Avoiding prenatal tests

[sioleabha]

Last night I was reading something on some blog about routine prenatal testing and how this or that was pointless. I was only skimming it, but it reminded me that I want to talk to my OB at my first appointment on Wednesday about what he'll let me skip. Basically, this is my sixth pregnancy, I have never had any problems with any of the things they test for, and I don't see the point of getting stuck and poked and prodded for nine months for what appears to be no reason.

Well, my husband does not agree. He says that I'm going to make the doctor not want me as a patient, and that I should only refuse things if I have a specific reason. (I think I should only consent to things if there is a specific reason.) Since I am a VBA2C and the climate here sucks for VBAC, my choices are pretty much this doctor or repeat c-section. (I'd rather have NO prenatal care and walk into a hospital unannounced and ready to push than agree to major surgery for no reason.)

Am I crazy? Can you walk into an OB's office and basically say you don't want to do ANYTHING unless there's a specific medical reason for it? Considering that he wants me to have an ultrasound at my first appointment before I even meet the doctor, I'm not sure how that will go over...

[MaerynPearl]

is the ultrasound for some specific reason? (I have not had a c-section so I dont know if they check the scars that early to be sure they will not risk you out of a vbac?)

[sioleabha]

It's for dating. The lady on the phone said they do it for all new maternity patients. When I go in I plan to mention that I know what day I ovulated, and see if they'll let me out of it, but since it's before I even meet the doctor I am not hopeful.

[umsami]

It depends on the provider, honestly. Some will respect a well-informed patient, and others want somebody who will just follow directions.

Things I think you can make an argument for skipping:
-Most routine ultrasounds... although they may give you grief over a dating u/s or 20 week. (I think you have a strong argument against the dating u/s though.)

-12 week nuchal scan/bloodwork plus quad scan.. especially if you know that you would not terminate regardless (They are screening, not diagnostic.)

-Amnio/CVS...if you would not terminate regardless

-GTT, although as you age, your risk goes up. I would volunteer to monitor my own blood glucose levels (after normal meals and fasting) with a meter instead

-HIV/STD tests... assuming you're confident in your partner's fidelity

-RUbella titer (sometimes they do that as part of the first bloodwork) if that's been done with previous pregnancies


Things You'll Probably Still Need:
Group B Strep
If you're RH-, the antibody test
-fingerprick to check for anemia in third trimester


I think a lot depends on how you present it, and how well informed you are... but a big part is provider preference.

[3crunchycarrots]

Firstly, More power to ya mama! It takes a lot of courage to ask questions especially to your Dr. about "protocol" and if youre not being fully supported. Remember you are the patient, which gives you plenty of rights and power. You choose your Dr. not the other way around. Ask questions, research and if something sits funny with you, dont just push it aside. If your Doc doesnt like that, then you may want to start shopping for one that wants to work with you to bring about a healthy and satisfying birth experience.

As far as tests, do what feels right. The above mama was right on about the 2 tests. I am on govt funded medical insurance and they wanted me to submit to so many tests! I did a blood screening in the beginning and when everything turned out good I have not had any other testing or ultrasounds and asked them to put it in my file that I'm not interested in others. As long as you feel healthy and it sounds like you have had some experience in being pregnant Thats what matters.

[briome]

Of course is a woman wants this or that test I think she should be able to get it but otherwise I agree that a lot of them are just because they are there.

I have heard of some areas where everyone has an ultrasound machine so a woman gets one at EVERY appointment just to check the heartbeat. I think that is overkill (and this is for your regular average pregnant woman not high risk at all).

It seem that a woman like you who is likely deemed 'high risk' because you have previous c-sections, have a high amount of pregnancies and are possibly over 35 (?) your mainstream doctor will not feel like you should 'pass' on any test. I would like to think you would be respected and treated as an educated adult and give you leaway to decide which ones you need/desire but you never know... Don't forget you CAN switch care providers at any point in your pregnancy. You are the person in charge of hiring your care provider, no one should have to pretend like their doctor is an all knowing god and disagreement or refusal of his opinion should never result in chastisement or maltreatment. You do have medical care providers to ask their opinion, but it is ludicrist to suggest that you have to accept everything carte blanche....HE is not your father and you are not 8yrs old!
Anyway, I'm sure you get my point with that!

You CAN have a heathy pregnancy with out ultrasound dating, or any ultrasounds at all (I have had none with all three pregnancies).
I also had a c-section (with my first) and you DON't get any established benifit by having it looked at by ultrasound (check the ICAN website for more on this http://ican-online.org/ )
Some of the other test like amnio and CVS have a miscarriage rate higher then baby death rate due to VBAC uterine rupture. ( http://vbacfacts.com/2008/05/21/comp...amniocentesis/ )

Again, of course-----get thease things if you want but the test are SOOO COMMON that no one ever tells you the negitive things of them ----for example-getting the femer measured every 2 weeks (the stress and strain on the pregnancy if a mesurement is a cm off) MOST things detemined by pre-natal testing lead to More testing and most things we can do nothing about untill the baby is born anyway!

A lot of care providers do prefer a paitent that just does what they are told. A doctor/MW may not like to be questioned, challenged etc...but that should not mean your bodily intregrity should be deemed unimportant.

[AustinMom]

I am having a HBAC and I refused all of the primary first trimester blood work except for the CBC which looks at iron levels, as I sometimes have that issue. I am o- blood type and our son was ab+, but I refused the antibody screen because it's just a screen, if it comes back, no, you don't have the antibodies, they can't do anything about it, your body is going to decide that. I thought that was one that was pointless. If you had a previous pregnancy with a +blood type baby and got the rhogam shot after birth, you pretty much have nothing to worry about. If you didn't get the shot, the chance is still around 1% that you would have issues and the "screen" wouldn't help any of those issues.

As far as u/s, if you know your ovulation date, don't get it. It's not medically necessary, even ACOG says that. I would advise you, before you consent to any test, ask your Dr. for a print out of ACOG guidelines on the procedure. THey say that u/s is only recommended when medically necessary, dating is not one of those, especially if you have your ovulation date, even more so ifyou have regular cycles. I personally am getting a 20 week u/s, mainly because we are having a home birth and I want to rule out placenta previa, and other life threatening congenital abnormalities that would make is safer to birth in a hospital. If I was already birthing in the hospital, I'd not get one.

Any of the screens like CVS, amnio, etc, are not diagnostic, meaning they just tell you how at risk you are. I'd not get them as they carry a high miscarriage rate that is not worth the lack of benefit of the test. If your Dr. is pushy in these tests, and then says a VBAC is too risky, you can inform him that CVS carries a 1% miscarriage rate and VBAC carries a less than 1% rupture rate with only around 6% of babies in that 1% of ruptures dying, so if he is "fine" wiht the CVS, he should be fine with VBAC.

Glucose, I'd say you'd like to take the test with instead of the sugar concoction, eat a hearty breakfast, as that is a normal thing you do. No (that I know of) pregnant women wake up in the morning and drink almost a cup of sugar on an empty stomach. It's unrealistic.

The STD testing, if you are confident that you are in a monogamous relationship and so is your spouse, there is no point in my mind. I didn't get it.

Always ask for the studies and then, while in the Dr. office, come to a decision with your Dr. Like a previous post said, you chose them, not the other way around.

You can still have a great VBAC even if your Dr. is intervention happy. I would recommend just based on what has been said of him, to have a Doula if you are worried about dealing with refusing interventions in labor. They'll help you stay focused on your labor, and not feel like you have to keep your guard up the whole time. Also, since you are a VBA2C, it's good to have the emotional support.

Happy Birthing!

[evjolin]

your provider will make all the difference in the world with this, and i would encourage you to find a different one if he is not okay with you having less testing than most people want. i only had one u/s, and skipped all the other "is something wrong with baby" testing. one note on the std testing--depending on your state laws, if you refuse the testing during pregnancy, some states require the baby to have it at birth. mine does, which is why i went ahead with that (plus, they do bloodwork anyway, what's one more vial?)

[Tiffanoodle]

If you're sure on when you ovulated, I don't see any real reason for the early u/s. I always got them because I never knew when I ovulated. Even with this one, I had a regular af that I knew the date of, but according to the early u/s (and when I got the bfp) I ovulated a week later than "normal". Especially for a VBAC, this is a good thing to know. I know some providers will push for a c-section if you go over dates. That week could make a big difference for me. The 20 week u/s, I like to do. Especially this time, my placenta was close to the opening. Not covering, but close enough that there could be a problem with a vaginal birth if it doesn't move.

I submitted to the general CBC and stuff in the first tri, but declined the triple screening. My OB was perfectly fine with that. We wouldn't terminate for anything they test for, so there was really no reason other than to be prepared. Most things that we would need to be prepared for would show at the 20 week u/s. (Selfishly, I want to know what we're having, so the 20w u/s was never really a question for me.)

I opt to do the at home testing for GD. Since GD can cause a lot of problems with birth and endanger the baby at birth, I like to know everything's okay.

[sioleabha]

Thanks for all the replies! I promise I am reading and digesting them!

I am so nervous about this. I'm the type who likes to have things *my* way, and I don't like pushy doctors. But all I keep reading on the local ICAN list is that this doctor and that doctor is not doing VBACs anymore, and I've already been turned down by all the local birth centers. I really feel like this OB is my *only* choice. Fortunately, I have also heard repeatedly how *wonderful* he is. I'm very excited and very nervous about meeting him on Wednesday!

BTW, I am only 28, so I don't think I qualify for any of the "advanced maternal age" stuff, LOL. I know you'd think I was older having this many kids -- guess I'm just lucky!

[sioleabha]

Originally Posted by Tiffanoodle

If you're sure on when you ovulated, I don't see any real reason for the early u/s. I always got them because I never knew when I ovulated. Even with this one, I had a regular af that I knew the date of, but according to the early u/s (and when I got the bfp) I ovulated a week later than "normal". Especially for a VBAC, this is a good thing to know. I know some providers will push for a c-section if you go over dates. That week could make a big difference for me.

For me, if this is going to be an issue, then it's going to be an issue. ALL of my babies have gone past my due date; the last three went to (or past) 42 weeks. With my third pregnancy I had a dating ultrasound (well, sort of -- I was having an ultrasound on my leg for a non-pregnancy-related issue, and they asked if I'd like to check on the baby. I wasn't sure of my dates, so I figured why not? I mean, I'm not anti-ultrasound, just anti-wasting-time-and-money! LOL.) Even dating from the ultrasound, my daughter was born at 42w3d. Even though I went past my due date, I went into labor naturally with all five pregnancies. (And four of those times I was a VBAC, since it was my first and fifth labors that ended in c-section.)

To get to the point, I am not the least bit concerned about going past my due date. I know I will. I was already planning to bring this up at my first appointment, and if it's an issue for the doctor -- well, then I'll know we have a problem. Fortunately, from what I have heard, I think it will be ok.

[sioleabha]

Originally Posted by AustinMom

You can still have a great VBAC even if your Dr. is intervention happy. I would recommend just based on what has been said of him, to have a Doula if you are worried about dealing with refusing interventions in labor. They'll help you stay focused on your labor, and not feel like you have to keep your guard up the whole time. Also, since you are a VBA2C, it's good to have the emotional support.

Everything you said was such good advice, thank you. I do have a doula lined up, and I am SO excited about that. I have never had a doula before, and she is a friend of mine. We have very similar beliefs about birth, and she is a kind, warm, supportive person. I wish I'd known her when my other children were born, because I definitely would have had her as my doula! (I only wish I could have my baby at the birthing center where hers were born!)

[mrsfru]

Originally Posted by MaerynPearl

is the ultrasound for some specific reason? (I have not had a c-section so I dont know if they check the scars that early to be sure they will not risk you out of a vbac?)

You can't see the uterine scar on an ultrasound, except to tell later on in pregnancy if the placenta has attached to it (placenta accreta, I think). The only time anyone truly "sees the scar" on the uterus and knows exactly that's what it is, is during the c-section itself. I even had surgery 5 mos after my first c-section, on my pelvic region for endometrios, and my well-trained and very experienced doc couldn't find my uterine scar from my traumatic c-section (it was a slightly irregular cut).

mrsfru (2 c-sections)

[mrsfru]

Originally Posted by sioleabha

It's for dating. The lady on the phone said they do it for all new maternity patients. When I go in I plan to mention that I know what day I ovulated, and see if they'll let me out of it, but since it's before I even meet the doctor I am not hopeful.

You can refuse anything you want to. The vast majority of docs, even the most conservative ones, are quite unlikely to refuse you as a patient *just* for turning down that ultrasound. Now, if you refuse *everything* the whole pregnancy, they might refuse to treat you (then can drop you up to 36 wks).

Just let the ultrasound tech know that you know your ovulation date and do not want the ultrasound right now, thanks. It's really not that big of a deal.

mrsfru

[HeatherB]

Definitely, refuse anything you don't want. I am also in Houston (well, suburbs), and refused the triple screen or whatever it was with my first. I just said, "What will this tell us? Why would I do it?"

I'm now pg with my 4th, and 3rd HBAC. I will do a basic panel of bloodwork with whatever my MW recommends (it's really wonderful having someone you trust!!), and will do whatever she requests as far as glucose testing later. I'm certainly at risk for GD, but have never had any issues. Last time, she had me use a glucose monitor to check after an over-indulgent breakfast. And I don't do beta strep testing at all. I also refuse exams until sometime in labor when I decide I want to know what's going on (last time, I checked myself prior and told her what I could feel).

I'm on the ICAN list but haven't followed your story, so I'm not sure if there are other issues. But, there ARE options here in the Houston area, including an array of really experienced and fabulous midwives. They're definitely a very good option. I hope the OB is good, though, as it's true there are fewer and fewer of them here!

[sioleabha]

Originally Posted by HeatherB

I'm on the ICAN list but haven't followed your story, so I'm not sure if there are other issues. But, there ARE options here in the Houston area, including an array of really experienced and fabulous midwives. They're definitely a very good option. I hope the OB is good, though, as it's true there are fewer and fewer of them here!

Basically I can't do a homebirth; it's complicated. (I've given the whole long explanation before, so I hope it's not rude to say just trust me, I can't.) I've already called and been turned down by literally every birthing center in the city, and the only other VBAC OB on my insurance. Dr. Del Castillo is the only one left.

[jecombs]

I hope it all works out for you, Mama! I just wanted to reiterate that some of the tests for STDs and AIDS are mandated by state law. In my state, we are required to get tested for AIDS and STDs. I'm not sure what would happen if you didn't get tested, unless you claimed a religious exemption or something. For me, it's more trouble than it's worth to refuse the testing. Also, keep in mind that a dr. can drop you from for refusing testing. I would feel that out very carefully with this doc, since he appears to be your only option. Yes, all the u/s's do appear to be excessive and rediculous, but there are other things he might require that he feels pretty strongly about. We do have a right to choose our provider, but our provider also has to feel comfortable with us as a patient.

[sk8boarder15]

I'm in a similar boat, had to do ultrasound because my cycle was all screwed up and I had no idea how far along I was, but tomorrow I get to go in and tell them I AM NOT doing the AFP screening. They have been pushing it big time, but there is absolutely no need! I'm 23 and healthy!! There are far too many stories of false positives out there that left families stressed for no reason. If my baby has a "problem" I will find out when he/she is born!