While on the nursery portion of my pediatrics clerkship, I took on an interesting case. The baby boy in question was born without complications to mother who admitted to tobacco and marijuana use during pregnancy. After the baby was born, urine toxicology was sent for mother and baby, of which both turned up positive for marijuana. As a result, child services got involved, and placed a hold on the baby to prevent him from leaving the hospital in the mother’s custody. So day after day, the crying baby lay in the hospital nursery awaiting placement, while the distraught parents visited daily, being unable to take him home.
There are a couple of ethical and clinical questions that arise from this situation. First, are we doing what is best for the baby? Child services prevented the mother from taking custody of the baby because she allowed him to be exposed to marijuana. In the literature, marijuana exposure in utero has been linked to some mild growth restriction and neurodevelopmental delay. However, due to the hold on the child, mother-child bonding was significantly reduced during a critical period in the newborn’s life, not to mention the future consequences of growing up in an unstable household. Which is worse?
The second question is whether or not the mother intentionally hurt the baby. I doubt that the mother smoked during pregnancy to deliberately cause harm to her infant, but it is clear she showed reckless disregard by doing so. That is what I assume forms the basis for the accusation of child abuse. Yet, there are many other conditions during pregnancy– diabetes, hypertension, and advanced maternal age, to name a few – that can cause much worse fetal anomalies compared to what marijuana can do. The difference obviously is intent – mothers don’t intentionally get diabetes during pregnancy, but they definitely show intent when they light up a joint. But what do we really care about – maternal intention or fetal outcome?
It is clearly a complicated situation, but no matter what the result is, I hope that the baby boy is given the best shot at a happy, unburdened life.
