NST (non stress test): Doing or not? - Mothering Forums

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#1 of 20 Old 04-19-2011, 04:14 PM - Thread Starter
 
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My OB today is recommending weekly NSTs. shrug.gif

 

From the little research I've done, I've found the following:

 

"A NST may be performed if:

  • You sense that the baby is not moving as frequently as usual
  • You are overdue
  • There is any reason to suspect that the placenta is not functioning adequately

 

"If your baby's heart beats faster (at least 15 beats per minute over his resting rate) while he's moving for at least 15 seconds on two separate occasions during a 20-minute span, the result is normal, or "reactive." A normal result means that your baby is probably doing fine for now. Your practitioner may want to repeat the test every week (or more often) until your baby's born.

"If your baby's heart doesn't beat faster while he's moving or your baby doesn't move after about 90 minutes, the result is "nonreactive." A nonreactive result doesn't necessarily mean something is wrong. It just means that the test didn't provide enough information and you may need to take it again in an hour or take other tests such as a biophysical profile or contraction stress test.

"However, a nonreactive result could indicate that your baby isn't getting enough oxygen or that there are problems with the placenta."

 

And then, the path can lead to [as I suspected...]:

 

"If your practitioner thinks that your baby's no longer doing well in the womb, she'll probably decide to induce labor."

 

Aside from the exposure to ultrasound, which I do not want (as DH put it: you don't even want to be monitored during labor, why would you want this now??), I have none of the "risk factors" indicated. But since I am over 40, the OB recommends. My gut feeling is: NONSENSE.

 

Anyone else faced with this decision? What did you decide, and why?

 

 


~Karenchicken3.gifso happy to be mothering my four... DS ('94), DS ('94), DD ('00), and DS -- June 8, 2011, our UC baby!

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#2 of 20 Old 04-19-2011, 08:21 PM
 
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I never had them with DS, but had read in my books that they were pretty standard. I inquired about it with him and was met with the answer that they weren't needed. I shrugged and moved on.

 

With this one if my midwife thinks it's needed I'll trust her on it. I doubt she will, though, she's pretty laid back about most things.

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#3 of 20 Old 04-19-2011, 09:00 PM
 
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I don't think I would do it if I was confident in my baby's health based on their movements and my own physical condition. That he's suggesting it based on your age vs a specific concern with the baby would make me even less likely to go along with it.

 

I think ultimately, like so many things, NSTs (while certainly called for in some situations) are usually about a caregiver taking CYA actions based on perceived risk - like being over 40, or over 40 wks. If you're not even comfortable with U/S, then that's just one more reason why not to do it. Most of the "standard procedures" employed towards the end of our pregnancies tend to lead you down a slippery slope to either induction/failure to progress/distress/C/S or just straight to C/S, and I think it's wise for us all to at least second guess / research the reasons and motivations behind them if we have any ambivalence about them, then decide if that seems reasonable to us for our own situation.

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#4 of 20 Old 04-20-2011, 05:47 AM
 
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I had one when I was 41 weeks with DD. If you have a good history of pregnancies, I don't know that I would do it, as they will "require" induction at the first sign of possible issues, even if it's a false positive. My NST ultrasound said my baby was 9.5+ pounds. She was 8lb10oz 3 days later when she was born.

 

If it's suggested with this pregnancy, I am going to decline it. I've already decided that if my OB gets too pushy toward the end of my pregnancy I'll stop going in period, so I'm definitely not wanting a NST!


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#5 of 20 Old 04-20-2011, 05:57 AM
 
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I will probably have one at some point.  I had one with Dylan and it wasn't really a big deal to me. I do beleive that as small as they are, the risk factors for still birth do increase after 42 weeks. 

 

My kids cook for a long time and I have indicated I'd like one at 42 weeks if he or she hasn't been born by then.


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#6 of 20 Old 04-20-2011, 06:53 AM
 
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OB's/midwives who do standard NST's when you're overdue would have them done well before 42 weeks, most will even want to induce at 41 weeks or earlier.  When did you have yours?  Just curious. 
 

Quote:
Originally Posted by Evergreen View Post

I will probably have one at some point.  I had one with Dylan and it wasn't really a big deal to me. I do beleive that as small as they are, the risk factors for still birth do increase after 42 weeks. 

 

My kids cook for a long time and I have indicated I'd like one at 42 weeks if he or she hasn't been born by then.



 


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#7 of 20 Old 04-20-2011, 07:18 AM
 
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I had an NST a week after my due date with Monkey. The OBs wanted to make sure he was doing ok. He refused to wake up and they had to give me "medically necessary" chocolate pudding. It was rough. The monitor was beeping so loud they could hear it down the hall and ended the test early since clearly he was doing fine.

If you are not comfortable with something, ask more questions. What are the benefits, the risks, etc. What happens if we choose not to?


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#8 of 20 Old 04-20-2011, 07:36 AM - Thread Starter
 
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 thanks, mamas! love.gif

 

from my conversation yesterday with my OB, it sounds like she is "recommending" based on their standard practice and policy for women over 40 (in my case). when i questioned her about the test, what it is, what it is for, etc., she indicated no other reason to me other than my age. obviously i am not overdue! :P (if that ends up being the case, then i would reconsider at that point) then, when i said i would think about it, she commented that she would never "force" her patients to do what they didn't want to do. well, that's nice!

 

this whole thing kind of put me off because it is the first time in my pregnancy where i am being called out for being "over 40". i must say, i was a little down after my appointment. i was talking with OB about birthing positions, and was she comfortable with alternatives, and her reply was basically "yes, but we never know who will end up attending the birth..." i know i'm essentially in good hands if i deliver at our birth center, which is very progressive and naturally inclined, but i didn't like that response from my own caregiver for some reason. i felt like i got the brush-off. then, this business about the NST and i really felt bad....

 

i'm going to follow my instincts on this one and decline. smile.gif


~Karenchicken3.gifso happy to be mothering my four... DS ('94), DS ('94), DD ('00), and DS -- June 8, 2011, our UC baby!

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#9 of 20 Old 04-20-2011, 07:40 AM
 
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I just switched out to a HB partially because my practice based midwife was starting to go overboard with the testing.  As much as I asked for a direct answer at the beginning of pregnancy I've come to see that this practice does not allow those 40yrs+ to reach full term. The OBs goal in the practice was to induce me between 38-39 weeks and I have gone 40wks and 41wks with my past two pregnancies.  They wanted to test me to death with twice weekly NST's and BPP u/s and essentially force induction.  With this pregnancy the baby is super active and I could count 10 kicks in about 30 mins, 3-4x a day easily.  If you feel like the baby is very active and you have no other health risks, other than age, I would discuss whether you need so many of the NST's and what the practice's policy is for allowing you to reach 40 wks or beyond.

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#10 of 20 Old 04-20-2011, 07:59 AM - Thread Starter
 
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Quote:
Originally Posted by KarenMT View Post

I just switched out to a HB partially because my practice based midwife was starting to go overboard with the testing.  As much as I asked for a direct answer at the beginning of pregnancy I've come to see that this practice does not allow those 40yrs+ to reach full term. The OBs goal in the practice was to induce me between 38-39 weeks and I have gone 40wks and 41wks with my past two pregnancies.  They wanted to test me to death with twice weekly NST's and BPP u/s and essentially force induction.  With this pregnancy the baby is super active and I could count 10 kicks in about 30 mins, 3-4x a day easily.  If you feel like the baby is very active and you have no other health risks, other than age, I would discuss whether you need so many of the NST's and what the practice's policy is for allowing you to reach 40 wks or beyond.

thank you! i never considered that might be the case. i will ask at my next appointment. hmmm, now it makes me think why she might have brought up the point that a 14wk u/s estimated my due date at 6/2 and 5/27 (based on conception date it is 6/6).... ugh.

 

my intuition is that this babe is coming a little early. like 38 weeks. but i would hate to have the pressure of induction no matter what.
 

 


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#11 of 20 Old 04-20-2011, 08:02 AM
 
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Quote:
Originally Posted by lovebeingamomma View Post

OB's/midwives who do standard NST's when you're overdue would have them done well before 42 weeks, most will even want to induce at 41 weeks or earlier.  When did you have yours?  Just curious. 
 



 

 

41 weeks 6 days, baby came two days later after "passing" the NST.
 

 


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#12 of 20 Old 04-20-2011, 12:04 PM
 
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Yes, I think that a lot of OBs can barely handle someone 40 or over 40 going to full term or past full term. I think they were just hoping I  It probably depends on where you live (ie. I know from my own experience that Santa Cruz is far more liberal) but I live right outside of Boston and although it is wonderful to be so close to some amazing hospitals, it is nearly impossible to have a birth that isn't a medically managed event.  I've had a lot of conversations with women lately since I am obviously quite pregnant and not a single woman has had a natural labor /delivery. 

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#13 of 20 Old 04-20-2011, 03:04 PM
 
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I'm managed by a high-risk perinatologist, and have gotten 2x/weekly NST's for months now. She's convinced that there's something wrong with the placenta and that I have a very high risk of stillbirth. Given all of her fearmongering I actually appreciate the extra monitoring.. it gives me a little peace of mind. I always try to eat something about 45 min before, and that seems to get her going every time and decrease the likelihood that I fail just because she's sleeping.

 

However, if you have no reason to believe that your baby is at high risk, it seems like you have to ask yourself what would happen if you had a nonreactive NST (i.e. fail the test). What would the next step be in terms of follow-up? Would you be glad that you had the extra information, or would you feel as if you were setting off a potentially unnecessary cascade of medical tests and interventions? I would think that a nonreactive test would trigger things like a ultrasound to check baby's status, and that they wouldn't just order an induction without confirming that there was indeed a problem. But I could be wrong, and probably all providers are different. 

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#14 of 20 Old 04-20-2011, 03:16 PM - Thread Starter
 
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Quote:
Originally Posted by sillysmile View Post

I'm managed by a high-risk perinatologist, and have gotten 2x/weekly NST's for months now. She's convinced that there's something wrong with the placenta and that I have a very high risk of stillbirth. Given all of her fearmongering I actually appreciate the extra monitoring.. it gives me a little peace of mind. I always try to eat something about 45 min before, and that seems to get her going every time and decrease the likelihood that I fail just because she's sleeping.

 

However, if you have no reason to believe that your baby is at high risk, it seems like you have to ask yourself what would happen if you had a nonreactive NST (i.e. fail the test). What would the next step be in terms of follow-up? Would you be glad that you had the extra information, or would you feel as if you were setting off a potentially unnecessary cascade of medical tests and interventions? I would think that a nonreactive test would trigger things like a ultrasound to check baby's status, and that they wouldn't just order an induction without confirming that there was indeed a problem. But I could be wrong, and probably all providers are different. 

 

thank you for your thoughtful reply. may i ask what signs you have that show your placenta is not functioning properly? is your baby growing?

 

yes, i can say that i am wary of setting off the cascade of further interventions. i don't want to get on that slippery slope, especially as i have no indications of needing this monitoring. i don't think induction would be the first stop, but could very well be the end of the road. i am already wondering why some practices don't want women 40+ going to full term. if i am going to be in that game, i want to be very prepared. i have to ask my OB next time about that.

 


 

 


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#15 of 20 Old 04-20-2011, 11:59 PM
 
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BHappy - Our baby looks great on all of the ultrasounds (we've been having those weekly), 50th percentile for growth, but my AFP levels were extremely elevated early on in the pregnancy (18x the median), suggesting a fetal-maternal hemorrhage or some other type of placental anomaly. I also have GD, but they are much less concerned about that.

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#16 of 20 Old 04-21-2011, 12:02 AM
 
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BTW I have also heard that decreasing levels of fluid is a fairly sensitive, early, sign of placental dysfunction. So if you had a nonreactive stress test and the fluid looked totally normal on u/s, maybe they would take a more conservative approach (e.g. repeat NST a few hours later) vs. jumping to recommend an induction.

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#17 of 20 Old 04-21-2011, 04:04 AM
 
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This has been interesting reading.  I was scheduled to have one at 41 weeks with DS1, but I went into labour 2 days before the appointment (phew!).  I am not opposed to them and I think if I went to 41 weeks again, I would probably have one for peace of mind....but I am curious if there is actually any evidence (beyond anecdotal) that they have an impact on outcomes, and what that impact is (do they improve survival, or just increase intervention rate)?  It seems like one of those things that everyone uses because it's reassuring, but I've never been cited a study that showed it was actually likely to decrease risks.  Kinda like electronic fetal monitoring during labour, I guess.

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#18 of 20 Old 04-21-2011, 08:09 AM
 
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With DD, my OB sent me for an NST and AFP at 40w3d.  It was just a precaution, and the word induction never came up  I went all the way to 42 weeks.

 

This time, I will have an NST at 41 weeks to check things out.  Again, there is no threat of an induction, not that there could be since I'm a VBAC patient. winky.gif  It's just to check things out and make sure baby is doing well.  I have until 42 weeks to have this baby before my repeat c/s is scheduled.

 

 


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#19 of 20 Old 04-21-2011, 08:13 AM - Thread Starter
 
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Originally Posted by kmb9906 View Post

With DD, my OB sent me for an NST and AFP at 40w3d.  It was just a precaution, and the word induction never came up  I went all the way to 42 weeks.

 

This time, I will have an NST at 41 weeks to check things out.  Again, there is no threat of an induction, not that there could be since I'm a VBAC patient. winky.gif  It's just to check things out and make sure baby is doing well.  I have until 42 weeks to have this baby before my repeat c/s is scheduled.

 

 


 

oh! i didn't consider the VBAC angle. i am a VBAC, too. this will be my second VBAC (DD was my first), so i don't really consider this one to be a VBAC ! i suppose induction is not in the cards, eh?!


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#20 of 20 Old 04-24-2011, 12:24 AM
 
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