routine lab work (OB panel)...pros and cons?

[caedmyn]

I'm 5.5 weeks pregnant and will probably not be seeing a midwife until around 27 weeks as we'll be moving to a different state then and I don't really see the point in finding someone to see here. I have found a midwife in the location that we'll be moving to, and she mentioned that she normally orders the "OB panel" toward the end of the first trimester, but that I could wait and do it when I establish care with her. I know with DD's pregnancy I had the blood panel twice, during the first trimester and again around 28 weeks. I don't really understand what the panel checks, though. Can someone explain this to me? Also, is it really necessary, and if so, are there advantages and disadvantages to getting it done earlier or later in the pregnancy? It's an extra $150 and I may just skip it if it's not necessary.

[holly6737]

Aren't they testing mostly for STDs/HIV and an initial hemoglobin? That's what I was always told when I was pregnant. I'm not a midwife, though, so maybe someone else could help. If that's true and you already know your STD/HIV status, I would think they could do an initial hemoglobin with just a finger prick, instead of the full panel.

[rajahkat]

A basic panel is going to include blood type and factor (which you should already know if you're positive or negative since you've already had a baby). Hemoglobin/hemocrit to diagnose anemia concerns and get a baseline reading, and possibly testing for Rubella immunity, hep B, and HIV.

In my opinion, most of it is unnecessary if you have had it done before and your risk status for diseases like hep B & HIV hasn't changed.

Kat

[bobandjess99]

Yep, what has been said.

I personally feel very comfortable declining this test, since I know my blood type, STD status, etc...

[caedmyn]

The only thing I would "need" out of that list is the hemoglobin, so maybe I'll see if there's a cheaper way to get that, or I'll just skip it altogether. I did just have some blood work done for life insurance...I wonder if hemoglobin was one of the things they checked with that. I'll have to check my copy of the paperwork. Thanks for the responses.

[Reha]

You could instead ask to have a simple CBC, which will look at your Hemoglobin/hematocrit, white blood cells, platlets, red blood cells. It runs around $25 in these parts.

[Defenestrator]

I would be very reluctant to get a HIV test while pregnant. Pregnancy itself can make certain kinds of screening unreliable and if you are marked as being HIV positive, you may face some very restrictive policies if you transport. If you are interested in your HIV status, you can always do anonymous testing.

I order a CBC w/ platelets, a Hep B test if one has never been done, a blood type and screen if women don't know their blood types, and an antibody test. I sometimes do rubella testing, though rubella is extrordinarily rare in my area and so I try to provide informed consent for that one.

Sometimes I do testing for some stds as well, if the clients want them.

[Paige, CPM]

I would recommend that you discuss this with the midwife you will be working with and find out her reasons.

One other reason, not that I think it is a definite reason to get the panel, but a reasonable reason to do it, is because if you should ever need to consult with a doc or transport they have the info and this makes you and your midwife seem like 'normal' and not so out of the realm...if that makes sense.

The panel does not include HIV, that has to be ordered separate.

An OB panel usually includes:
CBC
Type & Factor
Antibody Screen
Rubella Immunity
RPR (Syphilis)
Hepatitis B

Some also order a Urinalysis w/ culture and sensitivity IF necessary.

Then there is a routine pap and breast exam and some do physicals.

I am wondering if there are low cost prenatal clinics that you could go to and have the inital done and covered by the state or grants or just plain low cost... I would ask other midwives where you are living, they would know of these places...or maybe they can do it for you...my OB panel is 75$ (plus a visit fee).

Best in your decisions!

[Midwife Kris]

Originally Posted by Paige, CPM

One other reason, not that I think it is a definite reason to get the panel, but a reasonable reason to do it, is because if you should ever need to consult with a doc or transport they have the info and this makes you and your midwife seem like 'normal' and not so out of the realm...if that makes sense.

This is what I would say too. It's also been suggested in the thread that you "don't need" the panel if your status of X, Y, Z haven't changed. I wonder how you will know if it's changed until you screen? I have known more than a few women with some significantly surprising results and they had no idea because their health status (that is, how they feel) hadn't changed in a way that would've alerted them without the blood test.

[rajahkat]

"health status (that is, how they feel) hadn't changed in a way that would've alerted them without the blood test."

I said risk status, not health status. As in, if you had a Hep B test and it was negative 3 years ago, you haven't switched partners, slept around, started working around needles or infected people, or become a drug user, then your risk of having caught the disease hasn't increased, taking the test again doesn't really make sense.

I don't think your blood type is going to have changed on you either. If you have paperwork or medical records with your blood type/factor testing for it again is a waste. And if your midwife can order the individual tests you do need separately, it should bring the cost down for you. A finger prick for hemoglobin probably won't cost you anything if she has a meter in her office.

I'm not saying anyone SHOULDN"T get tested. I'm just questioning the line of thinking that you should get tested because if you need to consult with an ob, then you'll look normal. How is it normal to test for things that you already know (your bloodtype,) and diseases you've already tested negative for? It makes you look like you are incapable of understanding information given to you and making your own decisions. Is this really what we want to propagate as normal?

I can see how it happens with providers who see a large volume of women, they have a routine, and the women rarely even know what is being tested or why. Who has time to explain, right? It's easier to fall into the easy way of covering your bases and testing everyone regardless of need or risk status just so you can say you provided thorough care.

Well folks, that's not thorough care. Thorough care is explaining to the woman what the tests are for, what HER risk status is for diseases like Hep B, Rubella, HIV, C&G and letting HER decide what she needs/wants.

[Paige, CPM]

I don't think anyone is disagreeing that if you have intelligence and are thoughtful you can get a good health picture of someone and have confidence in caring for them, or they themselves can have confidence...but, the majority of consultations (even with the ob in my area who has an 8% c/s rate and is very respectful) are going to want to have everything at their fingertips if there is a problem to rule problems. An OB panel makes that easy to do. Even for some of these tests, a partner may have had an affair without the mom knowing...it doesn't happen in all relationships but it does happen a lot...and exposed her to something dangerous, so having current blookwork is not a bad idea.

I'm just questioning the line of thinking that you should get tested because if you need to consult with an ob, then you'll look normal. How is it normal to test for things that you already know (your bloodtype,) and diseases you've already tested negative for? It makes you look like you are incapable of understanding information given to you and making your own decisions. Is this really what we want to propagate as normal?

rajahkat


The point you are tying to make comes across as a bit harsh...about how intelligent you are or someone is if they do great counseling and tests are declined or pulling old results together...I do not think we are debating this as legitimate form of care...but the fact remains that no matter how great a care provider you are, in the real world, there are many many docs, nurses and even nurse midwives who think hb is dangerous and their aptitude (ability to be open to) and time frame for having a philosophical discussion about what good care is in this context is probably best saved for the CPM 2000 study discussion and homebirth over all, rather than silly blood work.

I explain all the bloodwork what/why to my clients and make sure they know they can decline anything, I also explain about consultations and why that might be a different reason to do them and they decide

Just my 3rd cent re the subject.

[Cativari]

Not a birth professional but thought I'd chime in...I already have 1 baby (she was my 2nd pregnancy) All of my tests came back normal for both of my previous pregnancies but this time something new come up on the blood work...it showed I have an anti-body to little c. This one isn't particularly agressive so even if it was not found it prolly won't have been bad (although we're keeping an eye on it with titiers every few weeks)...However had it been something that produces more anti-bodies and had not been detected it could have been really bad.

My point is you don't have to do all the tests over again each time especially if your risk factors haven't changed for the tests but if there is a possibility that the test will be different consider taking it.

[rajahkat]

Paige, it's not a personal attack. I'm sure you explain things to your clients very well.

And really, it's just my own personal opinion, and something that I feel strongly about (women being given a little credit for being able to understand when testing would make sense and when it might not and respect for decisions they make about their care, instead of being coerced into what is easy)

So, if it comes across as harsh, well, I guess the things we feel strongly about do, sometimes.