This article was published in partnership with The Marshall Project, a nonprofit news organization covering the US criminal justice system. Sign up for their newsletters, and follow them on Instagram, TikTok, Reddit, and Facebook.
Across the United States, an expanding coalition of state legislators is pushing to establish formal legal protections for maternity patients subjected to drug screening at the point of delivery — a practice that advocates argue has long operated without adequate oversight or patient safeguards.
The momentum behind at least three of these legislative initiatives traces directly to a joint investigative series by The Marshall Project and Reveal, which systematically documented the institutional failures embedded in perinatal drug testing protocols. The reporting illuminated how false-positive results and clinically misinterpreted toxicology screens were routinely triggering child protective services referrals — and how women were being subjected to child welfare investigations and family separations over substances that hospital staff themselves had administered during labor and delivery.
In New York, proposed legislation mandating informed consent prior to any patient drug screening has been steadily advancing through the legislative process. Meanwhile, comparable measures introduced in Arizona and Tennessee stalled before clearing their respective chambers, underscoring the formidable political obstacles that reform advocates continue to face.
"When drug testing is conducted without a patient's knowledge, the consequences for families can be devastating," said New York state Rep. Linda Rosenthal, a Democrat representing Manhattan, who pointed to documented cases in which women were reported to child welfare authorities following positive test results attributed to poppy seed consumption or legitimately prescribed medications. "This isn't an abstract policy debate. These are real families being torn apart by a broken system."
Rosenthal first introduced iterations of the New York bill as far back as 2019, and the measure has encountered persistent resistance within the legislature ever since. Parallel reform efforts in Minnesota, Maryland, and California similarly collapsed during earlier legislative cycles. Nevertheless, advocates who lobbied directly for the New York legislation credit The Marshall Project's investigative coverage with shifting the calculus among previously uncommitted lawmakers, generating the critical mass of support needed to push the bill forward.
Should the New York measure be enacted into law, hospitals would be permitted to conduct toxicology screenings on birthing patients and their newborns only when a demonstrable medical necessity exists. Critically, the legislation would also mandate that providers obtain explicit informed consent before administering any drug test — a process that would include a clear disclosure of the potential legal and child welfare ramifications that could follow a positive result.
In Tennessee, the reform effort attracted an unusually bipartisan sponsorship, with both a Democrat and a Republican introducing companion bills during the current session. Sen. Janice Bowling, a Republican from Tullahoma with a consistent record of championing parental rights, was initially brought into the conversation by a progressive advocacy organization — and quickly recognized the issue's cross-ideological resonance. Bowling said she was genuinely alarmed to discover that women had been flagged and reported to authorities based on false-positive results stemming from poppy seed ingestion, the common heartburn medication Zantac, and other entirely legal substances.
"Can you imagine if someone took the baby from you out of your arms or never even let you hold your child?" she said. "Taking children from families because a state entity says they have the authority to determine whether or not you're a fit parent, that's a slippery slope."
Despite the rare show of bipartisan support, the bill was ultimately defeated in committee following a particularly contentious legislative session. Bowling has publicly committed to reintroducing the measure in 2026.
Arizona advocates and lobbyists have similarly pledged to revive their reform efforts in the next legislative cycle, pursuing both an informed consent framework and a broader, more comprehensive bill that was introduced but failed to advance this year.
The Pro-Choice Arizona Action Fund and reproductive health advocacy organization Patient Forward launched their legislative campaign in the wake of a Reveal and New York Times Magazine investigation published in 2023. That reporting centered on an Arizona woman whose newborn was placed in foster care after she was reported to child protective services for using physician-prescribed Suboxone to manage opioid use disorder during her pregnancy. Under existing Arizona statute, healthcare providers are legally required to notify child welfare authorities whenever a newborn is delivered with any exposure to controlled substances — a mandate that encompasses legally prescribed medications including Suboxone and methadone.
"We were like, how does this happen? What are the mechanisms in place that allow this to happen?" said Garin Marschall, co-founder of Patient Forward. "We wanted to understand what we could do to make sure that it didn't happen again."
The proposed Arizona legislation would have amended state law to explicitly prohibit a positive drug test result, standing alone, from serving as the basis for a child welfare referral or investigation. In cases where clinicians identify no evidence of abuse or neglect, the bill would have redirected mandatory notifications from child protective services to the state health department — a model already adopted in states including Massachusetts and New Mexico. Separately, hospital systems across the country have independently begun revising their internal drug testing protocols, reflecting a broader institutional reckoning with the issue.
In New York, the primary opposition to the consent bill has centered on the concern that affording patients the right to decline drug testing would result in a meaningful uptick in refusals. Healthcare providers who spoke with The Marshall Project, however, pushed back on that premise, noting that patient refusals are exceptionally rare in practice — and that the clinical utility of perinatal drug testing is itself limited. Physicians generally do not require toxicology results to diagnose or manage neonatal abstinence syndrome, and a positive test result carries no diagnostic weight as evidence of parental addiction, according to clinical experts.
The medical literature increasingly supports structured screening questionnaires as a superior alternative — tools that gather contextual patient information, including factors such as a partner's substance use history, and have demonstrated effectiveness at identifying addiction risk without exposing patients to the collateral consequences of a child welfare referral. Clinicians have also emphasized that therapeutic relationships built on transparency and trust represent the most reliable pathway to supporting at-risk patients, while research consistently shows that punitive testing regimes deter women from seeking prenatal care entirely — an outcome that poses far greater risks to maternal and infant health.
"If the trust between a doctor and patient is broken, that will lead to much more severe consequences for the child and the mother," Rosenthal said. "Everyone does better if that doesn't happen."
From New York to Arizona, Efforts Emerge to Curb Drug Testing During Childbirth is a story from Reveal. Reveal is a registered trademark of The Center for Investigative Reporting and is a 501(c)(3) tax exempt organization.