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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Aug 06
    2007

    Benefits of nonstress testing?

    Archived User

    Hello-

    Are there any studies that show a benefit from serial nonstress testing?  Is there any evidence that these tests can actually show if the placenta is not functioning well enough to continue the pregnancy?

    I am normally someone who takes the "no prenatal testing" route and has home births.  However, due to developing Rh antibodies during this pregnancy, I have been "risked-out" of the homebirth, and I am in "the system".  All of this is incredibly stressful to me and I am struggling to find an OB who will look at common sense and not just "do the standard" thing.

    Incidentially, the Rh problem, isn't really a problem for me.  The titer is remaining low (1:4) and the perinatologist I'm seeing is not concerned about it.  She however, has taken the liberty of testing me for every other conceivable "problem" and has deemed that I have gestational diabetes.  I have read the copious postings on the subject in this forum and others, and like so many others, I am fighting to not be induced "to avoid a large baby."

    I have found an OB who will agree not to induce just because of the GD, but wants weekly NSTs to prove that the placenta is still functioning well.  Is this just a mirage?  Does the NST actually show this?

    Thank you for this incredible forum, it's truly the best pregnancy and birth information message board on the net!

    Melanie Kollman

    Archived User

    Hello-

    I just wanted to update what's going on with my quest for an OB.  I've found a wonderful doctor who is very reasonable and practices in a very evidence-based way.  He is an "older" doctor (though he's not that old, mid-sixties), and has seen the way obstetrics is practiced change over the last 40 years, and doesn't think that it's for the better.  I'll have to go to a community hospital about an hour away from my house, but I'm glad to do it!  He takes very few patients now (he's semi-retired) and sort of "specializes" in consultations for women who want VBACs, vaginal delivery of breeches and twins.

    As for my previous post, the midwife at his office had told me that he would want weekly NSTs.  It turns out that the doctor listens to the baby with the dop-tone, gives the baby a little poke and checks that the baby responds to this with movement and an increase in heart rate.  The whole thing took 30 seconds!

    As for the gestational diabetes diagnosis, he has seen the baseline cutoff for fasting levels go from

    Henci Goer

    I am delighted for you! It is also good to hear that obs like him exist. I only wish he were mentoring a crew of young obs before he retires completely.

    Well, it seems as if you have solved your own problem, but you illustrated the old saying that a healthy person is simply one who hasn't undergone enough testing. In point of fact, we have no evidence that nonstress testing or any kind of fetal surveillance testing improves outcomes--and it isn't benign. Like all screening tests (amniotic fluid volume, biophysical profile, oxytocin challenge testing, electronic fetal monitoring in labor), nonstress testing has a high false-positive rate, meaning the test says there is a problem when there really isn't. No one, though, is going to sit tight when a test shows the baby might be in trouble, so these tests lead to unnecessary labor inductions and cesarean surgeries, and in the case of electronic fetal monitoring, unnecessary cesarean surgeries and instrumental vaginal deliveries.

    Even with a true positive, the tests can do more harm than good. Thinking about it logically, if the test says "here is a baby who might have less tolerance for labor," does it make sense to stress the baby with the rigors of an induced labor, which usually involves stronger contractions over a longer period of time than with normal labor and without the protective cushion of amniotic fluid? And if the baby is really in serious trouble, the cause is often one that will not be helped by a rescue delivery, although, of course, one would have to try. Unfortunately, too, newborn outcomes reinforce the use of surveillance testing whether the baby is in good or poor condition at delivery. The ob says (and believes), "Thank God we got the baby out in time! Who knows what might have happened if we had waited."

    Please let us know how everything goes.

    -- Henci


    All Times America/New_York

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