hi. im 8 weeks pregnant and my homebirth midwife does not recommend that i do any ultrasounds or testing. im welcome to if i choose it, but it is not something she pushes in any way. i lean toward doing no testing, but i also wonder about the triple screen for instance. it seems to have a high false positive rate, but can also diagnos something where the baby may not live outside the womb. i am 29. any thoughts? thank you.

Of course, Henci should answer this from the research point of view, but here my take.

With any testing, inluding ultrasound and blood tests, I evaluated the reasons as to why to do them, and why not, I evaluated all the possible results I could think of within reason and within my particular situation, and then I looked at what I would do with the possible bad outcomes, the good ones being a non issue.

We chose to not have ultra sounds for various (informed) reasons and we chose to accept a bad surprise as something to deal with at or after birth. A very personal choice.
The only three ultrasounds I had, were:
1 with my first child because dh wanted to know if the baby was ok.  We didn't with the next 3 because we realized there is no point for us. Dh was just worried first time around and wanted to prepare mentally if something was wrong. Me, I much rather not know and enjoy the pregnancy the way it is, bond with the perfect soul inside of me and deal with any physical issues later. Very personal choice again. My faith plays a big role in my decisions.
2 when I miscarried. I wanted to know for sure that my spotting was indeed miscarrying but opted to not have any medical involvement after the fact was established and went on to have two unassisted miscarriages with a back up midwife. We buried the reamins and this was all very healing and in my opinion the way it is best.
3 when I got pregnant again after that to make sure there was a viable heartbeat. Not that we would have done anything if there wouldn't have been but I wanted to know instead of wait, out of protecting myself, not wanting to get too attached.

I do have my blood tested with each pregnancy because I am Rh- and want to at least know what my status is at conceiving. How I would proceed if I had antibodies would not have been what a general OB would have suggested I am sure, but I would have acted informed and responsibly according to what I know and researched. Any other tests I declined, again informed. I am a healthy person with no reason to believe there are hidden disasters in my blood. I know waht to watch for when pregnant and how to remain healthy etc. My responsability and choice here too.

So what I am saying is that I am all for prenatals a la carte and the mom making informed decisions about those with the help of a professional if needed.

maria.

Maria's story illustrates perfectly that "one size does not fit all" when it comes to deciding whether to have a test. In order to make an informed decision, you need to answer:

·         What exactly is involved in having the test? This would include such things as discomfort.

·         Are there any potential adverse effects of having the test?

·         How accurate are the results? Tests evaluating fetal well-being have high false-positive rates, meaning the test says there is a problem when there really isn’t. Fetal weight estimates and due date estimates aren’t very accurate either.

·         What other tests might become necessary as a result of having this one?

·         What treatment would be recommended if the test diagnoses a complication?

These last two tell you whether you want to get on the train because once you get on, it may be very difficult to get off. For example, take gestational diabetes testing. Once you are identified as a gestational diabetic, you are now, inappropriately for almost all women, in my opinion, in a “high risk” category. Being treated as “X marks the spot where something could go wrong at any moment” tends to be a self-fulfilling prophecy because you get subjected to tests, restrictions, and medical interventions that are far from harmless. (For more on GD testing, go to http://www.lamaze.org/NormalBirthForum/tabid/363/view/topic/forumid/11/postid/735/Default.aspx.)

 

With any test, you also want to consider what you will do with the information. If the answer is “nothing,” the rule is: “Don’t have the test.” For example, if you would not terminate a pregnancy under any circumstances, you may wish to refuse testing whose intent is to diagnose congenital anomalies or genetic problems. Maria also raises what the Dutch midwives call “spoiling the pregnancy.” Sometimes, for some people, it really is better not to know.

  

I hope this helps.

 

--Henci

I thought I'd add my two cents though I agree with everything that Maria and Henci have said. Just as I am wary of doctors who order every test under the sun for every woman, I also don't agree with no prenatal testing for every woman. Both are "cookbook medicine" (or cookbook midwifery, for that matter.) The best approach in my opinion is to pick and choose the tests that make sense for you. With that said, it is certainly reasonable that a healthy woman who isn't at risk for sexually transmitted diseases would have no testing at all. Maria brings up the point of Rh negative blood. I do recommend getting a test to determine your blood type if you don't know that you are Rh positive. And you should also check to see if you have antibodies to other blood types, particularly if you have ever been pregnant or had a blood transfusion. As for ultrasounds, there is a peculiar thing going on in our culture where women are being lured to the ultrasound machine with promises of ever-increasing detail of what their baby looks like. It is really being spun as a social event in which you meet your baby for the first time and go home with trinkets to put in your "baby book." Meanwhile, on the medical side, researchers are learning about more and more "soft markers" on ultrasounds that signify risk for - but can not diagnose - genetic problems or birth defects. In every case, many many healthy women will be told they potentially have a baby with a problem when in fact they don't. This is definitely "spoiling the pregnancy" (which Charlotte Devries talks a lot about on her blog at http://birthwithconfidence.blogs.lamaze.org). It's also potentially harmful - in order to diagnose the problem with certainty you need invasive tests. Personally, I had no ultrasound with my first pregnancy and did have a 20 week ultrasound with my second, mostly to appease my mother who could get over all of my pregnancy and birthing decisions but could not understand why I didn't get an ultrasound! The other thing to consider is that some tests, despite their high false positive rates, can give you information that might affect your decision to have a home birth. Placenta previa or birth defects that could be stabilized and dealt with in a hospital setting are potential situations where having that information prenatally might help. But thankfully, both of those situations are very rare in healthy women in their 20's. And there is a much higher chance that you would get mis-information (i.e. a false positive). I hope that all helps! Sincerely, Amy Romano, CNM Forum Administrator