False positives

Laura Kuzdale didn’t think twice about stopping at Tim Horton’s or her regular bag of bagel bites and a blended, iced coffee drink. She was on her way to her last prenatal appointment before her scheduled cesarean section two days later. Kuzdale also picked up egg pizza and orange juice for the staff. “I was feeling good,” she recalled.

But when she arrived, staff tested her daughter’s vital signs and told her they wanted to move Kuzdale over to Oishei Children’s Hospital in Buffalo, N.Y., to perform her C-section right away. Kuzdale called her husband and a couple of other people to let them know. She remembers telling the staff about her breakfast of bagels and iced coffee, since doctors can’t perform a C-section on a full stomach. They scheduled the operation for later that afternoon and took samples of her blood and urine. Kuzdale wasn’t worried about the tests. It all seemed normal and routine.

The C-section went well, and Kuzdale and her newborn daughter settled into the postpartum wing of the hospital. But a social worker walked into her room at 9 a.m. the next morning. “She said, ‘You tested positive for opiates, and we are going to have to turn you into child protective services,’” Kuzdale recalled. “I’m pretty sure I scoffed in bewilderment.”

Kuzdale told them she didn’t do drugs. In fact, at the time, she directed the social work department at a skilled nursing facility owned by Kaleida Health, the company that also presided over Oishei Children’s Hospital. She called her doctors and demanded to speak with someone higher up. But the hospital social worker reiterated that because she’d tested positive, it was out of their hands. CPS had to get involved.

Kuzdale eventually filed a lawsuit against Kaleida Health for testing her for drugs without her knowledge or consent. Her case is one of a growing number seeking to challenge mandatory maternity drug testing and reporting policies. A spate of stories last year spotlighted other instances of faulty tests, including more harrowing separations triggered by poppy seed bagels or salad dressing. The outrage—and subsequent lawsuits—­compelled several large hospital chains to change their policies, and a growing number of states to introduce legislation clarifying when reports are necessary.

Some proponents of the harm reduction model of addressing illicit drug addiction take it further, arguing that drug use, by itself, shouldn’t reflect on parenting ability at all. But amid the escalating criticism of substance use policies, Christian child welfare advocates are quietly urging local churches to step in to assist women in crisis and prevent long-term family separations when possible.

UNDER FEDERAL LAW, hospitals aren’t required to drug test maternity patients, but most do anyway. Federal law requires hospitals to notify child welfare authorities anytime a child is born substance-affected, though it’s up to the states to determine whether a positive test result constitutes abuse or neglect. State testing and reporting requirements vary. Most policies direct hospitals to create a safe care plan to be shared with child welfare agencies, but not all say positive test results should trigger a child abuse or neglect report.

“Wiser states have specified that it does not, and that a separate report of abuse or neglect would have to be made to trigger an investigation,” Michael Ramey, the president of the Parental Rights Foundation, told me.

But nuanced situations often escalate to full-blown investigations quickly, Ramey pointed out. Even though hospitals may just be reporting a positive test for statistical purposes, they’re still reporting it to a child welfare service, which is “not known for using a lot of discretion,” he noted.

For instance, Philadelphia community activist April Lee told me her nonprofit, Philly’s Voice for Change, often interacts with women recovering from drug or alcohol addictions who were prescribed medications that stimulate the brain’s opioid receptors to a far lesser extent than illicit opioids, but still show up as opioids on a toxicology test. Their babies can experience withdrawal symptoms, triggering hospital policies about alerting the resident social worker, who is legally obligated to report suspected abuse or neglect.

“They didn’t touch anything throughout the entire pregnancy,” Lee noted. But child protective services still opened an investigation and removed their babies after they were born. Lee told me she knows women who were beating their addiction, but after authorities removed their children, they relapsed. After that, chances of a quick reunification narrow, she noted.

Kuzdale, the New York mother of three, filed her lawsuit in April 2024. Staff ignored her when she told them she had consumed bagel bites that contained poppy seeds for breakfast before her labor. The baby did not test positive for opiates, the suit said, quoting from Kuzdale’s medical notes. When she demanded another urine test or a blood screening, the hospital denied her request, her suit claims.

Kuzdale had been home from the hospital a mere 20 minutes when a woman from Child Protective Services showed up to scour her home. The woman checked whether Kuzdale had a crib for the baby and other safety measures in place. Later, the agency told her she would need to talk to a substance abuse counselor as a part of the investigation.

Roughly three months later, the family received a letter acknowledging the investigation was unfounded.

State data from 2019 showed roughly 83% of CPS reports and subsequent investigations proved to be unfounded, and at least two-thirds or more of reports fall into the catch-all category of neglect, not abuse. Parental illicit substance use falls into this ­category. More than 46 million Americans had a substance use disorder in 2023, according to National Institutes of Health data. That means roughly 19 million American children—1 in 4—live with at least one parent or primary caregiver who has a substance use disorder.

Herbie Newell, president and executive director of Lifeline Children’s Services, told me that in his experience, the harmful effects of substance abuse are the No. 1 reason his agency sees children enter foster care. And while one positive drug test doesn’t mean that’s what a child will experience, he says there’s always the chance it could indicate a larger issue. That’s why he believes maternity drug tests are important.

“Whenever there’s drug abuse, there’s just always the opportunity for neglect, physical abuse, physical harm, as well as mental anguish to a child,” he said.

But harm reduction proponents argue drug use is a poor indicator of an individual’s ability to parent. Glyceria Tsinas, co-founder and director of development for the Academy of Perinatal Harm Reduction, said that while medical professionals have a responsibility to encourage healthy behaviors during pregnancy, current testing and reporting practices discourage women from seeking prenatal care—“the best defense we have” against the long-term impacts and harms of drug use, she noted.

Sudheer Jayaprabhu, an OB-GYN in Texarkana, Texas, told me he works hard to build relationships with his expectant patients who are using substances that could harm their babies. Jayaprabhu said the policy of the hospital where he practices is to ask patients for consent before they test them for drugs. But if they refuse a test for themselves, hospital staff still test the baby after birth. Once a mom or baby tests positive, a state social worker gets involved to further evaluate the situation. But it’s “usually not just based on one test,” he said.

NEW YORK LAWMAKERS are considering a bill that would bar hospitals from testing patients without informed consent and would direct healthcare professionals to only test newborns and their mothers for drugs if it appears medically necessary based on other indications. Lawmakers proposed similar bills in Arizona and Tennessee, but they got stuck in the legislative session. In April 2024, Mass General Brigham, a large hospital system in Massachusetts, announced positive toxicology tests would no longer automatically trigger child welfare reports.

Herbie Newell doesn’t believe these changes are the best way forward for children. “I don’t think we need to take the signs and overreact, but we don’t need to eliminate those signs,” he argued, adding a positive drug test should at least trigger an investigation.

But he agrees that supportive services are key—and that’s where the church can step in. Lifeline oversees a program called Harbor Families in South Dakota that connects mothers at risk of losing their children with volunteer couples from local churches willing to temporarily house their children to prevent formal separations while the mom receives the treatment or services she needs.

But Nancy Osborne, the senior director for foster care and family preservation at Lifeline, said, so far, Harbor Families doesn’t often get that call. “I think hospitals do feel obligated to call child protective services,” she said. “But if they were aware of us and our hospital social workers, I know that that could be an option, especially if they want to work with that mom toward reunification.”

Osborne hopes more hospitals—and struggling parents—encounter their program as more volunteer families get involved.

“We certainly have seen parents for whom giving birth to a child is the thing that is a turnaround in their story, and then their ability to successfully complete treatment and to get to a place of recovery,” she said, “We … would want to offer that opportunity if there is a safe way to do so.”