The two original posts about the top half and bottom half of the screening tool included a lot of tentative answers. Now that we've had time to do some research, our answers are at a final draft stage. We're posting them here to share with you before we leave for a 2-week vacation in Europe. That will give us time to really think about our answers, all of you to give any input you might like to add, and then for us to come back with a fresh mindset to make any final tweaks before we submit our Screening Tool to our counselor, Katie.
Top Half of the Screening Tool
Age - Newborn to 3 months
Gender - Either boy or girl
Description / Race - All
Twins - Yes
Bottom Half of the Screening ToolThis was by far the hardest section. Everything in the top half was very straightforward while this section is all about potential risks. Even with 'Severe' exposure in any of these categories, a baby could still be perfectly healthy and normal, but the inherent risks are present.
Alcohol - Mild
Notes - It's been well documented that alcohol use during pregnancy can result in birth defects. For us, we just have to decide how willing we are to risk it. Realistically, I have a few drinks every week. If I were to accidentally get pregnant, then my baby would automatically be in the 'Mild' or 'Moderate' category since it would take a few weeks to find out I was pregnant. Overall, I think the biggest concern is binge drinking which boosts exposure compared to drinks that are spread out over time. In this instance, additional research on WebMD and Wikipedia make me feel comfortable with 'Mild' exposure. There may be cases where 'Moderate' may also be ok, but that would be a case-by-case basis.
Marijuana - Moderate
Notes - This was a tougher one to research. Given marijuana's status as an illegal substance, there's a lot of speculation and 'just say no' information out there. Sticking with WebMD, there is a brief paragraph suggesting risk of premature birth and low birth weight. Wikipedia has some conflicting research. Another article chock full of research takes a more realistic look at the research and suggests that there is not consistent evidence based on research that marijuana is harmful. An interesting thing to note is that limited research cases and sample sizes for the research that has been done may also be impacted by concurrent factors such as alcohol use, poor nutrition, etc. during pregnancy. For this case, it is readily apparent that marijuana is far less harmful than alcohol and we're very comfortable with going 'Moderate'.
Methamphetamine - Moderate
Notes -Meth is another drug with limited research available. One source lists increased rates of premature delivery fetal growth retardation, heart abnormalities, and brain abnormalities. A WebMD article reviewing a study with mice showed distinctive changes with a single low dose of meth. Additional information from March of Dimes shows low birth weights and smaller head sizes for babies, but does not address the amount of exposure to meth. Our response for this is 'Moderate' which matches marijuana, but this is an exposure of seemingly greater concern that may need to be addressed if we are chosen by a birthmother that has used meth.
Cocaine - Moderate
Notes - The National Institute on Drug Abuse has some interesting analysis on cocaine. They say that extreme damage is not likely but that there are signs that there could be later deficits in children for areas of cognitive performance, information processing, and attention to tasks. WedMD has some additional review that reference back to NIDA. For this case, I think I'd lean towards a similar 'Moderate' answer that was given above for meth.
Heroin - Moderate
Notes - NIDA has a high level review for heroin with the main concern being low birth weight. March of Dimes discusses several potential issues such as withdrawal, lower birth weight, breathing problems, and learning/behavioral problems. Continuing the trend, we'll stick with a 'Moderate' rating along the lines of the previous two.
Prescription Narcotics - Moderate
Notes - Some examples of these are oxycodone and hydrocodone. Given the wide variety in this category, there could be a variety in both the magnitude and type of affects. March of Dimes supports this with a general catchall that "some medications can hurt your baby, causing birth defects, premature birth, and other health risks." Given that this one has such a wide range of drug types, a solid 'Moderate' rating seems appropriate.
Tobacco - Moderate
Notes - NIDA has some surprising stats here. They state that about 16% of pregnant women smoke during their pregnancies. The adverse effects include fetal growth retardation and decreased birth weight. On the positive side, there seems to be a dose-dependent correlation with birth weights which means that the potential for negative impacts reduces as the amount of smoking is reduced. Similar to many other drugs, development of addition for the baby is possible. WebMD has similar information but also discusses cleft palate. The majority of these are all short-term problems that can be addressed right away, so a 'Moderate' response fits well.
Mental Illness of Birthparent - Moderate
Notes - The next three categories are more easily answered without research. This one is more heavily influenced by our long-term relationship with the birthparent(s) rather than the health of the baby. There could be a wide range here from minor things such as depression or autism all the way up to schizophrenia. Katie specifically pointed out that finding a birthparent with 'None' in this category is getting more and more rare with a higher rate of diagnosis for things like autism. For us, I think that 'Moderate' is a happy medium which will open us to a majority of birthfamilies and we can make decisions on a case-by-case basis.
Developmental Disabilities of Birthparent - Moderate
Notes - Similar to the last category, this will be important for maintaining a relationship with the parent. Many development disabilities can be due to external influences like accidents or trauma. Katie also provided some input here with some specific guidance that IQ plays a factor in the screening. At this stage, 'Moderate' feels right for us.
Child with Known Medical Condition - Moderate
Notes - Well... this is a vague category isn't it? In truth, this could be completely independent of drugs. In an unplanned pregnancy, a birthmom might not realize or accept she's pregnant until month 5 or 6. It would then make sense that the baby would be behind in development due to lack of proper nutrients. Something like that can be corrected but could warrant a Mild or Moderate designation. There are many more potential considerations here, but 'Moderate' seems like an acceptable catch all that reflects what we may be able to accept.
Whew! Glad that's done.
It's important to remember with this list that it's meant as a general guide, and individual cases may vary. The agency will use this to ensure that they aren't handing out our profile to birth families in situations where we're sure we won't be comfortable, but that's as far as this tool's usefulness goes. If and when a birth family picks us, we'll still absolutely have a chance to review the individual circumstances and make our own decision then. There's a great facility at UW which will review the mother's and child's medical records for a small fee, and will be able to provide better guidance based on the specific parameters. So it's good to have this research in now, although we'll have a lot more thinking to do in the future!
We'd love any input that you have too. Any comments, questions, or other feedback are definitely welcome!