buy cialis online

Subscribe to our mailing list

Email Format
Close

Image by ##erika**

When you’re pregnant, there are many different tests that are fairly standard for most OBs and some midwives.  Do you have to take these tests?  What are they for?  Who should seriously consider them?  And what happens if you want to refuse?

Testing, Testing!

Women are subject to many tests during pregnancy.  These include the following (and possibly more; not all women will have all of these).

Blood Tests

Most women are given blood tests at their initial visit and their 28-week visit.  The first is to check for STDs, anemia, immunity to rubella, and a general blood panel ( sugar, creatinine, etc.).  The second is specifically to check for anemia.

Urine Tests

Many women are given these at each visit.  These are to check for the presence of protein or sugar in the urine, which could be indicators of pre-eclampsia or gestational diabetes.

Blood Pressure

A woman’s blood pressure is checked at each visit to make sure it is in the safe range.  Consistently high readings raises the risk for pre-eclampsia.

Swelling/Edema

Some swelling in the legs can be normal in pregnancy (but is usually caused by dehydration, lack of exercise, etc. and easily remedies).  Excessive swelling can be a sign of pre-eclampsia.

Heartbeat

Both mom’s and baby’s are checked, to make sure they are within the normal range and strong.  If either are too fast or slow it can be an indication for further testing.

External Palpitations

This is to check the fundal height of the uterus in cm (which should roughly correspond to the number of weeks pregnant a woman is after 20 weeks), as well as the position of the baby and the placenta.  It can be an indication if a baby is posterior or breech or otherwise in a bad position for delivery.  It can also be an indication that the placenta is poorly placed and could hinder a safe vaginal delivery (which may require follow-up testing).

Internal Exams

Most women are offered internal exams at their first visit and their last few visits.  The initial visit is sometimes for a pap smear and also to check to see if the uterus “feels” pregnant.  The final visits are to check for dilation and/or effacement, to see if the body is “preparing” for labor.

Quad Screen

This is a third blood test, taken around 16 weeks, to check for potential genetic abnormalities.  It can’t give an accurate result, only the statistical chances that something is wrong based on the results.  If the chances are high, then follow-up is indicated (usually amniocentesis).

Nuchal Scan

This is an ultrasound that is done around 11 – 12 weeks that checks for thickening of the neck folds, or the “nuchal fold,” which may indicate the presence of Trisomy 21 (Down Syndrome).

Ultrasounds

Ultrasounds are usually offered at around 8 weeks and 20 weeks, and women who are high risk may have one nearly every visit.  These are to check on baby’s growth and development, position, position of the placenta, and a number of other possible abnormalities (for example, if there is a heart defect or the lungs aren’t developing properly).  The most common use is the 20-week ultrasound to measure fetal growth and do a check for major abnormalities.  It may also be used to confirm a multiple pregnancy.

Amniocentesis

This is a genetic test where amniotic fluid is drawn out of the uterus, and fetal cells are checked for any abnormalities.  It can usually diagnose any genetic defects before the 16th week of pregnancy.

Gestational Diabetes

This is a common test at 28 weeks, where women drink a 50-mL sugar solution and then have their blood sugar checked one hour later.  Should they fail this, they go on to a 3-hour fasting glucose test where they drink a 100-mL sugar solution and have their blood sugar checked each hour for three hours to watch how it drops.  Women who fail this are diagnose with gestational diabetes.

Group B Strep

Group B strep is a bacteria that naturally colonizes the vagina and anus of some women and it can come and go.  A swab is used around 36 – 38 weeks to check for the presence of this bacteria.  Women who test positive are usually given IV antibiotics during labor to prevent their newborns from becoming infected.

Non-Stress Test

This is usually offered to women late in pregnancy if their babies are not moving well or if they are past their due date.  It checks to make sure the baby’s heartbeat is strong and that s/he is moving well, indicating that baby is healthy.  ”Failing” a non-stress test usually results in another one a day or so later, and another fail usually results in an induction or c-section.

This is not an exhaustive list of tests that women may face during pregnancy.  These are common tests for women with low-risk or moderate-risk pregnancies.  If you are high-risk, you may be subject to all kinds of tests that are not listed here.

Are These Tests Necessary?

The tests that I would personally consider necessary, or at least safe enough not to worry about including:

  • Urine tests
  • Blood pressure
  • Heartbeats (not using Doppler)
  • External palpitations
  • Swelling/edema
  • Anemia blood test (28 weeks)

These tests are non-invasive and pose no risk to the baby or to the mom.  They can indicate a need for further testing by forming a picture of a potential problem.  The anemia blood test is slightly invasive (finger prick), but anemia in late pregnancy can seriously increase your risk of hemorrhage during birth.

Some women with uncomplicated histories may choose to forego some or all of these tests (for example, women who are choosing unassisted birth), but there is no risk involved in choosing them.

The Doppler is an interesting issue.  A Doppler is ultrasound.  It is potentially dangerous to the baby and not something to be used indiscriminately (which now happens, thanks to at-home Doppler devices used frequently by eager new parents).  That is irresponsible.  Using a Doppler very briefly around the 12th week of pregnancy for mother’s peace of mind may outweigh the risks, but using one frequently or at every visit is not a good idea.  Past the 20th week of pregnancy, a fetoscope can be used to safely hear the baby’s heartbeat.

Tests that I would consider mostly “non-invasive” but potentially problematic would be:

  • Blood tests (STD panel)
  • Internal exams
  • Gestational diabetes
  • Group B strep
  • Non-stress test

These tests are typically harmless to the baby, but may cause problems for the mother either directly or because of care decisions that are made based on results.

The basic blood test could lead to recommendations for an MMR shot (harmful in pregnancy), or to iron supplementation (ferrous sulfate, which is poorly absorbed and often makes women very sick), etc.

The internal exams can be traumatic for women who may have been victims of sexual abuse.  The initial internal exam gives no useful information as we don’t really need to know if the uterus “feels” pregnant (a urine or blood hcg pregnancy test will confirm a pregnancy just fine).

Late in pregnancy, internal exams may be used to make decisions about whether an induction is necessary, or whether a woman will ‘probably’ go into labor sooner rather than later.  However, effacement and dilation can cause a woman to feel needlessly excited or depressed, depending on the result, and the state of things internally is not related to how soon labor will begin.  It is possible for women to have cervixes that are high, closed and babies who are not engaged and deliver mere hours later.  It is possible for women who are dilated to 6 and mostly effaced with babies engaged to walk around for a month without going into labor.  Women often feel that progress or lack thereof is indicative of labor; it’s not.

Internal exams also allow foreign bacteria to be introduced, increasing the risk of infection.  They also allow doctors to do questionable procedures, like “stripping the membranes,” which can increase the risk of infection as well as potentially prematurely breaking the water.  Sometimes doctors will do these things without a woman’s consent.  The easiest way to prevent it is not to consent to an internal exam in the first place.

Internal exams may be performed late in labor to check for dilation, but even then, some women are ‘ready to push’ before they actually reach 10, and the anterior lip that is so common may lead to painful and unnecessary stretching even though it will usually move itself if left alone.

The gestational diabetes test usually leads to heavy monitoring late in pregnancy, special (not so healthy) diets, and early induction due to a suspected “big” baby.  If you do not eat sugar or refined grains anyway, there is no need for this test in most cases, especially if you have no history of diabetes in your family and are at a normal weight.  This is even according to ACOG guidelines.

The Group B strep test is controversial.  There is evidence to show that babies born to GBS-positive mothers have a very tiny risk of infection, and that the risk of yeast/thrush and gut damage from the IV antibiotics is actually greater.  Mothers who test positive are usually pushed into antibiotics regardless of how rapid their labors are when their water breaks.  (Long labors where water breaks early significantly increase the chances of infection.)  This is one to be careful of.

Non-stress tests may be rough depending on how they are performed.  Some women are simply asked to drink a sweet liquid to get the baby moving (sometimes orange juice).  Others have their bellies physically manipulated.  Know how your care provider will perform the test ahead of time.

Unnecessary Tests

The following tests I consider unnecessary for women with normal, low-risk pregnancies (not high-risk women):

  • Ultrasound
  • Amniocentesis
  • Quad screen
  • Nuchal scan

These tests are mainly to check for genetic abnormalities in your baby.  If you know you are high risk (because of familial history, not just because you’re an “older mom”) you may choose to take the tests.  They can unfortunately cause false positives — especially the bottom two, that are just ‘screening’ tests — and a lot of extra worry and stress.  Plus, for many families the results of these tests won’t change their decision to carry the pregnancy, so they feel there is no point.

Others feel they’d like to know if there is an issue so they can be prepared, if needed, for the special care required at birth.  Some would choose a different delivery location, specialists on hand, etc.  A few very rare issues can be fixed via surgery even before birth, and this is another consideration for some families.

Ultrasound is the most controversial.  Most parents think ultrasound is fine and fun, with no potential harm.  Others think that ultrasound should be kept to a minimum but the 20-week ultrasound is necessary.

Ultrasound absolutely does come with risks, though, including potential brain damage to the baby, miscarriage, and intrauterine growth restriction.  The chances of a defect that may be found and remedied during pregnancy is very, very, very rare; much more rare than the possibility of harm from a routine ultrasound.  In my opinion, routine ultrasounds are not necessary.  This is a great source showing lots of peer-reviewed, published studies on the harm from ultrasound.  Here are more studies.

An ultrasound should only be considered in high-risk situations in which another method of assessment is impossible.  Manual palpitations are often preferable, especially from a skilled provider, and come with no associated risk.

This is very brief look at common maternity tests, and we’ll cover many of these more in-depth at a later time!

Refusing the Tests

If you do not want to take any of these tests, you do not have to consent.  You should be aware that some doctors or midwives will kick you out of the practice for refusing.  It is a good idea to find a practitioner who generally agrees with your philosophy on pregnancy and birth anyway, so that if something does go wrong you are on the same page and you can trust his/her advice.

Simply say “I do not consent to that.”  Later this month we’ll talk about some other responses to pressure to consent!  Always remember that it is your body and your baby, so you make the final decision!

Which tests did you choose to have?  Which did you choose to skip?  Why?

Like what you've read? Subscribe so you never miss a post! You can also follow us on Facebook or Pinterest. Thanks for reading!

This is the writings of:

Kate is wife to Ben and mommy to Bekah (5), Daniel (4), Jacob (2), and Nathan (born March 2013). She is passionate about God, health, and food. She has written 7 cookbooks and a book entitled A Practical Guide to Children's Health. When she's not blogging, she's in the kitchen, sewing, or homeschooling her children. You can also find her as a contributor at Keeper of the Home.

Like what you just read? Stay in touch with our newsletter!

Email Format

11 Comments

  1. I was a High risk pregnancy with all 3 of my pregnancies. I have healthy babies, but, only because I had every test available, when the problems were detected, I was able to take steps to ensure my babies health. In my opinion, the mortality rates for pregnant, and new moms & newborns was extremely high as little as 100 years ago. It’s because of modern medicine that those mortality rates are now so low! Why refuse a test that might save your baby!? Because of being high risk, my doctors monitored my babies very closely via ultrasound, it was a “routine” ultrasound that found I had dangerously low fluid with two of my babies, neither made it past 38 weeks, and my last one I would have risked him dying if I had refused this monitoring because the day he was born at 37 & 2 days I had NO fluid left. So having him that day not likely saved his life. Also, durin one of my routine ultrasounds it was discovered I had a hematoma, big enough, if my doctors had not found it, and put me on strict bedrest until it re-absorbed, chances were with it’s size I would have miscarried sometime between 16-20 weeks! But because of this testing, my doctors saved my baby’s life twice!

    I understand some people’s hesitation. For one thing goin to the doctors 1-4 times a week is definitely inconvenient. But no amount of inconvenience is worth risking a baby’s life. I know 3 people recently who had stillbirth at 30-40 weeks! All because a midwife was not monitoring the baby with ultrasounds. There were warning signs but all 3 (different) midwives were not trained in those areas, so they missed the signs. Also, non of the women accepted the standard prenatal tests, which could have saved at least 2 of the three babies. I’ve talked to two of those women & gotten their opinion. In retrospect, they would have gone to qualified ObGYN’s, (there are plenty who have midwives who work along side if that’s a preference) they say they would have had every single test, anything, just to not have lost their babies. Is it really worth the risk? Not to me!!

    And just for the record I’ve had every single test listed above with all of my pregnancies, Only one amniocentesis though. And more ultrasounds than weeks pregnant. But my babies are healthy and Alive! :)
    Just my 2 cents :)

    Reply

    • High-risk women are in a different category simply because they are at a high risk of complications.

      Low risk women, however, are NOT better off getting “every test available.” Sure, the maternal and neonatal death rates were higher 100 years ago. But they’ve DOUBLED in the last 20 years! They were at 6.6 per 100,000 in 1987 and as of a couple years ago they were 12.3 per 100,000! More testing and more interventions is NOT better for most women. There is always a risk something will be missed if you forego a lot of the tests. But there is always a risk that further problems to the mom or baby will actually be caused by the tests or interventions too! I definitely don’t think the risks outweigh the benefits for low-risk moms.

      My healthiest baby is the one I had the least interventions with. We could tell personal stories all day long…but the overall statistics don’t lie. LOW risk women are safer skipping many common tests.

      Reply

      • The problem is, a high-risk woman might not KNOW she was high risk without some of this testing. Some issues, like low fluid, I do not believe (and I am no doctor) that you cannot find without ultrasound can kill babies.

        I have three healthy kiddos, and two were high-risk pregnancies (well one of those was normal until I turned pre-eclamptic at the end). I had plenty of monitoring and hte peace of mind of knowing my baby was well, in spite of my own issues, was worth the risk. Of course, that is my opinion, but I am sticking to it! I suppose I can respectfully disagree.

        Reply

  2. That’s interesting. Each of my pregnancies started out “normal” they each individually became high risk all at different times during the pregnancies as standard tests revealed a problem. Funny thing I was age 24-30, & considered very healthy prior to all my pregnancies. I also ended up with 4 miscarriage, one an ectopic which burst! Diagnosed with premature ovarian failure & told I would never be able to have more without IVF using donor eggs. I went on a super healthy diet, a huge concoction of herbal pills after months of research. Not sure if it was the herbs or my 5 year old’s prayer, but either way I got pregnant naturally & am holding number #3 miracle baby in my arms! :)

    I would not ever voice my opinions unless asked either. Ultimately, Everyone has to do what they feel is best for themselves & their babies, no matter what route they choose. Love your blog!! Wish I had found it a couple years ago!!

    Reply

  3. I declined ALL testing during our recent pregnancy (it was the right decision for us. I regularly checked in with my body and baby and intuitively felt there was no need for testing.) We had a beautiful home water birth to a healthy baby girl on June 8 and I had a really positive and enjoyable pregnancy! Thank you for this informative post!

    Reply

  4. How do you know if you’re “high risk”? I have a history of sever Crohn’s disease and 10 major surgeries, incl. bowel resections. Thank the Lord, I have been on the GAPS diet for a year, and my symptoms are majorly decreased. I’m not pregnant yet, but I just wonder if the past medical history will classify me as “high risk.”

    Reply

    • Abi, I’m not sure. I’d see a midwife and ask what their opinion is. If your issues are under control then maybe you will not be.

      Reply

  5. I had low-risk, normal pregnancy and was under a midwife’s care the entire time. I had all of the non-invasive tests (heartbeat, urine tests, blood pressure, etc.). I had the STD panel the first time but will not this time. My midwife only does gestation diabetes tests if a mother is at risk, which I am not.
    I had one ultrasound at 20 weeks. I knew it wasn’t necessary but asked midwife to schedule one anyway. I had a certain amount of fear that an undiscovered complication would harm my baby or me (such as a serious health problem that would require immediate care or placental previa) and the ultrasound helped to allay them. I will probably go the same route this time…I am not concerned enough about the risks of a single ultrasound to forgo it (just my personal decision).
    I only had internal exams during labour and only because I asked for it. In hindsight I regret this; it was very discouraging to hear that I was only 4 cm after 20 hours of labour.
    My midwife recommended a Group B strep test because, as she explained it, if we didn’t have a negative Group B strep test and had to transport, I and baby would be forced to have antibiotics. I admit I am in favour of this test, though, because two women in the local Mennonite community who refused the test for religious reasons have lost their newborns to Group B strep.
    I never knew anything about informed consent until I became pregnant and planned a home birth…now, I’m completely passionate about it! :)

    Reply

  6. My Sister, who is 29, just had an intrauterine ultrasound at her first OB/GYN visit. She was only 6 weeks along. Now at 8 weeks she has had a “spontaneous miscarriage” and is scheduled for a D&C tomorrow.

    We are very close, only 14 months apart, so I sent her this blog post when she told me her doctors office had scheduled her for an intrauterine ultrasound. I encouraged her to think about waiting or forgoing ultrasounds alltogether since she is a healthy woman and this was her first pregnancy.
    From the email I sent her:
    I also wonder if I would be doing the ultrasounds for my own peace of mind, or to help the baby. I admit that I am definitely selfish, so will be tempted to do things because I want to do them…not because they are actually needed. So, I will have to pray and ask the Lord to help me make these decisions when the time comes! Anyways, I don’t want to tell you what to do, or make you think I’m judging. Whatever you decide to do is great with me, but I thought you might want to see some of the information out there about ultrasounds.

    I’m not sure if she read this blog post, or any of the other links I gave her about ultrasounds and other pre-natal tests. (She seemed interested…) We will never know why she miscarried and I am not blaming her or the doctors office or the ultrasound. It is heartbraking and I can’t even fathom what she is going through right now. I just wanted to post this so perhaps other women will think about getting an un-needed test so early. My sister told me she wanted the ultrasound because “until she saw the baby”, the pregnancy was not going to “feel real”. I desire for all women to feel empowered to make their own decisions and feel confident in them! Thank you, MAP, for tackling the taboo topics so clearly.

    Elisabeth

    Reply

  7. [...] are also a variety of lab tests your doctor will order to screen for diseases that can affect your unborn child and determine your [...]

    Reply

  8. [...] the diagnosis of IGT and GDM, glucose tolerance test remains the screening mechanism of choice. The GTT is done between 24 and 28 weeks, where women [...]

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *

*

*

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

Back to Top