Thursday, May 31, 2012

The Last Trimester of Pregnancy: Testing and Interventions Are They ALL Really Neccessary?

Or has the medical health care system added these as "Routine" and no longer looks at us as an individual? 

I am speaking about testing such as, Group B Strep, Routine 2nd trimester blood screens (CBC Panels), glucose testing,  possible vaginal exams weekly for your entire last month of pregnancy??????  Other tests also after baby arrives....

Did you know that in most cases Group B strep can be treated in most cases naturally without having to have antibiotics while in labor?  Dr. routinely test for this at 36 weeks and the flora can change by the time you deliver so treating it naturally a few days before your due is a good way to change the flora
Weekly vaginal exams (sound fun right?) wrong.  In most offices now they don't do this, but in many across the nation they still do.  What a way to introduce bacteria into your vagina, have someone shove things up it weekly to see if you have an infection, bacteria or if you are in labor.  I get if moms want to know if things are progressing but 4 weeks in advance is a little extreme.  Also it gives some doctors the opportunity to strip your membranes without you even knowing it.  I think a lot of doctor's now don't do this as much but many still do.  Eliminating something as simple as these exams can help prevent other interventions during birth.  A good doctor or midwife can feel your baby and what position it is from the outside, no need for an internal exam.

Glucose testing, does knowing if you have Gestational Diabetes change the outcome?  Yes it can in how you end up actually going into labor.  In most cases women with GD are persuaded into Induction which has a huge slippery slope of other interventions to come.
Or things after baby arrives:
~Eye Ointment (optional should be taken into account of Grp B positive or other infections are present)

~Vitamin K Shot (optional as an oral liquid instead of a shot- also not always necessary due to the birth and health of both mom and baby this could be something they don't even need) I know that Fremont Hospital Pharmacy (in Yuba City) has the oral dose of Vit K. that is where I got mine for my son, and I did not even do it for my daughter.

~Hep B Shot (not necessary at all in most cases.  How many babies do you know that are exposed to others people blood? -Unless mom is positive)  So read about it and see if your baby or family is at risk, if not you can pass on it.

~Blood Glucose testing (standard for 8lb and over not even needed in most cases wait for nursing and signs in most cases first 24 hours can be pushed off to see how baby is before intervention)

~Baby blood panel (in most cases unless baby shows signs or there is a history of concerned diseases then this is also completely unnecessary in most cases)

~Infant hearing test, many postpartum nurses have said babies don't always cooperate so it is hard to get an accurate reading.  Did you know this is a test that can test up to $500 (when it cost the hospital about $50)?  Why not wait until baby is 6 months old and able to react and respond so you can get a better result?  Oh I know, it is so the hospital can bill more to your insurance for your inpatient stay.  I get it, it comes down the the mighty dollar again.  Again read about it and check out the high risk list to determine if this is something you want to pursue.

All of the above are routine in our state and our nations hospitals right now.  But do we really need to be doing them on a 100% of everyone.

Think of the cost associated with all of these, if you didn't have insurance and had to pay cash for all of it, the providers probably would rack up close to $5k in testing alone.  Providers, Medical Assistants, RA's and other assistants lack the knowledge in most cases how much the testing costs someone.  If you had to pay cash for these I bet you would be advocating for yourself about which ones are absolutely necessary.

An example: Someone I know needed some additional testing on a routine annual test, but the nurse just went ahead an ordered a lot of follow-up tests.  The patient mentioned she didn't have great insurance and the nurse was like, "oh, well you might qualify for assistance in paying your bill."  WHAT?  Why not skip the unnecessary tests and read the last 5 years history of tests, oh no that will take time and effort.... so sorry for the inconvenience but it is our wallet your digging into not your own.

Examples like this plague our entire health care system.  It is getting closer to home for me when talking to many of my clients that I teach in Childbirth education. 

Another example: A mom tested that they were RH- for their blood type and they "routinely" just started giving her the Rhogam shots (sometimes you get up to 3 and cash wise they are not cheap).  Well a big thing was over looked, the spouse could have been tested also and if he came out RH- as well the shots would not be necessary.   This could have saved this couple a lot of money, but not one minute was given to the patient to make a choice, at all....just "routine" took over.  Some insurance companies will not pay for the $175 per shot fee.

Another mom had two different CBC panels taken during pregnancy because the first came out low. The reason what low meant was never communicated to her.   The second was given in transfer of care because they wanted to see if it still came out low.  Well no discussions of the second results were given and nothing about why they needed the second one and how it may change from the first to the second test.  Nothing about if your CBC is low what possible complications this may bring during birth, how to increase iron, or how to make sure by increasing iron that the chance of extra bleeding (or hemorrhage) could be avoided.  Simple things like increasing your iron by eating iron fortified foods like, kale, spinach, lentils and kidney beans.

I get providers don't want to scare moms, but if a test is going to be given explain what it is, if the finding are A or B what options there might be, and if it is necessary or just a precaution due to this particular moms health.  If the test is only being done out of routine, is it optional?  Why or Why Not?

This is not only about costs but the need to have some kind of intervention.  In most healthy moms and baby's 50% of the tests done "Routinely" aren't even necessary. 

Taking your own health care back into your own hands is very important especially now in these times.  It is important to educate yourself about tests, costs, and why they need to be done.  This will help in a huge ways for all moms expecting out there.   These moms can bring down health care costs if all of them ask why and if they are necessary.  Even if your insurance covers it (which you won't know until after the fact).  Having the "Routine" be taken out of the equation and bringing it back to "you and your baby" as an individual is extremely important to get this industry to change.

Food for thought ladies and dads....thanks for reading.