If a patient admits to drinking while pregnant, shall her doctor report this to authorities? Shall the hospital lock the patient until she is handed in to police? Shall her newborn be taken away by child protective services?
If you were her health care provider, what would you do? Would you:
- Admit her (involuntarily) to the hospital
- Call the police or child protective services/ social workers
- Admit her (involuntarily) to a mental health facility
- Force her to undergo rehab
- Counseling her about risks and let her go?
What are your thoughts ? Share your comments below.
In the USA, fifteen states consider substance abuse during pregnancy to be child abuse under civil child-abuse statutes, and three states consider it grounds for involuntary commitment to a mental health or substance abuse treatment facility.
Canada promotes alcohol-free pregnancy but has no law against consuming alcohol while pregnant. In 2005, Bill 43 (Sandy’s Law) came into effect in Ontario requiring warning signs where alcohol is served or sold. It is worth noting that in the Criminal Code of Canada” a fetus is not a person” and thus has no protective rights until delivered.
In the UK, the Department of health warns that pregnant womyn “should avoid alcohol altogether, never more than 1 -2 units once or twice a week”
In a recent press release by ACOG, the American College of Obstetricians and Gynecologists urges health care providers to “Help Retract Punitive State Legislation”. In Committee Opinion #473, “Substance Abuse Reporting in Pregnancy,” published in the January 2011 issue of Obstetrics & Gynecology, ACOG states:
Drug enforcement policies that deter women from seeking prenatal care are contrary to the welfare of the mother and fetus. Incarceration and the threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse… They are encouraged to work with state legislators to retract legislation that punishes women for substance abuse during pregnancy.
The argument is not whether a woman has the right to drink or use drugs while pregnant, whether drug or alcohol use cause harm to the woman and her fetus. The question is: are we improving the health outcome of this pregnancy by enforcing such laws? There is no evidence to support that. Based on the most recent evidence, we now know that placing a pregnant womyn with substance abuse in jail or mental institution against their will is futile.
What do you think? Is alcohol use by pregnant womyn a form of child neglect that needs punishment or an addiction that needs medical attention? Do pregnant womyn with addictions need medical help or incarceration? What is safer for the fetus and pregnancy? Who decides how much alcohol during pregnancy is too much?
Medical literature is unclear on this issue. In August 2010, the Journal of Obstetrics and Gynaecology Canada (JOGC) published “Alcohol use and Pregnancy Consensus Clinical Guidelines” that states:
There is insufficient evidence regarding fetal safety or harm at low levels of alcohol consumption in pregnancy. There is insufficient evidence to define any threshold for low-level drinking in pregnancy.
In the light of these guidelines, shall alcohol drinking during pregnancy be a personal well-informed choice or shall it be the responsibility of our authoritarian governments to punish competent womyn who after adequate counseling still choose to drink during pregnancy?
To heat up the debate, a 2009 study from the UK found that light drinking during pregnancy did not cause any harm in babies, on the contrary, boys born to mothers who drank lightly during pregnancy were “better behaved and score more highly in tests at the age of three” than the sons of womyn who abstained. This study was recently featured in The Guardian.