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What tests will you get, if any? - Page 2

post #21 of 51
Thread Starter 
Quote:
Originally Posted by AKislandgirl View Post

Some families like to do tests not because they would termintae the pregnancy but because they like to be prepared if they will have a special needs child. For us we'll be OK with waiting till birth.


Exactly. We wouldnt terminate but we would use any information to make sure we are prepared for anything the baby might need at birth.
post #22 of 51
As few as possible.

Can't do the diabetes screen because I've had gastric bypass and that glucose drink could darn near kill me. We want to do just one ultrasound, but haven't decided if we want to know the gender or not.

The only "tests" I want done are at today's appointment. I want to have my thyroid checked because I really suspect some problems there, and I would like to test for the toxoplasmosis antibody so I can stop wearing a freaking mask to change my catboxes. My pregnancy breath is gross and I hate breathing "recycled" air.
post #23 of 51
Quote:
Originally Posted by AKChix0r View Post

I would like to test for the toxoplasmosis antibody so I can stop wearing a freaking mask to change my catboxes. My pregnancy breath is gross and I hate breathing "recycled" air.


 

I love pregnancy because I use it as an excuse not to change the cat box, that becomes DH's job. IN fact I have convinced him that he had to keep doing it after dd was born because i breastfeed, better safe then sorry. lol.

post #24 of 51

I typically turn down almost all the tests. I don't do the GD screening, but instead will test my blood sugar with a glucometer for about 3 days somewhere between 28 and 32 weeks. Waaaaaaaaay better than drinking a bottle of sugar and actually a more accurate tool for discovering blood sugar issues.

 

If I decide to use a hospital-based provider, I will get the GBS, because like PP said, if I don't get the test, the will automatically assume me positive and try to force the ABX on me at birth or require baby to stay longer and possibly undergo additional testing.

 

In my last two pregnancies, I have not had any ultrasounds. If I go with a hospital-based provider, I will decline this again. If I instead go with a CPM, I am considering getting the 20 week anatomy scan to look for any congenital abnormalities that would indicate the need for a higher level of care at birth. Still undecided about this (heck, still undecided about who I will use as a care provider!).

 

That's pretty much all the testing I do.

 

Oh, and during the pregnancy, I request use of the fetoscope instead of the doppler for regular heart rate checks.

post #25 of 51

I will be turning down all testing with this pregnancy just like with my last.  Luckily I have a MW that doesn't push them, even with me being 38.  I've had experience with a false positive AFP and it was incredibly stressful.  I won't go through it again.

We will probably not even have an U/S since we have to pay out of pocket for it.  If for some reason my MW thinks there is an issue that needs to get looked at then I will consider it. 

GD has never been an issue for me before and we will likely just focus on healthy eating habits instead of over loading with sugars.  GBS can come and go so no matter what the test says, you r baody could have gotten rid of it or it could have formed between the test date and delivery.  I will just stick with a hibiclens rinse prior to delivery since I stay away from ABX anyway. 

post #26 of 51

For those declining ultrasounds, are you planning on using dopplers, or only fetascopes (post 20 weeks).  Klemomma, please share more!  

post #27 of 51


 

Quote:
Originally Posted by Asheya View Post

You may want to consider the 'nocebo' effect of medical tests, which means that in most cases you can't do anything about what you find anyway, and the test themselves create an atmosphere of worry and stress. Also, the North American testing approach to childbirth begins the process of the fear that your body is flawed and relying on medical interventions in childbirth.

 

For Gestational Diabetes, there are signs you can look for in a urine strip to alert you to whether you may have it, and a home blood sugar testing kit (the same as diabetics use) is much more accurate than the sugar drink, wait an hour, take your blood test.

 

For Group B Strep, you should be aware this is normal bacteria that comes and goes in both men and women. Just because you test + for it a few weeks before birth does not mean you will even have it when you are birthing. You may want to take a look at the information about the risk of your baby getting an infection if you have GBS, the risk of your baby getting sick from that infection, and the risk of your baby dying. Info is at http://www.mothersofchange.com/2010/09/group-b-strep-look-at-facts.html

If you test positive for GBS then you will have to decide if you are going to accept IV antibiotics during the birthing process, which may interfere with your comfort and increase your stress level. Having an IV in your arm is also very convenient for the hospital staff to now augment your labour, give you morphine etc. Antibiotics is often the first step in a cascade of interventions, so it can be important to look at the research, weigh the benefits and risks and your particular circumstances, and make an informed decision about your care.

 

I know ultrasounds are very popular and everyone expects to get one, but research indicates that routine ultrasounds, without any medical indications (i.e. you are not having bleeding or any other problems) do not improve outcomes. This means that the same number of babies have problems before birth/at birth/after birth whether you get an ultrasound or not,  if you have a healthy pregnancy. You can find more information in this 3 part series about ultrasounds at http://www.mothersofchange.com/2010/06/routine-ultrasound-part-i.html

 

The best things you can do to prevent problems for your baby is to eat a healthy diet (lots of dark and bright coloured fruits and veggies, whole grains, enough protein, sea fish such as salmon, salt to taste, healthy fats, lots of water) and get emotional support throughout your pregnancy. These are the only interventions that have been shown to improve outcomes.


Agreed!!! 

 

No testing here unless I have some abnormal symptoms or complications.  I eat really well and I exercise a lot.  Looking forward to a healthy, low-stress pregnancy. 

post #28 of 51
Quote:
Originally Posted by Amy May View Post

For those declining ultrasounds, are you planning on using dopplers, or only fetascopes (post 20 weeks).  Klemomma, please share more!  



fetalscope. 

post #29 of 51

DDCC!

 

Actually, research has shown that GBS is stable for about 5-6 weeks at a time.  So if you test positive it's likely that you will still be positive at the time of birth.  Of course, rarely, some people who test negative will be positive at the time of birth, but that's why hospitals and responsible midwives have protocols in place to deal with things like maternal fever.  It's why GBS in babies is so rare. 

 

Good luck to all of you!  So exciting!  I'm at the other end of the journey now, and it's fun to look back and remember these days!

post #30 of 51


 

Quote:

Originally Posted by Asheya View Post

For Gestational Diabetes, there are signs you can look for in a urine strip to alert you to whether you may have it, and a home blood sugar testing kit (the same as diabetics use) is much more accurate than the sugar drink, wait an hour, take your blood test.

 

For Group B Strep, you should be aware this is normal bacteria that comes and goes in both men and women. Just because you test + for it a few weeks before birth does not mean you will even have it when you are birthing.

 

MDC should not be a forum for posting potentially harmful misinformation like that posted above.

 

Gestational diabetes can occur without signs. In several of your points you referenced research, yet you seem to be unaware of the research indicating that routine urine dips for protein and glucose in pregnancy are not evidence-based and it is recommended that they be abandoned. Also, I am not sure how you can claim that home glucose monitoring with a glucometer (that by industry standard is only accurate to within +/- 15%!) when recommended standard for the glucose tolerance testing is what has been shown by evidence to be the most effective at diagnosing gestational diabtes.

 

Group B strep is a normal bacteria to be found in the gut, not in the vagina or urinary tract. True, it is transient and just because you have it today does not mean you will have it when you give birth. However, again, the evidence is that the results of the test are accurate for 5 weeks, and that the testing protocol is the most effective at preventing transmitting group B strep to your newborn.

post #31 of 51
Quote:
Originally Posted by Asheya View Post

I know ultrasounds are very popular and everyone expects to get one, but research indicates that routine ultrasounds, without any medical indications (i.e. you are not having bleeding or any other problems) do not improve outcomes. This means that the same number of babies have problems before birth/at birth/after birth whether you get an ultrasound or not,  if you have a healthy pregnancy. You can find more information in this 3 part series about ultrasounds at http://www.mothersofchange.com/2010/06/routine-ultrasound-part-i.html


Again, if you had read the research that is presented in the articles you linked to, you would see that that the study the author quoted from was on the use of doppler ultrasound, which is a very special test used to examine blood flow in the umbilical cord and the uterus. This "evidence" the author presents in her article has nothing to do with the testing being discussed here.  Another Cochrane review that is often misquoted as finding no benefit to routine ultrasound looked only at the relevance of routine ultrasound in late pregnancy. This did not include the routine anatomy screen around 20 weeks which identifies most anomalies of the baby and placenta,which again, is the topic of this discussion.

 

I am not advocating for any of these tests during pregnancy, but women need to make these decisions based on factual information.

post #32 of 51

I will have a 20 week u/s for my husbands peace of mind(and to find out gender while we are at it lol, but I wouldn't have one just for that reason.) If my midwife felt the increased need for me to get a test then I will decide, but if there is no indication in place I won't. I don't test for GBS because I deliver too quickly to get antibiotics during labor so I act as if I am positive and do hibiclens rinse and monitor baby closely afterward.

post #33 of 51

I got the whole list of tests they do today (it was my nurse intake appointment). No pressure, just "this is what we offer." I'm declining the CF test. I'll probably do everything else. My practice still seems to be doing the quad screen. I get ultrasounded to death because I have hypertension and take beta blockers and the baby's growth needs to be monitored.


The only one that annoyed me was being asked to do the 1hr GTT already. Mostly because of their policy: they ask everyone over 200 lbs to do it, so they can rule out existing Type 2. In my case, it's actually not a bad idea (I'm seriously insulin resistant and was on Metformin + Byetta pre-pregnancy) so I'll do it, but if I knew my sugars were totally normal I would have refused.

post #34 of 51

I'm generally against a lot of testing, but do have some considerations due to my age (43). I already had a quick peek u/s this week, and will do the NT scan and the 20 week u/s. If the NT scan gives me bad numbers, I will do an amnio.

 

My midwife does a modified GD test which involves eating a McDonald's pancake breakfast and then testing blood sugar. I still hate this because the carb load makes me sick, but it's much better than the glucola.

 

We don't bother testing for GBS. I was positive in one pregnancy, so we just treat as if I'm positive again with a course of antibiotics before and during labor.

post #35 of 51

The best evidence to date indicates that routine ultrasound screening at any point in pregancy does not "reduce adverse outcomes for babies" quoted from the Cochrane review http://www2.cochrane.org/reviews/en/ab007058.html
However, "Early ultrasound improved the early detection of multiple pregnancies and improved gestational dating which may result in fewer inductions for post maturity."

More research may be needed on this topic, as the Cochrane Review admits that the evidence is not robust, but this is the best evidence we have right now.

Quote:
Originally Posted by nashvillemidwife View Post




Again, if you had read the research that is presented in the articles you linked to, you would see that that the study the author quoted from was on the use of doppler ultrasound, which is a very special test used to examine blood flow in the umbilical cord and the uterus. This "evidence" the author presents in her article has nothing to do with the testing being discussed here.  Another Cochrane review that is often misquoted as finding no benefit to routine ultrasound looked only at the relevance of routine ultrasound in late pregnancy. This did not include the routine anatomy screen around 20 weeks which identifies most anomalies of the baby and placenta,which again, is the topic of this discussion.

 

I am not advocating for any of these tests during pregnancy, but women need to make these decisions based on factual information.

post #36 of 51

"A huge Canadian study demonstrated that the only effect of routine glucose tolerance screening was to inform about three per cent of pregnant women that they have gestational diabetes (20). The diagnosis did not change the birth outcomes." Quoting from Dr. Michel Odent at http://www.wombecology.com/maternalemotional.html and the study he quotes is Wen SW, Liu S, Kramer MS, et al. Impact of prenatal glucose screening on the diagnosis of gestational diabetes and on pregnancy outcomes. Am J Epidemiol 2000; 152(11): 1009-14.

 

I know that many midwives look for ketones in the urine strip, and if there is an indication of ketones then they recommend the woman eat a meal high in simple carbs (white rice or pasta with a dessert) and then test their blood sugar using a glucometer at intervals after the meal. I would be interested in a link to the research that indicates that urine strips are not effective.

 

Dr. Michel Odent recommends (at same website as above) "Another routine screening practiced in certain countries is for so-called gestational diabetes. This is the reason for using the glucose tolerance test. If the glycaemia (amount of glucose in the blood) is considered too high after absorption of sugar, the test is positive. This diagnosis is useless because it merely leads to simple recommendations that should be given to all pregnant women. These are recommendations regarding lifestyle, particularly dietary habits and exercise."

 

I also know that there is much debate about the current method of testing for gestational diabetes, because it is not an actual measure of how a woman's blood sugar would fluctuate, since hardly anyone would drink such a sugary drink as part of their diet. Some midwives think that using a glucometer is more accurate because it gives a more accurate overall picture of how eating a meal affects the woman's blood glucose levels.

 

It is my understanding that Group B strep is another controversial issue, where the evidence is not entirely clear, particularly when it comes to treatment.  I would be interested if you could point me to the research you are referring to about the tests being accurate for 5 weeks. I think it is also important that women are aware that even if in the majority of cases the tests are accurate for 5 weeks, in some cases there is no GBS at birth, which means if they opt to receive IV antibiotics during the birth they may be receiving treatment for something that doesn't exist. Also, it is not the testing protocol that is effective at preventing transmission of GBS, it is the IV antibiotics. And routine antibiotics for something like 30% of the birthing population, some of whom may not even have the bacteria present, has significant risks of its own. For more on this see http://www.mothersofchange.com/2010/09/group-b-strep-look-at-facts.html
 

Quote:
Originally Posted by nashvillemidwife View Post


 

 

MDC should not be a forum for posting potentially harmful misinformation like that posted above.

 

Gestational diabetes can occur without signs. In several of your points you referenced research, yet you seem to be unaware of the research indicating that routine urine dips for protein and glucose in pregnancy are not evidence-based and it is recommended that they be abandoned. Also, I am not sure how you can claim that home glucose monitoring with a glucometer (that by industry standard is only accurate to within +/- 15%!) when recommended standard for the glucose tolerance testing is what has been shown by evidence to be the most effective at diagnosing gestational diabtes.

 

Group B strep is a normal bacteria to be found in the gut, not in the vagina or urinary tract. True, it is transient and just because you have it today does not mean you will have it when you give birth. However, again, the evidence is that the results of the test are accurate for 5 weeks, and that the testing protocol is the most effective at preventing transmitting group B strep to your newborn.

post #37 of 51

Cochrane also says this:

 

"The detection of fetal malformation was addressed in detail in only two of the trials."

 

So, most of the studies in that meta-analysis weren't looking at the 20 week anomaly scan; they were focusing on dates, detection of multiples, etc. For which they say: "Early ultrasound improves the early detection of multiple pregnancies and improved gestational dating may result in fewer inductions for post maturity."

post #38 of 51

DDCC to correct some egregious misinformation.

 

1.  Testing for ketones in urine is useless.  Very few people with glucose intolerance, either due to gestational diabetes or Type 2 diabetes will have ketones.  This is mostly a problem seen in Type 1 diabetics (insulin dependent), because they can not utilize the glucose in their body at all and their body in essence starts to digest itself.  I have had type 2 diabetics in my practice with blood sugars over 600 who are asymptomatic and have no ketones.

 

2.  Using urine strips to test for glucose is also useless.  For there to be glucose in your urine, your blood sugar has to be AT LEAST over 200 for a sustained period of time.  This is because it takes at least a level of 200 mg/dL to overwhelm the renal tubules and spill glucose into the urine.

 

3.  Informing "only 3% of women that they have gestational DM" in not insignificant.  That's about 180,000 women in the US per year.

 

4.  "This diagnosis is useless because it merely leads to simple recommendations that should be given to all pregnant women. These are recommendations regarding lifestyle, particularly dietary habits and exercise."  This is nuts.  This are not the only things that are done with a diagnosis of gestational DM.  Fingersticks are checked carefully.  Blood sugar level recommendations are stringent.  If diet and exercise don't do the trick, oral meds or insulin is given.  The baby needs to be watched carefully for signs of respiratory distress and hypoglycemia.  Plus, the mom is at risk of developing Type 2 DM later in live.

 

I apologize for the DDCC.  However, as a physician, I was really alarmed by the incorrect information being given.

post #39 of 51

I, for one, appreciate the ddcc WildKingdom and NashvilleMidwife.  Asheya, I'm sure you mean well and it's obvious that you care greatly about woman's birthing experiences and helping them make informed decisions which is great. But if you are posting to this DDC in your capacity as a birth educator, I think you are majorly overstepping your bounds with your posts here. Pointing people towards information so they can make their own informed decisions with the help of their health care providers is great. Saying, "Here are some studies you may want to look at and bring up with your doctor or midwife" is fine. But trying to interpret medical studies and reviews and then give advice based on them is just not something a childbirth educator is qualified to do. There are many valid reasons that a heath care provider would recommend any one of these tests to their patients. 

post #40 of 51
Thread Starter 
Quote:
Originally Posted by LAWoman View Post

I, for one, appreciate the ddcc WildKingdom and NashvilleMidwife.  Asheya, I'm sure you mean well and it's obvious that you care greatly about woman's birthing experiences and helping them make informed decisions which is great. But if you are posting to this DDC in your capacity as a birth educator, I think you are majorly overstepping your bounds with your posts here. Pointing people towards information so they can make their own informed decisions with the help of their health care providers is great. Saying, "Here are some studies you may want to look at and bring up with your doctor or midwife" is fine. But trying to interpret medical studies and reviews and then give advice based on them is just not something a childbirth educator is qualified to do. There are many valid reasons that a heath care provider would recommend any one of these tests to their patients. 


yeahthat.gif  I, for one, am kinda annoyed by Asheya's posts. It's different to say "hey, I was passing through and thought you all might be interested in these links to read and discuss with your care provider". But that's not what she is doing.

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