Prenatal Testing

  When I meet with pregnant women as a volunteer counselor at our crisis pregnancy center, many women have no idea about prenatal tests they will encounter in upcoming weeks.  Let alone, the nature of these tests and their right to decline or allow these prenatal tests.  It seems that since the 80's prenatal testing has expanded greatly.  During my pregnancies, women who had children in the early 80's or before seemed surprised at the litany of common prenatal tests.  This expansion of technology in obstetrics may have benefited the already medically high risk, but it also introduces unnecessary testing to those with no indication of high risk.  Therefore, viewing all patients with the potential for complications and their pregnancies as a disease process.
  As previously stated, all testing should be thoroughly explained.  Women should understand the value of the test, along with  it's risks and benefits.  Practitioners should maintain an air of courtesy  in explaining the testing to the woman and remain respectful of her decision if she should decline.
   Testing to be expected initially:

• Medical confirmation of pregnancy- When you go to the ob, doctors will administer a pregnancy test (not unlike the 5 you previously took at home) to detect hCG. hCG stands for human chorionic gonadotropin  and is a hormone present in both blood and urine after fertilization.  It is produced by the cells that form the placenta.  hCG levels peak in the first 8-11 weeks of pregnancy and later level off.
• Blood tests to test for HIV, your immunity to various childhood diseases such as chickpox, your iron level, and your blood type.  All of these blood tests are essential and give your practitioner a picture to your overall health.
• Blood pressure
• Current weight
• A pap smear (if you're due for one)

Subsequent Routine Visits:

• Weight Checks: To see if your gaining too much or too little  The growth of the baby will also be monitored to judge that according to the EDC (due date) your baby is growing appropriately.
• Fetal Heart Tones: Fetal Heart tones can be heard at around 10 weeks gestational age with a doppler device.
• Urine tests: to monitor the presence of sugar spilling into the urine.

Other Tests:

• Alpha-fetoprotein (AFP or triple screen test): A screening test is blood test done at 15-20 weeks of gestation that looks at multiple markers of proteins or hormones in the blood that can suggest a potential problem with the developing fetus.  This is only a screening and can only suggest that the abnormally high or low levels of various proteins indicate the possibility of a problem such as a neural tube disorder such as spina bifida or a genetic anomaly such as Down's Syndrome.  It has a high rate of false positives that are often discovered with further testing.  Of course until those other tests are performed, you don't know that.  This is a test that the pregnant woman has the right to decline.  Some women chose not to have the test because even if they were to have a child with a genetic disorder or neural tube defect, it would not affect their decision in parenting a child born this way.
• Ultrasound : Routinely performed at 18-20 weeks to detail the growth and development of the baby as well as monitoring the levels of amniotic fluid.  Sometimes performed earlier in pregnancy to determine due date or detect proper implantation when accompanied with other symptoms. Misread ultrasounds can lead to unnecessary intervention.
• Glucose Screening Test: At 24-28 weeks, a glucose tolerance test is performed to screen for gestational diabetes.  Gestational diabetes when unchecked, can lead to large baby at the time of delivery and other concerns such as frequent bladder infections.
• Group Strep B: At around 35 weeks, a vaginal swab will check for the presence of Group Strep B. About 20% of women will have this in their system and will have to receive IV antibiotics prior to delivery to avoid the transmitting to the baby at the time of delivery.  The baby is greater risk of developing a serious infection such as meningitis.

  You have the right to decide which of these tests you are fine with having administered. With the proper information, you can feel good about your choice.  Some women are fine with knowing less about their pregnancy. They choose to avoid the  anxiety sometimes accompanied with testing. While others find it is important to know everything possible.  And knowing would help them feel prepared in the event of a health concern regarding the health of their baby or pregnancy.  Either way, the choice remains yours and that will ultimately bring you peace and enjoyment during your pregnancy.

Epidurals...Making an Informed Decision

  Earlier in the week, between planning our church's annual bible school, picking up spilled Cheerios, and wondering where my sanity went, I had the opportunity to view a video segment re: one person's uninformed opinion about epidurals.  I am referring to actress-comedienne, Ali Wentworth's reaction to Victoria's Secret model, Miranda Kerr's decision not to have an epidural because she did not want her baby "drugged up." Ms. Wentworth responded that her babies were not drugged and how dare she! As a childbirth educator I cringe at public personalities further disseminating misinformation.  

   There is some debate on whether drugs used in epidural anesthesia crosses the placenta .  This is largely due to the type of anesthesia administered.  But many women are uniformed or misinformed by their health care professionals when making a decision about receiving an epidural.  To flippantly say, "an epidural won't affect your baby," is WRONG.

      Studies show that epidurals can have the following implications:

• Increased need to augment birth with Pitocin;

• Increased maternal risk of low blood pressure while using epidural;

• Decreased spontaneous birth;

• Increased risk your baby will be evaluated for infection and receive antibiotics;

• Increase risk your baby will be jaundiced.

• fetal malpresentation (meaning baby is not in a good position);

• breathing problems in the baby immediately after birth;

• babies scoring lower on the Neonatal Behavioral Assessment Scale (NBAS)

      For some women, the risks of these complications are risks they can live with.  And often the fear of losing control, and enter the unknown are too much to bear.  Too often by failing to educate and inform we fail to empower birthing women. There is nothing more powerful to a woman who will give birth in their life, than the realization that she can learn to dance with the power of her contractions and discover the depth of her strength.