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Mandatory prenatal HIV testing

Posted

Specializes in OB, lactation.

Does anyone know if prenatal HIV testing is legally required?

On our unit last night, we had a note that stated that if there weren't the two legally mandated HIV tests on pt's prenatals, that we are to order a rapid HIV on admission. So I just got curious...

If it is legally required (I'm in Florida), does anyone have a link to the law/ information? I googled it and didn't come up with what I'm looking for.

Thanks for any feedback!

mm

epidermnurse

Specializes in Critical care.

It's my understanding that it has become law in high risk states. I live in Baltimore and we run an HIV test on all Moms if it wasn't done during prenatal care. I haven't tried to look it up--I'd be interested to see the actual written law.

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

HIV testing is an important part of prenatal care, and I believe it is the standard of care to include it in routine prenatal labs.

But I know of no situation where a patient can be required to submit to a medical test against their will, unless there is a court-order or they are not competent to make their own health care decisions (such as someone under a legal guardianship).

If a patient expressly refuses an HIV test, I would not do one. If there is a compelling reason for it to be done, turf it up to your spervisor and the legal team of your institution.

I guess the important question here is why hasn't it been done, and who is insisting on it?

APBT mom, LPN, RN

Specializes in Med/Surg, Tele, IM, OB/GYN, neuro, GI.

In Florida it's not a law. It's a recommendation from ACOG. They recommend what testing should be done and at what time. If you search the website the pamplets related to testing for certain things will pop up.

Like the poster mentioned above. No one can force the patient to allow testing for it without a judge deeming them incompetent.

mitchsmom

Specializes in OB, lactation.

In Florida it's not a law. It's a recommendation from ACOG. They recommend what testing should be done and at what time. If you search the website the pamplets related to testing for certain things will pop up.

Like the poster mentioned above. No one can force the patient to allow testing for it without a judge deeming them incompetent.

That's what I was thinking/ wondering when I saw the note...

HappyNurse2005, RN

Specializes in LDRP.

No, its not mandatory here. Sure, most women get it. Some don't. It's recommended, but, correct me if i'm wrong, but don't they have to sign a specific consent for a HIV test? so you can't just test them on admission, b/c they didn't consent to that? the only ppl we test at the hospital are those who have been part of an accidental exposure, and those who come in and have had no prenatal care at all. those ones, we ask if they want one, don't just do it. I've been in l&d for 3 years, almost, in a pretty busy hospital (300-340 deliveries a month) and i've only taken care of 2 HIV positive women. there's been a small amount more, that i haven't cared for, but not that many, i dont think

though, i went with a friend of mine to her initial OB appt back in Nov 2006. They gave her the consent to HIV testing and said "This is permission to draw your blood". thats it. she was a nurse, and read what she was signing, and didn't mind having an HIV test....but, hey, there's consent for you:)

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

In my state it's law. I don't like it, as I think it's too intrusive. But either mom consents to an HIV test during pregnancy, or we draw the baby's HIV once he's born. I don't like it, like I said. If I had a patient refuse, I'd still honor it.

That said, we have found a few HIV+ moms that would not have otherwise been diagnosed.

chudy

Specializes in Home care.

Hi everyone.

I am currently 8mths pregnant and live in nassua county, NY. During my first prenatal visit the nurse told me that I have to take a mandatory hiv test at the begining and towards the end of the pregnancy. I guess it is a requirement now for some states I believe. Six years ago I remember that they usually ask if you would like to have a hiv test during your first prenatal blood work up.

In my state it's law. I don't like it, as I think it's too intrusive. But either mom consents to an HIV test during pregnancy, or we draw the baby's HIV once he's born. I don't like it, like I said. If I had a patient refuse, I'd still honor it.

That said, we have found a few HIV+ moms that would not have otherwise been diagnosed.

but is it the law, or the hospital's wishes? we DO know they arent always one and the same, dont we?

have you seen the law? officially, not just been told?

very curious.......

Hi everyone.

I am currently 8mths pregnant and live in nassua county, NY. During my first prenatal visit the nurse told me that I have to take a mandatory hiv test at the begining and towards the end of the pregnancy. I guess it is a requirement now for some states I believe. Six years ago I remember that they usually ask if you would like to have a hiv test during your first prenatal blood work up.

i would be asking to see the law......

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

but is it the law, or the hospital's wishes? we DO know they arent always one and the same, dont we?

have you seen the law? officially, not just been told?

very curious.......

We have a copy of the statute in our breakroom; it is opt-out, so basically it's automatically done unless mom says no. If not done prenatally, it's done at delivery. If mom refuses then, we draw an HIV on the baby.

We have a copy of the statute in our breakroom; it is opt-out, so basically it's automatically done unless mom says no. If not done prenatally, it's done at delivery. If mom refuses then, we draw an HIV on the baby.

at least you are on sound footing....but why are these women given less legal protection than men?

and if she explicitly forbids her baby from being tested, what happens? besides the fact that it isnt very good testing......

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

at least you are on sound footing....but why are these women given less legal protection than men?

If I could read the legislators' minds, I could retire in style :smokin:....like I said, I don't like the law myself. My guess, however, is that if men could transmit HIV to their babies while they were pregnant, they'd have to get tested too.

Nope it's not mandatory and I really don't see how one could make it mandatory. I have the right to refuse any and all care for myself or my child and would be livid if anyone did something to my child without my consent or against my wishes. I can't see how a law like that could be constitutional, thoiugh I don't live in the US so I'm not sure how it works there.

Here it is offered at the first prenatal and it is perfectly within the woman's right to accept or decline it.

fmoore723

Specializes in L&D, Maternal Fetal Medicine, LTC. Has 7 years experience.

When I lived in Virginia--in the office, we had to take consents on all HIV testings for the prenatal panel. Otherwise, it was illegal to run the test. Im not sure the procedure for the hospital, but I supposed it would be the same as far as consenting. I agree that many women are diagnosed during pregnancy, that otherwise would have not been tested. BUT, I also agree with a patient's right to refuse ANY treatment. Although sometimes I think its not the smartest thing in the world--its one of the few rights left in this country that laws should intrude on. I too, would like to see in text a LAW stating you have to get HIV testing if youre pregnant. Cant we make decisions for ourselves anymore?

Felicia

ragingmomster, BSN, MSN, RN

Specializes in many. Has 25 years experience.

NC legislation mandated beginning in November of 2007 that all pregnant women must have proof of HIV testing in the antenatal period or be tested upon admission to the hospital for labor. In the presence of a refusal on the mother's part to allow HIV testing, the neonate is to be tested.

NC also forces pts to submit to Syphillis testing during the antenatal period and a repeat test at hospital admission for labor if the pt is under the age of 25.

IMHO - Just a leapfrog back into paternalism.

MichelleB34

Specializes in Med-Surg/Pediatrics, Maternity. Has 13 years experience.

I work in New York state. I'm not sure if there is a law but this is what happens. An HIV test is done with the initial prenatal blood work. I have noticed that one of the doctors has the HIV test repeated later in the pregnancy but I don't believe the other group does. (I have been on vacation and haven't looked at a patient history in 2 weeks) If the mother refuses to have an HIV test during the pregnancy then the baby has to be tested. I know if an HIV test is drawn on the floor counseling is provided, usually by the infection control nurse. I can't remember how the counseling is done when the HIV test is ordered as part of the routine prenatal blood work. (It's been 4 1/2 years since I have had that prenatal blood work myself.)

nursejohio, ASN, RN

Specializes in NA, Stepdown, L&D, Trauma ICU, ER. Has 8 years experience.

NC legislation mandated beginning in November of 2007 that all pregnant women must have proof of HIV testing in the antenatal period or be tested upon admission to the hospital for labor. In the presence of a refusal on the mother's part to allow HIV testing, the neonate is to be tested.

NC also forces pts to submit to Syphillis testing during the antenatal period and a repeat test at hospital admission for labor if the pt is under the age of 25.

IMHO - Just a leapfrog back into paternalism.

Maybe I'm a paternalistic type of girl, but I just can't see the problem with mandatory STD testing in pregnancy. Aside from the obvious benefit of getting mom treated and cleared of the sterility inducing gc/chlamydia, the systemic effects of syphyllis... these are things that can cause serious damage to baby. Add in the HSV and HIV with transmission rates that can be reduced to nearly zero with proper treatment, and we would be not be doing our job (as patient advocates, and as a L&D nurse, I'm responsible for 2. Mom AND baby) if we did any less.

Yeah, I know. Every mom is in a monogamous relationship and such tests are unnecessary for them. I call horse dookie. I've seen too many girls come in (with negative tests at their first prenatal visit) c/o abd pain or discharge and get positive results. Most of them are lucky enough that whatever their husband/boyfriend/baby daddy brought home can be treated with abx, but sometimes they'll pass on a gift that keeps on giving :angryfire

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