What tests does your midwife really insist on?

[boomer78]

I insisted to only see a midwife this time around. There are some tests I wanted to refuse and felt like a mdwife might be a better fit this time.

I was able to decline the pap smear and was going to not have the pelvic exam done but didn't stand my ground. I don't understand why was I afraid to decline one at that point. I'm such a chicken. It's my body and I'm really pissed at myself for not standing up to what I feel was right for me.

Anyway, the midwife had mentioned that there are 3 things she insists on - the initial bloodwork, diabetes test and group B strep test. I was going back and forth about the diabetes test but thought if they let me just eat my regular breakfast I can do it. I'm not drinking the nasty artificial glucola. Supposedly I would have to come early with an empty stomach, have a blood draw, then go somewhere and eat breakfast, then come back (in I believe 4 hours). I'm not sure I'm comofortable with that.

I was also not sure about the genetic test but decided to do them. I was given a choice between the new test and the standard quad test and after being reassured the new test has less false positives (is that even true?) I decided for that one. I wasn't even told that my insurance doesn't cover it. I wish someone has told me about that prior the blood draw and not right before leaving the office.

I now wonder whether this is just another practice that works the exact same way as the doctors do, meaning little room for my wants and feelings and pushing procedures on patients without informing them first.

Sigh. Sorry for ranting. I guess I'm just really disappointed at my self. If that was a male OB I would feel super violated.

I know it's my body and my choice. But when they say - this MUST be done. They will most likely kick me out if I don't comply, right? I'm not comfortable around doctors. We don't otherwise use doctors and/or western medicine anymore. 

If I could afford a home birth I would really go for it.

[josie423]

My midwife requires no tests and hasn't during any of my five pregnancies. No pap smears or pelvic exams and none of the three tests you mentioned. She checks my iron a couple times during the pregnancy, that is the most 'invasive' thing I have done (finger prick). I don't see why all the tests are necessary. I'm sorry homebirth isn't an option!

ETA: She checks my urine, BP and the baby's heart tones at each visit.

Edited by josie423 - 9/21/12 at 2:47pm

[boomer78]

Thank you Josie423. I'm jealous of your midwife (in a nice way). :)

I guess choosing a midwife (even very carefully) doesn't mean a win win situation. I don't understand why the tests are necessary, didn't ask either. I was just told they have to be done. Could it be that the practice has an OB there, too? Meaning midwives and an OB working together (although I would never have to see the OB unless there was some sort of issue).

I have so much to read on I don't even know where to start. :)

One option is to not see anyone until I'm in labour. But I don't know what happens then. What kinds of invasive tests for both me and the baby could take place. I don't understand why pregnancy and giving birth has to be so medicalized.

[JudiAU]

The various tests are required/requested because they reveal common problems that can effect the health of you and your baby. They aren't to torture you and yes, you can decide that your discomfort with the test is worth the risk. But there is a huge difference between a routine pap smear and genetic testing or routine ultrasound used for no reason.

Pap smear / pelvic exam allows them to see if you have early cervical cancer, HPV which can turn into cervical cancer, legion removals from HPV that can effect dilation, and unusual pelvic shape. Baseline blood work allows them to check your iron as well as diseases (herpes, HIV, sugar levels) that can be managed during pregnancy but that can harm your baby or passed on during birth. Blood pressure/hypertension/blood sugar can spike in pregnancy even if you don't normally have issues with it which is why it is usually tested with each visit. Group B strep can be easily managed but very damaging if it isn't.

That said, my midwife only requires baseline blood work and blood pressure/doppler/urine test at each appointment. She prefers people take the glucoa test but you can opt out.

[JamieCatheryn]

Mine does urine strips, blood pressure, and hemoglobin for everyone. If there are indications of problems she might ask for more.

[katt]

My MW, independent, not part of a practice, does not REQUIRE any tests.  There are some she likes to take and we talk about them, why she prefers to do them and what information the tests provide and what we do with that information.  

I choose to do a blood test in the beginning (give my records a starting point for my health), I pee in a cup when asked :),  She doesn't have a scale and just asks me if i've weighed myself lately, I do the GBS swab because I can and do that in the bathroom.

I decline the diabetes test and any other test really.

If I presented with something to worry about then we'd discuss other tests further. 

[boomer78]

Originally Posted by JudiAU 

The various tests are required/requested because they reveal common problems that can effect the health of you and your baby. They aren't to torture you and yes, you can decide that your discomfort with the test is worth the risk. But there is a huge difference between a routine pap smear and genetic testing or routine ultrasound used for no reason.

Pap smear / pelvic exam allows them to see if you have early cervical cancer, HPV which can turn into cervical cancer, legion removals from HPV that can effect dilation, and unusual pelvic shape. Baseline blood work allows them to check your iron as well as diseases (herpes, HIV, sugar levels) that can be managed during pregnancy but that can harm your baby or passed on during birth. Blood pressure/hypertension/blood sugar can spike in pregnancy even if you don't normally have issues with it which is why it is usually tested with each visit. Group B strep can be easily managed but very damaging if it isn't.

That said, my midwife only requires baseline blood work and blood pressure/doppler/urine test at each appointment. She prefers people take the glucoa test but you can opt out.

JudiAU, thank you for your input. I wound actually do absolutely nothing if pap smear results came back abnormal, whether pregnant or not. Especially not while pregnant. We don't use any western medicine and the last thing I would do is hop on the train on more invasive procedures. HPV can but mostly doesn't turn into anything problematic. A healthy body can clear the virus. There can be false positives during pregnancy. I remember reading somewhere there are even more false positives after delivery but I have to read into that more.

The pelvic exam didn't involve looking. Just feeling. And as a result I was told I'm only 8 weeks along (should be 12). I mentioned I should be further along, so I was felt again and nope, you're about 8 weeks, pretty sure... I guess I don't know my body anymore or can't read HPT. Clearly I'm either 12 weeks pregnant or about to miscarry. The ultrasound confirmed I was 12 weeks. So to me, the exam was completely pointless, besides very uncomfortable. I'm still cramping and feel my cervix (always happens to me after a pelvic exam). My breasts are not connected to my uterus. No need to touch them. I understand the exam is now way of telling with certainty how long the pregnancy is but that is my point exactly.

From what I know the HIV test isn't always done by midwives for women that choose to home birth. Frankly, there could be a false positive and the treatment at the hospital after giving birth and so forth is another story based on nothing but guesses (yet mandatory). I'm not against testing for HIV. But I wasn't told WHY the initial bloodwork is needed OR what they test for. I just now feel like a teenager who accidentaly got pregnant and is not worthy of explaining stuff to. I guess Medicaid might be to blame. I bet they tested me for drugs, too. :)

Bottom line is - I wasn't against all tests. But I chose going with midwife this time because last time I had a lot of issues with the previous practice, simply for continuously refusing the flu shot. I thought it would be different this way, I would have more room to opt out of certain procedures and wouldn't be treated like a sick person. But now, being the way I am, I don't even want to do the diabetes test. Skipping glucola means coming in the morning with an empty stomach (office is 40 minutes away) while constantly hungry, having my blood drawn, eating what they recommend and coming back in a few hours. 

I expected something different. I didn't feel like refusing the vitK shot (unless clearly necessary) was a good option for the midwife either and that also felt strange. Not much joy for the drops either.

[fayebond]

You need to be able to communicate with your care provider, whoever they are, and it sounds like you ahve alot of work to do with this one.  

They can require whatever they want to to keep you in their practice, its their service, their rules.  But, you can negotiate, and you can leave.  If you showed up in labor you can't legally be kicked out or forced to do something you didn't want done but that's not really an ideal situation, since if you ahve no medical history they will ahve to assume the worst about your health situation (AIDS, GD, they'll have to treat you for everything or get you to sign non-consent forms to cover their legal bases).  

Is there no one else you can see as far as care providers?  What about birth centers?  Is there a friend you can bring to appointments (and, hopefully, the birth) with a game plan of what you won't be talked out of?  Could you bring up how you feel about this "required" testing and how you seemed unfairly pressured?  Hospitals aren't everyone's favorite place, but that have to please thier customers and keep their reputation like any place of business, they'll probably respond to a reasoned complaint.  

Its really hard to say no to someone who insists like that, but try saying "thank you for the information, but I refuse, next topic."  

Hang in there, you can be treated better than that, and you should require that better treatment since YOU are paying.  

[boomer78]

Originally Posted by katt 

My MW, independent, not part of a practice, does not REQUIRE any tests.  There are some she likes to take and we talk about them, why she prefers to do them and what information the tests provide and what we do with that information.  

I choose to do a blood test in the beginning (give my records a starting point for my health), I pee in a cup when asked :),  She doesn't have a scale and just asks me if i've weighed myself lately, I do the GBS swab because I can and do that in the bathroom.

I decline the diabetes test and any other test really.

If I presented with something to worry about then we'd discuss other tests further. 

Originally Posted by JamieCatheryn 

Mine does urine strips, blood pressure, and hemoglobin for everyone. If there are indications of problems she might ask for more.

Thank you ladies. I didn't even know we can do the GBS swab ourselves during the visit. That would be a lot more comfortable. I am not planning on any vaginal exams anymore, at least before and around the due date and if I remember correctly, this test was done closer to the end of pregnancy. Correct me if I'm wrong. That was not given to me as an option.

The scale. Oh yes. That's another thing. I was informed, like with my first pregnancy of what is the goal weight gain. I really don't belive in charts of any kind and this always makes me cringe. I'm very slim and gained about 27lbs with dd. I eat very healthy. I didn't mind with dd but now it feels like another strange procedure to me. I can weigh myself once in a while, I don't need to be weighed by anyone else. Or what, would they not trust me? Would they think I lie about my weight?

So if one CAN decline the GDT why does this practice insist on having it done? If most midwifes don't request it done should I really be looking for another provider since I don't want to go the stereotypical route of going along with everything and not questioning anything?

Does giving birth at a hospital (even with a midwife only) require these tests?

[JamieCatheryn]

You know, a lot of it depends on what kind of midwife they are, and whether the state licenses them and whether it regulates their practice. Some are constrained to do a lot by the book, evidenced based or not, client friendly or not, whether they agree it's needed or not. The homebirth CPM midwives I've seen are not, since they aren't state regulated or sanctioned. So they insist on what little they do find evidence based and just offer the rest.

With my first in the hospital, they required I get ANOTHER round of blood tests done while in labor, even though I had records of the same ones 6 months earlier and no risk factors. In fact they poked me multiple times with the needle to draw blood in the middle of contractions. I believe it was for HIV and Hepatitis and such, again though with a clean record from pregnancy and DH and I being a somewhat prudish married couple, no way we coulda picked anything up. Also I'd had the GBS test done and heard nothing bad back about it but they forced the antibiotics on me anyway. Anything I tried to refuse there was met with hours of argument and multiple "experts" brought in distracting me from dealing with late active labor. So even with the tests in pregnancy coming up fine the hospital ignores them and treats you like you didn't have them or they say you have the worst results.

As far as affording home birth, I found my deductibles and such with OB prenatal care and a hospital birth would be more than the fee for my current midwife ($2100). I am switching when I move and don't know the price of the new one, but it's a poor region and she serves Amish mostly so it can't be much. Her birth kit is cheap I know that. Some even take delayed payments or bartered services. Even if it's more it's so worth it not to compromise in the least if there is any way. That's what I found amazing about my second birth, I thought getting birth care was about fighting for minimal compromise, turns out you can have exactly what you want sometimes without a struggle.

[boomer78]

JamieCatheryn - that sounds scary! I don't understand the reasoning behing pushing all that on you.

As for home birth and Medicaid - it's about $2000 out of pocket. Hospital birth - $0. Obviously there are some charges that can be pushed on you during pregnancy that you have to pay, like in my case, but overall that's a huge difference. Hospital birth is so much more expensive and yet you pay nothing. Home birth, you pay while staying home and not costing Medicaid extra $.

[withlittlelungs]

At my initial check up I got a paper with a list of the procedures and I was able to consent or deny them. They didn't push me to consent to any of the test, but did ask if I would be willing to take the GD test if I could just eat a certain breakfast and come in for a blood draw. 

[boomer78]

Originally Posted by withlittlelungs 

At my initial check up I got a paper with a list of the procedures and I was able to consent or deny them. They didn't push me to consent to any of the test, but did ask if I would be willing to take the GD test if I could just eat a certain breakfast and come in for a blood draw. 

Thank you, withlittlelungs. So you just ate what they recommended and then came in for a blood draw? Not twice the same morning, once on an empty stomach (first blood draw) and then again a few hours lated after eating (for a second draw) like the only other option that I was given?

[withlittlelungs]

Boomer, I actually haven't had the test yet. When she explained it to me she said I would only come in for one blood draw after eating :)

[SmtmsAlwys]

I don't believe that our midwife (home birth CNM) requires any tests, but she does have some she strongly recommends. To my knowledge those are only the Group B Strep and the one for Gestational Diabetes. Based on some high bp readings, she wanted to do a blood panel early on to have a baseline to refer back to if need be - that was fine with me. Testing my blood sugar is no big deal. What she did in past with me was to send the Glucola home with me, have me drink it in the morning, check my sugar on my husband's meter, and phone her with the results. No muss, no fuss.

As far as the Pap/Pelvic, she really prefers to wait and do one after the baby, not before. Even with a past history of HPV, she doesn't worry about it until afterwards. I guess there has been more information coming out that shows it's better to do nothing during pregnancy.

[chocolatechip]

Hi Boomer, it seems from what you're saying that one thing that might make a huge difference for you is finding someone who will at least *explain* the reasoning behind the different tests, even if they recommend taking them, and then let you make your decision. One of things I love about my midwives is that with any given available test, they will sit down with me and my husband for as long as we want, explaining what the arguments are for having a test done, what could be done with the information once you have it, what some of the reasons are for not having a test done, etc. So, for example, they suggested we have a urine test done for gonorrhea and syphilis, even though I was sure I didn't have it, because if you don't have recent test results, and end up in a hospital, the hospital treats the baby with something under the assumption that I might have had one of those things. On the flip side, with recent negative test results, they won't do so (this might partly be because I'm in Seattle, which is pretty progressive with this sort of thing). Since this just required me to pee in a cup, I was fine with it. :) Similarly, with the genetic testing, they explained exactly what the initial screening would tell us, what our options would be if something came up positive, and explained why women over 35 are recommended to have amniocentesis after a positive screen, while women under 35 are not (it has to do with the relative risk factors of an actual genetic defect vs. miscarriage). I hadn't been able to figure that out at all, and was so happy to have it explained! That said, we still declined the test. :) For gestational diabetes, I pee on an indicator strip each visit (no hardship!), and they said they'd only recommend the glucose test later on if something started showing up on the strips (and it could still be declined). I did have a blood panel done early on too, which I didn't mind because I have no problem getting my blood drawn, and it was nice to see that my iron, Vitamin D, thyroid, etc., all looked fine (especially since I was SOOOO tired :)).

Anyway, sorry this is so long, but maybe it helps show that you can find someone who will explain to you the reasoning behind different tests, and give you the space to make fully informed decisions.

And as a sidenote - UGH with the whole "ideal weight gain" thing. I don't even own a scale, and I was very happy when my midwives said they were more concerned about me having a healthy pregnancy than they were about pounds, and asked me if I wanted to weigh myself while there. Which I did, because I was kind of curious at that point. :)

[LDoulaSteph]

My Midwife doesn't insist on any testing at all. If I declined to do any blood work I probably wouldn't qualify for a homebirth as they would have no way of knowing my platelet count. I do a urine strip, check my weight and she checks my blood pressure at every appointment. I am opting out of genetic screening, glucose (I have no risk factors) and the dating U/S. I am doing, by my own choice, GBS screening, initial bloodwork, and the 20 week U/S. I will be asking for no vaginal exams during labour until I know for sure I am well into active labour and I will not be doing any vaginal exams during pregnancy, didn't with my first either. Good luck :)

[finnegansmom]

My midwife doesn't really require much at all, but she really pressured me to have the 3 hour GD test which I did do this time (I have many risk factors and a history of large babies).  I passed with flying colors...glad to know I'm not a chubby diabetic.  Just chubby. 

She encourages a pap smear if you are over due for one, but most prenatal testing (nuchal fold, quad screen, etc) you have to specifically ask for because she doesn't routinely offer it.

She doesn't do dating US routinely or anything.  She doesn't do any cervix checks (pretty much ever) but I will have the strep culture and I'm OK with that.

[buko]

Originally Posted by chocolatechip 

One of things I love about my midwives is that with any given available test, they will sit down with me and my husband for as long as we want, explaining what the arguments are for having a test done, what could be done with the information once you have it, what some of the reasons are for not having a test done, etc.

This is how my MWs are, as well (homebirth CNMs).  I had the standard initial bloodwork done, partly because I needed an early progesterone check at the same time.  Other than that, I haven't had anything but my blood pressure checked, really (I'm almost 18 weeks now).  No pap/pelvic...  I don't think they even do them at all?  At least not routinely?  And I had one less than a year ago, so whatever. 

They had no problem with my declining doppler and will use a fetoscope on me starting next appointment (~21 weeks, when they can actually hear a heartbeat on it).  They just presented info and answered questions about u/s-- they aren't huge fans of routine u/s, but aren't against it, either (I decided not to get any).  (FWIW, though, they said 80% of their clients get at least one during their pregnancies.) 

I am declining being weighed unless I show signs of edema/Pre-e later on, which they were also fine with.  I am 95% sure you can decline almost everything with them, though they might strongly advise you to do a couple things routinely... I get the feeling they wouldn't even TRY to "insist" unless there were a major suspected problem.

This works fine for me, because I actually want to take the GD test and be tested for GBS, for example-- especially trusting that they aren't quick to overdiagnose things like GD.  But I don't want to be pressured into anything because it's "routine," either. 

[boomer78]

Thank you ladies!

Chocolatechip - you hit the nail on the head. I was just hoping for a different experience and well, this feels just like a doctor's office that I tried to avoid this time.

Anyway - talking with someone else, we came to the conclusion that it's not the midwives' fault, it's giving birth at a hospital in our state. She has had the same exact experience with another well known and respected group. Homebirth midwife would most likely have a different, more personal approach. 

I have no problem with GD test if I can just eat food, I will not, under any circumstances, drink the artificial glucola. GBS I will try and see if I can do myself. No more vaginal exams during this pregnancy. I'm OK with them weighing me but I don't want to be harassed about the weight gain. When I was pregnant with dd I gained about 28lbs total. At almost every visit they were bugging me with either eating too much, or too little. I had to laugh at them. I don't have a tendency to gain weight easily, was eating the same (and healthy) throughout the pregnancy and just because I was a pound or two off their chart I was told to adjust my diet on a regular basis. Sorry, not happening. I have to prepare for some pressure about no vitK at the hospital (or so was I told). I also have to look into why doppler isn't ideal. I have read it many times here on mothering but want to learn about the reasoning behind it and talk about it with the midwives.

And most importantly, I have to make some sort of a simple birth plan, things that are important to me, and run it by them. If it's a no go, then I have to figure out what to do next.

Thanks again!!!