8 out of 10
So much has happened since my last post! We've traveled abroad twice, I got a new job, Meg's lacrosse team won their conference tournament, and we found out that we're having a baby! I hope to write about each of these things in the future, but for now I want to focus on one aspect of my pregnancy.
So, living in the Appalachian region of Virginia brings with it a lot of unique opportunities and experiences. We were fortunate to find a midwife for my prenatal care and delivery, and she is amazing. Her practice, along with all of the other OBGYN practices in this area, do a complete drug screen with their 12-week prenatal blood test... and I mean complete. It tests for marijuana, opiates, methamphetamines, barbituates... probably some other things that I've never heard of or know how to spell. Prenatal drug screening is considered a preventative measure by the care providers in our area because the opioid crisis is a real thing. The theory is that knowing a mother is using can allow providers to educate about the negative effects of opioids on the growing fetus. They can then refer mothers to different types of treatment in the hopes of getting them off drugs before the baby is actually here, including individual therapy, group therapy, and medication assisted therapy (MAT is very controversial... this post is already going to be too long to talk about that, so I'll wait for a future post).
Meg and I were extremely shocked when we got the bill from our provider after the blood work. Everything was covered and considered "preventative" except for 3 things: 2 thyroid tests the midwife wanted done to see where my numbers are (because I have Hasimoto's) and my drug screen... which totaled about $975. We appealed to HR at the University that provides the insurance, and also to Aetna. Aetna determined that the drug screen was not 1) preventative or 2) a "normal" part of their global maternity plan, so it applies to our deductible, meaning it comes out of pocket. The rest of the blood work, which includes testing for things STD's (including HIV), HCG levels, hormonal levels, RH Factor, IS considered both preventative and a normal part of the global maternity plan, so those tests are covered at 100%. I suppose that any issues that come up on the "normal" blood work can be treated in some way to help either the mother or the fetus. But the same is true for the drug screen... right?
Today we got to take a tour of the hospital and do pre-registration, which prevents every movie scene of a screaming pregnant woman being wheeled into the hospital while her partner clutches a clipboard and tries to remember their insurance information. The initial paperwork was standard (name, DOB, address, insurance info). Then we went to the maternity floor and had more questions to answer (including weird ones, like what's my learning style, my highest level of education, do I receive government assistance in any way, and specific questions about drug use before and during pregnancy). We met with 2 nurses and the nurse anesthetist and had a pretty good time with them, laughing about some of the weirder questions. Meg and I are naturally chatty people. We enjoy talking to others and listening to what they have to say, so we've made a lot of "friends" throughout this pregnancy, especially with the nurses, support staff, and even the billing people at our practice. Today, the three people we met with told us we were "like a breath of fresh air" compared to the patients they see on a regular basis. I asked if anyone actually admits to using drugs during pregnancy, and the response was laughter and "Absolutely. Some proudly. You'd be surprised." When we asked more questions about women who answer "yes" to questions about using drugs, we were shocked by their responses. The hospital staff shared that they have experienced pregnant mothers and their partners falling asleep (passing out) during their pre-registration visits. We asked about the number of mothers who delivered high, and they estimated 8/10. Eight out of ten women who deliver at our hospital are high on illicit drugs.
We left that appointment and went to our 31-week appointment, where we got to hear the heartbeat (which was above 140 the whole time, which may indicate we're having a girl-- we are waiting until delivery to find out, which makes just about every single hospital staff member elated). As we checked out, we talked to our billing friends about our experience with pre-registration and they reiterated the same sentiments, providing their own anecdotes. One woman shared that during an OB interview, when she met with a pregnant mother to talk about insurance, the practice, and healthy choices, one mother was so high that she passed out and fell out of her chair onto the floor. Another worker said that during a checkout, she got up to grab something off the printer and when she returned the pregnant mother was still sitting in front of her, but had white powder all around her nose, acting as if nothing happened. We witnessed a man passed out in the waiting area while the woman he came in with went back with the doctor. They talked about people whose veins are so blown they can't get an IV in. And then they talked about the babies. Apparently, on an ultrasound, you can see a baby jerking around due to withdrawals. Can you imagine? Seeing our baby on ultrasound was one of the most profoundly amazing things I have experienced to date. I can not imagine seeing it in pain.
Because I work in social work, I asked what the laws say, and what happens after delivery when mom and baby are both obviously high. Is DSS called? What happens? The women at our practice said that DSS is called, the babies are detoxed at the hospitals (sometimes for upwards of 30 days... that's why MAT is so controversial, because the drugs used to wean people off of the harder drugs have a longer half-life, meaning they stay in the body for longer periods of time), and often times they are just sent home with the mother who has not received any sort of treatment for her drug addiction. The moms are not usually prosecuted (which I agree with, because I believe addiction is a disease), but they are also not given the resources they need to become sober mothers of newborns. Then, months later DSS gets involved... the baby shows inability to thrive or worse, dies.
Of course, all of this evidence is both empirical and anecdotal. We did not complete a research study on this topic (although our interest was piqued, despite both of us hating and struggling through research in grad school... and me in undergrad, too... perhaps this will be my Ph.D. research?). And, I believe strongly in the 90/10 rule... 10% of the population gets 90% of the attention. So, for the sake of argument, let's bump 8/10 down to 6/10 to account for a margin of error. Or hell, even 50%. That still means that half of the women who will deliver at our hospital will be drug users who are high at the time of their delivery, and their babies will be born high.
What. The. Hell. Is. Going. On. Here? I can not compare my pregnancy experience to this because I am slightly neurotic... I've taken 2 Tylenol's during this entire pregnancy, on a day of intense hormonal headaches (and promptly puked up both them and my eggs, so I don't think it really counts)... I use natural deodorant (which works for about 6 hours MAX) because I'm afraid of the aluminum crossing the placenta... I've been on decaf coffee for the past 2 years in preparation for this pregnancy... the smell of red wine, which is usually one of my favorite things, makes me want to puke, even at week 31. I ate Gorgonzola cheese on a salad this week and although it was one of the best-tasting things I've had over the past 31 weeks, I felt insanely guilty and watched for signs of listeria. I microwave my deli meat. Neurotic, and ok with it, but neurotic nonetheless. I do hope that, for the sake of this child and his or her future therapy sessions, my neuroses lessens as time progresses... but that will take a LOT of action on my part. Perhaps during my own therapy sessions. I suppose that since Meg and I had to get science and money involved, maybe we are more conscientious of my body during this pregnancy... but even that is ridiculous-- we know tons of heterosexual couples who are just as neurotic as I've been, some even crazier (I'm just saying... that Gorgonzola + cranberries + pecans in my salad was everything. And it was pasteurized, too.)
So we corrected for margin of error and bias and are working with 50% of a population. 50% of babies born at our hospital are not given a fair chance at life, from the time they were conceived. They were not asked if they wanted to use drugs, or if they wanted to live with the negative effects that they will undoubtedly face because of their early drug exposure, which include learning and speech deficits, ADHD, auditory processing disorders, and autism spectrum disorders. This article gives more information about the long-term effects of a fetus exposed to drugs in the womb if you are interested. Unfortunately, this topic does not have enough research behind it because it is challenging to gather accurate information from mothers who fear prosecution.
Is this Darwinism? Is this survival of the fittest? I asked a colleague of mine, and he says no... "Humans are experiencing feelings and emotions on these drugs that we were never, ever supposed to feel. There is no way evolution will ever be able to correct for this, because we are using chemicals to alter our bodies. Even when addicts die, there are a thousand more right behind them, ready to take the next hit. This is a problem that may never go away." So, is this the beginning of the end of civilization as we know it? I choose to think no. I choose to think that there are enough of us out there who are educated and understand the ill effects of drugs, in general, to support society. (Opioid use is now the leading cause of death in adults, and the sheer number of deaths has altered the life expectancy of Americans. New York Times article)
But, if this evidence is not enough to prove that a full drug panel on a pregnant mother is not a preventative measure, then I don't know what is. Hopefully, we don't get sent to collections over this bill, which we are choosing to fight on principle. Medicaid covers the cost of prenatal drug screens, so why don't private insurance companies? Probably because admitting the testing is necessary will also show their negligence; have you ever noticed that your Percocet prescription costs less than a gallon of milk? And research shows the first time many people experience, and subsequently get hooked on, opiates is after getting their wisdom teeth out. I rolled out of that surgery with a prescription in my hand for 30 oxy's. It was never filled and I never took one. Maybe I'm tougher than most. Or more scared. Or smarter. Who knows?
For the next 9 weeks, I'll be sipping on my decaf almond-milk latte and saying prayers for both our baby and the others who are born on the same day at our hospital. I will continue reading books and learning as much as possible about this crazy adventure we are on. And I will think about the 8/10 people who aren't given a fair shake at life and try to figure out what I can do about it.
So, living in the Appalachian region of Virginia brings with it a lot of unique opportunities and experiences. We were fortunate to find a midwife for my prenatal care and delivery, and she is amazing. Her practice, along with all of the other OBGYN practices in this area, do a complete drug screen with their 12-week prenatal blood test... and I mean complete. It tests for marijuana, opiates, methamphetamines, barbituates... probably some other things that I've never heard of or know how to spell. Prenatal drug screening is considered a preventative measure by the care providers in our area because the opioid crisis is a real thing. The theory is that knowing a mother is using can allow providers to educate about the negative effects of opioids on the growing fetus. They can then refer mothers to different types of treatment in the hopes of getting them off drugs before the baby is actually here, including individual therapy, group therapy, and medication assisted therapy (MAT is very controversial... this post is already going to be too long to talk about that, so I'll wait for a future post).
Meg and I were extremely shocked when we got the bill from our provider after the blood work. Everything was covered and considered "preventative" except for 3 things: 2 thyroid tests the midwife wanted done to see where my numbers are (because I have Hasimoto's) and my drug screen... which totaled about $975. We appealed to HR at the University that provides the insurance, and also to Aetna. Aetna determined that the drug screen was not 1) preventative or 2) a "normal" part of their global maternity plan, so it applies to our deductible, meaning it comes out of pocket. The rest of the blood work, which includes testing for things STD's (including HIV), HCG levels, hormonal levels, RH Factor, IS considered both preventative and a normal part of the global maternity plan, so those tests are covered at 100%. I suppose that any issues that come up on the "normal" blood work can be treated in some way to help either the mother or the fetus. But the same is true for the drug screen... right?
Today we got to take a tour of the hospital and do pre-registration, which prevents every movie scene of a screaming pregnant woman being wheeled into the hospital while her partner clutches a clipboard and tries to remember their insurance information. The initial paperwork was standard (name, DOB, address, insurance info). Then we went to the maternity floor and had more questions to answer (including weird ones, like what's my learning style, my highest level of education, do I receive government assistance in any way, and specific questions about drug use before and during pregnancy). We met with 2 nurses and the nurse anesthetist and had a pretty good time with them, laughing about some of the weirder questions. Meg and I are naturally chatty people. We enjoy talking to others and listening to what they have to say, so we've made a lot of "friends" throughout this pregnancy, especially with the nurses, support staff, and even the billing people at our practice. Today, the three people we met with told us we were "like a breath of fresh air" compared to the patients they see on a regular basis. I asked if anyone actually admits to using drugs during pregnancy, and the response was laughter and "Absolutely. Some proudly. You'd be surprised." When we asked more questions about women who answer "yes" to questions about using drugs, we were shocked by their responses. The hospital staff shared that they have experienced pregnant mothers and their partners falling asleep (passing out) during their pre-registration visits. We asked about the number of mothers who delivered high, and they estimated 8/10. Eight out of ten women who deliver at our hospital are high on illicit drugs.
We left that appointment and went to our 31-week appointment, where we got to hear the heartbeat (which was above 140 the whole time, which may indicate we're having a girl-- we are waiting until delivery to find out, which makes just about every single hospital staff member elated). As we checked out, we talked to our billing friends about our experience with pre-registration and they reiterated the same sentiments, providing their own anecdotes. One woman shared that during an OB interview, when she met with a pregnant mother to talk about insurance, the practice, and healthy choices, one mother was so high that she passed out and fell out of her chair onto the floor. Another worker said that during a checkout, she got up to grab something off the printer and when she returned the pregnant mother was still sitting in front of her, but had white powder all around her nose, acting as if nothing happened. We witnessed a man passed out in the waiting area while the woman he came in with went back with the doctor. They talked about people whose veins are so blown they can't get an IV in. And then they talked about the babies. Apparently, on an ultrasound, you can see a baby jerking around due to withdrawals. Can you imagine? Seeing our baby on ultrasound was one of the most profoundly amazing things I have experienced to date. I can not imagine seeing it in pain.
Because I work in social work, I asked what the laws say, and what happens after delivery when mom and baby are both obviously high. Is DSS called? What happens? The women at our practice said that DSS is called, the babies are detoxed at the hospitals (sometimes for upwards of 30 days... that's why MAT is so controversial, because the drugs used to wean people off of the harder drugs have a longer half-life, meaning they stay in the body for longer periods of time), and often times they are just sent home with the mother who has not received any sort of treatment for her drug addiction. The moms are not usually prosecuted (which I agree with, because I believe addiction is a disease), but they are also not given the resources they need to become sober mothers of newborns. Then, months later DSS gets involved... the baby shows inability to thrive or worse, dies.
Of course, all of this evidence is both empirical and anecdotal. We did not complete a research study on this topic (although our interest was piqued, despite both of us hating and struggling through research in grad school... and me in undergrad, too... perhaps this will be my Ph.D. research?). And, I believe strongly in the 90/10 rule... 10% of the population gets 90% of the attention. So, for the sake of argument, let's bump 8/10 down to 6/10 to account for a margin of error. Or hell, even 50%. That still means that half of the women who will deliver at our hospital will be drug users who are high at the time of their delivery, and their babies will be born high.
What. The. Hell. Is. Going. On. Here? I can not compare my pregnancy experience to this because I am slightly neurotic... I've taken 2 Tylenol's during this entire pregnancy, on a day of intense hormonal headaches (and promptly puked up both them and my eggs, so I don't think it really counts)... I use natural deodorant (which works for about 6 hours MAX) because I'm afraid of the aluminum crossing the placenta... I've been on decaf coffee for the past 2 years in preparation for this pregnancy... the smell of red wine, which is usually one of my favorite things, makes me want to puke, even at week 31. I ate Gorgonzola cheese on a salad this week and although it was one of the best-tasting things I've had over the past 31 weeks, I felt insanely guilty and watched for signs of listeria. I microwave my deli meat. Neurotic, and ok with it, but neurotic nonetheless. I do hope that, for the sake of this child and his or her future therapy sessions, my neuroses lessens as time progresses... but that will take a LOT of action on my part. Perhaps during my own therapy sessions. I suppose that since Meg and I had to get science and money involved, maybe we are more conscientious of my body during this pregnancy... but even that is ridiculous-- we know tons of heterosexual couples who are just as neurotic as I've been, some even crazier (I'm just saying... that Gorgonzola + cranberries + pecans in my salad was everything. And it was pasteurized, too.)
So we corrected for margin of error and bias and are working with 50% of a population. 50% of babies born at our hospital are not given a fair chance at life, from the time they were conceived. They were not asked if they wanted to use drugs, or if they wanted to live with the negative effects that they will undoubtedly face because of their early drug exposure, which include learning and speech deficits, ADHD, auditory processing disorders, and autism spectrum disorders. This article gives more information about the long-term effects of a fetus exposed to drugs in the womb if you are interested. Unfortunately, this topic does not have enough research behind it because it is challenging to gather accurate information from mothers who fear prosecution.
Is this Darwinism? Is this survival of the fittest? I asked a colleague of mine, and he says no... "Humans are experiencing feelings and emotions on these drugs that we were never, ever supposed to feel. There is no way evolution will ever be able to correct for this, because we are using chemicals to alter our bodies. Even when addicts die, there are a thousand more right behind them, ready to take the next hit. This is a problem that may never go away." So, is this the beginning of the end of civilization as we know it? I choose to think no. I choose to think that there are enough of us out there who are educated and understand the ill effects of drugs, in general, to support society. (Opioid use is now the leading cause of death in adults, and the sheer number of deaths has altered the life expectancy of Americans. New York Times article)
But, if this evidence is not enough to prove that a full drug panel on a pregnant mother is not a preventative measure, then I don't know what is. Hopefully, we don't get sent to collections over this bill, which we are choosing to fight on principle. Medicaid covers the cost of prenatal drug screens, so why don't private insurance companies? Probably because admitting the testing is necessary will also show their negligence; have you ever noticed that your Percocet prescription costs less than a gallon of milk? And research shows the first time many people experience, and subsequently get hooked on, opiates is after getting their wisdom teeth out. I rolled out of that surgery with a prescription in my hand for 30 oxy's. It was never filled and I never took one. Maybe I'm tougher than most. Or more scared. Or smarter. Who knows?
For the next 9 weeks, I'll be sipping on my decaf almond-milk latte and saying prayers for both our baby and the others who are born on the same day at our hospital. I will continue reading books and learning as much as possible about this crazy adventure we are on. And I will think about the 8/10 people who aren't given a fair shake at life and try to figure out what I can do about it.
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