Beginning with your first prenatal appointment – or possibly even in preconception counselling – and lasting through the end of your maternity care, you will be offered a seemingly unending battery of tests and procedures. There’s blood-work to be drawn, pelvic exams to submit to, ultrasound appointments to schedule… Some of these will be presented as options and others as “just how it is” when you’re expecting. The truth, though, is ALL TESTS AND INTERVENTIONS ARE OPTIONAL.
Does this mean that I, some doula on the internet, am advising you to decline all tests and interventions? HECK NO! The right procedure at the right time can can give needed peace of mind or prepare you for struggles ahead, can save you money or other interventions down the road, and can even save your or your baby’s life. The wrong procedure, however, can cause unnecessary heartache and expense. So which are the right procedures, and which are the wrong ones? That will, of course vary from one pregnancy to another and is a decision you must make for yourself in collaboration with your physician or midwife.
The key advice I can give is to encourage you to practice informed consent and refusal. Your doctor or midwife is not the boss of your medical care, or your baby’s: YOU ARE! You, not your provider, are the person who must live with the consequences and accept the responsibility for your decisions, so it stands to reason that only you should be the final determiner of your healthcare choices.
But doesn’t your provider have her/his degrees for a reason? Yes! Yes, of course. But you are an intelligent, responsible adult about to take on the total care of a tiny new human. Your provider has experience and protocols and access to evidence. (You also have access to evidence if you care to access it–it’s a brave new internet, and for all the unscientific forums, there is also real scientific research at your fingertips!–and as your doula I’ll be glad to help you hunt down and understand research related to your care). And before you do or don’t choose a particular test or procedure, you have a right to ask your provider to share a distillation of her/his knowledge with you. A couple of key questions to ask include:
- What information will this test give me?
- How accurate is that information (margin of error, false positives and false negatives, etc.)?
- What, if any, risks are associated with this test?
- How will your care of my pregnancy change based on my test results?
- How will you react if I decline this test?
You may also be helped in your decision-making by asking:
- What will this test cost?
Cost, of course, is often a frustratingly un-answerable question in US medical practice, as actual cost won’t be determined until the office or laboratory negotiates with your particular insurer, who then filter their cost through your plan’s deductible and co-pay and so on. Still, you may wish to check with your insurance company to be sure the proposed tests are covered; you really don’t want to be hit for a bill for several hundred dollars for a test you were only partly convinced you needed.
Once you have this information, you are in a position to ask yourself the truly important question that only you can answer:
How will these test results affect the rest of my pregnancy?
What is the benefit to you of reassurance, versus the cost of knowing something is (or is more likely to be) amiss? If you knew for sure your baby was severely disabled, would you terminate? Would you change your birth plan? Would you seek counseling now to be better prepared? Or are you someone who would rather cross that bridge when you come to it? If the test is unpleasant to have done or carries risks to yourself or the fetus, how important to you is that unpleasantness versus how important to you are the results?
Your doctor can’t answer these questions. Your doula can’t answer these questions. Your childbirth educator, your mother, your preacher can’t answer these questions. Only you (and your co-parent) can hold the scale of risks and benefits and come to the right conclusion for your own circumstance. This is your pregnancy, your parenthood, your life: own it!