In this episode, Carlyn Mast, LCSW shares more about her experience working within hospital birth systems to support birthing people who use drugs.
Is there a topic that carries more bias than pregnant people who use drugs? How can we combat stigma & show up for pregnant people using drugs? How do we address decades of policies that result in hospital birthing spaces that can feel hostile and punitive to this population? How we can support pregnant people who are using drugs and make it so that they feel safe and that they are actually being cared for instead of criminalized?
Listen in as she explores:
~Facts about drug use in pregnancy
~Harm reduction strategies during pregnancy
~Examining our biases & emotions as care professionals
~Navigating hospital policies around surveillance & reporting
~Supporting families without CPS
In this episode, Carlyn Mast, LCSW shares more about her experience working within hospital birth systems to support birthing people who use drugs.
Is there a topic that carries more bias than pregnant people who use drugs? How can we combat stigma & show up for pregnant people using drugs? How do we address decades of policies that result in hospital birthing spaces that can feel hostile and punitive to this population? How we can support pregnant people who are using drugs and make it so that they feel safe and that they are actually being cared for instead of criminalized?
Listen in as she explores:
~Facts about drug use in pregnancy
~Harm reduction strategies during pregnancy
~Examining our biases & emotions as care professionals
~Navigating hospital policies around surveillance & reporting
~Supporting families without CPS
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I'm your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Welcome back. In this week's episode, we are diving into another heavy conversation. And this one, I don't know that I can think of maybe a more biased topic in the pregnancy, birth postpartum continuum than pregnant folks who use drugs. And I think there has just been large campaigns of intentional misinformation about what drug use means, the impact that it has on pregnancy, safety and parenting. And so I'm really excited to be able to have a more intentional conversation, and to really consider some of the stereotypes that we have perhaps played into and believed and how that affects the way we treat people who are in our care. And so to help us to navigate this, I'm really excited to have Carlyn Mast join us, who is a licensed clinical social worker, who really works at you know, the intersection of perinatal behavioral health and harm reduction. So I welcome you into this conversation with Carlyn. Onto the show!
Well, welcome. Welcome. Welcome, Carlyn. I'm so excited to have you on here to talk about kind of all things, surveillance and support and harm reduction and really dig into how we can really just partner with those who are in our care to really support what they need on their pregnancy journey. So if you want to just tell our audience a little bit about yourself again.
Carlyn, LCSW 2:05
Yeah, thanks so much for having me. I'm really excited to be here. My name is Carlyn and I'm a licensed clinical social worker. Currently, I live in the Philadelphia area. But prior to moving, I've spent my whole life in Baltimore, Maryland. Prior to moving I worked at a birthing center at a hospital and was the perinatal social worker. So that means I worked on a mother baby unit labor and delivery, in an outpatient abortion clinic, and a center for high risk pregnancies does like fetal surgeries and things like that. So in addition to that, I also helped co found the prison support programs through the Baltimore doula project. And I worked with the Baltimore City Public Defender's in their office of rental defense. So I've really worked at like the intersection of pregnancy, parenting and mental health, surveillance, all of those things, huh?
Maggie, RNC-OB 3:01
Yes. Yeah, that's it's, I love your your background, you just you bring such a rich experience to how we kind of interact with pregnant people. One of the big reasons that we wanted to invite you on here is when we learn about supporting pregnancy, we learn about it in this kind of like this, whatever "picture perfect," kind of like ideal way that it's all supposed to work. I don't think anyone has that, you know, like that textbook, no one has the textbook life. And so one of the things I wanted to particularly talk to you about is harm reduction in pregnancy and what that might look like and how we can support pregnant people who are using drugs and make it so that they feel safe and that they are actually being cared for instead of criminalized.
Carlyn, LCSW 3:47
Yeah, so thank you for bringing that up. As a social worker, I consider myself a harm reductionist and I've practiced with a harm reduction framework. And I guess just to like, lay the groundwork harm reduction is a term that we hear kind of often now, which is great that it's, it's being discussed. And it's kind of like out there in the public sphere. But for folks that aren't super, you know, knowledgeable on it, in essence, really, it's just a set of practical strategies and ideas aimed at reducing the negative consequences associated with drug use. It's also kind of a movement for social justice built on the belief and respect for the rights of people that use drugs. I like to think of it kind of as radical love and compassion for the folks that we work with. Here is autonomy, which those of us in birth work know is is really important, and sometimes something that that not everyone has access to. So what I love about harm reduction is it centers, autonomy and you know, nothing is for us without being by us. Does that make sense?
Maggie, RNC-OB 4:55
Yeah, I think there's this whole like double bias that kind of comes up where we You know, where people who are pregnant are automatically just judged way more closely for anything that they're doing with their bodies. And like you said, we just see so often that autonomy is not present in kind of just standard prenatal care and how people are treated both by, you know, birth workers and professionals, but also just by society at large, you know, like, we just seem to think that when someone is pregnant, all bets are off, and that they no longer get to choose what what happens to them. So I wonder in that context to where I think then there's a good double whammy, where we also tend to treat people who use drugs in that framework that like when someone is, is using something that, you know, it's an illegal substance, that all of a sudden, like all bets are off for how they want to how they want to handle their life, if and how they want to continue their drug, you know, all of that. And so, I wonder if you could touch on that kind of the, how those two things kind of intersect and what you see in your work?
Carlyn, LCSW 5:53
Yeah, so I think you you put it great. I mean, it is anyone that you know, works in healthcare or practices medicine, or has been pregnant or experienced drug use. I mean, it's really like you're working at the intersection of two very emotional, very, you know, people come like with a lot of emotion and a lot of ideas and opinions about both pregnancy and drug use. And like you said, You are kind of working at the crux of these things that are sometimes the only experiences where people feel totally comfortable to like come up to you and just like rattle off opinions. So it's both like a very emotional time. But it's also a very good a lot of opinions about drug use and pregnancy. So when I'm talking about pregnancy and harm reduction, I mean, there's just a couple of things that I really like to keep in mind. Is that something that you would like me to talk abut?
Maggie, RNC-OB 6:49
Absolutely, yeah, I think that'd be really helpful to just be like, cuz like you said, I think it's become somewhat of a buzzword. But yeah, there's not always a lot of kind of deeper meaning to again.
Carlyn, LCSW 6:58
So I guess the first thing that I like to do is really just talk a little bit about drugs and pregnancy, because that's something that there is like limitless misinformation about and there are, you could find a scientific study that could, you know, the conclusion could say whatever you want it to, but when we're talking about consequences of drug use during pregnancy, on long term outcomes of babies, the science is is particularly terrible. There are there have been throughout history, many studies, particularly thinking of Dr. Chasnoff that wrote the one of the first papers on the impact of cocaine use during pregnancy, like back in the 80s. That led to the whole like "crack baby" myth. There has been throughout history, just like terrible science around this. But what I feel confident saying and I think what other informed healthcare practitioners would agree with me on is that there is not good science that suggests that there is any long term cognitive or behavioral deficits in babies are born exposed to substances in utero, the caveat that we know that alcohol use during pregnancy can lead to a fetal alcohol spectrum disorder. And we know that that can be harmful. But when it comes to other drugs and substances, there is not good evidence. There's no evidence at all that that really points to, you know, babies that were exposed in utero having these like severe deficits and behavioral issues later in life. So that's the first thing I like to dispel. Because so many folks that work in healthcare are not, you know, this may not be their bread and butter, they may not be super educated on this. And, you know, it is a widely accepted cultural myth that, you know, if you use drugs during pregnancy, your child may end up being learning impaired or having behavioral issues. And that's simply not true. That is the first and foremost thing that I like to get out of the way.
Maggie, RNC-OB 8:58
Yeah, and I mean, that it that's a huge cultural shift. That's just that's not what we're, I don't think that's what we're taught, both from medical nursing that, you know, background like that is certainly not what is what is written about in the textbooks. And at least I also think that's just not what society that is not the story that we've told ourselves is certainly one that like there's going to be long term harm, and that absolutely feeds into then this kind of poor treatment of it. So I think that's really important to, to note and get out there.
Carlyn, LCSW 9:28
I think also, you know, we're talking about using any substance during pregnancy, particularly anything that is not anything that's elicit so it's not legal, there is harm and there is risk, particularly when it comes to infection and overdose. And those risks are a direct result of the war on drugs and criminalization. So we're talking about risks. You know, it's important to recognize that, you know, some serious risks not to downplay you know, infection or overdose at all. But these are risks that could largely be mitigated if we were to practice through a harm reduction lens, and we were able to have access to safe supply and health care that really treated folks that use drugs. So, I mean, there definitely is risk, but it is kind of a result of this system, if that makes them. Yeah, absolutely. After we've gotten that out of the way, and we've talked about it, because there's usually like, understandably, a lot of feeling, I really just can't stress enough that pregnant folks make the best decisions for themselves and for their bodies. Pregnancy, as you know, is this really interesting, unique time and like window of change, where folks that may not, you know, have a ton of exposure to the health care system for whatever reason, typically find themselves interacting with it a bit more. So it is this wonderful, beautiful time that as health care providers or mental health providers, you have the you know, the chance to really formed a trusting relationship with with a person and not just to serve them during their pregnancy, but hopefully, you know, be the jump off for for better health in the future, I think one of the most important things that we can do as healthcare practitioners is really create a safe and non judgmental space for folks that use drugs, and people that are pregnant, and, you know, people that are pregnant have unique needs, a lot of times they may have other kids. So whether that's, you know, creating a space that welcomes children, and, and maybe also has childcare or, you know, understanding that a lot of people that, you know, have the capacity for pregnancy may or may not have some sort of that history of sexual violence or trauma, you know, we need to be understanding of these things, but but really at the crux of all of this is really believing that our clients make the best decisions for themselves and for their families. Does that make sense?
Maggie, RNC-OB 11:54
It does make sense that I, that is certainly been I mean, autonomy is a, if anything is our core value, as you know, an organization here. And it's something that comes up so often in our conversations about a myriad of topics, because it is just, it should absolutely be the cornerstone of perinatal care. And it's not. And I think we see the reverberations of that, across so many different populations. So many different people are impacted by the paternalistic nature that we have set up in perinatal care, and it, it hurts us, it hurts the people we're trying to take care of. Because just like that, it sounds so easy. Like, of course, we're just going to create a non judgmental space for people to come in. And then tell us what, what do you need? Like, what, what what, what kind of support Are you looking for, but it's not how our system is set up at all. And it's not what we're what we're taught to do, you know, we're taught to kind of come in with a checklist, and that's inadequate, and harmful.
Carlyn, LCSW 12:54
Yeah. I mean, I and I've, I've gotten questions before, like, well, what can I do? Like, what where do I start? And I think the biggest thing and it may sound like silly, but the biggest thing is just listening to the folks that you're working with, you know, what do you need, I know, they'll tell you what they need, and understanding that that trust on the same, you know, the same note that trust may not be there initially, it may be something that you have to build, and you have to work in. Because, you know, historically, the health care system hasn't always been kind to people that are pregnant, or, you know, people that are pregnant and are using drugs. So, you know, over time, little by little if, if that's kind of how we're practicing, we're practicing through this harm reduction lens of centering autonomy, the trust will will begin to build.
Maggie, RNC-OB 13:41
Yeah, absolutely. I mean, it should be relationship based, you know, it's we have this, like this window, you know, like, luckily, we're pregnant for several months. And it feels like right, this is totally an opportunity where we are have so many check ins with people who maybe just haven't had an opportunity to discuss it with a healthcare provider to say what kind of support they need that like, here we are, where we're gonna expect to see you every month, every couple of weeks, you know, things go along, that there really is this chance for us to be open and accepting and let our relationship form and not feel like we need to go in, you know, drilling people on their first prenatal appointment, to understand everything about them instead of just allowing things to kind of unfold as it as they feel comfortable.
Carlyn, LCSW 14:24
Yeah, absolutely.
Maggie, RNC-OB 14:26
Yeah. And then I wonder, the other piece, I think that you touched on a little bit, and I think it's challenging, perhaps, is that emotional piece of it, I think, someone who's been, you know, a nurse in this field for like, a decade and worked in a couple of different institutions. And they've all had different policies, you know, around, how are we monitoring? How are we you know, assessing for drug use? What are we kind of asking for? And I think one of the things that I've seen across all of those is that there's always someone who either has a personal experience or has had Past professional experience with someone who was using drugs. And then there was a really difficult outcome, maybe during the pregnancy or you know, right there during the birth, you know, or immediately afterwards, and they are really holding on to this past experience really dictate how they then interact with people who use drugs. And I've certainly seen it for people who have had personal experiences, you know, they've had a loved one who has used drugs and has had a difficult time. And so then they're, they're carrying all of that, you know, we heard you know...we're not empty vessels, I think we think sometimes we're supposed to show up like that, but they are holding on to a lot of kind of this negativity that they've had associated people. And it makes it really challenging for them to kind of build and give a fresh set of eyes to the person who's right in front of them. And I don't know if you can speak kind of like your social work background to how do we kind of navigate some of those, like, hold that piece of it.
Carlyn, LCSW 15:59
So yeah, of course, the the fact that you're able to recognize that, right? Like in talking to you, if you were a co worker of mine, let's say a nurse I worked with that came to me and said, Look, I'm having a really hard time with this, because of x, y, z in my past, the fact that you're able to identify that it's challenging for you, because of a personal experience is like step number one. So, you know, speaking to this, as a social worker, I think it's always important to kind of check in with ourselves and understand where we're coming from when we show up to this birth work, right? If I'm someone that had a really difficult experience in the past, you know, in this field, and it's starting to, you know, inform how I'm seeing my client, or how I'm feeling about the situation, I need to check in with myself, and maybe give myself a little bit more TLC, and, you know, have a chat with myself like, it's, it's a tough space, right, like drug use, and pregnancy, both can have really difficult challenging outcomes and come with, you know, a ton of trauma, potential trauma. And it's important that we're able to kind of process our own past or things that have may happen to friends or family, and not have that, you know, impact our clients, if that makes sense. And one thing in the social work field, I mean, social work gets a lot wrong, I'm the first one to like, have an axe to grind with social work. But something that is built into our profession is this idea of supervision. where, you know, if you're working towards kind of like the highest level of licensure, weekly, bi weekly, you're meeting with someone in your field, a supervisor, someone that's, you know, I've been practicing a little bit longer to kind of just work through this stuff. Like, we recognize that lots of things can be really emotionally challenging. And if we don't put it somewhere, it has the potential to come and, you know, be in the room with our patient and our care. And I think it's really important to just tackle that.
Maggie, RNC-OB 18:07
Yeah. And then I think if, we had talked about this a little bit before, like the I think there's like two parts of it. Like, once you're personally kind of able to, like have that acceptance. So maybe like you've, you've done your research, you've read about this, you're listening to this podcast, and you're feeling like Yeah, absolutely. Like, I want to support the autonomy of everyone who's in my care. Sure, they're using drugs, like that's one aspect of them, I want to support, you know, whatever they need with that, I think then we also run into, like, a personal level of acceptance about it. And then policies, that at the work that could go very much in opposition to that, perhaps. So I don't know, you know, if we want to dig into a little bit of that side, because I think that's where sometimes kind of like rubber hits the road, I think most people do really want to, they want to support their patients. And then we end up feeling kind of like, our hands are tied by institutional policy and what's kind of been set up.
Carlyn, LCSW 19:04
Regardless of how you feel about all of this, there is a lot of policy that, like you said, makes it really challenging to practice in kind of a compassionate harm reduction manner. So most hospitals, most birthing centers, drug test, either pregnant people or babies, and, you know, nobody, it's it's not super uniform, a lot of people do it differently depending on where you are. But all of this stems from something called CAPTA. And that's a federal piece of law, the Child Abuse and Prevention Treatment Act, and I don't have the exact date. I think it was in like the 80s. Maybe this was a thing, but it's something that gets amended every couple of years and like keeps going but it is a federal piece of law that that is in charge of giving block grants to states. These block grants often go to fund like social service programs or aspects of the safety net, but what this, what CAPTA does, what part of it does is in a very twisted, misguided, horrific way it attempts to to deal with drug use and pregnancy. And it's a very punitive, not helpful, you know, method of of dealing with this at all. But what it's kind of turned into is the rules around what happens when there is a positive test. CAPTA doesn't say that you have to test everyone or you have to test no one. It doesn't give those guidelines, but it it says if there is a positive test, this is what has to happen. And and I think every case, it's it's reported to child protective services. So that does that make sense? Like a little background on why the done?
Maggie, RNC-OB 20:46
Yeah, absolutely. Because I think things are often just like done, because they've always been done. And so you're not really sure where you have to go to then kind of start to unravel the process.
Carlyn, LCSW 20:54
Yeah, yeah, chances are, if your hospital or your clinic drug tests, it is because of this legislation, or in response to this legislation. So I know where I used to work, it was in we very, we got like, very in, you know, into the the technicalities of it, but it when I left the hospital where I was working, it wasn't necessarily a mandated report, if a pregnant person was was tested positive for an illicit substance, but if the baby tested positive for an illicit substance, or a prescribed substance with the caveat that there was observe neonatal abstinence syndrome, so some sort of observed, like withdraw. That was a automatic mandated report to local Child Protective Services. So you know, and again, not everybody does this. This is not like a uniform thing across all 50 states. Every state does it a little differently. Some are like more punitive, others are less. But so speaking to Maryland. First off, I don't, I don't believe we should be drug testing any pregnant person or baby and I believe that firmly because I think we should have a good enough relationship with our patients, where they're honest with us, and we're honest with them. I don't believe that a drug test is a an indicator of your ability to parent, a drug test doesn't necessarily we're not what are we screening for? We're not screening for a substance use disorder, right? Like, plenty of people smoke weed here and there, they test positive, that doesn't mean that they have problematic use or cannabis use disorder. It's kind of this like, it just it doesn't make sense from like, a clinical perspective, I think, but it's, it's turned into this like very punitive marker for who is an acceptable parent and who, you know, we don't trust a parent. So
Maggie, RNC-OB 22:47
I think if you could just like say that part, even one more time, because I think that's a that's a big difference in and I think what we think we're testing, so being very honest, you know, I certainly, one of the places I used to work, they, you know, routinely drug tested everybody who came into labor, I didn't think too much of it. Like it was different from- we didn't do that at the place I'd worked before. But I thought like, "Oh, I guess this is just how they do stuff. Okay, you know, whatever." In retrospect, obviously, looking back, I wish I had questioned that whole process a little bit more to kind of understand, to your point, like, what are we actually? What are we testing for? What are we looking for? What is this information actually providing it? So I think if you just want to say that piece one more time, because I think there, we've crossed some wires there in terms of what what information a drug test can actually provide to us. And you know, one, one stop shop kind of thing.
Carlyn, LCSW 23:40
Just to say it again, a drug test is not a marker for ability to parent. So drug use has no bearing on your ability to parent and I have said this to countless people that I've worked with worked for, you know, I if I could kind of make that like my tagline, that's what I would like to make it. But you know, how we drug test, you know, you can have a endless conversation about how coercive that is, right? Like oftentimes people that that come to the hospital for care come to the breathing center for care. When you're signing those consents. Most of the time, you're not being told, like hey, by the way, we're going to drug test you and if you test positive, this is what x y, z could happen. So the way in which it's done is also super secretive and unethical in my opinion, but it's not a marker for your ability to parent what is the marker for is that sometime and in the past two weeks, probably you use this substance or had contact with this substance so it has no bearing on your ability to parent and and I think it's really irresponsible and harmful for us to complete those things.
Maggie, RNC-OB 24:53
Yeah, and we do it all the time. That has been the standard is to yeah, use those as stand-ins for each other.
Carlyn, LCSW 25:02
Yeah, I mean drug use in and of itself is not harmful, right, it's a normal part of human development to experiment with drugs. You know, if the the mom that loves to go to Target and drink wine is using substances just as much as the person that likes to smoke a joint or you know, casually use whatever it's, it's not, it's not a marker for being a bad parent, you know, people been getting high since the beginning of time. And I wish healthcare clinicians could be honest with themselves really, like, so many folks that I've worked with in the past, like, I don't know, when you were in college, or maybe you were a kid you experimented, it's, we act like drug use is just this horrible thing, when, in reality, you know, it can be part of a good time it can be done a non harmful manner. And, again, it has no bearing on our ability to raise our child.
Maggie, RNC-OB 25:57
Yeah, I think it is like that. The illicit substance, the ones that you've decided, like, right, your nicotine, your alcohol, those are fine, those are regulated, we're getting our taxes for them. That's okay. But if you're doing THIS... and I think that, I think having heard that, that was like a helpful thing for me to realize like, Oh, right, like, yes, we all use all sorts of different substances all the time. And absolutely, me having a glass of wine, while my children are sitting there playing is not making me a bad mom...
Carlyn, LCSW 26:30
No!
Maggie, RNC-OB 26:31
Obviously. And so you know, we've tried to make substance use this more encompassing thing, instead of recognizing that it can be, for some people, it can be an issue, it can be something that they want help with. And I don't know, if you want to kind of touch on that piece of it, too, is how it comes up kind of within pregnancy. And as we're developing that relationship with people, for people who want to make a change in their behavior, recognize that they are not comfortable with the way that their drug use could potentially impact their parenting.
Carlyn, LCSW 27:04
Yeah, so the beautiful thing about harm reduction, and the beautiful thing about meeting someone where they're at, is the relationship and trust that's built in just the act of not necessarily just coming out and judging somebody, but sitting with them listening to them, and saying, like, what do you want to do that, even if that moment, they may not be ready to reduce their use, or maybe speak to somebody that can help them out with medication over time, you're more likely to get into treatment by utilizing a harm reduction approach than if you were strictly to be punitive. So just that human connection, and that empathy makes someone feel safe, it makes someone feel heard. And they're more likely when they're heard, and they they're safe to come to you if and when they're ready to reduce or stop use. You know, for folks that are interested in treatment, that's amazing. And, you know, part of what I used to do at the hospital is help them with that, whatever that looks like, but not everybody is like, ready for treatment or wants to stop. And that's totally okay. That can be another really challenging thing, things for clinicians to kind of come to terms with, is that not everybody wants to stop using drugs and and, you know, it's okay, that's, that's their choice, that they have autonomy, they can do that not every choice is the greatest choice. But a person that continues to use as likely has their reasons for it. So our job becomes, you know, and when I say are like my job as a social worker, and a clinician becomes like, how can I help you make any positive change? Or any? Like, how do I help you be safe, whatever that looks like, how do we talk about that? So, for instance, if you're someone that uses heroin, and you you know, your means of using it is by injection? How can we get you safe needles or clean needles? How can you know, is there a place around I know in Baltimore, there was Spark, where can I send you so that you can get like safe injection kids and you get you can get fentanyl testing strips and you know that, you know, you have a safe place if you need it. I think when we talk about treatment, sometimes the conversation immediately goes from Oh, this person is using XYZ substance, oh, they need treatment. That's not how that works. We have to talk to the person, see, you know, what's going on what they want. And if you know that person wants treatment, excellent. let's hook them into, you know, a clinic or if they can come to our place to get it great. If not, what can we help them do to just like be a little safer?
Maggie, RNC-OB 29:48
Yeah. And I think again, I know from when I you know, as a nurse, I have a different relationship with folks and I tend to be meeting people kind of quickly at the hospital. I haven't had the benefit of you know, months of time. talking to them and understanding kind of you know where they're at. And sometimes it feels like, okay, we have this, you know, this drug screening that was positive for substance, and then it kind of puts in place this whole litany of things that have to happen. Can you speak a little bit to kind of like, what if we're working in a place that is not following a kind of harm reduction framework? What are the ways that we can still kind of step in and support our, you know, our patients autonomy, kind of within that, a bit of a retrofit? For if that's kind of where your system is still?
Carlyn, LCSW 30:33
Yeah, of course. So the first thing that I would encourage you to do is have a conversation and really read the law. So wherever you are practicing if you are at a hospital, and it's routine to drug screen, every pregnant person and every baby, what's the law around that? Why are we doing that? So the first thing is understand the law. So because this cascade of events doesn't happen in a silo, it can impact the entire trajectory of someone's ability to parent their child, you really want to know what that's going to entail. So, number one, advocate that the people in charge, read the law and fully understand what this drug test has the potential to do to I think people in healthcare don't understand Child Protective Services, or kind of better known as the family regulation system. That term was coined by Dorothy Roberts, people that are not necessarily in social work. It's been my experience that other health care providers don't understand what CPS or the family surveillance family regulation system is, it is it is not a friendly place. Oftentimes, I have heard nurses and doctors talk about, oh, this person's, you know, they tested positive for XYZ, and they just need support, send them, you know, you'd have to report it to CPS? Absolutely not. We're going to full stop on that. And let's unpack why the family regulation system in this country, just like the police are deeply rooted in white supremacy and slavery, just like the police used to be like the runaway slave troll, Child Protective Services, the family regulation system, directly, deeply embedded in slavery, it is not a place of support, nor should it be used as one. That's like the first hard point that I need to make. Again, a lot of nurses, a lot of doctors, a lot of people that may not have curriculum in graduate school that that kind of focuses on this. I don't know. I mean, it's not something that's widely talked about, you know, at this point in, in kind of, like our cultural dialogue, right.
Maggie, RNC-OB 32:46
Yeah and that's hard to hear. We want to believe in safety nets, you know, we want to believe that there is something... Yeah, but there's a lot healthcare workers, I think generally like our, our vibe, one of the things we want to do we think we can help fix something. Yeah, we want to be able to Band Aid rubber stamp something. And it's hard to know that, that that's not what's happening there.
Carlyn, LCSW 33:05
Now, yeah, full stop on there is no, like, you know, as somebody and this is just a caveat, like, I can count on one hand, the amount of times as a social worker and mandated reporter that I had to call CPS for something that was I was actually very concerned about when it comes to abuse or, you know, one hand, I mean, I could probably maybe three times CPS is punitive motive. It's just it's policing, it's family policing. So along with understanding the cascade of events that can happen when you drug test someone or you drug test their baby, you also have to understand the system in which that's working in it is a system that targets black and brown people black and brown families, far more than it does white. And it is designed to, I mean, it's designed to punish families and to rip them apart. And I know that's really hard to hear. And that is something that maybe folks that work in the child welfare sector may not necessarily agree with. But if you look at like the statistics of who is investigated and who is placed in foster care, it is it is a system of regulation of Black and Brown families. The positive is there are things that we can do to mitigate the need for interacting with that system. So I think mutual aid is the biggest, you know, safety net against having to get involved with this system. So, you know, if you're just trying to give concrete, you know, answers if you are working in a hospital that utilizes a social worker, get with your social worker and say like what are the community organizations Does that provide pack and plays? who provides cribs who provides take home formula? Do we have like a milk bank or for a formulary that has infant formula, if this person is going home, and they don't have the things that they need at home, can I give them formula? Can I give them a pump, you know, whatever. So accessing support from community organizations or individuals, I think is the biggest, you know, way to mitigate the need for for CPS involvement. Now, let's say we have somebody that has, you know, tested positive, so we know that we're their baby is tested positive. So it's an automatic mandated report. Let's talk about ways that we can decrease harm that's done through this process. So what that looks like is charting from a strengths based perspective. Oh, I, you know, mother and baby bonding beautifully, or like mother very attentive to baby's needs. I know, this is like very heteronormative language, but I'm sorry, that's like, the way a lot of it's done. So like, what are you observing or observing? Great bonding? Awesome, chart it like, what are you saying that could potentially help this person because, you know, I think it may be unsettling, but a lot of times these notes are read in court. And so whatever you're writing, like, has the potential to like, be in front of a judge and so chart in a way that's really going to help the family that you're working with?
Maggie, RNC-OB 36:32
Yeah, because I mean, that is something that that isn't that we can do in any system that we are in, you know, is really, and I think that, you know, the strength based approach, we've, there's, we've talked before about kind of some charting and how that kind of falls along with liability and all that stuff. But I feel like that piece of just being really cognizant of the impact and the power, that our words written or spoken, have on the family's outcome is just as important to keep at the forefront of our mind.
Carlyn, LCSW 37:02
Nurses, nurses in particular, can can be like, have the potential to be the best advocates, like the nurses that I worked with, at my old job. I like it would bring me to tears, like seeing them, like the way that they would advocate for the people that they were working with. And I mean, don't sell yourself short at all, like you can really help the folks that you're working with, like, God forbid, that note is read in in court, or, you know, this person does have to have this interaction with the surveillance system. You know, you can really help advocate for the least amount of harm possible.
Maggie, RNC-OB 37:41
Yeah. And then, you know, as we're kind of wrapping up, do you feel like what are the other ways that we can move from surveillance to support,
Carlyn, LCSW 37:56
Stop drug testing your patients! I mean, that's really like, yeah, stop, you know, coercively drug testing pregnant people and their newborns, and focus on building a trusting relationship with your patients where they can be honest with you, and you can be honest with them, making the mental shift from a, whatever outcome happens on a urine toxicology, to being a marker for being able to parent make the mental leap of separating those two. And, you know, I love what you said earlier about, kind of doing the work of checking in with ourselves and understanding that, like, we may come to this space with some difficult history, or even trauma, and we have to give ourselves love and give ourselves understanding in order to really come as as a clean slate and, and come at least understanding that like, we may have this past and we may have these preconceived notions, but we understand that not everybody that we meet is going to be the exact same way as our past or, you know, fit into this box.
Maggie, RNC-OB 39:08
Does that make sense? Yeah, yeah, that's huge. I do I mean, like I, you know, there's more like, this is something I don't want anyone listening to this to feel like you already supposed to have arrived, you know, to this point, like, this is something that it takes consciously, unlearning. Yeah, we've been taught about it the way that like I said, both in like kind of a structural education framework, and also just society, what we have picked up about kind of cultural norms around drug use and how you're supposed to feel and react to that. So there's a lot to unpack there to then realize like, oh, okay, maybe I didn't learn that the right way. Great. Now how do I go forward from here in a way that is still...You know, I don't want anyone to feel like they are stepping so far out of their you know, comfort zone like you should still be authentic. In, in your interactions, and you know, like we said, recognizing where, where you can and can't do that, and where do you need maybe more support? You know, where are there opportunities for you to, to partner with other people to talk about this with the social workers that you work with to see kind of understand get a greater understanding about your role and the impact that has on this whole, you know, system. This is not something that happens overnight. And, you know, we're going to link in the show notes as well. A couple of really like phenomenal resources about trainings for, you know, harm reduction within birth work. There's a really great, like lengthy PDF resources for everyone that talks about perinatal harm...the perinatal????
Carlyn, LCSW 40:41
Harm Reduction Academy.
Maggie, RNC-OB 40:43
Yes!
Carlyn, LCSW 40:44
Perinatal Harm Reduction Academy, I know the folks that put that together, and they're fantastic. And I use it all the time on labor and delivery. It's a fantastic resource.
Maggie, RNC-OB 40:53
Yeah. So we'll you know, we'll share that resource as well. Because I know that was really helpful for me in terms like reading through that and thinking like, okay, yes, like the, these are the steps, it's really like spelled out in ways that are really kind of easy to chunk up and understand, okay, like, this is how we can move forward at this place. And so you know, we want to provide that to all of you so that you have a little bit more context for, for this work for how you can show up to really best support people and how we can make these changes in our perinatal health care system, like they don't happen overnight, obviously. But we, we can still help one family at a time, to have a better interaction with us, to feel more supported through their birth and to your point, so that then they get the whole point is for us to help them so that they can go on happily parent, their child, you know, and I think just that separating a little bit more of that piece about like, our role, our expertise, what we are bringing to the situation and remembering that this is a snippet of someone's life, that they are going to go on living, once they leave the hospital and just kind of being cognizant of that piece of it to like holding that space around that.
Carlyn, LCSW 42:09
Yeah and a snippet that has the potential to to really impact them. But like a snippet, nonetheless, there's also Movement for Family Power, an organization that is doing phenomenal work around kind of abolishing the family surveillance state limit for family power, the great book, Shattered Bonds, the Color of Child Welfare by Dorothy Roberts, and then When the Welfare People Come by Don Lash is also really good for anybody that's interested in kind of learning more about this system.
Maggie, RNC-OB 42:45
That's so helpful. Thank you. Is there anything else you'd like to kind of share any other gems you want to leave us as we end up?
Carlyn, LCSW 42:52
No I just I think the fact that someone's listening, and they've continued to listen throughout the whole podcast,
Maggie, RNC-OB 42:57
[laughter] If you're still here...
Unknown Speaker 43:00
Means that you know, you, you're at least intrigued and willing to learn. And that's kind of the biggest part, like you said earlier, like give yourself grace. It takes a while to learn something, it takes an equal amount of time to unlearn something. So if you're curious, I'm always you know, happy to chat. I'm on Twitter and on Instagram, I'm not on Facebook. Just, you know, do the work, read the stuff and and try your best.
Maggie, RNC-OB 43:31
Thank you so much, Carlyn. Thank you for having this conversation with us. I really appreciate it.
Carlyn, LCSW 43:34
Yeah. Thanks for having me.
Maggie, RNC-OB 43:36
Thank you so much for tuning into this conversation and sharing it with me in Carlyn. I hope that this was really helpful for you to perhaps reframe, or to affirm some of the ways that you've wanted to care for pregnant folks who use drugs, and ways that you want to navigate surveillance in the hospital, and think more about our roles and responsibilities as healthcare professionals. We'd love to hear your feedback on this. You can join our community group on Facebook, Your BIRTH Partners Community, or follow us across social media; we're Your BIRTH Partners everywhere. We'd love to hear more about what you're thinking and what this brought up for you and what you're experiencing, where you work and where you care for pregnant folks. Definitely recommend that you check out the resources in our show notes. There's a lot of great information there for changing practice and and creating a better system. But we can't wait to hear what you think. Till next time!