What do you think of these doctor-ordered tests? - Mothering Forums

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Old 11-26-2007, 12:54 PM - Thread Starter
 
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Ok, I know that a title like that in a forum like this is like throwing the sheep into the lion's den or something, but in my previous thread

http://www.mothering.com/discussions...d.php?t=794083

I mentioned that maybe I could get my family doc to order the blood work instead of the OB clinic. Well I got the lab requisition. And he put extra stuff on it, I think, because the mw had only said Whole Blood Count. And I tried to talk the doc out of it, but he included a urine test for GD, as a screening. This includes fasting from 8 pm until after the test the next morning.

In fact, there are 3 tests other than the blood count on the sheet. Now, I've figured out it's easy enough to skip the urine test by "forgetting" to fast or simply refusing to pee in a cup ("Oh I just peed before coming and now I don't need to" if that's believable coming form a pregnant woman!)

Anyway, I'm confused about which tests to do, if any. I do want to get the blood count done, and I am still suffering from extreme tiredness, at 13.5 weeks. But then, it seems to me that could also be a sign of GD. Of course, I've also read that there's no point in treating GD, because it doesn't improve the outcomes for mom or baby, but I'm not sure about this anymore.

here is the list of tests:
CBC
Group and Screen
Rubella Antibody IGG (immune status)
Urinalysis, routine and microscopic

I don't know what all these even entail...

Does anyone here skip all tests? Do some of you pick and choose? How do you know what is necessary and what is extraneous?
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Old 11-26-2007, 01:41 PM
 
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If you don't feel comfortable doing the tests that you didn't request...then don't do them. It's that simple. You don't have to lie to the people in the lab...just tell them you only want "x,y and z" done and that's what they have to do. They can't make you take any tests you don't want to.

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Old 11-26-2007, 01:43 PM
 
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I only take the blood work and urine tests because they are easy and do not change the outcome of what I am going to do. It is just nice to prepare for certain things if certain tests come out a certain way. I skip the GD test. I mean come on, a pregnant lady has enough to deal with without fasting and then drinking syrup to top it off. Tiredness at 13.5 weeks is still pretty normal.(iron count?) I do take the beta strep but only one week before my due date. BS can change so fast.

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Old 11-26-2007, 01:54 PM
 
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Quote:
Originally Posted by Pam_and_Abigail View Post
Ok, I know that a title like that in a forum like this is like throwing the sheep into the lion's den or something, but in my previous thread

http://www.mothering.com/discussions...d.php?t=794083

I mentioned that maybe I could get my family doc to order the blood work instead of the OB clinic. Well I got the lab requisition. And he put extra stuff on it, I think, because the mw had only said Whole Blood Count. And I tried to talk the doc out of it, but he included a urine test for GD, as a screening. This includes fasting from 8 pm until after the test the next morning.

In fact, there are 3 tests other than the blood count on the sheet. Now, I've figured out it's easy enough to skip the urine test by "forgetting" to fast or simply refusing to pee in a cup ("Oh I just peed before coming and now I don't need to" if that's believable coming form a pregnant woman!)

Anyway, I'm confused about which tests to do, if any. I do want to get the blood count done, and I am still suffering from extreme tiredness, at 13.5 weeks. But then, it seems to me that could also be a sign of GD. Of course, I've also read that there's no point in treating GD, because it doesn't improve the outcomes for mom or baby, but I'm not sure about this anymore.

here is the list of tests:
CBC
Group and Screen
Rubella Antibody IGG (immune status)
Urinalysis, routine and microscopic

I don't know what all these even entail...

Does anyone here skip all tests? Do some of you pick and choose? How do you know what is necessary and what is extraneous?
Did he say why he was checking your rubella immunity?????

that seems ridiculous.

He said the Urinalysis was for GD screening?

A UA usually checks hydration status, kidney function, screens for kidney infection, UTI and out of control diabetes.... Your blood sugars would have to be pretty high to have any sign in your urine.... meaing you would also be experiencing other symptoms of High blood sugar. The microscope part is just to check the sediment (if there is any) to help determine if you have a UTI...

I may just be having a blank out moment, but I cannot even recall every hearing "group and screen" as an ordered test.....

Why did he say he wanted all these?

~jen~ )O( mama to k 07/05 o 5/08 and c 12/09
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Old 11-26-2007, 02:09 PM - Thread Starter
 
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No, I don't plan on doing the syrup test, this is supposed to be a pre-screen.

Rubella was one my mw said I didn't need. for some reason I thoguht the Rh immunity was in there somewhere, but I don't know.

The thing I am concerned about is that they will do the other tests anyway. The lab at one hospital did tests I specifically told them not to, which is why I am not going back to the OB clinic.

Iron is why I want the blood count done. That's really it. Why is this so hard, to just get what I want?

The urine, can't that be done with the test strips?
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Old 11-26-2007, 02:38 PM
 
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I actually havent taken any blood or urine tests this pregnancy other than the pregnancy test at home lol. I say just take what you feel comfortable with and if you dont feel comfortable with taking it, refuse it.. They cant force you into anything!
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Old 11-26-2007, 02:49 PM
 
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Do the one with the "whole" blood count. With my last pg, I was really tired like you and the dr. checked my thyroid. Come to find out it completely stopped working during that pg. Just something to check besides your iron which could be the case too. Now I'm finding out through another thread on MDC that it could be I'm low on Magnesium.

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Old 11-26-2007, 02:57 PM
 
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OK. If you're going to have a full blood count, having your group done primarily acts as a doublecheck that the right results go to the right person. Rubella immunity will not have any bearing on your care, but will result in your being offered a booster post-partum.
The one that I quibbled with this time is urinalysis: it's looking for bacterurea (symptomless UTI's, including group B strep in urine) that might or might not cause problems and PTL in the second trimester. It's my understanding that UTIs are the biggest cause of second trimester loss. Because for me, my assumption is that I'm healthy until proven otherwise and because we have major issues with antibiotic exposure and resistant organisms, this isn't the right choice for me, but there is enough evidence to show that it is a clinically effective test.
And the fasting urine test???? WTF is the American obsession with sugar anyhow?

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Old 11-26-2007, 03:19 PM
 
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You can get just an iron test and seems like you can skip the rest unless you feel like you need something in there. Personally I think the fasting urine test to check blood sugar is a set-up test for more interventions (and chart markers like "GD") and I would avoid it unless you are not feeling well. I use a glucometer by myself if I'm worried... but my sugars have usually looked nothing but stellar, so I avoid those tests like the plague. I have too many doula clients that have to jump through MAJOR hoops b/c they have numbers 4 points above the cut-off or something. Bleh.

And yes, the urine test can be done with the strip, no reason to go mega-high-tech.

All of this of course is just my opinion...

If you are afraid they will do a test you don't want you can always put your things into writing:
"I (fill in your name) give my consent to the following lab tests but not to any further testing that is not outlined below. If you have any questions, feel free to contact me" and then list your stuff. Keep a signed copy and ask that they put the other signed copy in your chart.

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Old 11-26-2007, 06:51 PM
 
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If you are concerned about GD you can always modify your diet without testing at all. Just balance your carbs evenly throughout the day. Don't gorge. And severely limit sugar. This is good advice anyway even for people without GD. I did not get the GD test even though I am currently seeing a mw. Thankfully she is super hands off and pretty much uses my appointment just to chat about my other kids and what they are up to. LOL. (However the fact I see her makes my dh more comfortable., he doesn't have to know that she does nothing. LOL) I am lucky that we have a glucose meter here at home (my dd is diabetic) so I just told her I'd check my sugar a couple times one day and I'd know if I needed to modify my diet and that was enough for her.
BTW a fasting test for diabetes whether for blood or urine is usually completely useless anyway. (You can however buy some strips at the drugstore to check for ketones yourself.)
I did go ahead and get an iron test. I have had low iron at times but I HATE just taking it randomly because it makes me feel crappy. So I wanted to know. If it's elevated I'll break out my cast iron pans.
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Old 11-26-2007, 07:46 PM
 
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I'm skipping ALL tests thie time, including the CBC, and I feel confident and extremely relieved and happy about it.
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Old 11-26-2007, 07:50 PM
 
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Originally Posted by BirthFree View Post
You can get just an iron test and seems like you can skip the rest unless you feel like you need something in there. Personally I think the fasting urine test to check blood sugar is a set-up test for more interventions (and chart markers like "GD") and I would avoid it unless you are not feeling well. I use a glucometer by myself if I'm worried... but my sugars have usually looked nothing but stellar, so I avoid those tests like the plague. I have too many doula clients that have to jump through MAJOR hoops b/c they have numbers 4 points above the cut-off or something. Bleh.

And yes, the urine test can be done with the strip, no reason to go mega-high-tech.

All of this of course is just my opinion...

If you are afraid they will do a test you don't want you can always put your things into writing:
"I (fill in your name) give my consent to the following lab tests but not to any further testing that is not outlined below. If you have any questions, feel free to contact me" and then list your stuff. Keep a signed copy and ask that they put the other signed copy in your chart.
: Great advice here. Or don't take the iron test even, and treat possible iron deficiency with food and/or a supplement. But me, I don't take needles unless I'm dying...
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Old 11-26-2007, 08:48 PM - Thread Starter
 
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Hmmm, is iron deficiency related to anemia?
I really don't think iron is a problem. I forgot that cast iron pans add it to your diet - that's all we use. Plus, I eat a fair amount of meat and eggs.

I like the idea of putting something in writing, but I'm just going to the lab, I don't know what kind of file they have there on me.

Rubella makes no sense, my mw already said it didn't need to be done. Fwiw, I've already shown "immunity" with previous pregnancies.

I'm usually low carb, it's only been this pregnancy that I've been eating crappy, but the tiredness seems to be more than just "I've eaten too much white flour crap" tired.

At home, we only eat whole wheat pasta and bread, and we only eat parboiled rice or brown. Even if I bake with white flour, I use organic stone ground unbleached flour that is coarse and behaves as if it contains bran.

I think I will try to get the blood done somehow. I thought of trying to modify the actual lab slip, either with white-out (which I don't own but maybe I could borrow) or print my non-consent directly on it. This shouldn't be so stressful.
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Old 11-26-2007, 08:58 PM
 
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Group and screen is the Rh test. Group is your blood type and your Rh status as well as testing for antibodies (if you have antibodies to any blood antigens like Rh)
Youve already figured out what the rubella and CBC are.
These three tests are blood tests, if you choose to have them all done it would probably be three tubes of blood. If you just do the CBC it should just be one tube.

I don't understand how a urinalysis is a test for GD? And why you have to fast for one? It doesn't make any sense as sugar in the urine has been removed from risk factors for GD. Maybe it's leverage to try to get you to do the GD blood test later. A urinalysis looks at the componenets of your urine and cultures for UTI's. I don't agree with asking pregannt women to fast without a good reason too.
Good luck in finding the right tests for you.

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Old 11-29-2007, 04:06 PM - Thread Starter
 
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Well, I have pretty much decided to do the complete blood count and the group and screen. The rest - no. I don't have any symptoms of an uti. If I ever do, then I'll consider that.

My mw actually called me today because her email wasn't working for her to respond. She didn't seem put off by me not coming at 16 weeks, and we've decided 19/20 weeks, or early January for the next one. She pushed the OB clinic thing a bit, well, at least she kept bringing it up. I don't know how much of a hard line I want to take. Before she even mentioned that in the call, she offered to provide her services for free so we can afford the Theraplay private counselling for my oldest dd. We'll probablu still pay her something. There's a lot up in the air with midwifery here, but they did announce they are going to publicly fund it starting in fiscal year 2008, which is before my edd.

There was one time in the call where I think I heard her say something about 'going to the OB clinic, or at least getting the bloodwork done'


Thanks everyone for helping me figure out these tests. All I need now is to build a little courage in myself and my body.
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Old 11-29-2007, 07:57 PM
 
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If your mw raises the subject again, try telling her that you feel uncomfortable with xyz, can the two of you make an entry in your notes saying that you've declined this in case of fallback?
SweetSadie, have you got links saying that sugars in the urine are not a risk factor for GD, btw? Standard practice over here is to go for a 1hour GTT after three urine samples spilling sugars, so I'm curious.

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Old 11-29-2007, 08:00 PM
 
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I think group and screen is blood typing?
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Old 11-29-2007, 10:02 PM
 
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Did he say why he was checking your rubella immunity?????

that seems ridiculous.
They are doing a ruebella antibody because if she isn't immune they plan on giving her the ruebella vax after she has the baby.

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Old 11-29-2007, 10:50 PM
 
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Did he say why he was checking your rubella immunity?????

that seems ridiculous.
I have had six different doctors in five different states test me for this during regular pgcy testing. I am NOT immune. I have told them this every time. I never "remember" to get the vaccine when I am not pg or nursing.

I usually allow any blood or urine tests just because it will not cause harm to me or baby nor will it alter the outcome. Other tests are totally different. I don't get the Rh incompatibility tests, though because I am negative, but so is Hubby, so it is not a possibility.

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Old 11-29-2007, 11:51 PM
 
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You tried to talk him out of it? Ummmmm, who works for whom? If you don't want a test, don't take it. I didn't do any w/ my 2nd. I wouldn't do GD, personally. Group-does that mean GBS? I wouldn't do that one either. I might do Rubella immunity if I was going to go in for tests anyway. These are just my personal preferences.

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Old 11-29-2007, 11:56 PM
 
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SweetSadie, have you got links saying that sugars in the urine are not a risk factor for GD, btw? Standard practice over here is to go for a 1hour GTT after three urine samples spilling sugars, so I'm curious.
The hard part of being a student is not haveing access to all the scholarly journals! Here's something though:
http://www.jfponline.com/pdf%2F5411%...alResearch.pdf
http://www.ncbi.nlm.nih.gov/sites/en...indexed=google

The ontario medical association guide to the revised antenatal records states:
"Urine glucose is not recorded as it is not a useful parameter. It does not detect gestational diabetes, and is not a helpful monitor for pre-existing diabetes."

It's still listed in lots of places as a risk factor, but I think it's going out of fashion.

Mother to none, midwife to many .
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Old 11-30-2007, 12:33 AM
 
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Well, I have pretty much decided to do the complete blood count and the group and screen. The rest - no. I don't have any symptoms of an uti. If I ever do, then I'll consider that.

Having experienced a TERRIBLE kidney infection that landed me in the hospital for a week of IV antibiotics that progressed from a symptom-less UTI, I am quick to suggest a simple urinalysis to any pg women. I have never had a UTI ever before that either.
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Old 11-30-2007, 10:36 AM - Thread Starter
 
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I don't think they're testing for GBS, just blood type. It seems to me that the mw could look that up in my records, but as far as Rh, can't that change with subsequent children? I need tor ead up in that again.

I like the idea of asking her to make a note on my file about refusing the OB visit, so then at least it's my "fault" not hers.

Rubella is the illness that is supposed to be dangerous for pregnant women, but I've been showing "immunity" all along, so it's good enough for me. Taking it means an extra vial of blood, and I'd like to keep as much of it as possible.

Mary you raise an interesting point about UTI's. I may revisit that one.
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Old 11-30-2007, 10:51 AM
 
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I always thought that Rh factor was something that was a constant, like your blood type? I thought it was a subset of the blood type.
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Old 11-30-2007, 12:49 PM - Thread Starter
 
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Yeah, I had to go look into it, because I forgot what it was all about. I'm going to skip the test, because I'm 99% sure I am O+, and I know my DH is the same blood type as me, and all they have to do is look up my blood type on record, and save me that vial of blood.

http://http://pregnancy.about.com/cs.../aa050601a.htm
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Old 11-30-2007, 04:01 PM
 
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I always thought that Rh factor was something that was a constant, like your blood type? I thought it was a subset of the blood type.
Rh factor IS constant. You either have it or you don't. I don't.

If you are Rh neg (meaning you DON'T have it) then if Rh mixes in your blood from your Rh pos baby (meaning they DO have it) then you will create antibodies for the Rh factor. It will not harm you. But if you then get pg with another baby that is Rh pos, you blood will treat their blood like a disease and try and kill it, therefore causing may problems with the baby, and even possibly death.

This is why you get a Rhogam shot, to prevent the Rh incompatibility or Rh antibodies from forming. Once they form, there is no cure. Any subsequent babies with Rh neg will be perfectly fine but Rh pos can have severe problems.

So this test is for Rh INCOMPATIBILITY or antibodies, not the Rh factor.


Now, I have no risk of this at all, as the father of my children is also Rh neg. The only time that you have to worry about this particular problem is if YOU are Rh neg and the father of the baby is Rh pos. Any other combination is no problem.

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Old 11-30-2007, 07:32 PM
 
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I read in a book that RH - can rarely become +... not sure how though. I would love to see the documented cases of those.

Human body and life in general is way too fascinating!

Mum to DS (8yrs), DD (6yrs), and DS(3.5yrs). kid.gif

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Old 11-30-2007, 08:43 PM - Thread Starter
 
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Well, if my husband and I are both O+, does that mean that the baby is safe? This is hard to wrap a pregnant brain around.
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Old 11-30-2007, 09:32 PM
 
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Yes, both + is not a problem with Rh.

The problem arises with an Rh- mother and an Rh+ father.

Since the mother does not have the Rh factor - that's what Rh negative means, no Rh present on the red blood cells - if she is exposed to the Rh positive blood of her baby, she may form antibodies against it as her body views it as threatening. The antibodies won't harm that first Rh positive baby, but subsequent Rh positive babies may be attacked by the antibodies created in the first pregnancy with an Rh positive baby.

Clear as mud?

In any event, you don't have to worry about it one whit if you are Rh+, no matter what the Rh status of the father.
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Old 11-30-2007, 10:27 PM - Thread Starter
 
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Clearer.. See I remember not having to worry about it with my last two pregnancies, but it seems I have pregnancy brain on top of pregnancy brain on top of pregnancy brain, and the test was recommended, and I wanted to make sure it wasn't important. I also know my mom had to have a shot because of the Rh factor thing when she was pg with me.
That's one vial of blood I can keep!
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Refbacks are Off