I would like to hear about the tox screen/brstfdg policies in other
hospitals, especially those with high rate of drug use in their client
populations.

Some staff members (LCs included) have been reexamining our guidelines for
tox screening and breastfeeding.  Obviously, if a mother states she has
recently taken drugs, they are not allowed to breastfeed (in the hospital
where we can see them anyway).  An ocassional mother will request to
pump/dump.  This is done very rarely  but it has happened with clear
guidelines for breastfeeding and follow-up after many sessions with social
services.

Usually  ---  A mother with a drug history within one year of her delivery
has a tox screen upon admission.  Also anyone with late prenatal care or
history of no shows for visits.  The pediatricians are supposed to be
notified for orders for tox screens on the babies.  Social service visits
the mom postpartum.  Usually the results of tox screens drawn in
labor/delivery on the mother are back by discharge.  The babies' screens
are usually pending but discharge is usually based upon mom's negative
screen.

A positive screen on mom requires Child Protective Agency get involved with
more assessment.  If the baby's screen is positive, the baby is put in
foster care.  Much counseling and follow-up is done but I don't too much
about that because I just work in patient.

This is how it is SUPPOSED to go.  Sometimes the MD overlooks the drug
history or forgets to ask the questions regarding last use.  Sometimes the
admitting nurse reads the history and does catch-up.   Sometimes mom's tox
screen is drawn and sent but the baby is overlooked.   Sometimes it doesn't
come to anyone's attention until the discharging PNP reads the history.
Then ensues uproar, of course.

I don't know if this is a subject of interest to many on lactnet.  Post by
private e-mail.

Thank you,
Christine Palmer, Mill Valley CA