsides.
You've made the choice not to wear a helmet; if you ride safely, in a safe area, the extra risk is probably quite small, and if you believe it's a fair trade-off for a little extra comfort, that's your prerogative as an adult. But don't pretend that wanting to feel the wind in your hair is taking a moral stand.
> But don't pretend that wanting to feel the wind in your hair is taking a moral stand.
Your words, not mine -- as most of your post by the way. However, there is value in not arriving to your destination sweating or stinking (i.e. going to a meeting, social event, etc). In cases like that it's perfectly fine not to wear a helmet as long as the rider is aware of the risk, and adapts his/her riding style to this situation. Mostly everybody does it in Europe and we're all fine.
[0] https://www.youtube.com/watch?v=BJKbXH2cAyI
Yeah, and then you go flying and your head hits the ground, or a lamp post, or another car. Not always, but often enough.
Head injuries are pretty common in car-pedestrian or car-cyclist accidents even though the average car is much lower than the average head. Collisions don't end at the moment of impact.
I get it, you're advocating for people's safety -- that's noble. But, sometimes you have to live and let it die. In other words, you have to respect people's choices, or move to a nanny state and stop judging the people that decided not to live under the same rules as you.
No offense, but that's what will happen when poorly educated riders bike in the door zone. See: http://www.bikelaw.com/2016/02/18/door-zones-a-dangerous-gam...
Biking amongst traffic on roads requires skill, knowledge of biking laws, good situational awareness, knowing how to posture and when to take the lane to protect yourself.
Oh, and a bit of luck that the people next to you in their steel cages aren't homicidal towards bicyclists.
What do you propose a well-educated rider should do, when all the bike lanes are in the door zone and bikes are legally required to stay in the bike lane?
> Oh, and a bit of luck that the people next to you in their steel cages aren't homicidal towards bicyclists.
Yup. Which is why you wear a helmet.
Well that's the usual poor planning I see in America. Sharrows or "share the road" signs are much better than many of the dedicated bike lanes I've seen here.
First, find another route, if possible. Second, start going to your city's public meetings and/or complain to the city about the clear danger that poorly planned bike lanes inflicts upon the public. Learn the law specific to bicycles for your area and get involved with a bike advocacy group if you really care.
As far as helmets go, I like to keep my brains intact, so I wear one, and have the abrasions on an old helmet to prove it. Front tire blowout and dumping at 45 KPH downhill on a recumbent was an experience that could have been worse sans helmet. That said, a pound of plastic and foam can only do so much for you. Good luck!
I have no doubt that a study would find there were more then than there are now, but things don't exist in isolation. We make trades for everything.
For example, we've traded relatively rare (and usually treatable) skin cancer for more widespread sunlight deprivation and Vitamin D deficiency that's implicated in a number of different conditions. I don't think this was a good trade, personally.
In this case we've traded our kids' childhoods and parents' exercise of discretion--this is part of their life cycle too, keep in mind--for what I'm quite convinced is a minimal increase in safety. Mandatory bicycle helmets? Sure, if it stopped there. But we've gotten way more paranoid than that. I don't think that's a good trade either.
If you really want to feel injustice and helplessness, why not try getting arrested for something you didn't do. Spend a few nights in jail, and deal with police, lawyers, judges, lose your job and friends because of it, find yourself on a bunch of lists you've never been on before, etc. That's what "being crushed by a system" is like.
Them, apparently omnipotent gods: silent shaking of head and look of pity
Also: There is no need to drive madly to the hospital. There will be no incentive to keep you for exactly how long your insurance will pay, nor to perform surgery. You get to sleep in your own bed, without constant beeping and light from the hallway. You can have as many visitors as you want. You will never be separated from your baby, not even for a moment. You won't be treated like a potential criminal. You get respect.
But hey, CPS didn't get to take your kid[2], so there's that.
[0] or the mother, or both
[1] which is anything but rare, even in the UK under obstetric care[3]
> The risk of dying on the day of birth (0.43 per 1000, or 430 micromorts) exceeds that of any other average day of life until the 92nd year.
and matches the risks of major surgery. Homebirth, especially with completely unqualified midwives (which is the rule in the US) is almost an order of magnitude more risky[4].
[2] the coroner did, to check for foul play
[3] http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12544/f...
[4] https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeM...
"Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P=0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth." [1]
"Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs 0.32 per 1000; P < .001). Midwife home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27 per 1000; P < .001) and midwife home births of women with a first birth (2.19 per 1000; RR, 6.74 vs 0.33 per 1000; P < .001) had significantly higher risks of total neonatal mortality than deliveries by hospital midwives. In midwife home births, neonatal mortality for first births was twice that of subsequent births (2.19 vs 0.96 per 1000; P < .001). Similar results were observed for early neonatal mortality. The excess total neonatal mortality for midwife home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births." [2]
[1] http://www.nejm.org/doi/full/10.1056/NEJMsa1501738 [2] http://www.ajog.org/article/S0002-9378(14)00275-0/abstract
Like, these are "am I willing to make this tradeoff" numbers similar to choosing to drive to work daily, rather than "fuck no, go to the hospital" numbers.
Look up earlier in the thread for my comment, but anecdotally, almost every parent that I have told my story to has changed their opinion on home birth vs. hospital birth.
It's an educated and sourced one, as opposed to your flippant comment.
> There are plenty of board-certified midwives
Not only are there plenty of midwives which are not that, how meaningful board accreditations are depends strongly on the board, CNMs are true professionals[0], CPMs are pointless layabouts.
> birthing centers
The comment I was replying to was about homebirth.
Birthing scenters are usually professionally staffed, attendant to hospitals, carrying necessary emergency materials and will immediately transfer to their linked hospital in case of complications. And good birth centers will plain refuse at-risk patients and direct them to hospitals.
> Importantly, a great deal of risk can be ascertained before labor
Which is already included in the statistics above.
[0] and even with CNMs homebirth mortality is significantly higher than hospital birth.
From what I've seen, hospital-associated ones are bait-and-switch. If you show up early, then you take longer than allowed and they transfer you to the regular hospital. If you show up late, then they also transfer you!!! (this shockingly lame excuse was actually used on a friend) Clearly, there is a purposely narrow window because the hospital makes more money if you end up in the regular hospital area.
I find it strange that you think homebirth midwives don't carry necessary emergency materials. Just considering the obviously visible example, every one I've seen lugs around an oxygen tank.
"You people"?
Unrelated stuff going on in the birthing center?
I am describing a situation where the midwife/ doula was MORE CONCERNED with maintaining a "positive and serene energy in the birthing space" (her words) than she was about what we would do to take care of a critically ill neonate.
I can assure you, my methodology on such a call is not to "stay and play" but to "stabilize, ideally while transporting". Let alone a fishing trip. To wit, I could not care less what else is going on in the home, be it legal or illegal, unless it directly affects the care I am or need to provide. My reference to DOH was not a "fishing trip", but in regards to a provider who, in my professional opinion, was being actively negligent in caring for what was their patient, until transferred to me.
I think your biases are showing.
You realize paramedics are qualified in neonatal resuscitation, right? While "scoop and run" is absolutely the right thing to do in some cases, if I'm handed a blue baby, I'm going to spend some time in stable, well lit environment getting an airway established. The sooner that happens, the better the baby's outcome is going to be (and it's much harder to do bouncing down the road in the back of an ambulance).
What in god's name are you talking about? Infant mortality is the one primary risk of childbirth and the primary measure of perinatal and neonatal care alongside maternal mortality, the risk of the child dying is the very first thing you compare when talking about childbirth.
> with completely unqualified midwives
And that is a very common risk in the US because most states don't require any formation (let alone certification) to call yourself a midwife.
I was very clear, I do not see how you could genuinely be confused.
>And that is a very common risk in the US
It is not a risk, it is a choice. You don't call up the midwife store and say "send me a midwife" and hope for the best. You choose one. People can choose one that is trained and certified.
In a hospital, all that was easy to access. If this had been a home birth, it may have been catastrophic.
Driving to the hospital and not being in your own home is an unfortunate reality. We do not live in hospitals.
Disrespect, misalignment of insurance incentives, and inflexible criminal treatment are all bad things. But their damage is amplified because the alternative - homebirth - lacks the medical advantages of being in a hospital. Draconian policies like this literally kill children at the margins.
That's about as reliable as:
"The dog moved funny, indicating it found drugs, so we have to search your car."
(it's totally normal for the heart rate to drop)
The sad reality is that the facility for C-section is not financially viable unless you use it on a regular basis. There is an incentive to use it. When used, it is profitable.
Doctors who push back on profitability find themselves replaced.
In any case, those who have trouble at home can get emergency C-sections. Since prepping takes time anyway, there is no added delay if you call ahead. Situations where mere minutes matter are rare to the point of being pretty much non-existent.
Much of the 'prepping' requires the mother to be present (administration of anesthesia, monitoring, etc). The prep of the OR is generally done in parallel with those tasks. If it takes you 30 minutes to the to the hospital, you are delaying a c-section by at least 30 minutes.
Additionally, measure that can be taken to reduce fetal stress (while waiting for the OR to be prepped, in the event that is delayed) are _much_ easier to accomplish in a hospital, rather than in a car, or the back of an ambulance.
No it is not!
We are not talking going from an exercise heart rate to a resting heart rate. We are talking about a resting rate to a lower-toward death rate.
Uh no, it's really not.
I trust my smoke alarm - to probably give me extra warning. I don't trust it to unlock the door and let me out.
Maternity ward infant abduction is an ongoing thing, though now fairly rare (and even more rarely successful, with dozens of attempts stopped within the ward for each successful abduction) because of the security measures that have been instituted by hospitals in the last few decades.
But that's a success of the security measures, not an indicator that they aren't necessary.
But in this case there's a rather large negative of being trapped.
It's not enough that there be some theoretical benefit, but that the benefit outweighs the costs.
Anyone who has a basic understanding of Bayes' Theorem can tell you that testing all new mothers for X (where X is relatively rare among new mothers) will lead to a large number of false positives even if the test has high specificity and sensitivity, simply because the prior probability for X is so low.
More screwed up is the fact that it took weeks to get the correct result, and that innocent people have to live in fear of CPS coming and taking away their newborn.
According to Healthcare Triage, home births have an overall lower risk of complications. It's only in the cases of things going spectacularly wrong that being in the hospital helps.
https://www.youtube.com/watch?v=xHWvSPhENtk
It fits with my view of things: If there's something really broken, go to the hospital to get it fixed. However, if you're fine, you're better off avoiding the place. (Do get checkups from a doctor you have a good relationship with.)
Also, the overall chance of pregnancy with unprotected sex involving a man and a woman of childbearing age is 1 in 4. So, would you engage in such sex knowing that there was a 1 in 40 chance it would lead directly to your own death? (Or your partners? Bees be Krayton!)
I wonder if that's where some of our cognitive biases around risk come from? It benefits our genes that we're cavalier about certain kinds of risk.
Also unprotected sex does not necessarily equal procreative sex, which I realize is a somewhat controversial statement, but nonetheless true.
[0] https://www.plannedparenthood.org/learn/birth-control/withdr... (there's no fragment, it's under the effectiveness section of the accordion)
[1] https://www.plannedparenthood.org/learn/birth-control/condom...
I knew that when I posted it. When I posted it, I thought I had clearly indicated it, but looking at it again, that must have been forgotten before it could be enacted. My intention was to play with the two wildly inaccurate figures together.
1 in 20 (~50 in 1000) in the UK until 1940/1950. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633559/
and lots of interesting reading here: https://www.google.co.uk/webhp?sourceid=chrome-instant&ion=1...
but 1/180 times your baby got a Staph Infection they would not have gotten at home and died?
The numbers are obviously bogus, but there are dangers to anyplace you choose to give birth... As long as people are well informed, seems they should be able to choose their own adventure.
https://news.ycombinator.com/item?id=11724332
Drinking a hot beverage is much more dangerous than drinking a cold beverage.
Life is full of dangers and risks. Why should birth be any different?
I could post many stories of people who had their first kid in a hospital and had a horrible experience, ends up getting a C section when not really needed, etc (See american C-section rates vs European for example). Then they chose to have a kid at home and had a 100x better experience and a more healthy baby (due to lack of C section and all the problems that leads to).
What you are doing here, is glossing over the underlying logic and falsely reasoning by resemblances. I find this sort of false reasoning flat-out stupid. It needs to be called out so others do not imitate it. (Which is a more meaningful resemblance to anti-vaxxers your comment is exhibiting.)
I'd be very surprised if that was a controlled study accounting for people who are at risk of complications making sure to deliver in a hospital.
> It's only in the cases of things going spectacularly wrong that being in the hospital helps.
Which you wouldn't really know in advance as it comes up during the delivery itself.
Yep. My wife had a perfectly normal pregnancy, and everything went perfectly until something went spectacularly wrong. When my daughter was born, and didn't breath on her own for the first 3 minutes. If she hadn't been in a hospital, it would have gone down as still born. She was in the hospital, immediately received resuscitation and numerous other treatments which maintained her blood oxygen level sufficient to prevent brain damage, and now at the age of 4 is ahead of every developmental measure.
"It's only in the case of things going spectacularly wrong" that any risk mitigation activity actually provides value, and in every other case is essentially worthless. YMMV, but I tell everyone I can the story of my daughter whenever they talk about home birth.
One of my daughters too didn't breathe when she was born. The midwives grew very very ernest very very quickly, and the little child was rushed off to hospital in an ambulance. All went fine. I was a little shaky that first night.
Yes, midwives (in some jurisdictions) are trained, qualified practitioners. That said, they are not equipped to deal with many, many complications other than by calling an ambulance and hoping for the best.
Choosing to have my daughter born in a hospital instead of a home birth was most likely the difference between having a healthy baby girl and something in the range of severe mental handicap to stillbirth.
Having a child is a huge risk and investment (by every measure, emotionally, financially, socially, economically, etc). Why would you risk having a stillborn child, life with a mentally or physically handicapped child (this is not a shot against handicapped children - it's a shot against people who refuse to apply critical thinking skills to emotionally charged high risk decisions) so that you can satisfy some foolish ideal that being born at home is better than being born around people who have trained for much of their adult lives to keep your kid alive in its first few days?
It ranks right up there with the foolish parents who refuse to vaccinate children against common ailments or choose naturopathy or homeopathy because of "toxic western medicine".
by whom? That's an easy claim to make if you don't have to test it.
Just doesn't seem worth the risk to me.
EDIT: And for the record, there was zero prior indication that something was wrong. The first sign was when the water broke and was green.
(not that it gets used much -- your case is far from the norm -- but they DO actually come prepared)
Is this not commonplace in the larger hospital markets (where I would assume most HN'ers live)?
"Complications" is a broad categories and includes many things that may not lead to adverse outcomes if managed appropriately, and which hospitals may be more prepared to manage.
According to this study of Oregon births in the NEJM, planned out-of-hospital births studied have substantially higher rates of infant death and neonatal seizures than planned in-hospital births (and these results are, per the study, in line with other studies of out-of-hospital vs. in-hospital births.)
http://www.nejm.org/doi/full/10.1056/NEJMsa1501738
Where things went wrong and bad in the story is the attitude of the nurses.
The social worker who initially responded was no presumptive and did the smart thing of not escalating the issue.
https://www.youtube.com/watch?v=UF1T7KzRnrs
https://www.youtube.com/watch?v=Ql2jEJ-6e-Y
That pretty clearly depends on the prior probability, P(M).
It doesn't matter what the prior probability is of a random person having used meth (or whatever you are testing for); it only matters how likely it is that someone who has not used meth will be given a positive result.
If that test is performed only on women, the false positive rate will be 100% regardless of accuracy. All positive results would be false positives.
If the test is preformed on any man leaving or entering the oval office, then the false positive rate will likely be significantly less then 100%, as there will be a president tested multiple times in that group, and when we test positive on him, it's not a false positive.
If we test the population at large, most positive results are going to be false positives, simply because we're unlikely to actually have a former president get tested. But in theory the false positive rate could be slightly less then 100% if we got lucky.
As the probability of an actual occurrence in the test group drops to zero, the rate of false positives approaches 100%, regardless of the accuracy of the testing method.
I think you might be talking about the rate relative to all positive trials. I think I am talking about the rate relative to all trials that don't meet the conditions of the test.
So, you survey 100 women and your test tells me that 10 of them have been president, I say that your test has an observed false positive rate of 10%.
If we test a group comprised of only former presidents, all positives must be true positives. So our false positive rate will be 0% while our female test set has been observed to have a false positive rate of 10%. This illustrates that the sample set effects the observed false positive rate.
As the rate of occurrence of what we are testing for approaches 100% in the sample set, the false positive rate drops to zero. Inversely, as the incidence of what we are testing for in a (sufficiently large) sample set decreases from 100%, the false positive rate will eventually increase to some non-zero percentage unless the test is perfect.
So if we only test meth addicts for meth, our false positive rate will be lower then if we test the population at large.
edit: If the answer is "will someone think of the children!" why isn't the state randomly drug testing all parents?
It's obviously a thorny question, but what should a facility that treats children do when it notices a conflict between the interests of the child and the interests of the parent? It's clearly going to happen.
My second son was premature... when we were in the NICU... there was a lady there, whos child was born premature because the taxi she was riding in from the airport was involved in an accident. She came from california... where her gyno was pro-mj, and she used MJ to manage her Hyperemesis gravidarum... so its in her system, clearly... but this is Texas... so even though her doc recommended it, not only was her child in the NICU, but when he got out, he didnt get to go home with her... because of stupid laws that pay no mind to actual scientific evidence...
When my daughter was conceived her mother was addicted to opiates. We were both in a bad place. I was just out of a relationship with someone with Borderline Personality Disorder and she was coming out of her own abusive relationship. Needless to say this wasn't how either of us had envisioned conception.
But her pregnancy was a strong motivator to turn things around. But addiction isn't something you can just switch of. Especially something like an opioid. It is extremely dangerous to the fetus for the mother to detox during pregnancy. Miscarriage is common. But that doesn't mean that treatment isn't an option. That treatment is, however, most commonly something like opioid maintenance in the form of methadone.
Methadone is still an opioid (although longer acting and "harder to abuse"). It still comes with the same risk of NAS. But that risk is actually fairly low. In researching the risks around my daughter's birth I came to find that only about 1/3rd of all babies born to opiate addicted women suffered NAS, and the greatest correlation was tied to usage of multiple illicit substances (say opioids and amphetamines together)
So we dedicated ourselves to having a healthy pregnancy and a healthy baby and she started methadone maintenance at a local clinic.
In the end my daughter was born four weeks premature (premature birth is actual common in opioid addicts). The author of this story did an excellent job of capturing how the atmosphere changed as soon as it was discovered that my wife was under a maintenance dose of methadone. The derisive judgment. The loathing in the eyes of the nurses. That was a very new experience for me.
And the procedures and policies described in the article are actually in many ways detrimental to and harmful to the outcome for the infant.
Opportunities for bonding should be encouraged. And at least in the case of opiates it has been found that breastfeeding decreases the risk of NAS and should be encouraged (opiate concentration in breastmilk of a woman using opiates is measured in micrograms, far below the threshold to affect the infant, but the simple skin on skin contact and intimacy seems to make all the difference).
My daughter did not suffer from NAS and after three days of observation we were discharged when it was clear her lungs were fine and she was not going to suffer withdrawals. Thankfully the attitudes of the nurses changed within about the first day. I suppose we weren't typical of "addict" parents...but I can say that being on the receiving end of that sort of experience...the only effect is going to be to push addicts further down a hole with even less chance of being healthy, functional parents.
> The bulk of my produce was organic, my drinking water purified through a reverse-osmosis system. I used clove oil on a persistent toothache instead of visiting the dentist, because I didn’t want any anesthetic to pass through my body and into the placenta. During all 42 weeks, the hardest drugs that entered my body were prenatal vitamins and puffs from my prescription asthma inhaler.
"But... I'm white! I'm middle-class! I have a doula! It's patently absurd that these nurses could think I did drugs! Just look at me! What do you mean that's exactly what a drug user would say?"
From her point of view she's a perfect mommy, but as far as the nurses and doctors know, she's just somebody who showed up pregnant with meth in her system and an unlicensed hippie who's smearing lavender oil around the place.