Refusing Some "Prenatal" Tests

[cottonlily]

My drs office requires you to have pelvic exams, pap smears and breast exams at your first preg. visit.  I ain't down with that.  I am so against all that, esp the pap and breast exam (my boobs aren't even connected to my uterus!) I'd just as soon forego going to the dr altogether.  DH's heart is set on that u/s to see the baby's heartbeat tho...I'm not sure I could take that away from him now.  Could I just show up and tell them what's what?  Like what I am and am not going to be subjected to?  I think I'm going crazy; I have this ridiculous fear now that he'll try to slip the pap stick in anyway or something!  I even called the drs office to see why I had to do those tests and their answer was "everyone does".  Well, this chicka ain't everyone!

[bluebunny]

My understanding of the reasoning behind having pap smears be standard at the first pregnancy visit is because they are suggested yearly and since a woman is pregnant about ten months, it makes sense to do it then.  Do you get paps otherwise? What is your reasoning for not wanting one? 

As someone who has had friends deal with cervical cancer, I think pap smears are extremely important. 

[imogenlily]

My HCP requires one, too, which I didn't want to do. We "compromised" on me agreeing to do one postpartum. I am going to do mine, but if you made a similar agreement, you might be able to get prenatal care, and then "accidentally" miss the appointment postpartum?

I agree with the PP that pap smears are important - for my body - but it's your body and your choice. At certain points I haven't wanted to have them either, for different reasons.

[DevaMajka]

I'm using a mw and had my first appt today- she asked when my last pap was (before ds2 was born, so maybe 2 years ago?) and asked if I'd be ok having on at my next appt. I said sure, because it's past time, and why not? But I would HATE if they said it was mandatory. Something about being an adult and being told what to do, kwim?

They don't do regular pelvic exams, iirc (going from memory from my pg with ds2), except maybe at the end? But they ASK if you don't mind, and don't *insist* on anything.

It burns me up that they try to take away your say in pregnancy. I just wanted to wish you luck in standing up to them. I assume that a midwife isn't an option where you are?

[LiLStar]

I thought I've heard something about a higher rate of false positive pap results in pregnancy? I think thats reason enough to decline while pregnant, unnecessary worry! And for a breast exam, just keep your shirt on and say no thank you :) If they have a problem with that, then maybe they just aren't a good fit.

[Mal85]

If you've had one recently, then it's perfectly reasonable to decline. I didn't have one at mine because I just had one in January, so it really wasn't necessary. If you're due for one anyway, I don't see the harm in having it done.

ETA: I think it's a bad idea to walk in there ready for a fight. Most places allow you to decline. I know where I go, it is mandatory, but it's no big thing if you say no, thank you. They don't make a big deal out of it. I think you should wait and see if it's really that big of a deal to them. You're at the beginning of your pregnancy and you really want to have a positive relationship with your provider/s.

[cottonlily]

I don't want the exams/tests for various reasons.  It's not just the principle of not being forced to do something, which is bad enough in itself.  I'm hiring their services, I pay them, they shouldn't boss me around.  Your financial advisor or even coffee shop girl wouldn't take your money and them force you to do what they say; you get to participate.  I don't understand why most women are cool with being forced to do medical things just because "it's not that bad" or "it will be over in a minute".  I sure hope I don't have to be ready for a fight :(...and that I'm not wasting my time going in anyway.  I've heard some women say their drs were ok with not doing them, others refused to see the patient.  I have had pap smears and all the other stuff in the past but I don't go regularly, only when something's wrong.  I know cervical cancer is important but so is my right to refuse to be tested for it, especially while I'm pregnant.

So we have the appt next Tues and as a back up we have an appt with another ob/gyn in April and I've started talking to a midwife.  We haven't decided where/how/with whom to give birth yet so I'm just bombarded with a hundred decisions right now!  I hope the first ob will be understanding that his patients should have a say in their healthcare and just see me for the pregnancy and not a bunch of unrelated tests.  I'm crossing my fingers!

[octanebeetle27]

Yep, I agree you should be able to decline any testing/procedure that you want. If the staff/OB gives you grief about it, it might be a sign to find a different practice that fits with what you want. "Everyone else does it" is not an acceptable answer. But I agree with the pp who says not to go in fighting. It really won't do any good. You lose either way. Bottom line is you have to find the right practice for YOU! Good luck :)

[cottonlily]

So how do you guys think I should start the conversation?  I was thinking since I'd already talked to one lady there I'd tell the nurse that I've decided not do a pap smear or a breast exam.  And that I understand if the dr has a problem with that and won't see me we can leave before they go to much trouble.  ???  I mean I don't want to leave, I want all the OB care, just not the GYN stuff at the same time.  I don't want to come off aggressively or as if I'm ready to walk out right out of the gate.  I'm just prepared to go if they can't respect my choices. 

[musicmama08]

I might even say I "don't feel comfortable with the Pap or breast exam at this visit."  I would hope they would respect your comfort levels and wishes since your presenting it in a non-threatening way.

By the way, is it ever dangerous to get a Pap during pregnancy?  I got my last and only one before I was pregnant with the last kid, and I could definitely feel it.  Couldn't it cause cramping or spotting or hurt the baby in any way?  That is my biggest concern.

[Ratchet]

It's not about "a fight."  It is about the right of informed consent.  If they can't do informed consent (which thus assumes the option of informed declining) for a simple breast exam then how is it going to go if they recomend a cesarean for a baby they say is too big?  So don't plan to fight of course but do be prepared to end your relationship with any provider who can't provide the services you are paying them for.  It's a contract between you two, so either party can back out if the other isn't meeting the expectations.  It sounds like a good test for a first appointment.  IMO, you should stick with the one who tells you why they would recommend it, asks why you don't want it, and then respectfully allows you to decline.  Bring it up as it comes up.  Like, if they ask when your last pap was, mention it then.  Or when the exam happens.  I am not aware of any harms of doing paps, and I would have to imagine the risk is pretty darn low if it has become the standard of care. 

[DevaMajka]

Originally Posted by musicmama08 

I might even say I "don't feel comfortable with the Pap or breast exam at this visit."  I would hope they would respect your comfort levels and wishes since your presenting it in a non-threatening way.

Don't even say anything about "the dr might not like it." Just say "I'm not getting a pap done today." If they give you trouble, it's definitely a sign that you should find care that is more in line with your needs.

It might be sort of like vaccines- they are "mandatory" and "everyone" gets them. They don't ask you if you want them or not, they just assume you do. But you can walk into an office here and say "oh, we're not getting them" and they're like "oh, ok." Don't know if it's like that everywhere, but the few doctors we've been to haven't made an issue of it at all. (ftr, it's against the Canadian constitution to make vaccines mandatory, but nurses etc. still use that type of wording).

All that to say, that it might be "mandatory," but it might be just fine if you refuse. I agree, don't go in looking for a fight, just be ready to stand strong for yourself.

[scottishmommy]

UGH. I tried to get out of the syphilis/HIV/STD tests, but no. It's required by law. If I refuse the HIV test they will test my baby. Ridiculous, especially since I have to pay for it! Honestly, why don't they just require that I have an MRI just in case I have fill in the blank cancer. It's a lot more likely than me having HIV!

[cottonlily]

From all I've read it's not that harmful to the baby except bacteria from the vagina can be pushed into the cervix and cause an infection.  But in any event I don't want someone digging a pipecleaner in the body part that is holding my baby in.  And I don't want the added stress of the pain, cramping and bleeding that's associated with it.  Apparently the doctors who write in the medical reports that pap smears aren't painful, just "uncomfortable" are all men who've never had it done.  Mine have all been excruciatingly painful and I've been sore for days afterward.  I'm just NOT dealing with that while I'm pregnant. 

Perhaps it is a good idea to wait until they bring the tests up before I say no I'm not doing those.  That's way it's not as if I walked in armed and ready from the get go.  Ratchet's right; medical care should revolve around informed consent.  Unfortunately there is 0% of that going on in my area.  Every mother I've talked to have said "oh yeah they make you do that, I didn't want to either".  I just can't accept that attitude.  And I would certainly switch providers if they wouldn't work with me but wearing a giant napkin with someone not even offering you the option is an intimidating situation to be in.  You have to be prepared before you go.  It's very sad for pregnant women everywhere to have to deal with this.

[cottonlily]

Excellent advice.  Thanks much!

 

Originally Posted by DevaMajka 

[imogenlily]

Originally Posted by musicmama08 

By the way, is it ever dangerous to get a Pap during pregnancy?  I got my last and only one before I was pregnant with the last kid, and I could definitely feel it.  Couldn't it cause cramping or spotting or hurt the baby in any way?  That is my biggest concern.

One issue with Paps during pregnancy is that if a Pap causes you to spot, it can be mistaken for miscarriage or other problems, and cause undue stress to the mama, or cause her to go through unnecessary diagnostic procedures to definitively figure out where the bleeding is coming from.

[KaliShanti]

I have refused a number of tests and my midwife is totally fine with it. *shrug* Informed CONSENT. You have to give your consent before ANY procedure.

[bubbagirl]

I refused quite a few things at a medical hospital midwife group. There were a few things they wouldn't budge on and I didn't want to cause a fight about it but I think if I had to go back I would now that I am not so "new".  I think it helps (depending on the practicioner) if they know you have been educating yourself and are doing a lot of pro-active things for yourself during pregnancy. For example I didn't have to take the GD test because I was taking my own blood sugars so the midwife just asked me to write down my morning and 2 hours after eating sugars, and write down what I was eating for her records, that was enough for her.

I never had to have a pap or get weighed.

A few that I didn't fight were the StrepB test and the blood test ( i wanted to).

[munchymum]

Second time around I definitely feel a lot more confident about refusing tests.  In my experience, medical practitioners are quite happy to respect my choices when I am well informed about my decision.  Like at the end of pregnancy last time around, I refused to schedule an induction.  The doctor was a little surprised that someone would refuse their "offer", but had no problem when I explained that I understood the risks.  The bottom line is that nobody can do anything to you without consent.

[Abraisme]

Yup, this pretty much sums it up.  I decline many of the tests and newborn treatments, it simply meant that I had to sign a form stating that I understood the risks associated with it.  My midwives are very liberal about this, so I didn't have to fight at all.  If this doctor isn't a good fit for you, find someone that is. 
 

Originally Posted by KaliShanti 

I have refused a number of tests and my midwife is totally fine with it. *shrug* Informed CONSENT. You have to give your consent before ANY procedure.