The Hypocritical Oath? Unintended Consequences of Prenatal Substance Use Policies and Considerations for Health Care Providers.

Prenatal substance use (PSU) is a serious perinatal health issue in the United States with consequential health effects. To address this issue and protect children from the detrimental effects of substance exposure during pregnancy, the US government amended the Child Abuse Prevention and Treatment Act to provide funding to states with protocol to notify child protective services of PSU cases and develop treatment plans for affected families. Although well-intentioned, this statute resulted in diverse inter- and intrastate interpretations and implementation of PSU regulations nationwide, ultimately leading to mass confusion about who the policy applies to and when it should be applied.

Critical Changes in the Maternal Health Landscape: Community Care, Doulas, and Coverage.

In this commentary, we present an overview of the accelerating trend toward community-based models for pregnancy care. Doula services, as part of community care programs, are the major target for new coverage changes. Obstetric professionals who include community care providers in their treatment plans can benefit from these local resources in the prenatal, birthing, and postpartum stages of patient management.

Family-centered care in the context of fetal abnormality.

Women confronted with prenatal diagnosis of fetal abnormality face emotionally challenging choice options and considerable uncertainty regarding impact of choice on their families. Prenatal diagnosis of fetal abnormality presents childbearing women with difficult choices, such as continuation of pregnancy with no intervention, abortion, and, in selected cases, experimental fetal therapy. Regardless of their decision, it is a time of transition marked by grief and loss.