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KelseyH 09-16-2012 06:19 PM

Update! What comprises "unnecessary" prenatal care?
I posted this thread originally on the pregnancy board, but thought you ladies might have something to offer, too! :)

Backstory: When I was pregnant with DS, I was on Medicaid, so I had what I assume was industry-standard prenatal care with my OB, including a glucose test (I have an excellent diet... This seemed really unnecessary to me, not to mention absolutely disgusting) and a barrage of tests for STDs and things like Down syndrome and other abnormalities - that the OB said he "had" to perform because of my insurance. I refused to see the results, but didn't agree with doing the tests to begin with. (NC does require certain STD tests for pregnant women on Medicaid, which is fine - I was more upset about the testing of DS).

This time around, we are no longer on Medicaid - we now have a HDHP through Aetna Feds. So, in addition to the fact that there are some aspects of "standard" care that I don't agree with, we have to pay for EVERYTHING until we reach our deductible (several thousand dollars). Then, of course, Aetna covers everything 90/10, but it's still a substantial bill that we're going to sustain.

SO, what I want to know is - what is absolutely unnecessary as far as my prenatal care goes? We do want an ultrasound at/around 20 weeks so we know the baby's gender, but outside of that... What do they really NEED to do? I had labs drawn last week and I was a little uncomfortable - like, do they really have to do that? BUT I don't have enough medical knowledge to be comfortably assertive and say NO to something. I do know that I want to skip the glucose test, and any tests on the baby since that wouldn't change anything anyway, but outside of that, I don't know what I can "safely" refuse.

I'm not a high risk pregnancy at all - DS and I were both totally normal. Well, aside from the fact that I gained 41 pounds, yuck (my goal this time is 25-30 max). I delivered vaginally after 18 hours of labor, induced by breaking my waters. I had an epidural for the last 4-6 hours of labor and one dose of pitocin sometime after my epi was administered. Don't know if any of that's relevant... But anyway. I've done research online and the line between necessary and unnecessary seems VERY blurry, especially depending on the "crunchiness" (if you will) of whoever's opinion it happens to be. What do YOU think?

RunawayBunny 09-16-2012 07:22 PM

I think you will definitely find a variety of answers on this board. Personally, I dont know enough about pregnancy and birth to feel comfortable turning down much that my OB recommends. But, thats me. Medical care is the one area where I am just not that "crunchy". Is your OB open to discussion or will you need to be forceful with what you want from the beginning?

KelseyH 09-16-2012 07:38 PM


Originally Posted by RunawayBunny
I think you will definitely find a variety of answers on this board. Personally, I dont know enough about pregnancy and birth to feel comfortable turning down much that my OB recommends. But, thats me. Medical care is the one area where I am just not that "crunchy". Is your OB open to discussion or will you need to be forceful with what you want from the beginning?

He is open to discussion, but definitely has a "protocol" that he follows. My mom and I had to have a "come to Jesus meeting" with him when I was in labor for (only) twelve hours after induction and he was calling for a c-section. Like, really.... We were like, it's Friday night and you just want to go home. Get over it, I'm not having a c-section.

He is a wonderful doctor, very thorough with an amazing bedside manner, but I think when it boils down to it, he's just a "normal" mainstream doctor. There are not many OBs in this area who are open to more "crunchy" mindsets. There are two or three decent midwives, but I'm not sure I want to go that route.

He's probably not going to be impressed when I sit down with him at my next appointment and try to talk about this... But we'll see. I feel like I have to have evidence/reasoning behind anything I want to decline because if he asks "why not" I would feel really insecure just saying "because". Mostly because I have no medical background.

chillimom 09-16-2012 07:56 PM

Re: What comprises "unnecessary"
I'm not doing the quad screen. I did with DD, just because it was standard, but after chatting with my midwife, I'm passing on it this time. It's got such a high rate of false positives and we wouldn't be doing anything differently if this baby winds up with DS anyway.

However, the 20 week u/s we will do, even if we decide not to find out gender. That anatomy scan is soooo important IMO. Not because I would ever, personally, choose to terminate, but because it can show critical things like spina bifida, heart defects, CDH, etc. All conditions which have better outcomes with knowing about them ahead of time (having a spina bifida baby by c-section rather than vaginally to prevent spinal damage, for example). We don't have any of those types of problems in our family but there's a first time for everything, and I'd rather err on the side of safety.

We have to do the STD bloodwork here, it's law. I'll also go along with having my iron, thyroid, and glucose tested, as I tend to be anemic and low thyroid runs really strong in my family on both sides, as does diabetes. I'll do the GBS swab and the GD test too, but if I had to pay for them (Canadian so it's all covered) I *might* skip those.

dani_p 09-16-2012 08:03 PM

Re: What comprises "unnecessary"
Let me preface this by saying that I am on the "super crunchy" side of things as far as my own care is concerned, but I am also an RN... so I think I have a pretty good understanding of both ends of the spectrum.

The thing I did to decide whether or not to undergo a test or procedure was to ask myself the following questions:

1. Is this a screening or a test? - Screenings find people at risk, tests are definitive. Nucchal translucency scans (ultrasound to look for signs of Down's Syndrome) are a screening tool while amniocentesis is a definitive test. Not every child with a positive nucchal translucency scan will have Down's Syndrome. The glucose tolerance test is also a screening tool; not everyone who "fails" actually has GD (anyone eating a relatively low glycemic index diet will probably fail). Take into consideration whether or not the procedure is a screening or a test. If it is a screening, what are the follow up tests that come with a positive or "failed" result? Is the test that follows the screening something you're willing to undergo?

2. What I would do with the information provided (or what would my healthcare provider do with the information provided)? - For me, knowing whether or not my child had Down's Syndrome would change nothing except my stress level (and stress is not good for pregnancy), for others, it would be reason to terminate or consider giving the child up for adoption. On the other hand, if I found out I was anemic or vitamin D deficient, dietary or supplemental changes are a simple fix that could do wonders for my unborn child. If knowing the results will alter your behavior for the benefit of your family, then the test is probably worthwhile. If they will do nothing but stress you out, what's the point?

3. What are the risks involved? Most tests and procedures carry some risk. Take them into consideration when making your decision.

4. What are the chances that I or my child has the condition we are being tested/screened for? If you and your husband are healthy, your risks for any complications are very small. The fact that you had a previous uncomplicated pregnancy and delivery makes those chances even smaller. Again, why subject yourself to the stress of waiting for results that are likely to be negative anyways?

For me, I had initial blood draws and was tested for anemia, thyroid levels, HCG levels... and maybe some other things that I'm blanking on. I had my BP and weight checked regularly and I was swabbed for Group B Strep at 36 weeks. That was it. I didn't have any ultrasounds, I didn't do the GTT, etc.

Bottom line is, do your research and ask a lot of questions. Any doctor worth seeing will take the time to discuss things with you so that you can make an informed choice and they will respect that choice. Don't be bullied into doing something that you don't feel comfortable with.

Good luck mama!

dani_p 09-16-2012 08:08 PM

Re: What comprises "unnecessary"
Also, I did a bunch of research while I was pregnant... I have some articles/studies saved on my computer somewhere. If you have a question regarding something specific, feel free to PM me and I'll see what I have on it.

EmilytheStrange 09-16-2012 08:48 PM

Hard to list what is unnecessary. A little easier to say what's necessary.

The initial blood tests don't bother me as they check out thyroid, etc. I don't get more blood tests or urine tests, although it sounds like some women pee in a cup at every appt.

The confirmation ultrasound we're getting this week is unnecessary. The 20 week one is also unnecessary (we don't find out the gender).

For me, I refused all of the extra testing (down syndrome, etc).

Glucose is fine and the juice didn't bother me. You can ask your doctor if they allow substitutes. For instance, like 25 jellybeans in 2 minutes or something (I can't remember) is sometimes allowed.

GBS testing is an absolute must because your baby can end up in the NICU if you aren't treated for it. It changes with every pregnancy, so you can't go by the past. You don't particularly need the 4hrs of antibiotics; there are natural type things you can take that my friend used for her homebirth. But it's wise to be prepared.

That's all I can think of right now.

UmmKira 09-16-2012 09:01 PM

It really is personal choice. I had little screening done for things like down syndrome or other ones that have high false positives. I did have GD tested, but not GBS originally since your GBS result can change through your pregnancy too. I ended up getting the GBS test when I was a week overdue in case I had to go to the hospital (instead of the birth center) since they would likely treat me as GBS positive with no test done.

Look into it and decide what is important to you and your baby. Your doctor can give you actual risk factors to help you decide.

Sent from my phone using DS Forum... Typos complements of Swype

EmilytheStrange 09-16-2012 09:23 PM

I've never heard of them doing the GBS test before 36 weeks. Do some people get several throughout their pregnancy?

KelseyH 09-17-2012 05:01 AM


Originally Posted by EmilytheStrange
I've never heard of them doing the GBS test before 36 weeks. Do some people get several throughout their pregnancy?

I only have one GBS test scheduled. I think it's at my 36 or 38 week appt? I'll have to check my calendar. Yes, I already have all of my appointments scheduled. Haha (A bit of an obsessive planner here.) I also only got one during my last pregnancy, but I can't remember exactly when it was.

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