Ethical dilemma HIV positive mother and baby

[KatelynRodriguez]

Hello, my name is Katelyn and I am currently a nursing student. Today in my OB class it was said that if a mother is HIV positive and she passes it on to her baby, the mother can decide to not tell the father that his child has HIV. My issue is that he has been placed at risk for contracting and treating HIV for himself and second it is his child as well so shouldn't he know that his child has HIV? It's a struggle between HIPPA and the safety and a right to information. I was just hoping to hear if this is correct or not. It just doesn't seem right. If this man doesn't know and they aren't together he could be spreading HIV. So it also seems like a public health issue.

[adventure_rn, MSN, NP]

Yikes, that sounds like a sticky situation. I don't know very much about HIV legal issues, but I thought there were legal statues that an HIV+ person must disclose their status to sexual partners. For better or worse, our job as healthcare workers is to protect confidentiality, not to enforce the law. However, there are some regulations about mandatory reporting of certain STDs for surveillance purposes.

Logistically, this is our procedure for NICU cases: if the mom names the dad on the birth certificate, he has a legal right to know about the child's diagnosis, status, and care. If parents don't want other family to know the diagnosis, we're obligated not to share it (this happens a lot on NICU with babies going through drug withdrawal and extended family like grandparents). However, a mom can't request that we hide information from the dad.

It becomes a much more complicated issue a) if the mom doesn't name the dad on the birth certificate, or b) if the birth certificate isn't formalized yet (parents have a few days to complete the process, usually if they haven't picked a name yet). If the dad wants to be on the birth certificate and mom refuses, I'm sure there's a way for the dad to fight for paternity rights. Usually in sticky cases like these, social work is following the case and the nurses are given strict parameters about what we can say to whom.

From a purely logistical side, I don't think these secrets can stay hidden for very long (especially if the kid is hospitalized). Our kids with HIV+ moms come to the NICU for monitoring and to receive antivirals. We do occasionally have parents who are trying to hide the reason for their child's admission from family (again, usually neonatal drug withdrawal), but it almost never works. Birth is such a community event that family members get really nosy about why a term kid is in the hospital; I've seen parents try to spin really elaborate lies, but they almost always fall through. If a dad were involved in his child's care, even if not listed on the birth certificate, I think there's a good chance he'd eventually figure it out.

[Double-Helix, BSN, RN]

If paternity has been legally established- i.e. father's name is on the birth certificate, paternity test has been completed, legal adoption has been finalized, then the father has a right to access his child's medical records as much as the mother does. HIPAA allows the father's access to the child's (not the mother's) medical information, unless state or local laws have an overriding clause in these circumstances. If the father is not on the birth certificate, or paternity has not otherwise legally been established, then the mother is not obligated to share any information with a man, even if they are caring for/providing for the child.

[Here.I.Stand, BSN, RN]

Right...father has every right to his child's medical information. If nothing else, how is he supposed to safely care for the child if he doesn't know said child needs antiretroviral meds?? And doesn't he not only need to know his child's med schedule, but doesn't he need proper patient/family teaching? What is the nurse supposed to say, "Here is his med list...I can't answer any questions on it. Good luck!" ?? Or as the nurse is preparing to administer meds while still inpatient, "Sorry, but I can't tell you what I am giving your baby."

[Glycerine82, LPN]

I'm pretty sure it's only the mother whose information you can't disclose.

[offlabel]

The mother can decide anything she likes.

As others have stated, if the father's rights as a parent have not been terminated or restricted by the court, once that baby is born, he has the same rights regarding the care of the infant as the mother does.

What mom does is her business, what the hospital staff does is theirs.