Now that you have scheduled your appointments, it is important to find out how they do tests, what tests, and when. If there is informed consent then you should receive a form that states why it is recommended, whether statistically speaking is worth while, any possible side effects or contra-indications to the procedure or test.
Also, not all tests are mandatory, some are and some are not whether it is dictated by local government, care provider policy or hospital policy. If you are not sure, ask. They will tell you if it is mandatory, recommended or simply voluntary/encouraged. Ensure you know your options and are comfortable with everything going on in your body
On your visits, your care provider will probably have you pee in a cup and will check you protein and glucose (sugars) levels, many midwives will even let you check your own. The purpose of this is to monitor for a conditional called pre-eclampsia. Blood pressure evaluation using a bp cuff, fundal height measurement (this is a measurement using centimeters going from the top of your pelvic bone to the top of your uterus), this measure meant is a way to see if the baby is growing along the way it should without relying on an ultrasound at every visit.
Your provider will also listen to the babies heart beat either by using a hand held doppler or using a fetoscope. The doppler uses sound waves to detect the heart rate and depending on the unit may be played so you can hear it. A fetoscope is a stethoscope style listening devise that has a horn attached to the end that gets put on your belly, while the headset portion has ear pieces to be placed in the ears to hear the heart rate. Some styles of fetoscopes have a double headset so that the care provider and someone else may hear the heart beat. The down side to fetoscopes is that they typically can’t hear a heart rate until 20 weeks, where as dopplers can do it around 8 weeks.
At your initial appointment or even the second appointment, your care provider may ask to do blood tests and a pelvic examination. The blood test is looking for several things:
- Complete blood count (to see if anemic and if so what level)
- Hemoglobin (the amount of hemoglobin per re blood cell)
- Hematocrit (the percentage of red blood cells o\per total blood volume)
- Sexually Transmitted Diseases (specifically: HIV/AIDS and Syphillis, Hepatitis B and C)
- Rubella titers (to see if you, the mother, has immunity from German Measles. If this titer check comes back low you may be recommended to get a booster but at no time should it be administered while pregnant.)
- Blood Type (to help determine if there is a conflict with the Rh Factor. Mostly when Mother is negative and Father is positive in the Rh factor)
In the pelvic examination your provider may do a pap smear if it has been more than 2 years since the prior pap smear. This helps look for Gonorrhea, Chlamydia, and HPV (Human papilloma virus). The other purpose is using pelvimetery (a specific set of points to measure how big your pelvis is) which the provider can use as an indicator as to whether or not vaginal birth is right for you. Please note not all providers use this form of measurement, and if you ‘measure small’ doesn’t mean a vaginal birth is off the table. The pelvis does amazing things when in labor.
Around 20 weeks an ultrasound may be suggested since at that point and time everything is well developed and visible. The bones can be measured to get a slightly more accurate picture as to your estimated due date. The heart is fully visible and you can see that everything is there. This is also the check up where gender can be determined with fairly accurate readings.
At 28 weeks the tests at that point are Gestational Diabetes (GD). Gestational Diabetes is an inability to use glucose. This is a process of either drinking a glucose drink or eating 18 jelly beans or having a cup of apple juice (depends on brand) and then drawing blood after an hour. Depending on the results additional testing for GD maybe done.
Group B Strep (GBS) is something that 30% of the female population carry. It is a bacterium carried in the vagina and rectum. GBS doesn’t cause any problems to the carrier and is treated using antibiotics during labor and after birth.
The majority of these test can be done in both types of Birth Centers. However, depending on circumstances, the Freestanding Birth Center may refer you out for some of them, like the ultrasound. Other tests such as Quad (Alpha-fetoprotein screening) testing (genetic testing looking for specific malformations like Down Syndrome). This is typically offered around the 20 week mark but has a 20% false positive rating. Amniocentesis should only done when there or other indicators from the earlier tests. Most of the tests here have very little impact on you and very few side effects or risks. Make sure you ask any questions with your provider and research yourself to see if they are truly right for you to take.
Here is an additional resource to read over on Prenatal Tests.
Go ahead to Step #6: Childbirth Education Classes