FIA and Meconium Testing

  1. When and FIA caseworker requests a meconium collection on newborn of a mother with a drug history, do your docs order this? What do you tell the mother?

    Just curious. We are working on a protocol for this. I would appreciate any input.

    Thanks for your help,

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    About layna

    Joined: Feb '02; Posts: 123; Likes: 2
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  3. by   dawngloves
    I'd be interested in knowing what a meconium collection is!
  4. by   layna
    Meconium is the first stool that a newborn baby passes. If the mother has taken drugs during her pregnancy, it may show up in the meconium and be used as evidence in a protective services case.
  5. by   RMH
    We still test the urine, and yes the MD writes a order. The MD should also discuss with the mother, but if not, we just let them know we have to do a urine test because the MD ordered it.
  6. by   SmilingBluEyes
    never have done a mec test where I worked. Always had to slap on a urine bag and TRY to catch THAT. ugh.
  7. by   dawngloves
    Thanks Layna. We''ve always just done urine collection. I would imagine meconium would show a more long term use than recent, like urine?
  8. by   Mira
    I heared about mec testing to detect drugs taken in early trimester or entire pregnancy accurately,apparently it is more expensive to do that`s why urine testing is more popular(w MDs order).I know somebody who has taken methampetamineHCl on her first trimester,discovered she was pregnant on the 2nd tri and a dramatic change happen to her-she stopped taking drugs,she become responsible for her unborn child and swear she is drug free for 5mos now,should I believe her?or never give her the chance to change and be with her child?or let the child be with foster parents/case worker who might not be able to provide full time motherly love?Sorry, I am just curious about the point of checking meconium for drugs taken in early pregnancy where urine can check the most recent drugs taken,most of them take drugs when they know they are about to deliver,they can`t stand the blows of life how much more with contractions.
  9. by   NICU_Nurse
    If a mom was abusing drugs (you mentioned methamphetamines) early in pregnancy, even if she DID stop using for the remainder of the pregnancy, it would be bad judgement (IMO) to just assume that she's going to continue staying clean just because of the baby. For most people staying off of drugs isn't so easy, and pregnancy is temporary, just like staying straight can be. I am totally in support of the meconium testing, even in cases like the one you mentioned, because a red flag should go up when ANY drug use has taken place so that interventions can be made to assist mom in keeping clean and/or being a responsible parent. It's highly unlikely that whatever stressors or motivating factors that were present in the first trimester (those that "made" her or led to her doing drugs in the first place) would magically disappear. She needs counseling to STAY OFF drugs as much as a current user needs counseling to GET OFF drugs. Know what I mean?

    If most of them start taking drugs "when they know they are about to deliver", it is extremely unlikely that this is a first-time occurrence. Would you agree? Furthermore, most of them don't do drugs because they are in labor; rather, they are in labor BECAUSE they're DOING drugs.

    In the case of your friend and women like her, no, you shouldn't necessarily believe her. You can and SHOULD support her in whatever way you can, but the fact is that she endangered herself and her child by using, and the chance for her to change and be with her child should come as a result of counseling and supervision to ensure that she gets on and stays on the right road.
    Last edit by NICU_Nurse on Jul 25, '03
  10. by   babynurselsa
    Meconium starts forming in the intestine at around 20 wks. so mec drug testing can tell if mom was using basically during the last half of the pregnancy.
    IMO if a mom is using she will not be exposing her baby to a safe enviroment and intervention is needed.
    Sorry but I would rather see a baby with a safe foster parent than exposed to a cloud of meth smoke anyday. Many meth moms may love their babies but they usually love their meth more.
  11. by   legsmalone
    What kind of protocol are you working on layna?
    I know at my place we have one in place to automatically screen baby's urine if mom is 16 or under, precipitous labor, etc.
    But we don't often have docs order the mec screen, I would be interested to hear more!
  12. by   BBnurse34
    If the mother has had less than 5 prenatal visits, has a history of drug abuse, has track marks, has had an abruption, or more than 2 STDS we do both meconium drug screen and urine drug screen. The MDS shows use in the second half of pregnancy and the UDS shows use 72 hours prior to delivery.
    I tell the mothers that because of (whatever her case) we are screening the babe because we want to give them both help if they need it. Most mom's will let you know that to expect in the screenings. CPS is notified of positive results. The babe stays in our nursery for 72 hours to watch for neonatal abstinence syndrome. CPS follows up with the parents and the mother must take CPR before the child is released after CPS approval.
  13. by   BBnurse34
    AZ Law states than drug use in pregnancy is not child abuse Post #1

    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
  14. by   layna
    Wow, BBnurse...what a very tragic case. :-( I would really like to see your protocol. It sounds pretty comprehensive. We don't do the neonatal urine screens here. The MDS is ordered by the physician upon communication with CPS. The reason why we are working on a protocol is to hopefully avoid tragedies as described above. I also want to see better communication between CPS and the primary care physician BEFORE delivery. What prompted this review was CPS requests for MDSs that were being done by the nurses without an order and the test not getting paid for by CPS who were the ones requesting the test. Now, by the looks of this post, it looks like it may be a more thorough process if we include the UDS as well. Thanks so much for the info. I would love to see the policy you have, BBnurse.