Medical Choices During Pregnancy

Before my ALI journey, I had a pretty basic idea of what conception, pregnancy and childbirth entailed. You decided you were ready for a baby, you got pregnant, you went to your appointments and did what the doctor said, you went to the hospital and had your baby. BAM. Easy peasy, right?

When things took much longer than anticipated for us to even conceive, it was a shock to everything I thought I knew — but on the upside, it spun me into an alternate world of educating myself by researching statistics and options and asking questions about why doctors recommended we try different drugs or do different procedures in the quest to make a baby. I ended up following a mix of Eastern and Western methodologies during our TTC journey, and I truly believe there is a lot of benefit to be had and knowledge to be learned from BOTH of those ideologies.

Once we got pregnant, I was a fairly low-key pregnant woman who had educated myself on my birth preferences and thankfully had the ideal birth experience for me. I just went with the flow of what my hospital-based midwife recommended testing-wise during pregnancy (which honestly was a lot more hands off than the typical OB testing regimen), and it honestly never occurred to me to research much about it because I was so focused on the birth experience.

This time around, my insurance deductible is horridly high and we are planning a home birth for a variety of reasons, so this catapulted me into researching many of the “routine” tests and procedures that are currently done during pregnancy. When one is suddenly paying out of pocket for every test, money is a huge incentive to research and decide if the test or procedure is actually necessary or even beneficial.

*Please note – the estimated costs I included below are just that – total estimations, based on what I have paid in the past or what I found online. Costs can vary WIDELY (by hundreds of dollars) so you’d have to call your specific medical facility and/or lab to find out your actual costs.

Okay, so please bear with me and this long-winded post. There are a plethora of routine tests that are usually done during your prenatal visits, though this is by no means a comprehensive list if you are considered “high risk” for some reason (FWIW – this is also a term I take some issue with for reasons too lengthy to add to this post right now). I just thought I’d lay it all out here so you can see the gamut of tests that providers routinely bill your insurance for now days and how I made my decision to do or decline them. I am not a medical provider – please make sure to discuss any questions you have with your own provider! I was just thinking that some of you would find it helpful to have all of my research in one place. (here is a pretty comprehensive list of what is available to have done at standard prenatal visits)

At Every Visit: (my midwife does all of these)

  • Weight
  • Blood Pressure
  • Urine Dip: checks for protein and glucose, among other things
  • Measurement of uterine fundus (my midwife also measures my belly circumference)
  • Fetal Heart Rate

First Trimester:

  • Pap Smear (I didn’t do this – I will next summer at my annual appointment)
  • Urinary Analysis (to check for UTI) – this was done during my 1st pregnancy (hospital midwife), never even mentioned during my 2nd (homebirth midwife). I have no history of these or symptoms of one now, so it seemed a bit of overkill to routinely test for it at my appointments unless I was symptomatic.
  • Cultures to check for the STDs Gonorrhea & Chlamydia (I did these around 36w with Stella because my hospital required them to decline the eye ointment on the baby post-delivery)
  • Routine Blood Tests (my midwife charges $150 for this – prices can vary widely depending where you get this done!)
    • Blood type (A, B, AB or O)
    • Rh factor (Rh positive or Rh negative)
    • Antibody Screen
    • Anemia (CBC)
    • Rubella immunity status
    • Varicella (chicken pox) immunity status
    • Hepatitis B
    • Syphilis (RPR)
    • HIV (I declined this both pregnancies, as it’s an expensive test and I wasn’t worried about it.)
  • Early ultrasound (to confirm dates and intrauterine location) <– Not necessary by any means, but I did it both pregnancies for peace of mind — and I paid out of pocket for it (about $400).

Second Trimester: (I declined almost all of these – I’ll expand on this further below)

  • Nuchal Translucency (NT) screening – determines if baby has an increased risk of Down Syndrome or a congenital heart defect (note – doesn’t actually determine yes/no – just gives you probabilities) – cost around $200
  • Chorionic Villus Sampling (CVS) – analyzes for chromosomal or genetic disorders in the fetus. Cost is around $1500 out of pocket.
    • Chorionic villus sampling is not recommended for women who have vaginal bleeding or spotting during the pregnancy. It is not typically recommended for women who have Rh sensitization from a previous pregnancy.
  • Quadruple Marker (or triple test) – a screening procedure that measures the amount of four substances in your blood – Alph-fetoprotein (AFP), Unconjugated estriol(uEST), Human chorionic gonadotropin (hCG), Analyte inhibin (Inh). Based on the levels you will be classified as high-risk or low-risk for chromosomal abnormalities & neural tube defects. Cost is around $600 out of pocket.
  • Anatomy ultrasound – cost around $400
  • Gestational Diabetes (GD) Test – cost around $100
  • Rh- Screening + RhoGAM shot – cost $150-250

Third Trimester:

  • Group B Strep Test – cost around $100
  • NST (non stress tests) – generally only done if one is past 40w gestation or has GD – cost around $200
  • AFI (amniotic fluid index) – generally only done if one is past 40w gestation or has GD

*****

During the late 1st trimester / early 2nd trimester, there are a lot of genetic screening tests that one can opt to do. I didn’t do a whole lot of research on these because Charlie and I wouldn’t have chosen to terminate the pregnancy for any reason, and (in our opinion!) that would be the only reason we would have done the tests anyway. There is a lot of room for error on those early test results, and many of them just give you a percentage risk factor – not a yes/no if the fetus actually has the disorder, and for us, we didn’t feel like it was necessary to pay more to worry more – potentially needlessly! If the child was born with a trisomy or something, we would have figured it out from there. If there had been an issue that was incompatible with life, we figured we would find out about that at the 20w anatomy scan and make decisions then.

Regarding the rest of the tests that can be done in 2nd tri / 3rd tri that I did research on:

Anatomy Ultrasound

I wrote about this a few months ago, as I was torn about what to do. Ultimately, we decided that since I’m hopefully going to have a home birth experience about 30 minutes from the hospital this time around, we wanted to make sure that there was nothing physically abnormal development-wise with the baby that would require immediate medical attention at birth. For the $400 price tag, the peace of mind was definitely worth it, especially considering how much money we’re saving by doing a home birth. Most people call this the “gender scan” — but the real reason for this ultrasound is to measure the fetus’ organs and bones to make sure everything is developing correctly!

Gestational Diabetes Test

ACOG screening exemption criteria: Age less than 25, not a member of an ethnic group with an increased risk, BMI <= 25, no history of abnormal glucose tolerance or macrosomia, and no known diabetes in a first-degree relative.

Because I’m > 25 years old, I’m not automatically exempt from this screening, but this is still a test we’re going to decline anyway. My reasons? There’s no real proof that this test is being done at the right time of the pregnancy or actually changes anything at all in outcomes. The treatment for it is basically eating healthy and moving your body and delivering the baby — all of which I am doing / intend to do anyway! Here’s my research:

  • Evidence Based BirthGestational Diabetes and the Glucola Test
    • To this day, researchers still don’t know the answers to a lot of questions about screening for gestational diabetes. This is what I gathered from reading the most up-to-date literature:
      • We don’t know the best screening test for gestational diabetes.
      • We don’t know the best time during pregnancy to screen for gestational diabetes.
      • We don’t know if you need to fast beforehand.
      • We don’t know if the best cut-off point for the test.
      • We don’t know if screening the entire population results in improved outcomes. (Researchers theorize that screening can improve outcomes such as large birth weight, but nobody has done a randomized, controlled trial to test this theory)
  • Cochrane Summaries: Screening for gestational diabetes and subsequent management for improving maternal and infant health
    • This review of four trials involving 3972 women found that there is little high-quality evidence on the effects of screening for GDM on health outcomes for mothers and their babies.
  • Cochrane Summaries: Treatments for gestational diabetes
    • The review of eight studies (1418 women) suggests that offering specific treatment for gestational diabetes may be associated with better baby and mother outcomes, but has not found robust evidence on the best choice of treatment which provides the better outcomes for these women and their babies, even if identified correctly.
  • Cochrane Summaries: Different types of dietary advice for women with gestational diabetes mellitus
    • Based on the current available data, we did not find that any one type of dietary advice was more effective than others in reducing the number of births that required instrumental delivery or the number of babies who were large for gestational age or had a birthweight of 4000 grams or more. The included trials had various levels of risk of bias and it remains unclear which diet is the most suitable diet for women with GDM for improving the health of women and their babies in the short and longer term. 

Group B Strep

This test I wasn’t as sure about skipping because the complications for a GBS infected (not just colonized) baby are seroius, but the more I read, the more confident I am about declining it. Risk factors for GBS include:

  • African-American
  • Multiple sexual partners
  •  Male-to-female oral sex
  •  Frequent or recent sex
  •  Tampon use
  •  Infrequent handwashing
  •  Less than 20 years old

Based on my research below, I’m comfortable going with the “risk-based approach” (which the CDC used to recommend in the US and which the UK still follows). A positive GBS test would require me transferring to a hospital setting for antibiotics, and I’m not willing to do that at this point. However, if I do end up with any of the risk factors outlined below, I will definitely head to the hospital and get myself hooked up to an IV!

  • Evidence Based Birth: Group B Strep in Pregnancy: Evidence for Antibiotics and Alternatives
    • Based on information from these 3 studies, in 1996, the CDC recommended 2 ways to prevent early GBS infections:
      • The “universal approach.” Screen all pregnant women at 35-37 weeks and treat everyone who is positive with antibiotics during labor (this is the method that is currently used in the U.S.)
      • The“risk-based approach.” Treat laboring women with antibiotics if they have one or more of these risk factors: GBS in the urine at any point in pregnancy, previously gave birth to an infant with early GBS infection, goes into labor at less than 37 weeks, has a fever during labor, or water has been broken for more than 18 hours (this is the method that is currently used in the United Kingdom)
  • Cochrane Summaries: Intrapartum antibiotics for known maternal Group B streptococcal colonization
    • Very few of the women in labor who are GBS positive give birth to babies who are infected with GBS and antibiotics can have harmful effects such as severe maternal allergic reactions, increase in drug-resistant organisms and exposure of newborn infants to resistant bacteria, and postnatal maternal and neonatal yeast infections.
    • This review finds that giving antibiotics is not supported by conclusive evidence.

Rh Negative Mother / Possible Rh Positive Baby

This has to do with blood Incompatibility Issues (& automatic administration of Anti-D during and after pregnancy). Most women won’t have to deal with this. I’m A neg Rh- (which apparently 7% of the world’s population is), so I do need to address it. Because I have had no uterine trauma or vaginal bleeding during this pregnancy, and I had a negative antibody screen post-delivery with Stella, I’m comfortable skipping the 28w RhoGAM shot. I will, however, be getting the shot post-delivery. During my pregnancy with Stella I got it both at 28w (for $250) and post-delivery, but only because I had never actually researched the issue! If I had any sort of uterine trauma during the remainder of this pregnancy for any reason, there is a 72 hour window in which you can get the shot to still have it effectively block the antibodies from being formed. This makes me 100% comfortable with skipping the routine intrapartum administration of it and only getting it if necessary (as well as postpartum within 72 hours).

  • Cochrane Summaries: Anti-D administration in pregnancy for preventing Rhesus alloimmunisation (Click on “abstract” to read more)
    • Full text background here: Anti-d in pregnancy
    • Women whose blood group is Rh-negative sometimes form Rh-antibodies when carrying a Rh-positive baby, in response to the baby’s different red blood cell make-up. This sensitisation is more likely to happen during birth, but occasionally occurs in late pregnancy. These antibodies can cause anaemia, and sometimes death, for a Rh-positive baby in a subsequent pregnancy. Giving the mother anti-D after the first birth is known to reduce this problem. This review assessed two trials and found that giving anti-D during pregnancy is likely to help as well, although more research is required to confirm these possible benefits and identify any possible harms.
  • Cochrane Summaries: Anti-D administration after childbirth for preventing Rhesus alloimmunisation
    • This review of six trials, involving over 10,000 women, found that anti-D given to Rhesus negative women within 72 hours of giving birth to a Rhesus positive infant decreased the likelihood of the women developing Rhesus antibodies within six months of the birth and in their next pregnancy. 
  • From my midwife: With your blood test [done the day Stella was born], your antibody screen was negative. Stella has nothing to do with this pregnancy….and yes, she is O+ meaning she is Rh positive. As a result, she won’t have these issues in pregnancy like you have with the Rh negative factor. Most of our clients with a negative antibody screen only do the post-partum RhoGAM injection. We will plan on having the RhoGAM available for AFTER your birth. IF you do decide you want it at 28 weeks anyway, let us know. 

*****

So there ya go. There is obviously a ton that I have not researched, but for a standard, uncomplicated, low-risk pregnancy, that is the basic run down of the tests that are usually done – often without your approval, and simply because “it’s routine.” Don’t be afraid to educate yourself, ask questions, and make the decisions that are best for you and for your pregnancy!

If you have questions about other specific tests that I didn’t go into detail about here, I highly recommend the websites Evidence Based Birth and The Cochrane Summaries for really through, unbiased, research based information!

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36 comments

  1. I love how much research you’ve done. You’re an amazingly strong woman who’s educated herself well to make the right choices for you. I wish I could make some of these same choices, but I’m so old and high risk I have to go along with most of the tests. We did choose to do some of the first trimester screenings just to have a heads up if we had an increased risk for any of the trisomies. Again, I’m old and at much higher risk so there’s that. But like you it wouldn’t have changed the outcome or our choices of carrying the pregnancy to term. I’ve just been the nurse in the delivery room one to many times to a mom who had an unknown trisomy baby. It’s a horrible feeling as we recognize there’s an issue and mom freaks. I just wanted the heads up. And you know my insurance covers it because I’m old. There are some benefits to being old.

    As for the GD screening, just go with how your body feels. But I’ll give you this un-solicited advice. If you notice at any time you’re feeling a crash or surge after a meal or any shakiness at all, see if your midwife can do a random glucose check with a glucometer or find a friend who is diabetic and do one (obv much cheaper than a lab test). Some of the healthiest people I know came up GD+ and ended up on insulin for uncontrolled sugars even with an excellent diet and exercise. I know you know your body well. I have no doubt you’ll be perfectly OK. You’re young and healthy! You’ve rocked this pregnancy so far!!

    I love this, did I say that already?

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  2. Wow. What an informative, important post! I’m impressed! I remember being devastated when diagnosed with strep B when I was pregnant with Harriet. I thought that my birth plan was going to sail right out the window because I’d have to be hooked up to an IV. It was a bit of a headache, especially because I wanted to labor at home but I knew that they wanted to get two bags of IV antibiotics into me during my labor, so we headed to the hospital when I was about four centimeters dilated. At one point during the height of labor, the IV got ripped out and my doctor said it was just fine. He didn’t make me have the IV put back in. Thank God. I was really grateful for his flexibility.

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  3. I just realized I never got back to you on my review of the Rh information! I wrote notes and shit! Anyway, you covered it pretty thoroughly. This post is very thorough and well-sourced. I don’t have the guts to discuss a lot of this publicly.

    I declined everything but the NT and anatomy scans because I wanted the peace of mind and don’t pay out of pocket. My OB practice were fear-mongering jerks about it (especially the GD test), and my midwives were very accommodating. They seemed to think my expertise as a medical writer had some value in my decision-making process donchaknow! CRAZY TALK.M.D.

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    1. Ha! The M.D.thing was a total auto correct fluke!

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      1. I figured you had gotten busy with moving and such! No worries. 🙂

        Fear mongering. BAH.

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    2. How useful is the NT scan without the blood work they do at the same time? Does the NT measurement alone give you odds of certain trisomies? I was under the impression that you needed to do both NT and “1st trimester screening blood work.”. Who knew?!

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      1. They did the measurement and said it looked fine, so I opted out of blood work. I just wanted to see the baby, really.

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      2. This is what I found while researching — “Nuchal scanning alone detects 62% of all Down’s Syndrome with a false positive rate of 5.0%; the combination with blood testing gives corresponding values of 73% and 4.7%.”

        Basically, they do both to try to lower the false positive rate..albeit not by much!

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  4. Wow! What amazing research you do! I am impressed. It is very empowering as a woman to know we have choices. To know that we do not have to go along with what someone else tells us to do. I have learned so much from your blogs/it has opened my eyes to other options. Thank you, Josie!

    We had a late term (36 weeks) ultrasound. To be honest with you, I do not know why. I was just so excited to see her again. The u/s did raise some concerns that Ava wasn’t growing as she should have been. These concerns turned out to be nothing. It did cause some unnecessary anxiety. I don’t know what I will do if we have another. Things to think about!

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  5. I’ve never gotten the genetic testing done for the same reason as you: we won’t terminate the pregnancy. But when I was pregnant with Lyla, I did think about it a bit more after reading Nella’s birth story at Enjoying the Small Things. http://www.kellehampton.com/2010/01/nella-cordelia-birth-story.html I am SUCH a planner, a reader, NOT a go-with-the-flow kind of person that her experience of being shocked at birth scared me pretty badly. I talked about it with McMister, and we decided to stick with our plan of not testing. I just turned them down again for this pregnancy, and I still have hesitation, but not enough to change my mind.

    Good work!

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    1. It’s funny you mention that post, b/c that post is one of the main reasons I decided AGAINST testing before doing any research about it during my 1st pregnancy. I feel like even through the shock, she handled it with such grace, and she got to spend the entire pregnancy NOT worrying. I’d be curious to know if they had the testing done with their 3rd child. Also, if I remember right, she DID do the testing with Nella, and it came back negative. From my research, it also looks like there is a 5% false positive rate as well. UGH. NO thank you.

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      1. Ooh yeah, now I’m going to be obsessed with finding out if they did with their third. And yes, she most certainly handled it all with exceptional grace. I just don’t think I’m as good of a person as she is 🙂

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  6. Great post. Thanks for sharing. I feel like there’s a knee-jerk reaction of “you’re not taking care of your baby” when you decline tests such as gestational diabetes, and this really angers me. Equally annoying is being forced to take tests like HIV when I know I’m negative. Nice to see someone looking at the facts! 😉

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  7. Love this! You need a menu link to “things I have researched the shit out of”. I will use this info for my next pregnancy.

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    1. Planning on a 3rd, are you? You’re insane. 🙂

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  8. It’s really impressive to me to see how much time and energy you’ve put into researching all this. I respect very much that desire to know exactly the what AND the why for each situation.

    I’m curious – are there any of these tests that you would have chosen to do had it NOT been an issue of money?

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    1. Honestly, no! Money was the instigator for the research, but the more I read, the more it was apparent that a lot of routine stuff that’s done really isn’t needed or beneficial in any way, so I’m really not interested in doing it.

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      1. right!?! Birth (and arguably Death) are some of those things that is better and safer with a hands off philosophy. Thank god for modern medicine, it is definitely needed in certain cases, but once you do the research you realize that the pendulum of intervention in these areas has certainly gone too far.

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  9. I’m really impressed by all the thought you’ve put into this! I am one of the lemmings (mostly), which is fine for me, but I admire your thoroughness and thoughtfulness!

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  10. This is incredible. Thank you for doing so much footwork!

    I have a tendency to err on the side of comprehensiveness when it comes to noninvasive preventative healthcare and on the side of the risk-based approach when it comes to treatment and medication. We’re doing the NT scan, but truthfully, only because it’s covered by insurance and (gasp) it gives me another chance to look at the babies (which is an embarrassing thing to admit, as it’s very self-centered and impatient).

    As a recipient of healthcare, it’s sometimes difficult to remember that you have an active role. You absolutely have the right to decline services, even though doctors sometimes choose to make you feel like an asshole about it. I remember after my miscarriage the OB on call insisting on a RhoGAM injection, even though my husband is also Rh- so we have no chance of Rh incompatibility, because being Rh- is a recessive trait. When I tried to point this out, he mumbled some words about how common it is for people to be wrong about their Rh factor (despite the fact that my husband is a monthly blood donor and has known his Rh status for a decade). It kind of cheesed me off, but I let it happen anyway. Because doctor means authority and it can be incredibly intimidating to argue with that.

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    1. Ugh, this kind of shit pisses me off to no end. You actually KNEW that you were in the right, but they still do their scary, intimidation, I’m the doctor so you must listen to me tactics and bully us around. I feel like this is why having a provider you truly trust and connect with for your actual birth experience is SO important — b/c it’s all too easy to give in in the heat of the moment when a doctor uses scare tactics instead of truth and knowledge, especially when it comes to your unborn child(ren).

      PS – I know a LOT of women who did the NT scan simply for the chance to see their baby again. Nothing to be ashamed about. 🙂

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  11. I know if I had to pay out of pocket I’d be doing a ton of research! I’m so glad you have found someone who is letting you take charge of your care.

    With G, the NT scan was something I was told to do. Since we lost our first baby to Trisomy X we felt like it was a good idea. Ultimately, I felt it was a good we did it with G because cysts were found on his brain at the anatomy scan, and since the results from the NT scan were good, I felt confident the cysts would resolve themselves. They did and G was fine.

    This time, I did the NT scan for J’s piece of mind, as a baseline for the anatomy scan based on my experience with G, but mostly the chance to see the baby again (had to know it was alive, so no shame for those who do it for this reason. You’re not the only one!). Since we had to meet with a genetic counselor this time around (which I don’t think is common), the visit was actually really informative and I learned more about the chromosome abnormality our first baby had.

    My midwife seemed to hit it on the head at yesterday’s apointment as we were discussing the 2nd trimester screening: would you change your care/plan depending on the outcome of said screening? Say, if you found out your baby was high risk for DS, would you consider an amnio to know for sure? If not, then what is the point of doing the screening? You can’t have a definite answer based on a screening and since there are so many false positives you’re more apt to worry for nothing. She said the anatomy scan is actually a better indicater there is a problem than the 1st and 2nd trimester chomosome screenings, but no one will know anything for sure until the baby is born.

    Ultimately, it’s good to know what is “extra” so you can make your own decisions. I feel like I’m a little more informed after having G and some things will be done differently this time around.

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  12. We did the NT and quad screen and anatomy scan, which are all covered by my insurance, so it was pretty much a no-brainer. We didn’t do a cvs, the harmony test or an amnio–mostly because of the risks of complications, even though they’re small, and my docs totally supported and even advocated that once the quad screen results came in. It would have been nice to skip the GD screen last time, when I failed the 1-hour and had to do the yucky 3-hour! But my mom had GD in one of her pregnancies, so I want to be careful. it’s good that your medical providers on are board with your choices and can give you thoughtful advice.

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    1. Ya, my biggest “issue” I guess with the GD test is what would you do different anyway? The research shows that they aren’t even sure they’re testing at the right time or in the right way, and that they can’t even agree on what the best course of treatment is (basically which diet to follow).

      I’m totally not against people who want to do all of the screenings and such – I just think it’s kind of crazy how much it costs to have a baby now days, and I wonder how many routine tests became routine because they’re good money-makers…

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  13. This is pretty interesting to read. Thanks for putting it all on one place for us! I’ll definitely come back to this post if we have a third baby.

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  14. Wow, such a great post which I am sure will be extremely useful for so many other women out there who are also pregnant or hoping to be in future. What a great deal of research you have done. Good for you!! It blows my mind how many tests are done.. or at least offered. I got weight checked, blood pressure, measurement of uterine fundus, and fetal heart rate check once detectable with stethoscope, as well as a few ultrasounds. Zero tests. Which I don’t know if that is a good thing or not but I had no other choice so didn’t question it… and luckily everything went as smoothly as possible.

    So frustrating how much these tests seem to cost in America. Like I said, I don’t know how many I would want / choose but it is a shame that money is made to decide in a lot of cases.

    Thanks again for sharing! Neat to read!

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    1. Well, your standard care pretty much sounds like the type of care I asked to get here. 🙂 Birth is so overmedicalized.

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  15. I completely respect this article as I am currently in my 31 week of my second pregnancy, but I do encourage you to expand a little more in your research about GBS testing. With my
    First child Asher, I had zero risk factors and tested negative for the bacteria and he still died GBS positive when he was 8 days old. The more research I did after his death, the more I realized how
    Common death by GBS is or at
    Least a magnitude of problems a GBS survivor could have. I’m definitely not trying to scare you but I would love for your to expand your education about GBS. Check out my son’s story on Facebook. It’s called Asher’s Fight and check out Groupbstrepinternational.org.

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    1. Hi Kylie,
      First off, I am so sorry to read about your son. Sarah had actually told me about your story when I 1st asked her for her opinion regarding GroupB strep testing a few months ago. Sadness beyond words.

      That being said, I’d have to disagree with your statement about how common death by GroupB strep is (and the website you sent me to recommending that all women, even those who test negative, should be treated prophylactically for it). That just isn’t true & needlessly scares people & contributes to the over-medicalization of the birth process in America. I understand how when your life is directly affected/impacted by something it becomes a passion to educate others about it – I’m all for education. The complications of actual Group B strep infection are real – and we will be watching & temping vigilantly for any signs of infection post-birth (and if I end up high risk during the birth process for any reason like fever, extended labor after the breaking of waters, etc, I will 100% get my butt to the hospital for abx). However, even after reading through the website you recommended, I am still comfortable with using the risk-based approach to determine if going to a hospital for abx during 1st stage labor is necessary (FWIW, I wouldn’t have even gotten 1 dose last time even if I had tested positive b/c my labor went so fast).

      I appreciate you respecting my choices, even as I respect that you are (for obvious reasons) on the other end of the spectrum from me on this one.

      So many choices to make in life, and the ones we make during our pregnancies and birthing times are just a tiny snapshot of it. Sort of amazing if you think about it.

      Best of luck to you in this pregnancy, and I’ll be praying for a healthy little take-home baby in your arms this time.

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  16. Wow, this is incredibly helpful and comprehensive – and would have saved me needless suffering with that not-proven-to-be-all-that-reliable-or-necessary gestational diabetes test. Ha. Thanks for posting this!

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  17. I did all of these tests without even thinking about it, as they were all covered 100% by my insurance and there was no financial incentive to wonder otherwise. I’d probably have done them all anyway, though, but it was interesting to read this other perspective on their necessity. You really know how to do your research.

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  18. How cool that you are planning a homebirth. We had planned a homebirth for little fox too. I loved my midwifery care and still wonder what the experience would have been like if it all worked out as planned. I really appreciated the way that I was respected as a capable intelligent human being able to making informed decisions about the many options that pregnant woman are faced with.
    As you might remember we ended up choosing a hospital induction at nearly 43 weeks. It was a brutally hard long labor, and while I know that it was due to being induced, I can’t imagine having been at home without fast access to the pain relief when I finally decided it was time. IF we ever have another it will be a hard decision about whether to choose an OB or midwife.
    After having fallen into the less than 1% category too many times on our infertility journey I was too nervous to go without strep b testing. I had my midwives scrambling to figure out how to get me antibiotics at home if i tested positive – we were going to hire a home health aide to administer them at home if it was necessary, but i tested negative, and ended up at the hospital anyways, so it wasn’t an issue.
    My only advice – be very thoughtful about where you will transfer if the need arrises. Closest of course for an emergency, but if not, know your options in advance of needing them. If I’d been at either of the two closest hospitals to our house I would have absolutely ended up with a section birth – but we traveled a bit to get the respectful evidence-based care that I knew I wanted.

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    1. Because of the extremely rural area in which I live, hospital choices are pretty “easy” (i.e. almost non-existent). There is a hospital 30 min from here in the next town over where my Midwife has a great working relationship with the OBs (also where I delivered Stella with the hospital-based midwives 2 yrs ago). There is a more progressive hospital 2 hrs away, but if I’m transferring for an emergency, I’m not willing to drive that far to get to the hospital!

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  19. kaseypowers · · Reply

    Because we have decent insurance and all these tests are covered I’ve not really given it much thought. But I really love these research posts, they make me think and become a better advocate for myself. I’m debating declining the GD test now because when I give blood on no food I pass out – I warned the nurse of this last time, she didn’t believe me and I earned a two hour stay in the hospital. Also testing positive for Group B Strep is one of my big fears.

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  20. […] – I spent most of this month obsessively researching all of the Medical Choices During Pregnancy that are open to women. It was really eye opening to me to realize how often tests & procedures […]

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  21. […] Shot (for Mom) – as I mentioned in my birth decisions post, I am A neg Rh- blood type. This means I needed to have the rhogam shot (thermisol free) […]

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