Our first client manager told us to consider loosening up on the “medical stuff” and accepting a child from a mother who is a heavy smoker because "really, the doctors we work with say that smoking doesn't really affect the babies all that much."
Our new client manager didn't actively promote this same change but she did make sure we understood the mathematics of the situation, recommended we speak with a pediatrician, and simply take this information into account in the event we decide to change our profile.
I'm curious...have other people run into this same issue? What did your placement agencies recommend? What decisions did you make?