9 Procedures You Might Want To Reject During Pregnancy

9 Procedures You Might Want To Reject During Pregnancy

Depending on the type of pregnancy care you choose, you might be surprised to discover how much of your pregnancy will be spent in clinic waiting rooms.

You might well feel like a pincushion at times, as you’re poked and prodded for various tests and screenings.

You can be reassured to know not all pregnancy tests are necessary, and you have the right to refuse procedures.

9 Procedures You Might Want To Reject During Pregnancy

It’s also important to know, however, that you’re entering a ‘one size fits all’ prenatal care system.

But this is your pregnancy, your body, and your baby, and you DO have the right to decide which tests you will or will not consent to.

Here are 9 pregnancy procedures you might wish to avoid:

#1: Prenatal Vitamins

Although not a procedure as such, vitamins are an optional part of conception and pregnancy care, but most women will be advised to take them.

There is such a vast array of products available it’s hard to know which ones are best. Vitamins can be expensive, and many have additives which you might wish to avoid, especially during pregnancy.

A healthy and well balanced diet is the best way to achieve optimal nutrition for you and your baby. You can consider prenatal multivitamins if your diet is poor, or if you have underlying health conditions.

It is particularly important to have adequate levels of folate in early pregnancy, and most forms recommended for supplementation are synthetic, which can be problematic for many women. Natural sources or supplements of folate are best.

You can find out here whether prenatal vitamins are a waste of money  and what you should know about folic acid.

#2: Nuchal Translucency Screening

This test is offered as a combined routine ultrasound and blood test. The blood test is done between weeks 9 and 12, and the ultrasound is performed between weeks 11 and 14.

The first trimester blood test measures two different hormones that occur naturally in your blood during pregnancy. If there is a genetic condition present, the levels of these hormones will generally be abnormal.

The ultrasound looks at your baby’s nuchal translucency. This is a collection of fluid under the skin at the back of your baby’s neck. All babies have some fluid, but babies with Down syndrome tend to accumulate more fluid.

The scan measures the thickness of the nuchal translucency at the back of your baby’s neck to see whether it’s within the normal range.

The information from the blood test is assessed, along with your age, and the measurement from the nuchal translucency scan. These are used to work out whether you are low or high risk for having a baby with Down syndrome.

The nuchal translucency ultrasound alone will detect around 70-80% of babies with Down syndrome. Using the combined test (scan and first trimester blood test) the accuracy increases to 80-90%.

Some women choose to reject nuchal translucency screening for their babies because of concerns about the risk of false positives. Around 1 in 20 women will be told their babies have a high risk of Down syndrome, even though they actually don’t have it.

If you are considered low risk, or having a baby with Down syndrome would not affect your decision to continue with the pregnancy, then you might decide this test is unnecessary.

You might like to read BellyBelly’s article on expecting a baby with Down syndrome.

#3: Ultrasound After Week 24

Your care provider might suggest an ultrasound after week 24 if there are concerns about your baby’s growth and development, or if there are potential complications, such as a low lying placenta.

Late ultrasounds might also be performed for women who want another chance to see their baby before birth; some care providers do monthly ultrasounds as a matter of course.

A Cochrane review of 13 studies, involving almost 35,000 women, showed routine ultrasound after 24 weeks gestation doesn’t provide any benefit for low risk women or their babies.

Ultrasound is often used as a way of predicting your baby’s due date or size. However there is an increased margin of error for ultrasounds performed after 24 weeks gestation. This means you might be given inaccurate information about your baby’s size or gestation, and could undergo procedures such as induction or c-section unnecessarily.

There are also increasing concerns about babies being exposed to ultrasound during pregnancy. Ultrasound can heat body tissues, and the long-term effects are unknown. The risk depends on the type of tissue being scanned, the length of the exposure, the intensity used, and whether the transducer is moved or held still.

Doppler ultrasound uses continuous waves, rather than the pulsed waves of a standard ultrasound. Research has shown babies who have been exposed to more than 5 Doppler ultrasounds during pregnancy were 30% more likely to develop intrauterine growth retardation (IUGR) than babies exposed to routine (pulsed) ultrasound.  In most cases, Doppler ultrasound is specifically used to determine whether babies have IGUR.

#4: Testing For Gestational Diabetes

Depending on where you live, you might be offered a routine test that screens for gestational diabetes (GD). This is a condition affecting around 5% of women during pregnancy.

Like other forms of diabetes, GD affects your insulin and blood sugar levels, but it’s temporary and will go away after the birth of your baby.

The glucose challenge test is performed between 24 and 28 weeks gestation. You will be asked to fast overnight, then your blood is drawn and the blood glucose levels are measured. A result above the normal change is a positive for gestational diabetes. You will have the oral glucose tolerance test (OGTT) – a sugary drink – to confirm the diagnosis

While there are no risk factors for the GD test, many women experience nausea after the OGTT, and some also suffer vomiting, diarrhoea, dizziness, headache, and fatigue.

If you are not at risk of GD, you might wish to decline this test.

Risk factors for GD include:

  • Over the age of 30
  • Family history of Type 2 diabetes
  • Certain racial groups, such as Indian, Asian, Middle Eastern, African, Aboriginal or Torres Strait Islander.
  • Overweight with a BMI of 30 or more
  • Previously had gestational diabetes
  • Previously had a baby over 4.5kg

In most cases, women with GD are able to manage the condition with diet and exercise.

Read more about gestational diabetes signs and dietary treatment.

#5: Pelvic Exams

Your care provider might perform pelvic exams during pregnancy, particularly if you are in the United States, where this procedure is offered routinely in late pregnancy.

A pelvic exam is essentially done to check the cervix for any changes. It is usually done to see whether the cervix is thinning or ripening, what position it’s in, whether it’s dilating, and what position your baby is in.

Most women find this information interesting, but it doesn’t really tell you anything about what is going to happen. Your cervix can be high and closed during an exam, yet you can still go into labour later that day. On the other hand, you might have a slightly dilated cervix and expect to begin labour, yet still be waiting 2 weeks later.

Unless you need to be induced for medical reasons, in which case it can be useful to know how favourable your cervix is, routine pelvic exams aren’t very beneficial to mothers.

At the end of a pregnancy, many care providers might strip or rupture the amniotic sac, or try sweeping your membranes. This is often done without your informed consent so you aren’t able to consider the risks and benefits of membrane sweeping before it happens.

Find out more about how necessary pelvic exams are during pregnancy.

#6: Amniocentesis

If you are at increased risk of having a baby with chromosomal abnormalities, you might be offered an amniocentesis. Women who are older than 37, have had an abnormal maternal screening test, or have had a baby with birth defects, will also be offered this test.

An amniocentesis is usually performed between weeks 15 and 20. The test involves inserting a long, thin needle through your belly into the amniotic sac. The needle withdraws a sample of amniotic fluid, which contains cells from your baby, and which can be tested.

There is less than 1% risk of miscarriage following amniocentesis, but the risk increases if the procedure is performed earlier than 15 weeks. It’s important to know the benefits and risks of the procedure before making a decision to go ahead.

You can read more detailed information about amniocentesis.

#7: Chorionic Villus Sampling

Chorionic Villus Sampling (CVS) is another test performed, during pregnancy, to check for chromosomal abnormalities. This test can be performed earlier than amniocentesis, around weeks 10-13 of pregnancy.

It involves taking sample tissue from the placenta. A fine needle is inserted through your abdomen, or via a catheter inserted through your vagina into your cervix. The needle removes a sample from the placenta.

Around 1 in 100 women will miscarry after having a CVS, and around 1 in 1000 will experience a severe infection.

Find out more information about chorionic villus sampling and why it’s used.

#8: Fetal Monitoring

During pregnancy your doctor will check your baby’s heart rate and rhythm. This is a way of checking how your baby is doing, and whether there are any potential problems.

A normal fetal heart rate is between 120 and 160 beats per minute. This can change as your baby moves or sleeps, but abnormal heart rates and patterns can mean there is a problem, such as a lack of oxygen.

Monitoring is usually done externally, using a handheld device, such as a fetoscope or Pinard. These are similar to stethoscopes but allow your care provider to listen to your baby’s heart rate through your abdominal wall.

Some care providers will use ultrasound instead, such as a handheld Doppler, or electronic fetal monitoring sensors. If care providers have any concerns about baby’s wellbeing, they might suggest a biophysical profile to gather more information.

Most women will have fetal heart rate monitoring regularly throughout their pregnancy. It can be comforting to hear your baby’s heart rate but it can also be stressful if your care provider can’t locate the heart tones. This can happen during early pregnancy, if your baby is in an odd position, or if your uterus is tilted.

If you are expecting a baby you should know the risks and benefits of fetal monitoring.

#9: Group B Strep

Group B Streptococcus (GBS) is a type of bacterium commonly found in the lower intestinal and genital tract. At any time during a woman’s life, she might be colonised by these bacteria and they present no problems.

Around 30% of pregnant women will be colonised during pregnancy. GBS can cause infection of the placenta as well as urinary tract infections, which can lead to premature birth or sepsis. Newborns can be affected by GBS during pregnancy and labour, and this can cause life-threatening infections, such as pneumonia or meningitis.

Routine testing for GBS is recommended for all pregnant women between 35 and 37 weeks. This is done by taking swabs from the vaginal and rectal area. Women who are positive for GBS are advised they will be treated with intravenous antibiotics during labour.

However, a Cochrane research review found giving IV antibiotics is not supported by conclusive evidence. Fewer than 1% of babies born to mothers with GBS (who don’t have antibiotics) will develop infections.

There is also more research being done today regarding the effects of antibiotic use during pregnancy and labour, and how this might affect a baby’s immediate and long term health. Read more about Group B strep testing and antibiotics in labour.

Pregnancy should be a time of excitement, and yet many women they feel as though they’re on an assembly line, having constant tests and checks.

While it’s important to make sure your health and your baby’s development are on track, you do have the choice about which tests and procedures you will have.

All pregnant women have the right to control and make informed decisions about their pregnancy care. Your care provider should always discuss with you the risks and benefits of any procedure or test.

Recommended Reading:

When Doctors Don’t Listen: Informed Consent and Birth

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Sam McCulloch enjoyed talking so much about birth she decided to become a birth educator and doula, supporting parents in making informed choices about their birth experience. In her spare time she writes novels. She is mother to three beautiful little humans.

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