Routine pap at first prenatal appt? Why? - Page 2

[BetsyS]

I hate the way women are blackmailed and coerced. It just isn't right. :

That said, when I was a working CNM, we did offer pap smears to our patients. I worked in pretty low income populations. Pregnancy was the only time the vast majority of my mamas had any insurance (Medicaid). They weren't getting regular paps because of cost, not because of lack of desire. We offered paps early in the pregnancy, so that if some follow up needed to happen, we could plan for that to occur before their medicaid went away 8 weeks after birth. It was a logistical matter for that particular practice.

[momileigh]

I think that's great, Betsy. I think that OFFERING a pap is a great service. I think all midwives should be trained to do paps and should OFFER them. As long as women understand what it is they are being offered, and understand that they can refuse it, at their own risk, without being punished for it.

One woman I know of who refused a pap at a local clinic had to sign a piece of paper acknowledging that she was risking her life and could die as a result of not having a pap. The way it was written, I thought it was condescending. But I guess the office felt they had cya'd enough that way.

[JennaW]

This is an interesting thread. I am not big on vaginal exams myself. As a child, I had a pediatrician that essentially pulled down my under wear and did a pelvic exam without ever asking me or telling me what she was doing. It was a very traumatic experience for me and kept me away from ALL doctors for many years. I have recently found a NP that I really like and I feel relaxed with her. I am going for my first prenatal appt. on Wed. and if they want to do a pap I am going to refuse because I just had one done 2 months ago. I find them to be very uncomfortable and see no reason to do one again since I just had one done and it was normal.

[nashvillemidwife]

I don't like to do paps in pregnancy but I do recommend gonorrhea/chlamydia (and by "recommend" I mean just that). I used to just casually mention them but I've had two cases in the last year that changed my mind. The first was a married couple who had been seeing a doctor and switched to us and her records revealed she had chlamydia at her first visit. She had been carrying it around since before they got married and neither of them had been tested since before they got together. She did not feel she was at risk; if she had started her care with us she would not have been tested, putting her baby at risk for premature birth and severe illness and she could have gone on to have pelvic inflammatory disease.

The other was a married couple whose husband admitted to cheating on her. He developed symptoms of an STD and decided he needed to come clean with his wife for the sake of their baby (I guess he didn't care as much about the sake of his wife alone). The wife had no idea he was having an affair. I must admit I've been in this situation myself, as well as seeing it happen to other women I've worked with over the years.

If the client insists that she is not at risk I let it go, but as a provider I feel it's my responsibility to consider all possibilities, because if I'm wrong the results can be disastrous; to not care would be an injustice to the client and her baby.

[jul511riv]

breaks my heart ot hear these stories, but being cheated on and getting an STD that way sounds more like the exception, and not the rule. Also, I personally feel that being tested regularly and having each and every partner tested is a good rule of thumb for those "non-monogomous" times.

And yeah, I agree that the way womyn are treated by western medicine is wrong wrong wrong.

My Endometriosis (which is in remission/cured/however you want to semantic it) was ignored as a child by several OBGYNs. They said it was "all in my head" "pms" I was "sensitive and weak and fragile". I was told that Endo was a "white professional woman's disease" and that I couldn't possibly have it because I was "under 30" (I was 17 by the time I was able to ask point blank if this was what I had).

I left for a couple of years only to return to an OBGYN who immediately believed me and did surgery. Sure enough...

I felt so happy. Like, WOW, I had the surgery and now I'll be well but then she told me I HAD to have Lupron. I wanted to learn more. Here began my empowerment. I REFUSED to take Lupron and was "dropped" by my doc (at age 19).

Again I went away only to return a couple years later with a new obgyn who referred me to an acupuncurist.

Been crunchy ever since.

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