Informed Consent is Poorly Documented when Obtaining Toxicology Testing at Delivery in a Massachusetts Cohort

Informed Consent is Poorly Documented when Obtaining Toxicology Testing at Delivery in a Massachusetts Cohort
Kathleen J.Koenigs, Joseph H. Chou, Samuel Cohen, Moira Nolan, Gina Liu, Mishka Terplan, Brian M. Cummings, Timothy Nielsen, Nicole A. Smith, Joseph Distefano, Sarah N. Bernstein, Davida M. Schiff
American Journal of Obstetrics & Gynecology MFM, 27 March 2022
Abstract
Background
Positive toxicology testing at delivery can have enormous consequences for birthing persons and their families, including charges of child abuse/neglect and potential loss of custody for the birthing parent. State and national guidelines therefore stipulate clinicians should obtain consent prior to toxicology testing at delivery.
Objective
We examined: (1) clinician documentation of patient consent for peripartum toxicology testing and (2) the extent to which patient and hospital characteristics were associated with documented consent.
Study Design
Retrospective cohort of individuals who underwent toxicology testing within 96 hours of delivery between April 2016 and April 2020 at five affiliated hospitals across Massachusetts. Medical records were reviewed for documentation of: clinician intent to obtain maternal toxicology, testing indication, verbal consent to testing, and child protective services involvement. Hierarchical multivariable logistic regression was used to examine the association between patient and hospital characteristics and documentation of verbal consent.
Results
Among 60,718 deliveries, 1562 maternal toxicology tests were obtained. Verbal consent for testing was documented in 29.8% of cases (n=466). Documented consent was lacking across most demographic groups. Consent was no more likely to be documented when a report was filed with child protective services, and less likely in cases where the birthing parent lost custody prior to discharge (p=.003). In our multivariable model, consent was least likely to be documented when a maternal complication (abruption, hypertension, preterm labor, preterm premature rupture of membranes, intrauterine fetal demise) was the indication for testing (aOR, 0.46; CI, 0.28 to 0.76). Verbal consent was twice as likely to be documented in delivery hospitals with established consent policies (aOR, 2.10; CI, 1.01 to 4.37).
Conclusion
Consent for toxicology testing at delivery appears to be infrequently obtained based on clinician documentation. Provider education and hospital policies for obtaining informed consent are needed to protect the rights of birthing individuals.