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What the pho

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In Calif. and what is the ethical thing to do if she is your patient? Maybe I should ask OB forum, but that place gets almost no traffic. Oh if you can provide a link it would be most helpful.
 

beyond all hope

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There are no laws in the U.S. that prevent a woman from killing her baby with alcohol, cigarettes, or even illicit drugs. Perhaps some inventive prosecutor could call it child abuse...

The only thing to do is present the mother with all of the complications of alcohol abuse. I usually start out with a hard-line approach. "We've confirmed it. Your baby will be born deformed." Let that sink in, then add "if you don't stop drinking immediately."

Working in an inner-city hospital (in Cali), I meet a lot of mothers who are pretty uncaring about their unborn children, or simply in denial that their lifestyle hurts their child. You have to shock them to get them to listen to you.

Then present them with options: AA for example. Remember substance abuse is a disease that is partially genetic, it's not just about willpower. They need help and support.
 

Kalel

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I have read about attempts to prosecute and incarcerate pregnant women who use illicit drugs like heroin or cocaine. The last I heard of these cases though, they were being challenged in court as violations of civil liberty. It's a controversial issue.
 
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uclacrewdude

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Originally posted by beyond all hope
There are no laws in the U.S. that prevent a woman from killing her baby with alcohol, cigarettes, or even illicit drugs. Perhaps some inventive prosecutor could call it child abuse...

The only thing to do is present the mother with all of the complications of alcohol abuse. I usually start out with a hard-line approach. "We've confirmed it. Your baby will be born deformed." Let that sink in, then add "if you don't stop drinking immediately."

Working in an inner-city hospital (in Cali), I meet a lot of mothers who are pretty uncaring about their unborn children, or simply in denial that their lifestyle hurts their child. You have to shock them to get them to listen to you.

Then present them with options: AA for example. Remember substance abuse is a disease that is partially genetic, it's not just about willpower. They need help and support.

but you should downplay the disease aspect of it to prevent the powerless victim mindset that many pts embrace as part of their sick role. putting more weight on their own volition should result in a greater incidence of behavior mod.
 

The White Coat Investor

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As I recall, Roe vs Wade applies to the situation. If the mother can kill the fetus, what's wrong with just hurting it a little. Its her choice, isn't it?

P.S. I'm one of the strange few who still hasn't made up his mind as to whether I'm pro-choice or pro-life, so don't give me a hard time, I'll just agree with you.
 

irlandesa

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the above posters are correct; there is no law preventing the mother from consuming alcohol or smoking during pregnancy; you could get the mom charged for illegal drug use independent of her pregnancy status. One thing to consider telling the mother is that the child will be placed in protective custody or foster care once it is born if she doesn't get treatment for her addiction. This is certainly true in Massachusetts; we had a woman come in with abruption after using cocaine when I was on Ob/Gyn whose newborn son had to be placed in foster care. The baby had Apgars of 1, 3, and 6 after C-section; very scary, and turns out this wasn't the first time this had happened to the Mom (this was her 4th kid and 8th pregnancy or something). She did express an interest in treatment and I hope she is getting it; though with her history of addiction (alcohol and marijuana as well) I somehow doubt it.

As for the laws, our Ob/Gyn course director smartly pointed out that it is very hard to prosecute pregnant women for potential harm to the fetuses without impinging on personal liberties. Where would we draw the line; would we get to the point of arresting women who drink one glass of wine or forget to take their prenatal vitamins consistently? The scenario sounds absurb, but patient autonomy has to be considered.
 

group_theory

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also remember to write in the charts somewhere that the mother-to-be have been strongly advised against continued use of drugs and alcohol

perhaps write also that the patient has received brochures with phone numbers to contact (if she wants help)

remember - a few years later, she might be at home, watching TV, when a lawyer ad will show up saying "is your child not 100% perfect. Is he/she not what you expected your child to be? Well, it's not your fault - I'm *insert name here* and I can get you compensation. I work hard to find $$$ for you. I charge no fee unless you win $$$"

Some people will not accept responsibilities for their own actions ... and look for someone else to blame (and also the potential for money is tempting too)
 

edmadison

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Originally posted by group_theory
also remember to write in the charts somewhere that the mother-to-be have been strongly advised against continued use of drugs and alcohol

perhaps write also that the patient has received brochures with phone numbers to contact (if she wants help)

remember - a few years later, she might be at home, watching TV, when a lawyer ad will show up saying "is your child not 100% perfect. Is he/she not what you expected your child to be? Well, it's not your fault - I'm *insert name here* and I can get you compensation. I work hard to find $$$ for you. I charge no fee unless you win $$$"

Some people will not accept responsibilities for their own actions ... and look for someone else to blame (and also the potential for money is tempting too)

DO THIS AT EVERY VISIT. I'm not kidding. There have been several winning malpractice suits for failure warn of risk -- even when there was warning. Apparently the plaintiffs were not warned enough.

Ed
 
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