I'm having a hard time finding a good natural pregnancy/birth-minded resource for the various and sundry prenatal tests, scans, and procedures that I'll be expected to have done. So far all I've come across are standard procedure websites, and by their count I'm already behind by 2-3 tests!
I don't want to have a completely low-tech pregnancy, but I want to avoid any unnecessary tests, particularly those which haven't been in use for very long. We are certainly not planning on aborting this embryo/fetus/baby, regardless of what the tests indicate, so I wonder how many of the tests I can/should refuse.
Is anyone else out there considering a less-tested pregnancy? Have you done low-tech only in the past? Are there any resources that you know of that can give good information about the purpose and research behind all of the tests that will be offered? And how does one go about refusing a test anyway?
I dont do the GTT (never have) and I don't take the prenatal rhogam.
Here are some books I recommend:
Ina May's Guide to Childbirth by Ina May Gaskin
I LOVE Ina May and this book has been known to be a game changer for many women, helping them to feel more informed and empowered about the decisions they make during their pregnancy and birth.
The Thinking Woman's Guide to a Better Birth by Henci Goer
This book covers a lot and gives you the bottom line when it come to testing.
Gentle Birth Choices by Barbara Harper
An older book but very informative regarding all of the choices you will be faced with.
You might also want to watch The Business of Being Born. Excellent movie and Netflix does have it.
Hiring a doula would also be really helpful to you in navigating it all and helping to make sure you have all of the information you need to make the most informed decisions.
Last pregnancy I had a midwife and birthed DD in a birth center in a hospital. This time we are planning a homebirth with even less intervention. We are opting out of all testing except for state mandated blood work, and we are opting for one US at 8 weeks and the 20 week anatomic scan. We are also very happy that our midwife uses a fetoscope instead of a doppler for listening to fetal heart tones.
I hope this helps some. It can seem overwhelming but the more you know the more you are in control of your own birth experience. Remember, you as the patient have the right to informed refusal of any testing!
I do a basic blood and urine at the beginning of the pregnancy and then the ultrasounds unless I am sick or something and need more urine or blood. My dr. has never suggested any other tests because you aren't allowed to abort here anyway (not that we would) and he is able to monitor things via ultrasounds. My oldest did have a LOT of ultrasounds because I was super anxious after having three losses, so every visit, the dr. would just show me that the kid was still in there, still kicking and that was that, he didn't even charge me for those. Of course, my son WAS born with a birth defect, an imperforate anus, but you can't find that ahead of time anyway unless there are other complications, which there weren't, thank goodness.
I know you're asking for people that have done less testing, but I wanted to give you the perspective of someone that does all the normal tests. I didn't find any of them particularly invasive and i thought all the results were worth the effort. Everything is found with blood draws which they do anyway to make sure blood is looking good (for me it was very important as my platelets sky dived at the end) and urine. I found the results comforting. Chances are the results will come back good and I felt like if I didn't take the tests, then I would worry about what the results might have been instead of not having to. If I took them and they were bad, I would worry. If I didn't take them, I would worry they might be bad, so I would rather take the test and have a higher possibility of having good results and less worry..not sure if that makes sense. As you can see, I have a natural tendency to worry :) The word worry is starting to look really weird at this point..
I guess my point is that for me, there's no reason not to take them as they don't cause harm to the baby and it would help me mentally prepare if something was found out.
I didn't do much testing with DD, and I don't plan to do much with this one. My home birth midwife does BP and urine checks at every appt. She doesn't even do weigh-ins! She trusts me to tell her what my weight gain has been. She does palpate the baby for position, and measure my fundus height. I forget my blood type, so I'll have her test me and DD this time for rh, in case we have to worry about incompatibility with this one. And I'll get the 20w anatomic u/s, so that I can see placenta placement and be prepared for any major anatomical anomalies. That's it for testing. We probably won't even do the dopplar until labor, and just listen with the fetoscope at my prenatals.
I'm fine with a low level of testing, because I don't know that finding out that information would really change anything. Any major concerns will be picked up with the urine and BP checks, and the one u/s. I have faith in this level of testing because we were able to catch my pre-e in plenty of time with DD, at which point I transferred care. For me, hospitals make me REALLY anxious, and I just don't see any reason to set foot in a hospital (other than the u/s) unless I get sick. I guess the routine tests aren't that invasive, per se, but for me they cost more time, money and worry than they are worth.
We do very, very little testing. My midwife is very laid back (a CNM who attends home births and has a freestanding birth center). She doesn't check weight (she's got a scale in the bathroom, so I can check when i want to), we run the usual early blood tests, but we mostly choose not to have the rest done. We would not change anything by knowing something was wrong, so we just go along and enjoy the pregnancy. I've had two drug-free and intervention-free births, so I just trust that my body is doing fine. We will have one ultrasound around 20 weeks, to make sure there aren't major issues that will affect the birth, but that's about it.
My last several pregnancies were in a very rural area with a pretty laid back medical staff overseeing and I declined what I wanted to. This pregnancy I'm in an urban area so I'm not sure if I'm going to be offered any additional tests.
I will be declining the nuchal translucency u/s (statistical low risk, wouldn't abort), and the triple/quad screen.
I do take the GTT despite its variable reliability as I have a family history of diabetes. I would absolutely decline the 3 hour GTT if I failed the 1 hour. I took a 2 hour test (yeah I know, not really standard) and it was awful, I felt so ill by the end of it... if I "fail" that test, as I've said, I would insist on going straight to the diet if necessary.
I will allow a mid-pregnancy ultrasound to make sure there's nothing wrong with the heart or indicators of down's (again, just for "knowing" since they are already doing the u/s, not to abort). I would most likely not have an amnio unless there were indications of a lethal anomaly.
As for how you decline a test, they'll say something like "we need to draw some blood for XYZ" and you reply "no, I'm not interested in having that test done" and if you feel it's necessary, offer a reason. Don't let them push you into anything.
I did all the testing offered with my first. It was fine, but a little scary each time. With the second I decided not to do anything beyond the first blood work and the level II u/s I knew we'd have because of SO's family history. When I was 32ish weeks with #2 they were doing a routine scan after I took a big fall, and thought they found a big open space where part of his brain was supposed to be. They gave me the name of it to Google and found it was 5x more likely to be a false positive with a boy, but if I was carrying a girl she'd have Trisomy 18. I was devastated, especially as I never found out gender. I went from the Dr. office to the hospital, to the fancy regional hospital, where they finally (after a week of torment) were able to tell me that, of all things, it was just a bad angle on the u/s wand.
I've been thinking about what to do with #3. I don't want to do everything again, like DS1. I don't want to do NOTHING again, as that week of thinking my baby was going to die was not worth skipping testing on moral grounds. So, I have no idea what I'm going to do.
Things have been a little different in each pregnancy for me. I did most of the regular tests with my first pregnancy, though I declined the tests for birth defects, and have in all of my pregnancies. I declined the GTT with my second, and declined the GTT, GBS swab, iron testing, and ultrasounds with my third and fourth. With my fifth, I declined all of those except the GBS swab, and I had an ultrasound at, oh, around 37 weeks because I was measuring small.
I passed the GTT in my first pregnancy, I always measure small, and I have no risk factors for GD, so I will likely decline again. I'll likely decline iron testing, since I'll be bulking up on iron anyway and I don't have a history of problems with bleeding after birth, and I don't want to get stuck with a label if my numbers come back low. I will do the GBS swab again; when I've done it, it has come back negative for GBS, but with my last pregnancy, it was positive for group A strep. If I'm positive again, I want to make sure my care providers know, although even if I didn't swab, I would do everything the same way we did at that birth (I don't think we did any internals, maybe one? and I took my temperature regularly for the first day after giving birth). I also think I will do a dating ultrasound this time, because I was measuring small last time and when I went in for that ultrasound, it was a hassle not having a baseline to work from. I was close to risking out for a homebirth and needing to be induced just past term because of it, so I would like to have more information this time.
I skipped... a lot with #1. I think laws here have changed (like with mandatory HIV testing) so I might have to do some stuff I didn't do before. I did do regular weight, blood pressure and the occasional iron check. My iron levels were always fine and I didn't supplement. I did the 18 week ultrasound. I skipped the GTT and just monitored my own sugar occasionally. I also did the GBS swab which thankfully was negative but aside from that I refused vaginal exams during the prenatal checks.
I know that they now recommend the nuchal translucency test to check for chromosomal abnormalities (down syndrome, etc.). It's an ultrasound done between 11 and 13 weeks. It's supposedly more reliable than the triple/quad screen. I'm really on the fence about whether i'll do it or not. I'm just 35. I'm not one to run extra tests, but this one has me thinking. It's kind of a "do I really want to know this early if something might be wrong?" kind of fear, I think.
I'll be doing all the tests to make sure I'm healthy. I think it's very important to watch for signs pointing to complications that need to be addressed. I have talked with my midwife about doing my own blood sugar monitoring instead of a test, and I'll do all the blood and urine tests. I will not opt for tests on the baby except for heartbeat checks and an ultra sound (these will reassure me and help me shop). If there was something wrong we wouldn't abort so there's no reason to know.
With my first baby I declined all the tests except for the basic bloodwork (Rubella titer, CBC, etc.), urine dipstick, and an Rh sensitization test once a month. I am Rh negative and declined prenatal Rhogam, so the blood draw every month tested my blood to see if I had become sensitized. We tested Ds's cord blood when he was born and it was + so I got Rhogam at 48 hours pp. I didn't have any ultrasounds and we used the fetoscope for prenatals (doppler for labour). With this baby I will be going the same route, except I will be getting an early dating ultrasound since I don't know when I conceived (I am breastfeeding and didn't have a cycle.).
I'm considering skipping the GTT & GBS test. Although, my midwives are encouraging me to take the GTT because in the event of a birth emergency, any mama not tested is considered to have GD and the baby is treated accordingly. (Any thoughts/input about this?)
I'm absolutely skipping anything genetic, like the nuchal translucency and the triple/quad screen.
I did have an early ultrasound(yesterday!)because I have a history of RPL and wanted some peace of mind. I'll probably go back for the 20 weeks anatomy scan and possibly once in between. I know some people worry about the safety of ultrasounds but for me they're indicated. AND reassuring!
I do the urine tests and weigh in at every appointment. My midwife checks fundal height. I already know my blood type, and I'm RH+, so that's not a factor, and there's no need to retest every time I get pregnant. I don't do the STD screenings because both DH and I are clean and faithful, but if there was any question, I'd do it. I don't test for Rubella antibodies because I am ethically opposed to the Rubella vaccine and wouldn't do anything about it anyway. If there was something I could ethically do about it, I might test. I don't do the GTT because if I had a problem with GD, I would think that I would have glucose in my urine and I try to mostly avoid sugar anyway. If I had glucose in my urine... ever... I might consider it, but after hearing my midwives joke about how they know how to cheat the test, I'm not sure I'd trust the results anyway. I would probably do an A1C instead. I do the GBS test because my homebirth midwife says that in her experience, local hospitals do a lot of unnecessary interventions on moms who don't have it done.
As far as screening for the baby, I don't use a doppler except for in labor, and we tend to avoid ultrasound in general unless there is an indication for it (like when my midwife thought that DD might be twins). I'm very opposed to attempting to genetically screen the baby (CVS and amnio) because those carry with them risks to the baby, and parents face great pressure to abort if there is any sign that something might be wrong. I am especially opposed to most of the earlier tests. The only reason those tests are done so early is because if the parents are going to abort the baby, it's safer for the mother to do it early. If you are concerned about wanting to know ahead of time to be ready with needed medical care when the baby is born, you can see what you need to see with mid- to late-pregnancy ultrasounds, and if you find something after 20 weeks, it'll likely be a more accurate diagnosis, and you'll face less pressure to abort. I'm not opposed to blood tests for hormones levels that might give you a clue that things are fine or not, but ask questions about the false positive/negative rates on the tests you're considering. If you get back one blood test that indicates that there might be a problem (even if there is not), it could cause a lot of unnecessary stress, and you may feel a need to go through a lot more invasive testing so that you can really know. Even if you are fine without the more invasive testing, you may get a lot of pressure to do it. It's great when prenatal testing can put parents at ease that everything is going well. When there is any indication that there might be a problem (and there are a lot of false positives), it's a mess, such a mess that it might just be better if the test hadn't been done.
I would ask with every test if it would change what would need to be ready when the baby is born (such as needing to deliver by C-section or needing specialized medical equipment on hand that wouldn't normally be there), if it could detect something that could be treated before birth (there are some surgeries that can be done on a fetus, though they are quite risky and would only be done if it would save the baby's life), and if there is a more accurate test that can be done later since you are not considering abortion. The earlier tests tend to be less accurate and only done to make abortion easier, and many abortions are done on perfectly healthy babies. I would also question what effect the testing would have on you. Would finding out that your child has Downs Syndrome let you go through your mourning before the baby is born, or would you just begin the mourning earlier? Would finding out that your child has a cleft lip prepare you to learn about feeding a cleft affected child before your baby is born, or are you connected to good resources that you could pull from immediately after your child's birth?
SparklingGemini, would you be able to get an A1C instead near the end of your pregnancy? That is a more accurate test that doesn't involve putting anything you wouldn't want into your body. It is a blood test that shows what your blood sugars have been for the past several months, so you can see that you haven't had elevated blood sugar (which is what diabetes is). If you end up doing the GTT, talk to your midwives about using something other than the icky glucose solution. The requirement is that you get so many grams of glucose, not that you take that particular solution. You can also do things like exercise during the test period to get the glucose out of your system faster, get better results, and probably more importantly, reduce the amount of time that you have an unhealthy amount of glucose in your body.
JMJ - Thanks for your posts above. I don't know anything about all the tests yet, but your post provides a very thoughtful set of questions to ask myself and my husband to determine what we want. Thanks.
Wow, thank you all so much for your replies! I never realized there were so many different ways to handle prenatal testing! I think at this point I'm going to do the initial bloodwork, and ask how accurate the dating ultrasound will be. For all the other baby scans, I'll ask whether the knowledge gained from it will change any of my prenatal care, and whether it will be more informative to screen later on in the pregnancy. I would prefer to just hear heart tones with a fetoscope, but I don't know if that's common practice with the midwives I'll be using. I honestly don't know if we'll do a 20 week u/s. We'll definitely do a 3rd trimester scan so that if there are any indications that extra care will be needed after birth we can prepare for that. Otherwise, I think I fall into the category of "better off not knowing until the end." I'd rather assume that everything is proceeding normally for the majority of the pregnancy, so that my stress levels don't shoot through the roof. I've had several friends who got false positives on the genetic tests, and had months of stress, only to have healthy, happy babies. That would make me crazy!
As far as tests on me, I'm fine getting tested for rh, GBS, and iron levels. Not sure how I feel about the GTT. I'm torn on the vaginal exams. I know I don't want them during labor, (and especially not when I'm getting close to my EDD, don't want my membranes "accidentally" getting stripped!) but I'm not sure how useful they are during pregnancy. Are they very important for finding out information about how the pregnancy is progressing?
Well it's been forever since my last (healthy) pregnancy but...
They don't do the nuchal ultrasound here. So that's not a concern for me. I know my conception date anyways so I don't need it for dating.
I had the 20 week scan with DS but I'm considering NOT geting it this time, becuase I feel half teh time they miss important things, or diagnose things that aren't tehre.
A close friend of mine was told at 20 weeks there was a heart defect, then at 21 weeks that there wasn't... At 34 weeks they decided again that there was, and it caused her so much stress. She had the baby before 37 weeks. Baby is doing ok, but it's nothing that couldn't have been treated had she not known. It's good to be prepared but at the same time it can cause stress for nothing, since there's nothing they could do until the baby's born except more ultrasounds.... and there are risks to ultrasounds as well, including premature labour, which my friend had. And heating up the fluid, and bubbles being formed...
But then again I use a doppler in early pregnancy for reasurance (past miscarriages) Only a couple times. But the risks of that are higher than ultrasound.. and less necessary, so maybe I'm a hypocrit lol.
I refused the quad last time becuase I wouldn't abort anyways. Again, might be nice to be prepared if there WAS but there's a high rate of false positives. Concern for nothing, etc.
I've done my standard bloodwork so far, for STD's or whatever. It didn't bother me to get that done since I was doing betas anyways. Might as well keep my doc happy lol.
I'm not opposed to fundal height measuring. It doesn't concern me if it's too high or low so they can go nuts. I consider it a fun game lol.
My doc doesn't do weighing, thank friggin goodness.
I'll get my diabetes test. No risk and it's dangerous if you have it.
I wouldn't get rhogam if I were rh neg. You only need it if you've suffered trama, and you have 3 days to get it.
My last midwife didn't do cervical checks but I did my own (lol.) This time I'm going to NOT check becuase it means absoultely nothing if your dilated or not. No sense getting hopes up or down.
What's the deal with Rh factor? I had a bunch of bloodwork for infertility work-up (yay for spontaneous pregnancy before $$$ procedures!), and I'm Rh negative.
It's really only a big deal if your partner is RH + because then the baby could have + blood and you're body will develop antibodies against the baby. This isn't so much an issue with the first pregnancy because the body won't have developed the antibodies til blood exposure, most likely near the end of pregnancy, but it can be quite deadly to all the pregnancies after the first.
I did a lot of research about it my first. I would take it if i needed it but my dh and I are both negative and so there's no way we could have a positive baby (it's the recessive gene). Otherwise, I would have no problem having the shots, I feel the shot is very low risk especially considering the possible outcome otherwise.
Why you don't need the rhogam shot: http://thecontrarianmom.com/2009/06/24/rh-factor-the-truth-about-rh-factor-pregnancy/
Thanks for the education. I had never heard of this issue before, but I guess we're okay. I'm A- and my husband is O-.