This is one of those three way mirror type reply turned posts. If you want to follow the background, the comment thread appears on this post, but it is actually referring to an older post I wrote about mandatory HIV screening in pregnancy. This reply is in regards to the common practice of testing the newborn when the mother refuses.
I am really conflicted about this. Because, in essence, it is testing the mother. It is not the baby’s antibodies being tested, it is the mother’s that she transferred to the baby. A baby won’t have a valid HIV test until it is 12 months old or more, generally.
So, if it is to decide whether to administer AZT to the baby, which would be what it would be for, I would assume, I would also assume the same woman would probably refuse to have the baby treated. So, where are we then?
I am definitely speaking hypothetically, of course. If I get the local residency I want, I will be in a hospital system where I face the reality of caring for women with HIV and unknown HIV status.
If her child is going to be removed and become a ward of the state, then testing may be ethical once she has relinquished parental rights. Is it ethical to give AZT to a baby against the mother’s wishes? Will the state get a court order to take custody just to administer the medications? How soon until we get to imprisoning women with HIV? Oh, wait we already are.
That being said, I agree it is obviously better for the health of the baby and the mother if they know their HIV status and are medicated. And, both may be lost to the system if not screened and treated at this point. Pregnancy, especially labor and delivery, is a unique time in which women have more access to care due to increased Medicaid coverage and women seek out more care in the peripartum period than when they are not pregnant. But there are lots of ticking time bombs out there that don’t get the government in their lives like women do at the point of delivery. I think she should have a psych consult, possibly, and/or a social worker and a compassionate practitioner who can find out what is going on in her life and why she is refusing. Maybe she will agree at a follow up appointment. Maybe she will sign a release for the baby 12 hours or 18 hours after the delivery. How often does this even come up, and when it does, is it worth it to override her autonomy and remove the child from custody?