Clinician views on reporting pregnant and birthing patients who use alcohol and/or drugs to child welfare

Am J Obstet Gynecol MFM. 2023 Jul 29:101109. doi: 10.1016/j.ajogmf.2023.101109. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple health professional associations have expressed concern with policies that require clinician reporting of pregnant people’s substance use to child welfare, including that reporting negatively affects patient outcomes and the patient-provider relationship. However, research has shown that clinicians continue to report pregnant and birthing patients at high rates.

OBJECTIVE: To explore clinician views on reporting pregnant and birthing patients who use alcohol or drugs during pregnancy to child welfare and whether there are patterns in the types of decisions that clinicians agree with, disagree with, or feel conflicted about.

STUDY DESIGN: We conducted in-depth interviews with 37 hospital-based clinicians (13 obstetrics/gynecology physicians, 12 emergency medicine physicians, 10 family medicine physicians, and 2 advance practice registered nurses) in the United States. Participants discussed one or more patient cases where they or someone else on the care team had to decide whether to report that patient to child welfare related to their use of alcohol or drugs during pregnancy. We categorized cases based on whether the participant agreed, disagreed, or was conflicted by the reporting decision in that case. We explored patterns by patient-level factors, provider specialty, and whether the participant perceived that the decision was influenced by a state or hospital policy.

RESULTS: We identified 53 patient cases (average 2 per interview). Participants typically described cases where they agreed with the decision to report or believed there was no other option than reporting. These cases typically involved patients who: used nonprescribed opioids during pregnancy, were experiencing factors (e.g., unstable housing and untreated mental health disorders) in addition to substance use, and/or left the hospital against medical advice without their infant. Some participants, mostly obstetricians/gynecologists, also described cases where they felt conflicted about or disagreed with the decision to report. These cases typically involved pregnant patients using cannabis and patients reported because of hospital and/or state policy. Only one participant described a case where they disagreed with the decision to not report.

CONCLUSION: Participants agreed with most, but not, all child welfare reporting decisions. When participants disagreed or felt conflicted with reporting decisions, these feelings were almost entirely related to decisions to report, which, in some cases, were prompted by hospital or state policies. Policies may prompt reporting that exceeds what clinicians believe is appropriate.

PMID:37524258 | DOI:10.1016/j.ajogmf.2023.101109