Child Abuse

[RainDreamer]

This is a really tough subject and one of the saddest things I see ...... makes me the most mad too.

It's not really something you would think you'd see really in the NICU, as all or our babies are "new" ..... they haven't been home yet, therefore the parents can't abuse them.

I'm talking about moms that abuse their babies in utero.

That's legal, correct?

Mom can do all kinds of drugs, that's ok. At the worst, the baby will be taken into CPS custody (and even that's not always the case).

I actually had a discussion about this a few weeks ago with one of our baby's family members. The mom had done all kinds of drugs during the pregnancy and therefore the extended family was going to be taking the baby. The uncle of the baby had brought up the questions of why nothing is done to these mothers for abusing their babies. These babies suffer, it's abuse. The mom will just continue doing it, as she has repeatedly, nothing is ever done to stop her. He brought up a good point, one of which I've been pondering over.

We had another mom that was a cocaine addict and also had placenta previa. She had been hospitalized for bleeding, but left AMA. A few days later medics brought her in as she had abrupted at home. Mother and baby were VERY critical and were both not expected to make it. Baby was brain dead. Mom ended up pulling through. We had the baby on the vent ..... the docs talked to mom about taking the baby off and she said "I can't do this to my baby, I can't make the decision to take her off". UGH!! What?! This kid was ~34 weeks. The only reason she was brain dead was because of mom's stupid choices. How can she say she can't make these decisions, when clearly she is the reason her baby is like that? Ended up taking the baby off, end of story. I won't go into too many more details, but mom had many other kids, another of which was brain damaged due to mom's poor choices.

So, where does it end? Are there any states that do anything to these mothers? Do the babies have any rights to health and protection? Or since this damage is done in utero, then nothing can be done?

[RainDreamer, BSN, RN]

We don't routinely do drug tests, that seems like an invasion of privacy if there are no red flags. The only time we send an MDS/UDS is when the social situation is "questionable", if mom has had little or no prenatal care, or for abruptions.

To me, the no prenatal care and the drug use is kinda like the chicken and egg thing. Which causes which and which comes first? Drug moms might not receive prenatal care due to the fear of drug testing. But I think they just don't give a damn. I mean prenatal care is something you do to ensure your baby is healthy, right? So what's the point of getting prenatal care when you're smoking crack between visits? Kinda pointless, no?

My favorite drug moms are the ones that are SO incredibly intense and nitpicky about things while their baby is in the NICU. You know the type ..... they complain about everything, they feel their child isn't getting the best care, nothing is ever good enough for their baby. Well no, they're not getting a constant dose of crack like they did in the womb .... but God forbid the sheets aren't completely wrinkle free!

[elizabells, BSN, RN]

Our hospital policy is Utox only if: Mom is a known drug user w/in past 2 years, mom had no prenatal care, mom appears during admission to be drunk/high, or baby is showing signs of withdrawal. Abruption doesn't count for us. We cannot delay discharge for a pending screen.

[justme1972]

Not to disqualify what you are saying, but that would mean that all the babies have a U tox sent. Is this true?

I'm not sure what a U-tox is, but I'm assuming that you mean that babies are screened for drugs.

What happens here, from my understanding, is that many of the mothers are already known "frequent flyers" or come into the hospital absent of all prenatal care (which happens alot here), others are very honest about their drug use or start exhibiting symptoms that tell a different story from what they are, or that the baby does after birth.

No, it's not routine for every baby, but it ends up manifesting itself somewhere along the lines of their hospital stay.

Even our instructor was telling the class, "The normal, married couple, that work, have health insurance...isn't quite what you are going to see a whole lot of."

These are relatively small hospitals that do maybe 8 to 10 births a week.

I was as shocked to hear that as you are. I even looked at the LPN and said, "Come on, 50%? That's half!". My instructor was sitting there nodding her head, "You'll see!".

To put it in total perspective of how bad the social services department is...there was a case here about 6 months ago that made the paper where a guy was driving down a 4-lane highway past a trailer park (where the speed limit is 55 MPH) and noticed there were kids in the middle of the road....and then noticed that one of them couldn't have been more than 2 years old...was totally naked, it was about 55-60 degrees outside.

He called the police, they came out, found out where the kids lived and found the mother naked in the bed, passed out, drunk, with her boyfriend, who was high.

The children were taken away for about two weeks and returned to the mother b/c they said that since the children were not actually harmed...no crime was committed.

Yup...my jaw hit the floor when I read that too.

[morte, LPN, LVN]

Yep, a lot of them tried that.

Then they show up abrupting due to cocaine use, or infected from the waist up because they were too high to realize it, or delivered kids in the toilet because they were too strung out to realize they were in labor.

And they went to jail anyway.

not all, and you ended up with more dead/damaged infants, didnt you?

[NICU_babyRN, BSN, RN]

Every baby on my unit is "mec screened" always.

We see A LOT of positive mec screens but hardly ever is there much that can be done. Our social workers are AMAZING at their efforts to send babies home to safe environments.

I live in a large city and the drug problems are not sporifice...but still, in the last year I know of only two babies who didn't go home to mom. I'm disgusted that I actually discharged a pt home to mom who was in drug rehab...but "she was taking the right steps" so the court felt it was safe.

I learned that this mom relapsed and this baby has been tossed between mom, grandma and foster care for the past 7 months. SICK.

[FireStarterRN, BSN, RN]

Every baby on my unit is "mec screened" always.

We see A LOT of positive mec screens but hardly ever is there much that can be done. Our social workers are AMAZING at their efforts to send babies home to safe environments.

I live in a large city and the drug problems are not sporifice...but still, in the last year I know of only two babies who didn't go home to mom. I'm disgusted that I actually discharged a pt home to mom who was in drug rehab...but "she was taking the right steps" so the court felt it was safe.

I learned that this mom relapsed and this baby has been tossed between mom, grandma and foster care for the past 7 months. SICK.

Good Grief!!!

I think the system just must be overwhelmed. They probably don't have enough foster parents to handle this volume of drug babies. How terrible sad.

[SteveNNP, MSN, NP]

My last job, we did a meconium screen and UDS for any abruption, or no/limited/unknown PNC moms.

I have YET to see one done here in my new job, and I've been here almost 9 months.

[Sweeper933]

I have YET to see one done here in my new job, and I've been here almost 9 months.

Wow...

[dawngloves, BSN, RN]

We don't do mec screens. We do a u tox if mom admits to any drinking or drug use, baby is IUGR, no pnc, or if for whatever reason they do one on mom and it comes back positive.

The problem with a mec screen is that mom could have quit doing drugs months ago and it would still come back positive. You can't penalize a mother if she is activly getting help and turning her life around. Staying on the straigh and narrow is another story...

[BittyBabyGrower, MSN, RN]

Most of our positive screens end up going home with mom or a relative( and you know as soon as they go out the door, the kid is with mom again) because our foster homes are so overloaded there is no where to send these kids! We have has a few cases that we have tried to have prosecuted (full term kids brain dead on delivery from various drug uses) and they never go anywhere. Why, because our state doesn't recognize the unborn fetus as a person. Isn't that a sick twist?

And the drug moms are the worst..do this do that you are hurting my baby, etc. No sister, you are the one that harmed your baby,not me. We've even had the druggie moms disappear right after delivery, esp the ones that had to have central lines put in....and I think you can guess why, brand spankin new access! Compliments of Hospital Z.

It is a culture that totally blows my mind.

We don't routinely do drug screens on all kids, LD does more than we do, so if a mom is positive they tell us and then we screen. We don't do mec screens, only urine. Reasons we screen are abruption, and a totally bad full termer for no reason. I think we are most shocked when they come back positive on people you would never suspect, such as employess of the hospital, etc. But, I guess we shouldn't be so narrow minded when it comes to drug use!

[preemieRNkate, RN]

Just attended a delivery yesterday, mom with a + Utox for cocaine. As soon as the baby was delivered, she's asking if the baby is ok and crying and carrying on about how worried she is. Really?? You're so worried about your FT baby that you did cocaine in the last few days, maybe even in the hospital as L&D suspects? Gimme a break.

[littlepeach]

I think that in GA, a baby isn't considered a baby until 38 weeks gestation. The sad thing is that these women keep popping out sick kids that we help. but don't get any help for themselves, then they refuse tubal ligations. It is a cruel world.