AZ Law states than drug use in pregnancy is not child abuse

[BBnurse34]

From the Az Republic 08/23/02

In 10 short days of life, a cuddly bundle of joy with a beautiful name turned into a crinkly bag of death.

Anndreah Robertson's death was senseless and outrageous. To say that it shouldn't have happened doesn't do justice to the series of bad decisions that caused it.

Anndreah's mother is a cocaine addict who admitted to smoking crack cocaine on the day of delivery. Her grandmother, who takes care of Anndreah's two small brothers and to whom Anndreah was entrusted, also smokes crack cocaine.

"The use of cocaine or drugs is not in itself abuse," says Anna Arnold, the assistant director of the division of Children, Youth and Families in the Department of Economic Security. Abuse, she says, is tied to a child's condition, for example, how well-fed and clothed the child is and whether there's physical abuse.

Anndreah's mother, Demitres Robertson, is in jail without bond, accused of murder and two counts of child abuse - and pregnant again. Anndreah's grandmother, Lillian Butler, is charged with two counts of child abuse.

St. Joseph's Hospital and Medical Center followed procedure and kept Anndreah for three days to cleanse her system of cocaine. They notified Child Protective Services. And they leveled with Anndreah's mother: The baby would die if she were exposed to cocaine again.

She was, and she did. An autopsy concluded that Anndreah died of complications from cocaine exposure and dehydration. The pathologist ruled her death a homicide. A witness alleges that Demitres Robertson and Butler smoked "large quantities of cocaine together" in the presence of Anndreah.

This was a beautiful, healthy baby at one time, that actually died of NEC due to exposure to second hand crack. I am just sick over it.

In Az, where we do not consider inutero drug use child abuse, what can we do to protect out patients.

Would prosecuting these addict mothers result in more "garbage can babies"?

How can we convince child protective services that they are not "saving" a baby by placing him with the druggie mother's mother. Meticulous charting was done on this child, but it didn't help.

[BBnurse34]

Motivated, you sound like you have a good success rate with your patients and helping them overcome addiction issues. Unfortunately in Az at the hospital mentioned in the arcticle, they do not. We get "frequent fliers".Most drug using women have had other children under similar conditions.

The baby, Anndreah had two siblings that were born under the same circumstances (for those grimacing at confidentiality issues, it is public knowlege- in numerous newspapers).

Yes, the hospital does make refferals to CPS and social services sets up programs and rehab to try to keep the couplet together. It just isn't working.

Also, Catholic hospitals don't do elective sterilization or any birth control counseling.

I am not sure what the solution is, but in Az we sure need one.

[BBnurse34]

BTW, I agree with Anaclaire. I have seen abruptions, beautiful 7 pound babies that I have to pick up from the morgue to take to the family.

The type of therapy that Anaclaire mentions would be great.. if it was possible.

I also hate the connection between in utero drug exposure and a woman's right to chose. These women don't chose not to give birth. They just chose drugs over their baby's health. They cry and cry over the neonatal abstinence syndrome that their babies suffer through.....and then show up again in two years.. second verse same as the first.

[Motivated, SN]

For the record, many of my moms do voluntary choose tubal ligation because they do realize that they do not need to have anymore children. Most of them feel truly guilty for having neglected their children due to their AODA use and any physical or emotional damage that they MAY have caused. I do tell them that not all problems their children may have can be blamed on their drug use. They want to be good mothers and try very hard; but they first have to admit that they have a problem. Not all of them are ready to do this. Sometimes it takes many treatments and/or reapeated consequences for someone to become ready.

That is the nature of addiction. Also a slip or relapse can be part of addiction too; but that doesn't mean failure. It depends on if the person can learn from it and get back on track.

[BBnurse34]

They may chose tubal ligations, but if the hospital they deliver at doesn't do them, there is a greatly reduced chance that they will follow up with another hospital later.

Also, forgive me for sounding heartless, but my primary concern is for the babies.

Fortunately( or perhaps unfortunately), there are others who put the needs of the mother first.

You also imply that not much damage is done by in utero drug exposure.. Have you ever cared for a severely withdrawing newborn??? They have a constant high pitch scream, they thrash in pain pulling their legs to their chest. They are rigid and have severe tremors. Water loss from runny stools usually leads to a blistered bottom by day 4 of life. They sweat profusely and run the risk of seizures... all this even with MSO4..and it goes on for weeks or months.

They are doing what their mothers didn't have the strength to do...and they never had a choice

(climbs off soapbox)

[Motivated, SN]

BBNurse34:

We have three hospitals that are not Catholic in our area, and

we try to keep the moms in treatment until their baby is at least

2-4 mos. old. That gives us a chance to see how stable she is

dealing with the baby, bonding, etc. We have had some women

as long as 6 mos. to a year; who were really working on their

issues. It is part of my job to see that they follow through on

their choice to have a tubal; which is easier, because I am in the

tx facility not the hospital. I see the women on a daily basis.

Do you have any Prenatal Care Coordination programs where y

you live? Either through private agencies or your Public Health

Department? Or through any of the clinics? They can be

instrumental in your women having better follow through.

[BBnurse34]

They are seen through different agencies after delivery, but rarely by choice. Most don't admit to drug use to their prental docs. Even more are "stop and drops". Social services usually tries to set up inpatient treatment for the mother and babe when babe is medically stable. But, many times the babe is sent home with grandma (who obviously never taught mother good coping skills). The result is what occurred in the article.

True, some mothers get help, usually methadone, and learn to parent effectively. But, most relapse and have to restart trying to get clean. So, the baby, who was already born addicted frequently has to live with a withdrawing/relapsing mother if she is at succesful at rehabilitating.

It's not just a matter of getting mom help. Can we put her whole social structure in therapy?

I think its more of a social problem than we can handle.

[hogan4736, BSN, RN]

Originally posted by pebbles

I say protect the children after they are born by getting them out of the entire situation. Too much leeway is given to mothers who want to keep their kids, despite being unsuitable. Kids placed with a family member who may be only marginally better, or who lets the mom have access to the kids anyway. Less law enforcement and more social work is needed. More and better foster care. Perhaps more kids need to be premanently removed from the mothers custody....

But to try to go after the mother while she is still pregnant to protect the kid infringes on her basic rights as a human, and I cannot abide that. Yes, to most of us it is unconscionable to be doing things that would harm the baby while you are pregnant. Sitting in judgement on others does not entitle you to take away others rights. Courts have ruled time and time again that the fetus does NOT have rights that supercede the rights of the adult mother. There are good reasons behind those rulings.

Respectfully,

-Pebbles

Pebbles...who is going to now step up to the plate to take care of this child AFTER he is born, since mom can abuse her body while she was pegnant, because, dammit, it's her right!!!!!!

signed,

one who has taken care of many a crack baby

[Motivated, SN]

BBNurse34:

It's true that if they won't admit their drug use, they aren't ready for tx anyway. If your clinics had Prenatal Care Coordinators though or have the time to do thorough assessments, hx of previous pregnanacies should be able to illicit

child welfare involvement with other children. That's a pretty good indicator that they may be drug/alcohol use. Or tracks in the use of Heroin. Here we receive referrals before the woman delivers; from Child Welfare, P.O.'s, etc. We have realized the importance of collaboration across systems. It also sounds like you may have a bigger problem than we do with heroin and other opiates; because you said many of the moms are on methadone. Opiate addiction and withdrawal are worse than crack. It is very difficult to get someone off of opiates. I'm not sure what the answer is for your community. It sounds like it's too big for you to tackle alone. Maybe other nurses in your community could also get involved to work on the system problems. I realize its a very time consuming uphill battle, but think about the situation you have now.

[MollyJ]

This is about MONEY, plain and simple.

Casefinding, intervention and prosecution would be too expensive and probably _uncomfortably invasive_ for too many people, so child protection agencies just don't go there. Far more than worries about the vegetable police is the slippery slope on women who drink a beer or smoke a joint before they find out their pregnant ON TO those who drink or smoke periodically during pregnancy. As a nurse, I really WANT my patients to be able to honest with me; referral to treatment facilities (when indicated) needs to avoid punitive actions unless all else fails (removal of other children etc).

Here's a great link to a report by CASA, a think tank on drug and alcohol issues on how drug and alcohol abuse has escalated child abuse and neglect problems greatly. Makes interesting reading and any nurse in the community health or MCH domain would probably find it interesting.

http://www.casacolumbia.org/publications1456/publications_show.htm?doc_id=7167

Abstract of this document, "No Safe Haven: Children of Substance Abusing Parents" From this link, you can link to a pdf version of the report.

No Safe Haven: Children of Substance-Abusing Parents

Jeanne Reid, Peggy Macchetto and Susan Foster

January 1999

CASA's groundbreaking report, No Safe Haven: Children of Substance-Abusing Parents, is the most comprehensive analysis ever undertaken of the impact of substance abuse on child abuse and neglect. CASA's report illustrates how parental abuse of alcohol and drugs has overwhelmed the nation's child welfare system and seriously compromised its ability to protect children. The report calls for an overhaul of the child welfare system and provides an answer to the critical question of when a child should be removed permanently from the home.

Key Findings Reveal:

Over the past 10 years, fueled by alcohol and illegal drugs, the number of abused and neglected children has more than doubled-- from 1.4 million in 1986 to more than 3 million in 1997, a rise more than eight times greater than the increase in the children's population (114.2 percent compared to 13.9 percent).

Substance abuse causes or exacerbates 7 out of 10 cases of child abuse or neglect.

Children whose parents abuse drugs and alcohol are almost 3 times likelier to be abused and more than 4 times likelier to be neglected than children of parents who are not substance abusers.

In 1985, there were 798 reported child deaths from abuse and neglect; in 1996, 1,185 were reported but the U.S. Advisory Board on Child Abuse and Neglect set the actual number in 1995 at 2,000--more than five deaths a day.

Four out of five (78%) of the children killed were under age five and 38% under age one.

Children exposed prenatally to illicit drugs are 2 to 3 times likelier to be abused or neglected.

[BBnurse34]

Oh Molly, its even worse than I thought!

[labornurse]

A woman's right to choose what to do with her body is one thing, but when that right ends up costing money to everyone, I think that there should be some say so by the tax payers about what she chooses. Nearly all of these women are dependent on medicaid to pay the medical bills. What is the cost inflicted on the taxpayers for taking care of these sick infants, sometimes for months in the nicu, as a consequence to her choices? I think that if you are willing to pay the consequences for your choices, that is your business, but when others have to pay, including the infant and the taxpayers, I think the right to choose comes to an end.

[Q.]

Originally posted by pebbles

Sad as this sounds, I support that law. A woman's body is her own. If you outlaw drug use during pregnancy to protect the "baby" (FETUS), where does it end? That outlook outlaws abortion completely, which many people have fought long and hard to ensure that women have the right to.... Also consider the slippery slope... women with poor nutritional habits endanger their fetus also. Here come the vegetable police? I don't think so.

In a way, I agree with this statement, only because I am pro-choice and demand consistency throughout laws. I would tend to argue, however, that you can have abortion legal and drug use ILLEGAL, in that if a mother choses to carry the child to term and not abort, we are under the assumption that she does indeed want the child. If, under that same assumption, she chooses to abuse drugs, then that could reasonably be argued child abuse. After all, SHE defined her fetus as a child by not having an abortion.

I agree there can be a slippery slope with this, but I think we can easily draw the line at illegal drug use. Eating potato chips during pregnancy is not illegal. Also, while not ideal, there is still nutritional value in potato chips, where there is NONE in cocaine.

I saw in the article that this crack-whore is pregnant again. Sorry, and this may sound harsh, but in my opinion, an abortion is indicated here. Spare that child's suffering now.