Pregnant on Drugs

Abstract

Over the past 20 years, approximately 90 percent of female drug abusers have been of childbearing age (Saloum, Epstein, and Frost, 2012). Anesthesiologists may encounter drug users or abusers who are entering labor or during emergencies (e.g., fetal distress or placental abruption). Because drug use and drug abuse are possible, and increase risk to patients, anesthesiologists may screen patients for risk factors, including premature labor, absence of prenatal care, and alcohol use. Risk factors could correlate with use of cocaine, opioids, amphetamines, and marijuana. Pregnant patients who use or abuse substances are very likely to lie or play down their substance consumption. Suspiciousness may be appropriate and demonstrate best practices. Nonjudgmental questioning may be necessary to verify suspicions. If patients disclose drug use or abuse, but anesthesiologists do not respond appropriately, then criminal charges may be brought, depending on the level of negligence. In some jurisdictions, doctors can face some of the same charges used to prosecute mothers who harm fetuses in utero. Civil remedies may also be permitted under wrongful-death statutes. Civil recovery for wrongful death may be possible if patients die due to anesthesia, irrespective of their personal drug use (Glenn v. Performance Anesthesia, 2011). Doctors are not liable for fetal death if termination was intended and lawful; but doctors may be liable if patients die due to negligently or recklessly administered anesthesia that departs from the professional standard of care.