Confronting The Harms Caused By Racism In Perinatal Drug Testing


Diana Montoya-Williams, Rachel Fleishman


August 28, 2023


Today, you are the doctor in the well-baby nursery. As you walk from one hospital room to the next, talking with new parents, most of your patients are healthy. Your job is to ensure that rare but serious health problems don’t go undetected before these babies go home with their parents. As you walk by the nurses’ station, a nurse pulls you aside.

“The baby in room 7 is jittery,” she tells you. “And he just seems fussy. The resident had me check his blood sugar and calcium levels. Both were normal.”

You stand silent for an extra beat, waiting to see what else the nurse might say.

“Has anyone asked the mom how she thinks her baby is doing?” You say this because a parent’s perspective always matters.

“I don’t know,” the nurse offers.

“Thank you for letting me know your concerns. Let me go look at him.”

You knock, open the door, sit down beside this mother, and offer congratulations on the birth of her child. You ask if you can examine him.

As you unwrap his blanket, his arms move with an irregular, exaggerated jerking. As you move his limbs, then lift him up, you notice increased muscle tone in his arms and legs. He starts crying so you place his pacifier in his mouth. He begins to suck and calms.

You talk to his mother about her pregnancy, which was, by her account, uncomplicated. She tells you she missed a few prenatal care appointments because she could not miss work. After three days in the hospital recovering from her unremarkable, repeat cesarean delivery, she is expecting to take her baby home today.

“How do you think your baby is doing overall,” you ask her.

“He seems fine,” she affirms. “He’s acting just like his sister.”

You swaddle him back to sleep then leave their room. The nurse catches you in the hall.

“Do you think we should send a urine drug screen?” she asks. This is a nurse you know well; someone you trust to provide exceptional care to families.

She is worried about opioid withdrawal because babies with this condition can be jittery and fussy. She wants to know for sure what is going on….

DOI: 10.1377/forefront.20230824.716788


Montoya-Williams, D., & Fleishman, R. (2023). Confronting The Harms Caused By Racism In Perinatal Drug Testing. Health Affairs Forefront.