Student pregnancy

[iggywench, BSN, RN]

I apologize if this has been discussed before, but I searched, and couldn't find anything.

As a school nurse, what is our responsibility if a student reveals to us that she is pregnant, and asks us not to tell anyone? This topic came up in a meeting that I was in today with our counselors, and I told them when I was in nursing school, I was taught that once a girl becomes pregnant, she is considered an adult, and has to give permission for her pregnancy to be discussed with anyone.

Our counselor's understanding is that she will give a student 24 hours to tell their parents, then will call them herself. Do counselors have a different set of rules or laws that they are governed by, or am I totally wrong in this situation?

Our district does not currently have a policy regarding this, and I have never encountered that specific situation, but I'd like to be prepared if it does come up. Are there any laws regarding this that anyone knows, or is it specific to a state or a district policy?

[SaltineQueen]

How old is she and, if you know, how old is the father? That might change things a little bit...

Doing a quick run through of my School Nursing textbook, it looks like you may be more correct, depending on the state where you live. It says, "Several states have no relevant policy or case law; in these states, physicians commonly provide medical care without parental consent to minors they deem mature, particularly if the state allows minors to consent to related services."

[CanIcallmymom, BSN, RN]

I have always handled it with privacy and do not disclose any info without permission from the student, as this is how we handled it in the ER as well. I *encourage* the student to tell her parents, and I let her know that if she wants me/counselor to discuss with the parent then I will. I would never force them to tell their parents. However, under FERPA laws I believe, parents are entitled to school records upon request... I think the counselors can disclose to parents without issue, as long as the pregnancy is not a result of suspected abuse.

In Texas, if they are under 17 and elect to have an abortion, the doctor is required to notify a parent. So after I feel them out for what direction they're taking with their pregnancy, I may let them know this.

Title IX laws are federal laws regarding pregnant students.

Here is some info I found for my state:
https://texaslawhelp.org/article/pregnant-and-parenting-minors-and-health-care

[Cas1in72]

A lot depends on the age of the student and the state in which you live. I would look at the laws. Not sure if the counselors are under different guidelines than we are. Ill be watching this thread. Thanks for posting!

[SandIsMyGlitterRN, BSN, RN]

Check your state laws. In our state, over 14 we cannot discuss with parents unless we have permission. Under 14 we can until the baby is born and then the mother of the baby is considered an adult. As someone else noted, was this experience consensual? It is a whole different ballgame if the answer to that is no.

[ruby_jane, BSN, RN]

The Guttmacher Institute used to have the "rules" around STD and pregnancy when the person confiding is a student.

The student can ask me not to tell but in the long run, the parent will be in the know. And a pee-on-a-stick test has limited accuracy so I always start with "When we tell your mom/dad...."

Good luck.

[adventure_rn, MSN, NP]

On 2/27/2020 at 4:57 PM, iggywench said:

I told them when I was in nursing school, I was taught that once a girl becomes pregnant, she is considered an adult, and has to give permission for her pregnancy to be discussed with anyone.

Not sure if this policy varies by state, but where I work that isn't the case.

Ironically, if a teenager gives birth to a baby, the teenage mom can sign consent for her baby's care, but she can't sign consent for her own care, which has to be deferred to the teenager's parents. So you've got a 14-year-old who can consent for a newborn baby, but isn't considered mature enough to consent for herself.

Granted, there are some protections for teenagers surrounding the confidentiality of sexual health and birth control options. Maybe they vary state-by-state, too, but I've never heard of them depending on whether or not the teenager was pregnant (rather, it was an age-based cutoff).

[labordude, BSN, RN]

Guttmacher has this up to date reference on minor's access to different kinds of care. The third column is prenatal care. 33 states allow minors to access prenatal care without parental involvement or notification.

https://www.guttmacher.org/state-policy/explore/minors-access-prenatal-care

I agree with the others who suggest looking for your particular state laws, but in the presence of ambiguity, I'm protecting my patient's confidentiality and supporting her choices.

[JenTheSchoolRN, BSN, RN]

I can't legally tell the parents in my state - or even another staff member without student permission. I actually cannot legally document about the pregnancy in any school documentation system that is part of FERPA.

For reference, I'm in MA.

However, I will tell a student that pregnancy is hard to manage without telling a caring adult in their life. I offer to help doing so - offer options for medical care and follow-up testing to confirm pregnancy. Even a student who decides to get an abortion (which can be done without parent consent in my state, but requires the student to go before a judge first, so parents will be involved) needs lots of support.