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Old 09-17-2012, 05:18 AM   #11
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Originally Posted by EmilytheStrange
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.
Thanks! We did have a "confirmation" ultrasound, but it was mostly for dating purposes since I had stopped tracking my temps and never had a period after DS, so we had no idea when I actually got pregnant.

I don't feel like I really need to do the glucose test. I am at a very healthy weight (5'2" 115#), have 12% body fat, and work out regularly (well, before morning sickness) and eat a low GI diet. So many healthy women I know have failed the 1-hr and had to take the 3-hr, only to pass with flying colors.

I'll definitely be putting together a list of things I want to discuss and taking it to my doctor at my next appointment! You ladies have been very helpful.

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Old 09-17-2012, 06:57 AM   #12
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Re: What comprises "unnecessary"

I posted my response in your other thread I'll c&p it here, too...

It's ultimately what you feel comfortable with and want done. It's not (or shouldn't be!) up to your care provider what tests you do.
I would likely want to do a urine dip (and depending on that I would decide on the GD test, ie. if I was spilling protein, I'd want the GD test done, kwim?), check blood pressure and baby's heartrate, and do the 20wk u/s (not for gender, but for checking baby and placenta). I have done the GBS swab, as their "policy" is to treat with antibiotics if there's a positive result or if there's no testing done.

I am uncomfortable doing paps during pregnancy, so I decline that whole thing - which would mean I'm also declining the STD screening. No HIV testing done either.
I decline any vaginal exams until very late in the pregnancy, or during labor - with Levi I had one done at 41wks, IIRC, and then not until laboring.

For me, it is important that I do bloodwork at each appt - I get that "big draw" done at the beginning of pregnancy, for an idea of where my levels are starting, and I get my platelets and iron levels checked at each appt thereafter.
This is because I tend to have low iron during pregnancy, and because of my ITP we need to keep an eye on my platelets. Oh, and because of the platelet issues, I did have transfusions during labor/delivery with DS2 and DS3, and have had pitocin shots after each vaginal birth.

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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.

We have to do the STD bloodwork here, it's law.
Yes, we have never done the extra screening bloodwork (here done at 15wks) and have never been offered that 12/13wk u/s to check for nuchal fold and whatnot. I wouldn't do it anyways, but just saying it seems to be different protocol here than in the US. (Maybe it depends on the results of that bloodwork?)
Sidenote - Again, we don't do that test anyways, and even after losing Elli we wouldn't do it this time. A friend of mine did do it, and it came back a high probability of their baby having DS. She was upset and worried, and went to the city for further u/s. Everything ended up fine, baby is "normal", but that extra worry was just pointless, kwim?

I've never heard of the STD stuff being law? I've refused it with every pregnancy except my first.

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I've never heard of them doing the GBS test before 36 weeks. Do some people get several throughout their pregnancy?
It's routinely done here at 35 weeks - which is silly and useless, IMO, because of how quickly the results can actually change (at least week to week!). You could test negative at 35wks and actually be positive come birth at 37 (or whatever) weeks, and they would treat you as negative and never know. Or vice versa, obviously.
I've had it done every time because not getting tested means they automatically treat you as positive. I'd been negative with each pregnancy except unfortunately with Levi I was positive. I would need IV for transfusions anyways, so it wasn't really a big deal to need it for the antibiotics, but I had hoped to just test negative!

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I don't feel like I really need to do the glucose test. I am at a very healthy weight (5'2" 115#), have 12% body fat, and work out regularly (well, before morning sickness) and eat a low GI diet. So many healthy women I know have failed the 1-hr and had to take the 3-hr, only to pass with flying colors.
I would definitely run this stuff all by him and, if nothing else, leave it as "we'll decide for sure when we're closer to then", and base your decision on how things look/go between now and then, kwim?
If things are continuing normally, I wouldn't do it. But if risk factors are coming up, I would.
If nothing else, going in with a "we'd like this but are open to change depending on the situation", rather than a "THIS is how it WILL be", attitude will get him on your side easier
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Old 09-17-2012, 10:29 AM   #13
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Re: What comprises "unnecessary"

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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.
This is my understanding:

1) The blood and urine tests are to double check levels of things like progesterone (low levels could indicate problem and potentially lead to miscarriage), and they check protein the urine, which rules out kidney issues, I believe. I would do those, as they are relatively inexpensive and can catch a variety of issues that are easily treatable but can do serious damage unchecked. They also test for STDs because some can be passed on to the baby and may require immediate treatment.

2) 1 hour glucose - this is a test for gestational diabetes I believe. When you are pregnant, your blood absorbs sugar more quickly, which means your pancreas (I think?? maybe another organ) may not be able to produce insulin fast enough, causing gestational diabetes. Even if you eat healthy, anything you buy prepackaged or from a restaurant has added sugar, as does any drink besides water usually, so you may be eating more than you think. I would personally be hesitant to skip this unless you were on all organic, whole foods, nothing prepackaged diet. Gestational diabetes can be terrible untreated.

3) Anatomy scan at 20 weeks is good, they can tell a TON about the health of the baby, and if everything looks good, you shouldn't NEED another. I did have one more to confirm the baby's position since my baby was sideways til right before I delivered.

4) If you don't want to screenings on the baby for things like Down Syndrome, those can be easily skipped.

Now, lot's of people go without any of this stuff and do just fine. Some don't. If you trust your doc, then discuss the tests with them, what you can learn, and why should do them. My personal minimum for peace of mind is the blood tests, the glucose tests, and the 20 week anatomy scan. Then regular check ups where they examine you and check the heartbeat.
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Old 09-17-2012, 11:37 AM   #14
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Re: What comprises "unnecessary"

I forgot to add I also get the Rhogam shots. I am O negative and they prevent the formation of antibodies that cause Rh incompatibility, which is good since I know my DD1 is O positive.

Also, just so you know where I'm coming from with my philosophy, I am generally pro-modern medicine. I'm not against natural alternative remedies, either though. Without very specific and regular monitoring and intervention for DD1, we would have lost her on top of losing her twin sister. I personally feel that too little medical intervention can be just as bad as too much, sometimes worse depending on the the situation. Good luck!
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Old 09-17-2012, 11:50 AM   #15
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Originally Posted by mibarra

This is my understanding:

1) The blood and urine tests are to double check levels of things like progesterone (low levels could indicate problem and potentially lead to miscarriage), and they check protein the urine, which rules out kidney issues, I believe. I would do those, as they are relatively inexpensive and can catch a variety of issues that are easily treatable but can do serious damage unchecked. They also test for STDs because some can be passed on to the baby and may require immediate treatment.

2) 1 hour glucose - this is a test for gestational diabetes I believe. When you are pregnant, your blood absorbs sugar more quickly, which means your pancreas (I think?? maybe another organ) may not be able to produce insulin fast enough, causing gestational diabetes. Even if you eat healthy, anything you buy prepackaged or from a restaurant has added sugar, as does any drink besides water usually, so you may be eating more than you think. I would personally be hesitant to skip this unless you were on all organic, whole foods, nothing prepackaged diet. Gestational diabetes can be terrible untreated.

3) Anatomy scan at 20 weeks is good, they can tell a TON about the health of the baby, and if everything looks good, you shouldn't NEED another. I did have one more to confirm the baby's position since my baby was sideways til right before I delivered.

4) If you don't want to screenings on the baby for things like Down Syndrome, those can be easily skipped.

Now, lot's of people go without any of this stuff and do just fine. Some don't. If you trust your doc, then discuss the tests with them, what you can learn, and why should do them. My personal minimum for peace of mind is the blood tests, the glucose tests, and the 20 week anatomy scan. Then regular check ups where they examine you and check the heartbeat.
As far as my diet, literally the only thing I eat that is prepackaged is the occasional bowl of popcorn. Most of the carbs that I consume are ones that come from grain I grind into flour and bake myself, so definitely nothing refined or high GI there.

DH and I both feel pretty comfortable skipping the glucose test, and figure if the doctor can really back up any concerns he has with us, we can do a nonchallenging/postprandial test. But I am at minimal risk for GD, have no family history that would put me at risk, etc.

I think we've decided to stick with the anatomy scan, Rhogam shots, and GBS test, and I will probably do the rest of the monitoring on my own until I'm much further along. We're getting a fetal doppler heart rate monitor and we already have a digital blood pressure monitor and I think we will be okay with that. Anything else anyone thinks we should have?
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Old 09-17-2012, 02:05 PM   #16
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Re: What comprises "unnecessary"

I can't understand why regular blood or pee tests would be at all necessary simply because I don't get them. The military gives you the bare minimum and that means we do blood and urine at the beginning and not again.

but I know it's hard to convince people sometimes that things aren't necessary when they're accustomed to them.

My appts are 'check heartbeat, check blood pressure, do you have any questions? make your next appt'. I've been considering just skipping half of them since they were a waste of time last time. but I probably won't cause last time I had to leave work early, drive 30minutes, spend 15minutes in an appt and be done. Now, I could walk to the hospital, have the appt and be home within an hour or less. Not as big of an interruption.
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Old 09-17-2012, 03:09 PM   #17
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Re: What comprises "unnecessary"

I think that tests that are unnecessary if you wouldn't end up doing anything differently, anyways. These things often include NT screens (would keep the baby regardless of DS or not), progesterone levels (many doctors let nature take its course except for recurrent miscarriages), and rhogam shots if DH is rh negative. Most doctors don't recommend anyone skipping things like the GD test because GD can strike anyone (even though it's less likely for people who eat well) and it's a BIG deal left untreated. The 20 week anatomy scan can make a big difference for early treatment, too.
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Old 09-17-2012, 04:21 PM   #18
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As far as my diet, literally the only thing I eat that is prepackaged is the occasional bowl of popcorn. Most of the carbs that I consume are ones that come from grain I grind into flour and bake myself, so definitely nothing refined or high GI there.

DH and I both feel pretty comfortable skipping the glucose test, and figure if the doctor can really back up any concerns he has with us, we can do a nonchallenging/postprandial test. But I am at minimal risk for GD, have no family history that would put me at risk, etc.

I think we've decided to stick with the anatomy scan, Rhogam shots, and GBS test, and I will probably do the rest of the monitoring on my own until I'm much further along. We're getting a fetal doppler heart rate monitor and we already have a digital blood pressure monitor and I think we will be okay with that. Anything else anyone thinks we should have?
Your probably safe on the glucose test. . Lots of people don't realize how much sugar there is in everything. To each their own! I am coming from a different place than many moms because my 1st pregnancy was very high risk and required constant monitoring. While it did not stop the death of DD1s identical twin, my everyday biophysical profiles (a specific kind of ultrasound) did save DD1s life. So I like to err on the side of knowing.
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Old 09-17-2012, 05:31 PM   #19
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Re: What comprises "unnecessary"

All have made good points in this thread. My only advice would be to read up on procedures that you are on the fence about doing and let your heart guide you.
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Old 09-17-2012, 05:45 PM   #20
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Re: What comprises "unnecessary"

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Originally Posted by mibarra View Post
Also, just so you know where I'm coming from with my philosophy, I am generally pro-modern medicine. I'm not against natural alternative remedies, either though. Without very specific and regular monitoring and intervention for DD1, we would have lost her on top of losing her twin sister. I personally feel that too little medical intervention can be just as bad as too much, sometimes worse depending on the the situation. Good luck!
It all depends on the situation, definitely. What is necessary for some women, isn't necessary for all.
But I also believe that there's really not much we can do to keep things from happening - with Elliana's pregnancy I had the most care that I've had since my first pregnancy, and... well, she died. Even though I did everything "right", she wasn't okay. Sometimes things just happen, unfortunately.

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Originally Posted by EmilytheStrange View Post
I can't understand why regular blood or pee tests would be at all necessary simply because I don't get them. The military gives you the bare minimum and that means we do blood and urine at the beginning and not again.

but I know it's hard to convince people sometimes that things aren't necessary when they're accustomed to them.
They do a urine dip at each appt (whether with the family Dr, OB, or MW) here. I've never bothered refusing it because I always have to pee anyways!
And the bloodwork is necessary for me, with each appt. I (and my Dr) want to know what my platelets are doing, so we can adjust my care if necessary. But this is a situational thing for me, not a generally needed thing, kwim?

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Anything else anyone thinks we should have?
You can easily get test strips for urine dips, if you want to keep tabs on that too.
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