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Tests & Procedures During Pregnancy

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Gracie Dillon-Moore

on 25 July 2013

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Transcript of Tests & Procedures During Pregnancy

Tests & Procedures
During 40 Weeks of Pregnancy

If Your Intuition
Tells You,
"This isn't the right Care Provider for me."
Listen to it.
Don't be afraid to change providers.
This is YOUR birth. You will remember it forever.
You can not choose how your birth unfolds but you can insure you are in the best care for the birth you desire.
A good provider welcomes questions and wants you to have a full understanding of your options.
A good provider is secure in their knowledge and is not threatened if you choose to question procedures.
A good provider treats pregnancy as a normal, alternate state of the female body.
A good provider insures that when you leave the office, you feel good about your experience.
Coach's Role:
SAFE, SECURE, SUPPORTED
Vaginal Exams/
"Check Your Cervix"
Ultrasound
Gestational Diabetes Mellitus (GDM), is defined as carbohydrate intolerance that begins or is first recognized during pregnancy.
B.R.A.I.N. Analysis
Routine Tests & Procedures During Pregnancy
Informed Consent & Refusal
“As an ethical doctrine, informed consent is a process of communication whereby a patient is enabled to make an informed and voluntary decision about accepting or declining medical care.” - ACOG

Avoid this effect by keeping in mind your body's natural ability to nourish, develop and give birth to your baby and that your instincts are your first insight into how baby is doing.
“Nocebo Effect”
Benefits - What are they?
Risks - Are there any and if so, what are they?
Alternatives - Get all options on the table
Intuition - Are you listening to it?
Nothing - Are there consequences to doing nothing at all?
Glucose Tolerance Test
First prenatal appointment: Assessment of risk -
family history of diabetes, ethnicity, age, weight before pregnancy, history of abnormal glucose tolerance, any issues with previous pregnancies.
1-hour screening test “offered” between 24-28 weeks. 50mg of sugar
If you “fail” the 1-hour test you should be offered the 3-hour diagnostic test to ensure a proper diagnosis.
Benefit: Debatable if you are a low-risk Mom
Risk: Nocebo effect, induction, false positives
Alternatives: Declining test, eating a varied, nutrient-rich diet, requesting a re-test, check blood sugar levels at home
Intuition: What is it telling you?
Nothing: What if you opt out of this test?
If diagnosed with GDM:
You may be asked to monitor your diet and exercise, or pursue pharmacological assistance - insulin therapy.

Bottom line: Keep doing what you are doing… eating a variety of whole foods, exercising daily and staying relaxed. If you opt to take the test and show signs of glucose intolerance, you have many options to consider.
Group B Strep
(GBS)



Intuition: What is it telling you?

Nothing: You may refuse screening or antibiotics and opt for treatment only if symptoms warrant, leave vernix on the baby
GBS+ B.R.A.I.N. Analysis
Benefit: If GBS+, screening and treatment can prevent 80% of infections in babies. (Colonization rate is 50% and Infection rate is 1 - 2% of babies whose Mother declines antibiotic prophylaxis.
Treatment = risk of infection reduced from 1% to .2%
Risk: Nocebo Effect; separation of Mom and Baby (NICU); antibiotic allergies in Mom and Baby; increased risk of other late-onset infections; antibiotic resistance (not common with penicillin in newborns); impact on newborn gut flora and breastfeeding; possibility of being tethered to the bed during labor; thrush
sauerkraut; probiotic supplements
Alternatives to Testing/Routine Antibiotics:
Two types: Continuous (Doppler, EFM, IFM) and Pulsed (scan that provides the picture)
Difference in frequency exposure: 1000 seconds of “pulse” scan = 1 second of continuous.
Ultrasound B.R.A.I.N. Analysis
Risks: slight risk of bacterial infections ESPECIALLY if the BOW has broken; risk of
sweeping or stripping the membranes, painful,
false hope, devastating to a hopeful mama.
Generally “offered” every week during the last month of pregnancy to see if there are any changes in the cervix and position of baby (dilation, effacement, station, position).
Ask them any specific questions related to the issue and wait for educated, specific answers.
How to Talk About Your Options
Remember why you chose this provider to begin with. Tell them why you chose them or what impresses you about them.
Also keep in mind, it is their job to insure you understand your options so that you can make informed choices.
Calmly make them aware of your concerns: “Can you help me understand the benefit/risk/purpose of... …?”
Tell them what you have learned and where you learned it - be as specific as possible. Site an article, documentary, etc.
Ask them how they "feel" about this subject. Listen carefully with an open mind.
"The nocebo effect is a negative effect on the emotional state of pregnant women and indirectly of their families. It occurs whenever a health professional makes more harm than good by interfering with the imagination, the fantasy life or the beliefs of a patient or a pregnant woman." - Odent
Benefits: ???
Nothing: What happens if you don’t have any vaginal exams?
Intuition: What is it telling you?
Alternatives: Avoid or limit exams
Benefit: Bonding activity, breech positioning, help identify genetic problems with baby’s development, identify placenta location prior to uterine surgery or amniocentesis, can help confirm Baby is healthy past 40 weeks
Risks: Largely unknown (left-handedness, cell changes/heats tissue)
Alternatives: fetoscope rather than doptone, intermittent doptone rather than EFM during labor, limiting or opting out of ultrasounds during pregnancy and labor
Intuition: What is it telling you?
Avoid the "Nocebo Effect" by having the knowledge of tests and procedures beforehand, and the courage to ask questions
and refuse/consent based on the answers
The FDA and ACOG currently recommend using
ultrasound to establish a birth window, EDD, around 8-10 weeks and look for developmental
risks around 18-20 weeks
These organizations caution against
using ultrasound recreationally.
Nothing: Can you opt out all together?
GBS (beta-strep) is a bacteria, part of the
normal flora, in approximately 30% of pregnant women. It's presence in the vagina and rectum comes and goes regularly. Moms are routinely tested around 35-36 weeks.
Grapefruit seed extract taken orally, immune support using vitamin C, propolis, garlic, Echinacea, chlorhexidine, panty liners lined with probiotics
Request a retest at a later date (some say retest every week)
Port or hep-lock for antibiotics instead of IV
Request penicillin specifically unless allergic - does not attack other groups of gut flora like it’s sisters and cousin antibiotics do
Prior to the test eating large amounts of Fermented food (yogurt, kefir, miso, kombucha,
Orally and/or vaginally; garlic clove scored and inserted vaginally - repeated for at least 4 nights (lessens GBS bacteria up to 4 hours)
If you are unable to come to a conclusion or
do not feel ready to make a decision, it is
perfectly acceptable to tell you provider this and
ask to revisit the issue at a later date.
You can always ask if there is any harm postponing or delaying a procedure or substituting another until you decide how you feel (i.e., using a fetascope instead of doppler or delaying a vaginal exam until the next visit, etc.)
Grocery shop and cook with her
Do weekly relaxations with her
Exercise with her
COMMUNICATE WITH HER
Encourage her
Praise her (get used to public praise)
Educate yourself
Take an active interest in pregnancy
Take an active interest in birth
Go to prenatal appointments
Be her/Baby's advocate
Ask questions, take notes
Thank Them
Full transcript