Pap in Pregnancy?

[sweetsunshine85]

Hello Mamas!

I was just talking to a friend of mine who is prego with her first lo. Her midwife (at the hospital) told her she would need a pap. She has never had one and thinks it sounds horrible. She was a virgin when she married DH and there doesn't seem to be any real need for her to get one now. Does she need a pap? Can she refuse it or put it off til after pregnancy????

[texasnurse3]

She can certainly put it off.

Offering a pap at the first appointment is a standard of care, not a requirement. Her midwife also may be thinking that your friend's DH may not be a virgin, in which case he could have picked up and passed along HPV to her.

[avalonfaith]

the pap is pretty routine and she can most definetly put off the pap to potpartum if she wants, she has a right to choose what procedures she wants. it is important to know, also, that STDs are not the only thing that causes cervical cancer. cervical cancer can happen even in women with no sexual partners ever. the risk is lower, of course, but sexual history does not rule out the reccomendation for a pap.

[AutumnAir]

I have read that pap smears during pregnancy have a very high rate of false positives, and that they also carry a 1% risk of miscarriage of an otherwise healthy fetus if carried out in the first trimester. Personally I would decline if offered.

[MeepyCat]

AutumnAir, that is a crazy high miscarriage rate - on par with amniocentesis. Do you have a link for it?

I agree that a pap is the standard of care, and many midwives will offer a routine pelvic exam as well. These things can be uncomfortable. It's like a trip to the dentist, really. You're not going to like it, but an understanding professional will be gentle, and then it will be over.

[nashvillemidwife]

That doesn't even make sense. The overall rate of miscarriage is higher than that, so more than 1% of women who have paps during pregnancy are going to miscarry naturally.

[2xy]

I agree that the miscarriage number sounds fishy.

Paps done during pregnancy and even immediately post-partum do tend to have "false" positives. Meaning: there are cellular changes, but much of the time those changes resolve themselves without treatment after all the hormones even out.

After my oldest was born, I had a Pap done at my 6-week checkup that led me to suffer through colposcopy and cryosurgery. I had never had a bad Pap prior to that. Years later, I learned that all of that might have been totally unnecessary; that my body might have healed itself.

[MegBoz]

I agree with others that she can decline. Sorry, I don't know much about pros & cons of the pap during pregnancy. (I personally agreed to have one anyway because it was the exact same month I was due for my annual pap & check-up pelvic exam anyway.)

Originally Posted by sweetsunshine85

She has never had one and thinks it sounds horrible.

Um, well... Pap during pregnancy aside, I think she needs to learn to deal with these feelings. An annual pap should be a regular part of well-woman care. If she thinks that sounds horrible, she may have some serious fears about giving birth, particularly with interventions.

[jecombs]

Originally Posted by MegBoz

Originally Posted by sweetsunshine85
She has never had one and thinks it sounds horrible.

Um, well... Pap during pregnancy aside, I think she needs to learn to deal with these feelings. An annual pap should be a regular part of well-woman care. If she thinks that sounds horrible, she may have some serious fears about giving birth, particularly with interventions.

This was my thought exactly! Yes, the pap isn't the funnest day of the year, but I view it as essential to my health. Cervical cancer can happen in the absence of the HPV virus.

Your friend does have the right to refuse any tests and procedures, but if she refuses this one she probably needs to wrap her head around the fact that she needs to get it done after LO is born.

I had a pap in my 2nd trimester and everything turned out fine.

[Evergreen]

Because of the higher rates of false positives during pregnancy I have never gotten one while pregnant. Since your friend has never had one, though, my thought is that she should go ahead and have one as soon as possible and then incorporate it into part of her life. It really isn't too bad.

[BoringTales]

If she thinks a simple pap sounds terrible how is she ever going to manage child birth?

I've had a pap with each pregnancy at the first exam. I've never found a good reason not to, and I've never had a false positive from them either. I'd encourage her to work through her feelings and get the test.

[AutumnAir]

I can't find my source for the miscarriage rates, but I'm nearly certain I read it in this book If someone else has it (DK Pregnancy and Birth by Miriam Stoppard) they might be able to skim through it.

It was a pretty mainstream book, so I assumed that the information was widely known and accessible, but I've just googled it and all the medical sites claim there are no risks associated with paps, in pregnancy or not (which I'm sorry, I just don't believe - there are always risks associated with any invasive procedures.)

[sweetsunshine85]

Ok, she didn't say it sounded horrible or that she was planning to refuse it. I think she said that it sounded unpleasant. She didn't seem to think she had a choice, so she was pretty resigned to having it. I just was looking for some perspective and to see if she really needed to have it right now or if she could wait until she is not pregnant.

[CallMeMommy]

Yes, she can absolutely wait, it's her body and her choice.

On another line of thinking, have her think of what her response would be if she did test positive for HPV or precancerous/cancerous cells - would she treat? I knew right away that no matter what the outcome of the Pap was I wouldn't treat until after the pregnancy, so there was no point for me in even getting the Pap until afterwards. AND, the 1 time I've gotten an abnormal Pap in my 10 years of getting them is the one I had during my postpartum visit with my first son. The followup was normal. I'm convinced it was irregular cells from pregnancy.

[sweetsunshine85]

Yeah, thats what I was thinking. Last thing she needs is to add unnecessary anxiety and stress to her first pregnancy. And I have definitely read that the false positive rate is very high during pregnancy!

[Amatullah0]

Originally Posted by BoringTales

If she thinks a simple pap sounds terrible how is she ever going to manage child birth?

I had a wonderful birth(natural w/AROM, w/mw, in hospital), and i think a pap sounds terrible(and unnecessary). I've never gotten one before this last pregnancy(OB bullied me into it) and unless i see a need for one, i wont be having another.

IMO, i dont go for regular brain/lung/skin/you-name-it cancers, so why cervical? just because its easy to check? no thanks.

[MeepyCat]

Originally Posted by Amatullah0

IMO, i dont go for regular brain/lung/skin/you-name-it cancers, so why cervical? just because its easy to check? no thanks.

Because prompt treatment of HPV can help prevent cervical cancer, perhaps? Because the other cancers you mention have symptoms you would (we hope) notice without medical testing at a fairly early stage, leading you to seek treatment, whereas HPV can pass unnoticed?

I keep an eye on moles (and on my tattoos) for signs of cancers, I wear sunscreen, I get mammograms on the recommended schedule...

[SandraS]

Of course she can refuse it. She can refuse anything. it's her body.

And FWIW, my doc says a woman with no family history of cervical cancer doesn't need an annual pap. Every 2-3 years is fine, as long as she's had several negative results in early paps. I only go about every three years.

[momileigh]

Originally Posted by BoringTales

If she thinks a simple pap sounds terrible how is she ever going to manage child birth?

I'm responding to not only this comment, but several other comments along the same lines.

I have had two beautiful natural straightforward births. And, I must say, I handled it pretty darn well, especially the second time. I do have pain, but I do a great job at birth.

Also, I have a very good working knowledge of pap smears because I perform them.

And, the very idea of having to have a pap smear myself scares the crap out of me. My heart starts palpitating, I start to sweat, tears form in my eyes...

I have full-blown freak-outs whenever I have a pap. I have refused them ever since my 6-week postpartum pap after my first daughter's birth. That's right... I haven't had one in 6 years, and don't ever plan to have one again unless my risk factors increase. (Dh and I are exclusive one-and-only-ever partners, so I have decided paps are not worth it with my miniscule risk of cervical cancer. I sometimes think that if he were to die or something, I probably would not ever remarry for fear of possibly getting HPV and needing paps!)

And in case you're wondering, no, I've never been abused... unless you count a doctor pressuring me into a pap smear, and me not finding the strength to refuse.

My point is, some people are afraid of spiders, some are afraid of needles, and some are terrified of pap smears. That doesn't mean they aren't going to be rockstars when it comes to birth!

[sweetsunshine85]

THANK YOU! Thats how I feel about it personally. My friend would handle the Pap just fine if she had to, but she just doesn't like the idea. But I definitely don't think that it should be abnormal to have a fear of getting one! I have NEVER had one and don't look forward to the first one. But thats just my personal feeling.