The current standard of care in U.S. hospitals calls for screening a woman’s urine for drugs before she gives birth, despite the test itself being notoriously unreliable and easily manipulated by other substances. The results of these tests are used as grounds for social service investigations that can lead to newborns being unjustly taken from parents. Relying on flawed testing mechanisms to separate mothers from their children undermines parental rights and personal autonomy, and health agencies should implement better safeguards before turning to such drastic measures.
A recent article by The Marshall Project shed light on the heartbreaking consequences mother of five Susan Horton faced because she indulged in a salad with “everything bagel” salad dressing before giving birth. She said she was completely shocked to learn that she had tested positive for opiates, all because the salad dressing had poppy seeds in it. Without requesting a follow-up test for verification, Kaiser Permanente, the hospital where Horton gave birth, promptly alerted social services, leading to her baby being placed in protective custody. While this protective hold was only temporary, it was unjust and unnecessary.
Horton is far from the only mother to receive a false positive, and poppy seeds are not the only cause. Many common substances—like ibuprofen, antacids, and certain antibiotics—can trigger false positives. Research shows that false positives in urine drug tests can range between 5% to 15% depending on the substance tested and the methodology. This variability leaves countless mothers at risk of losing custody based on flawed test results.
Medical professionals and federal officials have warned that urine tests are particularly prone to false positives and also cannot differentiate between occasional and chronic substance use. Regardless of this problem, many state policies and hospitals still treat primary urine drug screens as finalized evidence and proceed to tag in social services without ordering confirmatory testing. For example, a follow-up to a primary drug screen would include searching for thebaine—an organic compound used to differentiate consuming a tasty treat topped with poppy seeds from heroin. Healthcare systems aren’t required to complete this follow-up testing, which leaves us to question why such an imprecise test is used as a basis for governments to seize a mother’s child.
It is also concerning how frequently pregnant women are subjected to drug testing without consent in healthcare settings. A study of five Massachusetts hospitals revealed that only about a third of cases documented verbal consent for toxicology testing on expectant mothers. Such practices undermine trust between patients and providers, particularly when test results lead to police involvement or child welfare investigations. At a time when support is critical, these adversarial conditions create unnecessary barriers to care.
The economic impact of these false positives also cannot be overlooked. When families are torn apart due to hasty decisions based on flawed data, the costs can quickly add up. The judicial system gets bogged down with lawsuits, and social assistance programs are stretched thin as parents try to navigate the next steps to take to regain custody of their child. A report from the National Center on Substance Abuse and Child Welfare highlights how drug testing procedures, in an attempt to secure child welfare, not only misallocate already limited staff and funding but also deepen the crisis by forcing families into legal battles to reclaim custody of their own children.
A cost-effective and simple solution that the U.S. Department of Health and Human Services could adopt is to implement confirmatory testing, which would ensure custody decisions are based on reliable evidence, ultimately saving both financial and emotional resources. Furthermore, the performance of any test must be done with the informed consent of the patient. Keeping expecting mothers informed about what tests are being done and why (and allowing for the opportunity to say no) is an essential part of adherence to the Hippocratic Oath and respects the autonomy of the patient, leaving bodily control in their hands. State health agencies should also protect informed consent and adopt confirmatory testing.
In the current healthcare culture, which promotes “patient-centered” and “evidence-based” practices, the failure to use confirmatory drug testing in maternal care is unacceptable. Moreover, informed consent should be standard for any testing that could affect a mother’s parental rights. Beyond the ethical obligations of the healthcare system, studies from the Society for Research in Child Development show that wrongful separation of families has lasting detrimental psychological, emotional, and health effects on children, families, and communities. Advocating for reliable drug testing practices is not just a matter of policy; it’s about ensuring fairness and justice for all mothers.