Do You Have To Take Maternity Tests?
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 maternity tests? What are they for? Who should seriously consider them? And what happens if you want to refuse?
Women are subject to many tests during pregnancy. These include the following (and possibly more; not all women will have all of these).
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.
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.
A woman’s blood pressure is checked at each visit to make sure it is in the safe range. Consistently high readings raise the risk for pre-eclampsia.
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.
Both mom’s and baby’s are checked, to make sure they are within the normal range and strong. If either is too fast or slow it can be an indication for further testing.
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).
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.
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).
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 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.
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.
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 diagnosed 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.
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 Maternity 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
- 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.
Maternity 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.
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.
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 the 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 Maternity Tests
The following tests I consider unnecessary for women with normal, low-risk pregnancies (not high-risk women):
- 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 are 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 ultrasounds. 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 maternity tests did you choose to have? Which did you choose to skip? Why?
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 🙂
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!!
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!
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.”
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! 🙂
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.
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My name’s Sirena & im having my 3rd child. Every thing is fine & all my children where and will be natural births. My first baby was 14 years ago, then 12years after that. I hate all the new test that they push. 14 years ago it was simple, 3 years ago wasnt so bad but now im told i have to get a anal swab that ive never had with any of my other pregnacies. There is no signs that anything is wrong, he just wants to do one. Im refusing the GBS test. Ive done my research and even if its positive, it could be negitive the next week or they push for anitbiotics that could harm my new born. Increase garlic, vit C & yogourt is best. I understand the reason why but no ones going in my butt just to see. Maybe i would feel differently if i had it done with my other pregnacies but come on now. When is enough, enough. My body, my choise. All natual, no medical interventions. I hate how they push for early indusing, managed 3rd stage labour because they dont want to wait, iv’s and checking all the time for no reason plus a synthetic vit k with fillers..im happy this is my last. I just want to go to the hospital and have a natual birth but some times i think its easier just to stay home & do it my self. Sorry but i dont look forward to going to the doctors office any more. I hate to see what they push when my kids have kids.
This thread is older but I get the need to comment! I was dishactged from my first OBs office at 28 weeks bc I refused to take a second glucose screening test (had passed first one just dandy at 24 weeks).
Now I’m planning to refuse twice weekly NSTs and ask the OB for once weekly w no ultrasound unless something is very wrong. I was put on low dose HBP medication at 30 weeks and my bp has been stellar since. Don’t see the need to go in twice a week to be hooked up to EFM and all when I am tracking babies movements, my bp and my general health and everything is fine!
Hoping when ob calls me back we can come to an understanding !
[…] This is going to vary widely depending on how your pregnancy is going and the type of care you’re receiving.
[…] aware of potential symptoms and always doing basic testing is important, because it will help your doctor or midwife to know before problems occur if […]
I declined a STD Panel test and once I had given birth the doctor came in and tried to force me to have it – saying I was risking the baby and also asked me if I was a drug addict!! I am a very normal working mum with no history of anything but he thought that might be the reason I had declined the test! Awful treatment
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