I’ve gotten several questions lately about the various tests and procedures that come with pregnancy and birth and what I choose. These are topics that I researched extensively when I was expecting my first and have continued to research throughout my pregnancies, so I have shared my opinions and research below. I’ve also written in depth about my own pregnancy and birth experiences and how I’ve come to my opinions. I am not a doctor or midwife and you should always consult with yours before making any decisions during pregnancy.
Personally, while I often feel that some tests and procedures are not needed, I still consent to some of them to make my doctor/midwife more comfortable and more willing to agree to my non-intervention approach to birth and after care. I think that each option should be carefully researched and weighed by an individual couple after taking in to account their specific circumstances.
Prenatal Vitamins Or Not?
Typically, prenatal vitamins are recommended during pregnancy. While these are certainly beneficial for many people, especially those who aren’t getting adequate nutrition from diet, but I don’t usually take them for several reasons:
- Most contain synthetic forms of Vitamin A and other vitamins that are not only not beneficial during pregnancy but can also be harmful
- As I’ve mentioned before, you can’t out supplement a bad diet, and while some high quality vitamins can fill in the gaps from a poor diet, they won’t take the place of it and can give a false sense of health
- I personally notice that I feel better when I take certain isolated nutrients instead and concentrate on an extremely nutrient rich diet
As I said, this is something that is very individualized, but during pregnancy, I take:
- 1-2 teaspoons of fermented cod liver oil daily for the vital fat soluble vitamins
- Consistant daily magnesium intake before and during pregnancy (this post explains what I used) This is also supposed to help with labor- I’ll let you know!
- Daily bone broth for the minerals and gelatin
- 800 micrograms of folate (not folic acid!!! it is synthetic) daily before and during the first trimester (this is the one I take)
- Lots of probiotics, fermented food, and fermented drinks daily since baby inherits my gut bacteria. This is vital!
- a very high nutrient diet that I consider non-optional. I mostly follow the Weston A. Price pregnancy diet except that I eat sweet potatoes and squash in place of sprouted grains.
First Visit Blood Tests/ Pap Smear
Though I don’t find much of a need for these personally, I agree to them anyway. I monitor by blood levels and check my Vitamin D levels regularly, so I already know that I am not anemic and after four pregnancies with the same person (my husband), I am also relatively confident that I do not have an STD.
The reason I consent is because I refuse some of the routine after-birth options like antibiotic eye drops and then have proof that I don’t have an STD that could be passed on to baby. (more on that later).
These tests are often unnecessary, but can also reveal important information (like rH problems) and have no downside so I don’t mind them.
Ultrasounds/Dopplers for Heartbeat
There is some controversy about the safety and necessity of ultrasounds and regular checks for baby’s heartbeat with a doppler. This article outlines some of the potential dangers in ultrasounds especially multiple or unnecessary ones. While I opt out of routine ultrasounds or those to check the size of the baby (which are not accurate anyway), I do consent to one 20-week ultrasound in my specific case.
My reason for agreeing is that I had placenta previa with my third that was not caught, despite an ultrasound and I hemorrhaged and could have died at 35 weeks gestation (we are both fine now). Since the risk of placenta previa is slightly higher if you’ve already had it, the risks of one ultrasound are less to me than another potential undiagnosed placenta previa. I would not consent to other ultrasounds to diagnose size, gender, etc.
In non-high risk cases, no ultrasounds may be needed and a mother should carefully research and weigh the options for her pregnancy. Most experienced midwives and doctors are able to feel size, position and movement of the baby without the need for ultrasounds unless there is a specific risk.
Dopplers (the instrument used to hear the baby’s heartbeat) come with their own set of concerns and some doctors prefer not to use them because they do pass on some radiation. As this article explains:
“According to the U.S. Food and Drug Administration, fetal Dopplers are not intended for over-the-counter use. The radiation used during a Doppler session has the potential to cause harm to the baby. You should only use a Doppler in your doctor’s office or under your doctor’s supervision. If you chose to use one at home, get a prescription from your doctor first. A Doppler should not be used when the number or lengths of sessions are not specified and should only be used when it is medically useful.”
I’ve had midwives with differing opinions on this and I prefer to avoid dopplers for the most part. I will sometimes consent to one very quick check for a heartbeat to satisfy the midwives at a first appointment, but then once it is possible (3-4th appointment usually) I ask them to use a fetoscope instead. Most doctors and midwives have a fetoscope and are able to do this if asked.
In labor, I will consent to doppler checks to monitor baby occasionally if it removes the need for constant monitoring and being tethered to my bed (oh the joys of v-bacs!)
I consent to urine tests when indicated my my midwife/doc because they are non-invasive and test for sugars or ketones in the urine which can both be signs of problems, especially when paired with other symptoms like blood pressure changes, rapid weight gain, headache, etc.
If a urine test revealed a problem, I would seek additional testing (blood or otherwise) to confirm before consenting to any treatment.
Blood Pressure Checks
Another non-invasive test that I agree to as high blood pressure in pregnancy can be very dangerous and it would be better to find an elevated blood pressure as soon as possible and attempt to treat naturally if possible, or to get medical treatment to avoid a pre-term delivery if needed. High blood pressure, especially paired with other symptoms, can signal preeclamsia, a very dangerous condition.
I completely refuse internal exams (cervix checks) and only consent during labor when I feel the urge to push (mainly to pacify the midwife, not for me). There is really no information that an internal exam can reveal that is useful or relevant in prenatal care before labor. It is a chance for external bacteria to enter the vaginal area and baby’s size, position, etc can be determined with an external exam.
Many women like to know how far dilated they are at the end of pregnancy in hopes of knowing when they will go in to labor. Unfortunately, this is a notoriously inaccurate test for when labor will begin. I personally know women who were not dilated and effaced at all and delivered less than 24 hours later, as well as women who walked around at 3-4 cm for weeks.
Without a specific need, I always refuse internal exams… plus, it makes prenatal appointments easier and faster to not have to disrobe at every appointment. Here is an article detailing the risks and why one might refuse these.
I do not consent to the normal glucose screening test that involves drinking 50 grams of a glucose solution for several reasons. First, there is no situation during pregnancy in which I would ever consume that much sugar/carbohydrates in one sitting, so the test is not accurate for me. There is a risk of false positive, which leads to another, longer test.
That being said, I do think it is important to make sure I don’t have blood sugar issues or gestational diabetes, as they can both cause complications. Instead, I monitor my blood sugar over a period of a week at two separate times during pregnancy and record it for my doc/midwife to check. I take my blood glucose levels four times a day and record. This article explains more on what the normal levels should be, but basically:
- Fasting blood glucose (first thing in the morning) of 86 or lower
- 1 hour after eating= 140 or lower
- 2 hours after eating= 120 or lower
- 3 hours after eating= back to fasting leve
There can be some variation in this, but the majority of my readings should be in these ranges. I do this at 28 weeks and 33 weeks (my preference) to make sure my levels are good. Another reason I prefer this is that it is a more comprehensive view of glucose tolerance and I even get to see what foods cause higher spikes for me personally and which don’t affect it as much at all. I’ve also found through this testing that adding 1 tablespoon of coconut oil before each meal helps my glucose reactions improve and get back to baseline more quickly, so I would use this if I ever needed to control my levels.
Many doctors may not be familiar with this and I have had to suggest it to a doctor before and let him research it before he agreed to it. With anything I do that goes against the norm, I make sure to present it in a friendly and firm way and show that I’ve done my research and explain why I feel it is a better option. This is one thing I’d encourage you to research for yourself if you consider it, and talk to your doc/midwife about the best option for you.
Optional Screening During Pregnancy
There are various optional screenings that can be done during pregnancy. This article explains the usual ones:
- “Chorionic villus sampling (CVS). Tests the tissue around the baby to see if he has a genetic condition, like Down syndrome. The test usually is done between 10 and 12 weeks of pregnancy. Your provider may want you to have CVS if you’re older than 35, if genetic problems run in your family, or if your first-trimester screening shows that your baby is at increased risk for birth defects.
- Cystic fibrosis (CF) carrier screening. Tests to see if you have the gene that causes CF. CF is a disease that affects breathing and digestion. If you and your partner have the gene, you can pass CF to your baby. You and your partner can have this test any time during pregnancy.
- First-trimester screening. Tests your blood to see if your baby is at risk for some birth defects, like Down syndrome and heart defects. You get an ultrasound as part of this test. The test usually is done at 11 to 13 weeks of pregnancy.
- Maternal blood screening. Tests your blood to see if your baby is at risk for some birth defects, like Down syndrome and heart defects. The test is done at 15 to 20 weeks of pregnancy.
- Amniocentesis. Also called amnio. Tests the amniotic fluid from around your baby to see if he has a genetic condition, like Down syndrome. The test usually is done at 15 to20 weeks of pregnancy. Your provider may want you to have an amnio for the same reasons as for CVS.”
I refuse all of these tests. They all have some risk of a false positive, which can cause needless worry for the parents and they provide information which is really irrelevant to me. As one reader put it, one must consider “what you would do with the information.”
Finding out that my baby had any of these problems would not affect my decisions about my pregnancy and I would certainly never consider not continuing the pregnancy, so this is simply not information I need to know and it could cause needless worry… I skip it.
Group B Strep
Pregnant women are generally screened for Group B Strep or GBS at 25-37 weeks gestation. It can be a life threatening infection if a baby contracts it from a mother during birth, so it is certainly best to avoid GBS, and the usual method is a GBS test and antibiotics during labor if necessary. There is some controversy over if GBS testing actually improves outcomes in GBS cases, and even more controversy over if routine use of antibiotics for all those with GBS is necessary.
The bacteria is naturally present in some women and it can come and go in the gut/vaginal bacteria. In my opinion, the best bet is to optimize good bacteria and work to avoid GBS and a positive GBS test as this makes labor much easier (IV antibiotics =stuck in bed on an IV). I highly encourage all women to do research on this topic before the appointment that tests for GBS. This article gives some advice for preventing GBS and making sure you test negative on the screening.
If you do test positive for GBS, I highly encourage researching the options in depth. Antibiotics are the usual treatment, but as more information emerges on the importance of gut bacteria and how baby inherits it from mom, antibiotics can have a much longer impact than just during the birth and days after. There is even information linking antibiotic use in labor and in baby’s early days to higher rates of allergies and asthma, which makes sense under the gut bacteria theory.
This article explains ways to avoid GBS and treat it naturally should this be an issue. I proactively consume a lot of probiotics and use them vaginally during pregnancy to optimize my gut bacteria that I am passing on, even if GBS is not a concern.
Many thanks to a brave reader for stressing the importance of checking kick counts, especially if baby is moving less or if there is concern! Especially in the third trimester of pregnancy, this is an easy and non-invasive way to double check the baby is doing well.
Basically, you just want to ensure that you feel some type of fetal movement within a 2-hour stretch. This doesn’t mean that you have to be constantly kicking ,but just that at some point during the day you check to make sure you are feeling movement. A decline in fetal movement can indicate fetal distress or a cord wrapped around the neck and this information can be life saving for baby if found early enough.
The bottom line…
Whatever a couple decided on pregnancy and prenatal care options, I think it is very important to research individually and not agree to or refuse any test without researching both sides first. While it can be hard to go against the norm, especially under pressure from a doctor, we (as mothers) must remember that ultimately we have the responsibility for our pregnancies, our health and our babies. We have the right to refuse or consent to any procedures and we certainly have the right to make an informed decision! In future posts I’ll be covering specific conditions of pregnancy and my preference on birth options/interventions.
I’d love for you to weigh in! What other pregnancy testing is there? What do you refuse or consent to and why? Let us know below!