My current pregnancy is considered "high risk" because I was diagnosed with pulmonary embolism at 13 weeks - therefor I'm on blood thinner injections.

I've had two previous, uncomplicated home births. (One with Amy Romano) My plan is to STILL have a home birth with baby #3. I have a home birth midwife whom I trust, and a maternal fetal medicine doctor so my blood thinner levels can be monitored and adjusted as needed during the pregnancy.

I give the background mainly because of my question.

My MFH doctor (during my last trimester) wants to do a lot of NST and fetal heart monitoring (20 minute strips in office). By a lot, I mean every visit.
Personally, I'm uncomfortable with this. I know that NST can be inaccurate, is there any information you can relay to me about 20 minute strips?

I'm just afraid that due to the machine they'll find "something". I know I have the right to refuse, but having some background research would be great! I can't find anything about the risk/benefits of such monitoring.

Add to that notion, that when my mother asked if they were worried about the baby during this pregnancy, they said "no. our main concern is mom. baby should be fine and unaffected by the blood thinners" then I wonder why they want to do all this amount of testing anyway.

Any research you've found would be great!!

--

Michael Robertson

I think you are right to be anxious about the possibility of a false-positive (the test says there is a problem when there isn't). The NST has a high false-positive rate in general and, according to this systematic review (a structured study of studies on a particular topic), the NST has not been shown to be beneficial in high- or intermediate-risk pregnancies. Moreover, the NST looks for fetal heart rate response to such things as Braxton-Hicks contractions and fetal movement, and somewhere rattling around in my brain, I recall that until the fetus reaches maturity, the fetal heart rate doesn't respond to these sorts of stimuli. Don't quote me on that, though, because I might be remembering wrong. I suggest you ask your dr to show you research confirming the benefits of weekly NSTs because they certainly aren't harmless. A test result saying the baby may have a problem can't be ignored, which is likely to lead to an unnecessary induction, cesarean, and possibly a preterm delivery. If your dr can, then you will have to weigh the benefits against the risks of a false positive, but if your dr can't, then you may wish to decline.

-- Henci