Shoshana Walter was reporting on hospital drug testing in 2023 when she met a mother who had tested positive for methamphetamine right before giving birth. The woman said she had only taken a medication her doctor prescribed to treat high blood pressure, which is common during pregnancy.

Despite the woman’s pleas, child protective services placed her newborn in foster care while it investigated her.

“At first, I was skeptical and unsure whether I could really believe it,” Walter recalls.

Walter finished the story she was working on, which showed how child welfare agencies in several states had separated infants from mothers who tested positive for anti-addiction medication. But later in 2023, after starting a new job as a staff writer at The Marshall Project, Walter decided to return to the issue.

She wanted to know: How often do hospital maternity wards test pregnant patients for illicit drugs and harmful substances? How common are false positive results?

When she contacted a toxicologist to ask whether blood pressure medication can trigger a false positive, his answer shocked her.

“It’s not only very possible, it’s very common,” says Walter, who notes that foods such as poppy seeds and medications such as antacids and antidepressants can also elicit false positives.

The discovery prompted a yearlong, nationwide investigation that resulted in the two-part series “She Ate a Poppy Seed Salad Before Giving Birth. Then They Took Her Baby Away.” Walter interviewed dozens of medical professionals and patients, including more than 50 mothers in 22 states whose positive hospital drug tests were probably wrong, according to her reporting. State by state, she examined hospital drug testing and reporting policies.

What her investigation exposed

Walter learned that U.S. hospitals report tens of thousands of infants a year to child welfare agencies after they or their mothers test positive for illegal drugs and harmful substances. And neither hospitals nor child welfare agencies are required to confirm those results before case workers start investigating allegations of child neglect or harm.

Some of the other big takeaways from her investigation:

• When patients arrive at hospitals to give birth, medical professionals regularly test their urine for illegal and harmful substances. The tests many hospitals use are quick and inexpensive. But they give false positive results as often as 50% of the time, according to some studies, Walter reports.
• U.S. hospitals routinely report positive results to authorities before conducting confirmation tests, which are more reliable because they use more precise testing methods.
• In some cases, patients tested positive and were reported to authorities because of medications their doctors gave them shortly before or during childbirth. 
• Hospital drug testing policies vary. “Many facilities, such as Kaiser in Santa Rosa, test every single labor-and-delivery patient,” Walter notes. “Other hospitals flag only certain people, such as those with limited prenatal care, high blood pressure, even bad teeth, experts say. At many hospitals, the decision is up to doctors and nurses, who may view a mother’s tattoos, disheveled clothing or stressed demeanor with suspicion.”
• Federal officials know urine tests for drugs are unreliable. Although federal law protects U.S. workers against false positive results when taking work-related drug tests, such protections do not exist for patients.

Walter notes that once a child welfare agency launches an investigation, families “can get trapped inside a system of surveillance and punishment.”

“After a California mother had a false positive for meth and PCP, authorities took her newborn, then dispatched two sheriff’s deputies to also remove her toddler from her custody, court records show,” she writes in the first story in the series. “In New York, hospital administrators refused to retract a child welfare report based on a false positive result, and instead offered the mother counseling for her trauma, according to a recording of the conversation. And when a Pennsylvania woman tested positive for opioids after eating pasta salad, the hearing officer in her case yelled at her to ‘buck up, get a backbone, and stop crying,’ court records show. It took three months to get her newborn back from foster care.”

The impact of Walter’s work

The ACLU of New Jersey had filed an administrative complaint against a private hospital system there in 2023 after two pregnant women were drug tested without their knowledge. After Walter’s first story ran, New Jersey’s attorney general took action. He filed a lawsuit against Virtua Health in September, accusing it of discriminating against pregnant patients and violating a state law that requires patient consent for drug testing.

Women from across the U.S. wrote to The Marshall Project to share their experiences with faulty drug tests. At least two told Walter they had filed complaints with their state attorney general’s office.

Someone started an online petition demanding that Kaiser Permanente, one of the healthcare companies featured in Walter’s series, revise its policies for identifying at-risk newborns so families do not get separated based on false positive drug tests. As of March 25, almost 42,000 signatures had been collected.

Members of Congress said they would pursue changes. U.S. Rep. Matt Cartwright of Pennsylvania launched an investigation into public agencies and a major hospital network in his state. U.S. Sen Tim Scott of South Carolina plans to introduce legislation this session, his office told Walter last week.

The Journalist’s Resource contacted Walter to ask about her investigation and the strategies she used to gather information for the series. In interviews conducted by phone and email, she stressed the need for more accountability reporting on government agencies that investigate allegations of child abuse and neglect.

“There’s a real need for accountability journalism on the child welfare system, which is just as widespread and impactful as the criminal justice system, but even more closely guarded and secretive,” she wrote in an email to The Journalist’s Resource.

Walter shared these four tips to help other journalists pursue similar reporting projects.

1. Show patience and care when interviewing people who have been marginalized or experienced trauma.

It’s important that journalists understand it can take more time and work to develop relationships with people who have been traumatized or marginalized. Walter is a proponent of trauma-informed journalism.

“People can take a long time to get back to you, to trust you, they come in and out of contact, either because they have busy lives, or because revisiting what happened to them is stressful and triggering,” Walter explained by email.

What can help: Giving these sources a sense of control over how they tell their stories, what details to share and when they need a break.

“Treat the relationship you’re building with your subjects as exactly that — a relationship that requires tending to, trust-building, and patience,” Walter added. “A relationship is not extractive. It’s give and take. A lot of the women I spoke to for this story had difficulty recounting the experience of being investigated or forcibly separated from their newborns. Telling these stories was painful for them, and taking the time to build trust drew out the reporting process, but it also helped them get through the reporting process without recreating the trauma.”

2. Don’t let a lack of data discourage you from investigating a problem.

Walter learned that no one collects data on how often hospitals administer drug tests to pregnant women or the results of those tests. So, she found other ways to demonstrate the problem.

“You can often build data, or find ways to determine how widespread a problem is, by examining the system around it,” she wrote by email. “For this story, I discovered there is no entity or agency that was tracking how often birthing patients are drug tested, nor how often those patients experienced false positive results. There’s no data that I could request to measure the problem. So, I focused my reporting on understanding the science behind these drug tests, and on interviewing experts to understand the system around them.”

Another way to demonstrate the size and scope of a problem is by seeking insights from people with deep expertise in the topic.

“Indeed, after interviewing dozens of doctors and experts who have studied this issue, I learned that most institutions are not ordering confirmation tests before reporting results, in large part due to the state mandatory reporting laws that I closely reviewed,” Walter wrote. “This all but ensures that false positive results are being reported to authorities, on a widespread scale. I didn’t have data to measure the number of false positive cases reported, but I didn’t need it to prove this is a serious problem that impacts many birthing people.”

3. Ask for documentation to help verify people’s stories.

Walter noted that journalists should ask sources for government records, medical records and other documents to help verify their stories.

She acknowledges that this can be a difficult ask. But it’s less difficult after developing a relationship with a source.

“When you’ve taken the time to build trust, your source will be more inclined to bring their fears and concerns directly to you, rather than ghosting,” she added.

4. Understand the risks parents may face in sharing documents with journalists.

Someone who has been the subject of a child welfare investigation might be too embarrassed or ashamed to share records related to a government inquiry. But even if they want to share them with a journalist, they may be prohibited from doing so.

Unlike most government documents, investigative reports compiled by child protective service agencies are not typically public records. The identities of the people involved are generally protected by law.

Walter says journalists need to understand and appreciate the risks parents may face in disclosing confidential information.

“One problem is that in many states, someone who shares their records or information with someone who is not a party to the case can be charged with a crime,” Walter wrote by email. “Even without the threat of criminal charges, there’s a very real possibility that someone who criticizes child welfare authorities may face retaliation or increased scrutiny.” 

She pointed out the importance of discussing these potential risks with sources so they can make informed decisions.

“Some sources may not be in the right place or position to take that risk, and that’s OK,” Walter wrote. “One of our main jobs as journalists is to find sources, so in those situations, it might be best to move on and find someone else. There are also ways to utilize peoples’ stories without exposing them; perhaps that person’s story becomes one sentence in the piece, rather than a main narrative throughline, involving someone who is quoted. A person’s lived experience is always valuable, even if the specific details don’t make it into a story.” 

Read the stories

She Ate a Poppy Seed Salad Just Before Giving Birth. Then They Took Her Baby Away.

Hospitals Gave Patients Meds During Childbirth, Then Reported Them For Positive Drug Tests