Pregnant cannabis – users should know about toxicology tests.

What to know about toxicology tests ?

Pregnant cannabis users face stigma and stress over the possibility of losing custody of their child, all because they are medicating with a plant that is still illegal at the federal level. Despite the legal status of cannabis in every state, the federal classification prevails when it comes to the local child protection agency. Even before a patient is aware of a pregnancy, their custodial rights are already at risk, due to urine toxicology tests that are administered (sometimes unknowingly) during pregnancy.

Fear of this possibility keeps many pregnant people from getting adequate prenatal care or from being honest with their doctor. With more states adopting legalisation, many medical patients think they are safe from child protective services (CPS or DCF, depending on the area). Others assume that since they live in a state where cannabis use is allowed, it shouldn’t be a problem.

These presumptions usually come from pregnant people who do not consume alcohol or other controlled substances, and from parents who treat serious conditions with a plant they do not consider to be a drug. Unfortunately, the SPS authorities disagree, and while the general message may be that they will not intervene if drug abuse is not suspected, the evidence suggests otherwise. Social media groups for mothers and parents who consume cannabis are flooded with countless stories of CPS interventions in recreational states.

In many cases, the child is taken away or custody is questioned, despite evidence of a stable home environment. The agency subjects the new parent to an intensive investigation process, often resulting in unnecessary drug treatment programmes, lost wages, skyrocketing legal fees and long-term trauma.

However, many do not know that a patient can refuse a toxicology test.

Toxicology tests for new mothers and babies

“When a pregnant person is admitted to a hospital or medical centre for labour and delivery, they have the right to refuse drug testing, but in most facilities the newborn can be tested without parental consent,” – says Marissa Fratoni, a registered nurse (BSN-RN) and cannabis educator.

"In most establishments, child protection guidelines set by public health departments and the law take precedence over the rights of parents when it comes to drug testing."

One of the biggest factors influencing the outcome of a toxicology test is informed consent, i.e. when the patient is informed about the test along with the potential consequences. In many situations, the patient may not even consider the possibility of testing because the doctor does not raise the topic during the visit. Even if the chosen doctor understands the situation and agrees not to do the test, the pregnant woman must consider the possibility of intervention from external sources, such as other hospital staff.

If a lactation specialist found out, for example, that a parent was a cannabis user, they could alert CPS without informing the patient first. Currently, there is no foolproof way for a mother to avoid the possibility of losing custody of her child, especially when you have financial constraints and no choice of which provider you go to because of insurance. As Fratoni notes, finding prenatal workers who work outside the conventional system is not impossible, but it can be costly.

“Professional midwives (CPMs) and certified nurse-midwives (CNMs) are trained maternal health birth specialists. These care providers may work in or with regular maternity hospitals, but they may also work in private birth centers or provide care to families who choose to have a home birth. Unfortunately, their services are not always covered by health insurance, so families interested in working with these providers may have to pay out of pocket.”

One person who found a non-traditional provider was Stephanie Kerns, a long-time medical marijuana advocate and patient. She found out about her right to refuse a hospital toxicology test when she came into contact with the organisation Moms for Marijuana International. Kerns says one of the founders offered her support and said she was available to answer any questions.

Kerns found a doctor who learned her medical history and documented why she no longer chose to take medication to treat her endometriosis.

“She informed me that even though I was planning a home birth, we needed a plan if I needed a hospital. The plan eventually had to happen. When I got to the hospital and gave birth, my GP was with me,” says Kerns, adding that her GP informed the hospital staff that toxicology tests were not necessary.

Nothing was given to her without her consent: no vaccines, tests or treatment, and her GP made it clear that staff were not even allowed in the room unless necessary.

“She also said we would be turning off the lights in my room to keep me calm. Everyone was nice and did what we said,” says Kerns, making it clear that the hospital staff were very concerned when they came in, “They were amazed at how well informed I was, that I had an advocate (my doctor) with me and they didn’t ask any questions. “

Not everyone is empowered by such an advocate, mainly because they don’t know where to start. Finding out about a pregnancy is overwhelming enough; worrying about care before that conception can even take place is too much for one person to handle alone. Having an advocate is essential, so as legalisation becomes more global, more resources are starting to emerge.

Elephant Circle is an organisation that focuses on birth justice, with a range of educational and legal services among their offerings.

“Birth justice occurs when everyone is equally capable of making decisions for themselves during the perinatal period, when their self-determination is supported and empowered. To achieve this, we will need both the HOW and the WHY of birth justice. We will need strategies to address systems of power and oppression, as well as strategies for change and resilience. We will also need knowledge of health systems, legal systems and the perinatal period. Elephant Circle is here to help you expand your capacity to pursue birth justice.”

"Every pregnant person has the right to advocate for their needs. Every pregnant person has the right to work with health care providers who prioritize prenatal care services that are compassionate and non-judgmental," says Advocate, "One risk to consider is the very real possibility that health care providers will report marijuana use to the Child Protective Services (CPS), which could have social and legal consequences."

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