The Impact of Drug Testing and Child Welfare Reporting on Postpartum Care Engagement Among Perinatal Patients with Opioid Use Disorder

The first year after childbirth is a crucial period for mothers with opioid use disorder (OUD) to receive routine postpartum care and continue engagement in OUD treatment. However, the heavy reliance on and use of urine drug testing by hospitals and clinicians for child welfare reporting may discourage perinatal patients with OUD from seeking postpartum care for fear of child custody loss. Prior studies have also documented that losing child custody itself is strongly associated with disengagement from care and increased risk for overdose in postpartum.

Led by Caroline Darlington, this pilot study will examine the impact of urine drug testing and child welfare reporting practices on birth hospitalization and postpartum care engagement outcomes. The study will leverage hospital-level changes related to urine drug testing and child welfare reporting practices across four Penn Medicine hospitals and compare outcomes between hospitals that implemented changes to their practices and control hospitals. Through this pilot, Darlington and colleagues aim to shape clinical practices during birth hospitalizations, improve the continuity of care, and reduce morbidity and mortality among perinatal patients with OUD.

Caroline Darlington is a postdoctoral fellow with the National Clinician Scholars Program at the University of Pennsylvania. As a women’s health nurse practitioner (WHNP) and scientist, she is committed to advancing ethical, evidence-based maternal health policy and strengthening systems of care for women with opioid use disorder (OUD). Her research is informed by both her past and present clinical experiences caring for women with OUD in rural Tennessee as well as urban Philadelphia who face poverty, mental health comorbidities, and challenges navigating the child welfare and criminal justice systems. She has also supported NIH-funded research focused on understanding HIV-related stigma among women in Southern Appalachia, increasing Pre-exposure Prophylaxis (PrEP) uptake for HIV prevention through a women-focused intervention in Philadelphia, and identifying clinical barriers to PrEP delivery for women who inject drugs.