what tests/antenatal care

I'm 11dpo, so it may or may not be this month, but I'm beginning to think of
what kind of care and tests I want.

Brief history, I have a boy 15 months old, induced due to PROM at 37+4. He
was quite small, 5lb13oz, not IUGR, but there was a definite slowing of
growth from 28 weeks. I also had an irritable uterus, which landed me in
hospital 4 times from 26 weeks onwards, not enforced bedrest, but I did rest
a lot as pain relief. I was also very susceptable to thrush and urine
infections, which may or may not have cause the PROM or the irritable
uterus.

The usual plan would be
booking in with midwife
10 week early dating scan
14ish weeks blood tests including triple screen if you desire
16 weeks midwife check
20 week ultrasound
24 week midwide check
28 weeks blood tests and glucose tolerance
then midwife checks til you deliver

the midwife checks urine, blood pressure, listens to the heartbeat and
measures the fundal height

I'm happy with the early dating scan, my theory is get as late a due date as
possible to avoid pressure for post dates induction.
I'm dubious about the blood tests and glucose tolerance unless they are
indicated for a specific reason.
I'm unsure about the 20 week ultrasound, I'm really not convinced it's
necessary, but it was nice to see the baby!
The midwife checks of blood pressure, urine, and fundal height all seem
fine, but I'm concerned about the heart beat checking, they use one of those
little hand held ultrasound probes, I've heard that it's not been proved
safe, and if I can feel the baby moving, what's the point?
I felt my last pregnancy ended up quite medicalised, but it seemed to be a
route we slipped into from the start, so I'm wanting to get armed with facts
so I can make educated choices rather than just doing what I'm told!

Thanks for the help
Anne

Anne Rogers wrote in message
news:1095876975.zowQCIq514XaYipGn84p4w@teranews...
I'm 11dpo, so it may or may not be this month, but I'm beginning to think
of
what kind of care and tests I want.


I'm happy with the early dating scan, my theory is get as late a due date
as
possible to avoid pressure for post dates induction.
I'm dubious about the blood tests and glucose tolerance unless they are
indicated for a specific reason.
I'm unsure about the 20 week ultrasound, I'm really not convinced it's
necessary, but it was nice to see the baby!
Just for the record. At the 20 week scan we discovered #2 was missing one
hand. Obviously knowing didn't change the issue, but it was helpful to have
the time to get used to the situation. It meant that we could research into
the issues and made contact with the limb clinic during pregnancy. I think
from what Ive come across, it seems to be easier coming to terms with it
when found out at the scan rather than at birth.

The midwife checks of blood pressure, urine, and fundal height all seem
fine, but I'm concerned about the heart beat checking, they use one of
those
little hand held ultrasound probes, I've heard that it's not been proved
safe, and if I can feel the baby moving, what's the point?
It hasn't been proved safe, but I don't think it's really been investigated
into. Pregnant ladies are unwilling to be part of trials so it's hard to get
figures. I don't think there's any evidence of it being unsafe.
I hink it can pick up things like heart murmurs etc. I just liked the
reasurrance that she was still okay.

I felt my last pregnancy ended up quite medicalised, but it seemed to be a
route we slipped into from the start, so I'm wanting to get armed with
facts
so I can make educated choices rather than just doing what I'm told!

Debbie

Congratulations!!!

its really difficult choosing and getting the maternity care that is most
suited to your needs both medically and emotionally .Unfortunately if there
are any problems during the pregnancy, such as those you had in your
previous one the pregnancy often becomes medicalised, but if all is well
there is no need for this to happen.

Urine infections are often associated with irritable uterus or colicky type
pain. I am sure you are aware of things to do to reduce the risk or urine
infections, or if you feel you may be getting one how to treat it.

As for the usual plan for midwifery care, if you have any concerns its
always a good idea to talk to your midwife bring any concerns you have up at
your booking appointment, make a list of them if she is any good she will
listen and advise, if she wont then go to your doctor, or talk to one of the
midwives at the hospital where you are booked to have your baby, unless of
course you are having a home delivery.

The blood tests we do at booking are a really useful indicator for us,
obviously if you don't want to have them done it is your right to say no. it
helpful to have iron levels, blood group these can be very useful indicators
to your well being later in pregnancy, a few others are also taken. In most
places a glucose tolerance test is only performed if there are indicators
that you may be getting gestational diabetes ie baby feels big for your
dates, protein or glucose in your urine on two or more occasions or a
history of gestational or ordinary diabetes so I would certainly not see any
good reason for doing one routinely.

Ultrasounds are really useful for picking up any problems, I'm sure you know
they can pick up quite a few problems again you don't have to have one, but
most women find it reassuring to be told that all looks well, and its lovely
to see your baby kicking on the screen, somehow makes it more real.

Checking of the heart beat is actually very important, it is an excellent
indicator of fetal well being. As with adults there is a range of what is
normal for a fetal heartrate, anything outside of that can be looked into,
fetal movements are a good indicator but cannot tell us as much as heart
rate can. If you are not happy with your midwife using a sonic aid, which
lots of research has found that they are totally harmless to both mother and
baby, ask your midwife to use a pinnards, they are just like a little
trumpet thing we are all trained to use them.

if you are not sure or not happy about anything to do with your care, or
anything the midwife or doctor is saying they want to do ask them why it is
necessary. We have a duty as midwives to gain informed consent, this
basically means that we are performing whatever test etc with your consent
and your full understanding of why we are doing it. It is your body your
pregnancy and your right to have the kind of pregnancy and delivery you
want. Most midwives will do there utmost to ensure that you are getting what
you want, and at the end of the pregnancy have a healthy happy mum and a
healthy baby.

sorry to have gone on for so long, I hope it helps though and you get the
care you want!!

Helen the Midwife
"Anne Rogers" wrote in message
news:1095876975.zowQCIq514XaYipGn84p4w@teranews...
I'm 11dpo, so it may or may not be this month, but I'm beginning to think
of
what kind of care and tests I want.

Brief history, I have a boy 15 months old, induced due to PROM at 37+4. He
was quite small, 5lb13oz, not IUGR, but there was a definite slowing of
growth from 28 weeks. I also had an irritable uterus, which landed me in
hospital 4 times from 26 weeks onwards, not enforced bedrest, but I did
rest
a lot as pain relief. I was also very susceptable to thrush and urine
infections, which may or may not have cause the PROM or the irritable
uterus.

The usual plan would be
booking in with midwife
10 week early dating scan
14ish weeks blood tests including triple screen if you desire
16 weeks midwife check
20 week ultrasound
24 week midwide check
28 weeks blood tests and glucose tolerance
then midwife checks til you deliver

the midwife checks urine, blood pressure, listens to the heartbeat and
measures the fundal height

I'm happy with the early dating scan, my theory is get as late a due date
as
possible to avoid pressure for post dates induction.
I'm dubious about the blood tests and glucose tolerance unless they are
indicated for a specific reason.
I'm unsure about the 20 week ultrasound, I'm really not convinced it's
necessary, but it was nice to see the baby!
The midwife checks of blood pressure, urine, and fundal height all seem
fine, but I'm concerned about the heart beat checking, they use one of
those
little hand held ultrasound probes, I've heard that it's not been proved
safe, and if I can feel the baby moving, what's the point?
I felt my last pregnancy ended up quite medicalised, but it seemed to be a
route we slipped into from the start, so I'm wanting to get armed with
facts
so I can make educated choices rather than just doing what I'm told!

Thanks for the help
Anne

Anne Rogers wrote:


10 week early dating scan

Why? You just said you are 11dpo so you know your dates, why do you need
an ultrasound to tell you what you already know.

I agree with you on everything else, no need for the GTT or even routine
bloods if you don't want them. Maybe more frequent a/n's with the
midwife from 32 weeks on if you are concerned about IUGR again, and
perhaps an ultrasound around 34-36 weeks for same.

Normally my care would go something like this...
(Ante natal visits consist of urine check, BP check, palp, and fetal
heart check plus as they are in my house coffee and cake ;-)

8-12 weeks booking appointment with midwife (Routine A/N bloods)
16 weeks A/N with Midwife
20 weeks A/N with Midwife (morphology scan at private radiology clinic)
24 weeks A/N with Midwife
28 weeks A/N with Midwife (routine A/N bloods)
30 weeks A/N with Midwife
32 weeks A/N with Midwife
34 weeks A/N with Midwife
36 weeks A/N with Midwife (routine A/N bloods)
37 weeks A/N with Midwife
38 weeks A/N with Midwife
39 weeks A/N with Midwife
40 weeks A/N with Midwife
weekly until birth

Daily post natal visits for the first 3 days, then every 2-3 days for
the next week, then weekly until 4 weeks

6 week p/n check with midwife

But for various reasons I dont want so many visits or blood tests so my
care with my midwife this time will go something like this...

16 weeks booking appointment with midwife
20 weeks (morphology scan)
24 weeks A/N with Midwife
28-30 weeks A/N with Midwife
34-36 weeks A/N with Midwife
near term A/N with Midwife
A couple of post natal visits
? about the 6 week check, in the past they've only consisted of a baby
check and coffee so if I feel like it at the time I will.

Welches wrote:



Just for the record. At the 20 week scan we discovered #2 was missing one
hand.

I didn't know this Debbie, wow. Do you know why? Does she have a
prosthetic (sp?) hand or is she too little still.

Andrea

Anne Rogers wrote:

I'm 11dpo, so it may or may not be this month, but I'm beginning to think of
what kind of care and tests I want.

Brief history, I have a boy 15 months old, induced due to PROM at 37+4. He
was quite small, 5lb13oz, not IUGR, but there was a definite slowing of
growth from 28 weeks. I also had an irritable uterus, which landed me in
hospital 4 times from 26 weeks onwards, not enforced bedrest, but I did rest
a lot as pain relief. I was also very susceptable to thrush and urine
infections, which may or may not have cause the PROM or the irritable
uterus.

The usual plan would be
booking in with midwife
10 week early dating scan
14ish weeks blood tests including triple screen if you desire
16 weeks midwife check
20 week ultrasound
24 week midwide check
28 weeks blood tests and glucose tolerance
then midwife checks til you deliver

the midwife checks urine, blood pressure, listens to the heartbeat and
measures the fundal height

I'm happy with the early dating scan, my theory is get as late a due date as
possible to avoid pressure for post dates induction.

Sounds reasonable, particularly given your history.

I'm dubious about the blood tests and glucose tolerance unless they are
indicated for a specific reason.

I would agree. I had the regular OB panel (particularly
since I'm Rh-), but didn't have the triple/quad screen and
refused glucose testing.

I'm unsure about the 20 week ultrasound, I'm really not convinced it's
necessary, but it was nice to see the baby!

Routine u/s has not been shown to improve outcomes,
but it's probably not the end of the earth if you enjoy
it. Routine mid-trimester ultrasounds do find spurious
things sometimes, so there is some risk of it causing
trouble, but it's not the biggest culprit of that sort
of thing.

The midwife checks of blood pressure, urine, and fundal height all seem
fine, but I'm concerned about the heart beat checking, they use one of those
little hand held ultrasound probes, I've heard that it's not been proved
safe, and if I can feel the baby moving, what's the point?

They can hear the heartbeat with the handheld Doppler
before you can feel movement, but it's true that there isn't
proof that it's safe and they know that babies notice it and
often try to get away from it. My first two pregnancies I
didn't have any monitoring with the Doppler until I was in
labor and had gotten to the point that I wouldn't sit still
to monitor heart tones with the fetoscope (which is perfectly
harmless). The fetoscope will usually only pick up a
heartbeat around 20 weeks or later. You could request
that they use the fetoscope whenever possible, but many
providers aren't skilled at using one.

Best wishes,
Ericka

Anne Rogers wrote:

I'm unsure about the 20 week ultrasound, I'm really not convinced it's
necessary, but it was nice to see the baby!

I have a friend who had the 20 week scan, and found out that the baby has no
kidneys. This has given them time to get used to the idea (they refused to
terminate), and although they will grieve if the baby dies, much of that
grief was shed several weeks ago. (But as an aside, my friend now believes
that the something has changed with the baby, and is waiting impatiently for
her next scan in 2 weeks). I decided against the early scan, as I was
fairly sure of my dates. I debated about the 20 week one, but decided to
have it, as my mother really wanted to be there for it. And it was a bonus
to see that the baby had everything it should.

Cathy
DD 8 Jan 03
EDD 8 Dec 04

10 week early dating scan

Why? You just said you are 11dpo so you know your dates, why do you need
an ultrasound to tell you what you already know.

I should have said I think I am 11dpo, but there is no science behind that,
just it was 13 days after my LMP and I felt twingy on one side.

I agree with you on everything else, no need for the GTT or even routine
bloods if you don't want them. Maybe more frequent a/n's with the
midwife from 32 weeks on if you are concerned about IUGR again, and
perhaps an ultrasound around 34-36 weeks for same.

hopefully I'll have the same midwife, she said last time I saw here she had
no plans to move surgery, and neither have I, she was great, I think you are
right about getting more checks later on with her, I hadn't really thought
of that, I think it would be a relief for me, the same person examining you
is always helpful. An ultrasound would reassure me, but politics and the NHS
make that not something one can choose, I would consider organising it
privately though.

Normally my care would go something like this...
(Ante natal visits consist of urine check, BP check, palp, and fetal
heart check plus as they are in my house coffee and cake ;-)
LOL, we do tea and a biscuit!

Unadulterated Me wrote in message
...
Welches wrote:



Just for the record. At the 20 week scan we discovered #2 was missing
one
hand.

I didn't know this Debbie, wow. Do you know why? Does she have a
prosthetic (sp?) hand or is she too little still.

She has a cosmetic prosthetic hand. Looks just like a doll's hand. She got
her first at 5 months, and is on her second now. It's just to get her used
to something on before she'll get the myoelectric one at about 2. She is
happy to put it on, but as soon as she wants to move she pulls it off. Now
she's walking I'm hoping she'll be happier to wear it.
They don't really know why it happens. One theory is that the amniotic fluid
forms a band and stops the limb from developing. Another is that a blood
clot stops the blood flow going to the limb and so it stops developing.
We tell people that she has a "little arm" like Nemo has a "little fin".
We've had one or two funny situations. Someone stopped me and said that
she'd obviously broken her arm the other day. She was crying and so I was in
a hurry to get her out. So I just said "no, she's hungry". When I went to
get her out a few minutes later I discovered she'd pulled the arm off but
not out of her sleeve so it was hanging loose.
As for the looks we get when she's happily going round chewing it...It's
nice of the NHS to give her (free) a favourite teether!
She doesn't let it stop her though!
Debbie

Routine u/s has not been shown to improve outcomes,
but it's probably not the end of the earth if you enjoy
it. Routine mid-trimester ultrasounds do find spurious
things sometimes, so there is some risk of it causing
trouble, but it's not the biggest culprit of that sort
of thing.

yes, and they miss things too, I've still got to do a lot of thinking about
this one...

The midwife checks of blood pressure, urine, and fundal height all seem
fine, but I'm concerned about the heart beat checking, they use one of
those
little hand held ultrasound probes, I've heard that it's not been proved
safe, and if I can feel the baby moving, what's the point?

They can hear the heartbeat with the handheld Doppler
before you can feel movement, but it's true that there isn't
proof that it's safe and they know that babies notice it and
often try to get away from it. My first two pregnancies I
didn't have any monitoring with the Doppler until I was in
labor and had gotten to the point that I wouldn't sit still
to monitor heart tones with the fetoscope (which is perfectly
harmless). The fetoscope will usually only pick up a
heartbeat around 20 weeks or later. You could request
that they use the fetoscope whenever possible, but many
providers aren't skilled at using one.

with the schedule of appointments the first check they would use that is 16
weeks, with number 1 I had felt movements by this stage