to think I should have been informed they were testing me for HIV?

[islandbaby]

Because I´ve been living abroad for the first 7.5 months of my pregnancy, the local midwife wanted me to see a nurse and to have my bloods tested again a few weeks ago, as all my previous results are in spanish.

When I went to see a different midwife for a routine pregnancy check up a few days ago, she said she'd fetch my blood results and informed me that everything was looking good, iron levels ok etc and that I had tested negative for HIV.

I was, honestly, shocked. I had no idea they were testing me for HIV. I thought you had to give consent, and that you would be given the results with counselling if needed? What if I had been casually informed by the midwife that I had tested positive for HIV?

The midwife who gave me my results seemed concerned that I hadn't known I was being tested, and I wonder if it's something I should bring up with the nurse who took my blood?

opinions?

The insurance thing has changed some years ago - they won't now increase your premiums or decline you just for having a test as so many groups of people are tested. Blood donors, pregnant women, some occupational groups.

However an HIV positive result will affect insurance.

It is the responsibility of the person issuing the blood request form (ie the midwife here) to ensure informed consent has been obtained. It can be verbal, it doesn't have to be written.

The person taking the blood has to obtain consent for the procedure but won't necessarily have to obtain consent for the things to be tested for IYKWIM.

Sidge - are you really saying thsat the midwife only has to get consent for the takling of the blood, and then they are free to test that blood for whatever they like? I just don't see how that can be true.

taking, not takling (unless the blood is of a rugby playing disposition, obv...)

No no I mean that the responsibility for getting consent for the actual tests needed lies with the person requesting the tests ie the midwife. That person should make it clear to the patient what they are going to be tested for.

The person taking the sample may be a phlebotomist who really is a technician not a clinician, so they have absolutely no say or responsibility in deciding what is being tested for. The labs carry out the tests ordered.

Oh right - I see what you mean now - thanks

ZP, yes that is so.

But, if the MW had made a minor mistake of assuming the prior tests had covered HIV, this is just minor incompetence on her part.
Not the serious incompetence the OP was originally suggesting.

serious.incompetence negligence

I honestly don't understand why you would opt out of the tests. Partly because why would you now want to know the risks and partly because if you're having a baby on the NHS I think you should have the tests they recommend because they often don't just affect you but also the people you come into contact with, the way you give birth etc.

Usually, you see a list of what they're testing for so it's a bit strange you didn't see that. But Ive lost track of how many HIV tests I've had now. I just consider it part of the process.

it is routine, and when offered it when pg i did specifically question whether having had a test would affect insurance,. i was told that due to testing being routine in many situations,having a test was no longer considered by the insurance companies to be an admission of a 'high risk' lifestyle as it once was. it is now in a category similar to any other routine blood test.

i am not sure why you would assume that the tests here would be identical to ones taken in Chile

i presume that countries vary in what they test for

you would NOT have been told casually in an appointment if it had been positive. that's quite a ridiculous assumption to make too. If your result had been positive you'd have been dealt with sensitively and had an appt prob with someone other than the midwife, and offered counselling etc etc

it is routine over here, tho i was informed of each test that was done on my first pregnancy (not in subsequent ones tho)- i guess they must have figured i would remember>

i don't think it's that big a deal. you were tested for something, it's negative...

The was because obviously I'd want to know the results of a HIV test. As in, who wouldn't want to know that their baby may be at risk.

Routine here but then so are lots if things including monthly toxoplasmosis if you test out negative. I was just told blood was taken for a standard pregnancy screen, assumed that would include blood type, rhesus and HIV so wasn't overly surprised.

You no longer need any medical tests before getting married in France btw.

It is routine, but consent should still be gained. You can't give consent if you didn't know what was been taken. Some people do decline it.

I had "swabs for infection" taken by my GP last week. He didn't tell me (though I knew) that they were for STDs - gonnorhea and clymadia. Communication is terrible at times.

yy back in the day I declined a HIV test as it would affect Life Insurance

I must say I find it very hard to think of reasons why someone would not wish to discover they are HIV -ve.

There are some ... but they are pretty weird.

island it is fair enought that you assume thaat the test were the same than in chile, but the midwive still has to make sure you understand what you are tested for, and it seems to me a waste of resources to test you again if they can only translate your notes.

See, I find that sort of argument dangerous, Cumfy. It's a slippery slope. What if medical professional assume that you must want some procedure or other - simply because they can't think of a good reason why you wouldn't? There are many threads on e.g. childbirth topic that show people have v strong feelings about medical procedures and these can often differ from their caregivers' views. Look at all the women who have to fight to be "allowed" to VBAC...

Sorry, cumfy, - I wasn't v clear in my post above - I don't think you were actually using "but why wouldn't you want to know" as an argument for testing for HIV, but I think a lot of HCPs do - I have certainly come across that attitude.

I was given a leaflet in my first pregnancy (and possibly this one, can't really remember). Was there nothing alongside your notes about antenatal screening and what they test for?

Testing is routine as most other posters have said. It has been for many years now in the UK healthare system in pregnancy, because knowing a woman is HIV positive means that treatment can be started and the huge risk of transmitting infection to the baby can be reduced to an incredibly small risk.

But ALL tests should only be performed with 'informed consent', (apart from exceptional circumstances where it may not be possible eg some emergencies), and the midwife should have explained the tests. 'Informed consent' can mean a lot of different things. In the ideal world it means that the patient is aware of all the potential complications of the procedure as well as the implications of the results. In practice, professionals are partly guided by the patient's own questions - we are frequently accused of giving 'too much information'!

I had a case recently where a patient of mine had an unexpected positive test for HIV on her antenatal bloods. It was, of course, handled very sensitively and there was certainly no question of a casual delivery of the result to a poor unsuspecting lady.

i got a system, you will not get blood from me unless i know what it is for and what could happen if neg or pos. simple. i do the same with other bodily fluids, medication, etc... sometimes they just think it's too much info for your pretty little head.

i am sure they all have codes of conduct to abide, and their licences pending on them, so you can complain to the society or collegue if not happy, doctors do, midwives prob too, and they have to expalin very carefully why they didn't get consent, properly, it hink the only explanations start by somerbodys life was in danger and it was the only option....

I refused to be tested for HIV or siphillis - told them I thought it was a total insult to be asked.

i don't know siphillis, but hiv you can get through blood transfussions and stuff, is not just drug addicts and hookers, you know.
for me, they can test all they want, i though i was neg and i was, but i would liker to know if i was wrong...

higgie - do you mean every person you have ever shared bodily fluids with has presented you with an up to date test result showing they are free from syphillis and HIV? Really? It's not an insult to be tested. Very strange way of looking at it.

However, back to the OP, I'm disappointed that nothing has changed since I was pregnant eight years ago. My midwife casually went 'oh, your bloods are back' and passed me a form showing (amongst other things) HIV. No-one had ever mentioned HIV testing - I certainly had NOT given informed consent. I was astonished. Very bad practice indeed. (As it happened, I was working for an organisation that had been involved in campaigning for insurance companies to stop discriminating against people for merely having an HIV test so I was aware of the potentially worrying implications.)

Informed consent is an important principle and a legal right.

Oddly enough, I had to complain about informed consent wrt a sweep - got a full apology, promises of retraining etc. etc. etc. Didn't bother objecting to the HIV thing as I was still working full-time at that stage and just didn't have the energy.

(I mean showing that I had been tested for HIV, thankfully it was negative.)