COMMON LABS AND PROCEDURES OFFERED IN PREGNANCY

Midwives can order all blood work, ultrasounds, and other screens or tests typically indicated in pregnancy. Within the boundaries of safety, you may opt for as few or as many screenings or ultrasounds as you like as long as you understand the benefits and risks of consenting or declining each procedure offered. At every point a screen or scan is indicated, your midwife will have an informed consent discussion with you about the test, answer your questions, and support you in making an informed decision about your care. Specific lab work and scans are indicated at different points in your care and help your midwives continually assess you and your baby’s health and appropriateness for out-of-hospital birth.

The procedures described below are representative of current evidence-based practice and community standards for all clients.

• Initial Visit: 10- to 14-weeks

  Standard OB Panel: a blood test that screens for the following:

  • Complete blood count (CBC): assesses hemoglobin and hematocrit to screen for anemia (low oxygen carrying capacity of the blood, often due to low iron) and counts your platelets, an important blood clotting factor.

  • Blood type, Rh status, and Antibody screen: this test determines your blood type (O, A, B, or AB) and whether your blood type is Rh-positive or Rh-negative. If your blood type is Rh-negative, we will discuss how that can impact this and future pregnancies and offer medication prenatally and postpartum to limit risk.

  • Rubella (German measles) immunity: most people are immune to rubella, either through vaccination or previous exposure to the disease. Contracting rubella during pregnancy can be harmful to you and your baby. This test determines your level of immunity and helps to inform risk of exposure during pregnancy.

  • Syphilis: this is a treatable sexually transmitted infection (STI) that can pose a significant risk to your baby’s development.

  • Hepatitis B virus: carriers of hepatitis B are at risk of transmitting the infection to the baby during delivery. Identification of positive cases can reduce risk of exposure during care.

  • Hepatitis C virus: positive hepatitis C status poses an exposure risk to the family, baby, and care team. Identification of positive cases can reduce risk of exposure during care.

• Additional tests offered at initial prenatal visit or otherwise early in care include:

  • Human immunodeficiency virus (HIV): a blood test; when discovered in early pregnancy HIV can be treated and risk of transmission to the baby greatly reduced.

  • Thyroid function: a blood test assessing levels of thyroid stimulating hormone (TSH) and, if necessary, free thyroxine (free T4) levels. Both hyper- and hypothyroidism can have adverse effects on you and your baby during pregnancy.

  • Hemoglobin A1C: a blood test that assesses your blood sugar over the last 90-days. This test can be helpful in diagnosing a pre-existing diabetic condition and assessing your risk of developing gestational diabetes mellitus (GDM) later in pregnancy.

  • Urine culture: a urine sample tested for urinary tract infections (UTIs). UTIs can be present in pregnancy without normal symptoms and when untreated, can lead to kidney infections and increase risk of other complications in pregnancy. This test may be offered at other times during pregnancy should you report signs or symptoms of an infection.

  • Gonorrhea and Chlamydia: a urine sample to screen for two STIs that if untreated can affect the health of your baby at delivery.

  • Genetic screening: a blood test that can determine whether your pregnancy is low- or high-risk for a genetic anomaly such as Trisomy 21 (Down syndrome), Trisomy 18 (Edward syndrome), Trisomy 13 (Patau syndrome), sex chromosome abnormalities, or neural tube defects (NTDs), and if you are a carrier for a recessive gene that can cause cystic fibrosis (CF).

  • Dating and viability scan: an ultrasound to determine the location and viability of your pregnancy that can also be helpful in determining an appropriate estimated due date when unsure of your last normal menstrual period (LNMP), when unsure of conception, or with history of irregular cycles.

  • Anxiety and Depression screen: a questionnaire assessing risk for anxiety and depression in pregnancy. This screen can also help establish a baseline for assessing your risk of postpartum mood disorders.

• Ongoing Pre-natal Care

  • Fetal survey: an ultrasound typically performed between 18- to 24-weeks of pregnancy. This scan is a low-level genetic screen to assess the anatomical development of your baby as well as determine the location of your placenta.

  • Glucose challenge test (GCT): a blood test offered at 28-weeks to screen for gestational diabetes mellitus (GDM), a treatable condition of pregnancy that can affect the health of both you and your baby.

  • Complete blood count (CBC) and Antibody screen: a blood test at 28-weeks to assess your risk of anemia (low oxygen carrying capacity of the blood, often due to low iron) and determine the need for iron supplementation. This test may be repeated later in pregnancy to assess the effectiveness of supplementation. For those clients with an Rh-negative blood type, an antibody screen is also recommended to assess possible exposure to your baby’s blood at this point in your pregnancy.

  • Group Beta Strep (GBS) screening: a swab at 36- to 37-weeks to test for the presence of GBS bacteria in your vagina, perineum, and rectum. If positive, intravenous (IV) antibiotics will be offered to you in labor to minimize the risk of GBS exposure to your baby during delivery.

• Postpartum Care

  • Anxiety and depression screen: a questionnaire administered at 3-weeks postpartum to evaluate your emotional health.

  • Papanicolaou (Pap) test: a swab collecting cells from your cervix and vagina offered at 6-weeks postpartum to screen for cervical cancer and human papillomavirus (HPV).