Does anyone else's MW not do standard testing?

wifeofadam · September 2012

The MWs I used with #3 and now with this baby do not do standard prenatal testing, like GBS or GD tests. I do a urine test at every appointment that tests for 5-6 things and my diet is VERY strictly tracked, but that's about it.

Just curious if I'm alone in this.

iris427 · September 2012

My HB doc did some standard tests but not others. We did the GBS testing but he only did GD testing for people with certain risk factors, which I did not have. There was no NT scan or quad screen or that kind of thing, but I did have an anatomy scan.

Personally I think not testing for GBS is irresponsible on the provider's part. 1 in 4 women are colonized by GBS and it can cause sepsis in the newborn. Even if the MW is not going to put every GBS+ mom on antibiotics during labor, if you know you are GBS+ and have certain risk factors (like prolonged rupture of the membranes), you can make an educated choice about what to do. It seems like I have read way too many stories about mothers who were never screened for GBS by their home birth providers, or given any information on it, and then ended up with a baby who died or became gravely ill.

tokenhoser · September 2012

I only peed in a cup about three times my whole pregnancy.

And I was with a doctor.

We did the GBS and GSD tests, though, and I had the option for the NT scan and quad screen.

danienross · September 2012

My home birth MW gives you a choice for pretty much every test. I did the initial bloodwork. I did the GT test. I am declining the GBS test. I have yet to pee in a cup. She doesn't do any ultrasounds but has a tech she can refer you to if you wish to have an ultrasound. We did the anatomy scan. I also got my iron level tested at the last appointment.

wifeofadam · September 2012

I forgot to add that I do iron testing throughout pregnancy too. Forgot about that. No ultrasounds though.

Iris - America sort of stands alone in the routine GBS testing thing. Other countries don't test or treat for GBS like we do. The testing is optional and/or they only treat you if you have risk factors during labor. And America's infant mortality rates certainly aren't any better than the countries that do not test for GBS, so I guess I'm not understanding why it's such a big deal.

There are ways that you can decrease the chances of passing the bacteria to the baby. My MWs don't do internals during pregnancy or labor (unless there is a reason for it). Studies have shown that the more internals you do, the more likely you are to pass GBS to the baby. And after watching my friend give birth with her OB last week, I realize why it would be necessary for the antibiotics in your typical birth. She had a hand in her vagina what seemed like every other minute. And during labor they were rubbing all over her perineum and then inserting their fingers into her vagina to stretch it out. It seemed like a recipe for infection in the baby.

Also, it has been shown that water births can decrease your chance of passing the bacteria to your baby. The water "dilutes" the bacteria in the environment.

So, yes, I can see how it would be irresponsible to not do the GBS test if you're having a traditional hospital birth. But given the way in which my MWs allow me to labor and birth, combined with how small the risk of infection is, I feel comfortable with my decision. My MWs offered me a lot of information on the topic and would have supported me if I wasn't comfortable and wanted to test.

I also have some objections to treating all mothers with routine antibiotics just in case. Antibiotic resistant bacteria is a huge problem. What's going to happen if one day GBS becomes resistant and now the women and babies who truly need treatment aren't going to be able to get it as effectively. It's a scary road to go down.

My other problem is that the antibiotics kill all of the beneficial bacteria in your vagina and studies have shown that it is important that your baby get exposed to that bacteria in order to establish healthy gut flora. I guess you have to weigh the risk of that too.

I don't think this is an issue that is as simple as you make it sound. And it sort of sounds like the argument people use against homebirth in general - there is a small risk that something could go terribly wrong, so it's irresponsible not to take the preventative measure of being in the hospital just in case. We all have a certain level of risk we are comfortable with. Declining this test isn't any more irresponsible than declining to give birth in a hospital IMO.

ETA - I forgot to mention the Cochrane study in which the outcomes are no different in women whose babies get infections and receive the antibiotics and women whose babies do not receive them.

katiefalls · September 2012

Our presents us with the options the day we sign with her along with information about everything, often with documentation from each side. We then sign a form opting in or out. At her recommendation we opted in for GBS and GD.

StefandTodd · September 2012

My MW didn't think it was necessary for me to do the GD testing either, so I'm not. She also thought it was fine to skip GBS testing, which was an easy thing for me to decline since I was positive the last time so I feel like we should treat as if/be aware of my potential to be positive this time regardless of what a test shows at 36 weeks. What I figure is why test to find out if I'm + or - at 36 weeks when I could be either + or - at 40 weeks? Knowing I was + once means I'll take the precautions of someone who is + again (basically, assume positive - try for waterbirth, take lots of probiotics, hibiclens, watch for any symptoms/signs of sepsis, and antibiotics if I have prolonged rupture of membranes and/or a fever during labor). I don't see how that could be considered irresponsible. But I have seen a WHOLE LOTTA "you're a selfish ninny" on my BMB for not having the GD testing, heh.

stahlop · September 2012

My MW gives me the option to do every test. If I don't want to do it I don't have to. Simple as that.

perplexed59 · September 2012

I have a choice to do whatever testing I want. I will probably skip GBS this time. Last time I was GBS+ and I barely got anitbiotics in time. While they were giving them to me because it was so late they said either way the risk was very low for anything going wrong so I was perturbed that I spent 1 hour with them sticking me with needles trying to get a vein during my most active part of labour.

I will do GD tests for sure. I'm just scared of not being diagnosed and running into complications. This stems from a very close friend losing 2 babies in 2nd trimester due to undiagnosed GD and losing a baby at 35 weeks due to controlled GD complications. So it hits close to home and although she had way more risks factors than I do I have a very large fear of GD now.

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