I don't think this has been talked about here before. I don't think this is completely doula related, but kinda is, so if it is miscategorized, please feel free to move it to the appropriate category.
I was not informed of my blood type (A-) with my first baby, even though it is the law to inform women of their rh- status where I live. I did not receive rhogam prenatally, nor did I postpartum because my baby is also rh negative. So I have never had a rhogam shot.
Any thoughts on this matter? Any experience with clients positive or negative about refusing rhogam?
Where I feel very comfortable refusing rhogam prenatally, there is another test I am thinking about refusing which I think will cause a big issue. Gestational diabetes. I know that it can have a huge negative impact on mom and baby is untreated, but I also think it is overdiagnosed and mothers that would not be termed "high risk" get clumped into a group at risk for large baby, ultrasound, induction, c-section, etc so so easily without due cause, in my opinion.
There is a lot of research to do on the matter. I'm a little less confident about this decision to skip the test and I am thinking about monitoring my own blood sugar levels and urine around 24-28 weeks, just to feel a little safer about refusing the test.
I know though, that my doctor is going to really push for this one. What is your opinion on the matter? Have you ever had a client refuse the test? Would you work with a client that refused the test? Any other info that might prove useful?
Sorry for the long post and again, if thisis posted in the wrong place, please slap my hand and feel free to move it.
I am Rh- also. With my last two (homebirths) I did not have the prenatal Rhogam. My third dd's blood tested as + so I did have the PP shot. My ds' blood tested - and he's our last so I didn't get the PP shot. My experience probably doesn't help much since I refused the shot with my homebirths. I never have with a MD.
As far as the GD, I also refused that one with my homebirths. I had no history and at fairly healthy. I tried to with my 2nd where I was seeing a MD and basically was scared into it and didn't know enough to stand my ground. While I think it's something worth testing for, I think eating a healthy diet (which is what you would have to do if you were dxd with GD anyway) and the things you mentioned (testing sugar, etc) or an alternate GTT (i.e. jelly beans) is a better way to do it. I have a friend who's Dr let her test her sugars with a meter daily instead of doing the GTT. To answer your other question, yes I would support a woman who refused the test!
I refused the GD test, got a lot of flack from my OB, got more flack from the nurses when I checked in to deliver. I was very careful to follow a good diet and I know diabetes and GD do not run in my family so I wasn't worried.
I know some people use 18 brachs jelly beans instead of the nasty sugar drink if that's your concern. For me, I didn't want to have a million unnecessary interventions because I might possibly have GD.
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Ina May Gaskin has some good info on the GTT in her book Ina May's Guide to Childbirth of I recall correctly. I personally plan to refuse this test next time around also, and just focus on having a healthy and well rounded diet. I'll have to dig up the rest of my resources on this though, I know I have them around somewhere!
__________________ Marilyn, Mommy to Elijah Blaze
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I know that it can have a huge negative impact on mom and baby is untreated
Huge negative impact? As far as I know the only "risks" involved are having "too big a baby" and the baby having blood sugar issues, which are only "risks" for having more interventions (induction and giving the baby a bottle of sugar water).
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Originally Posted by loveslabor
but I also think it is overdiagnosed and mothers that would not be termed "high risk" get clumped into a group at risk for large baby, ultrasound, induction, c-section, etc so so easily without due cause, in my opinion.
I totally agree. We know that tests for something where there is no indication as a matter of routine are actually harmful.
"Researchers have found that screening with the GTT makes NO SIGNIFICANT IMPACT on perinatal mortality. In other words, routine use of the GTT has not been shown to significantly benefit pregnant women and babies. The only people who benefit from this testing are those in whom previously existing diabetes is suspected."
Quote:
Originally Posted by loveslabor
I'm a little less confident about this decision to skip the test and I am thinking about monitoring my own blood sugar levels and urine around 24-28 weeks, just to feel a little safer about refusing the test.
You don't even need to do this. You do not have to prove you are healthy. They need to prove there is a reason to check for abnormalities. I have a feeling you are looking for reassurance, that its Ok. I want to let you know it is - unless you feel inside or have an actual reason to believe you need testing - don't get it.
Quote:
Originally Posted by loveslabor
I know though, that my doctor is going to really push for this one.
Maybe the part about monitoring your diet and blood sugar levels at home could be a good compromise to an arbritrary test.
Quote:
Originally Posted by loveslabor
Would you work with a client that refused the test? Any other info that might prove useful?
I'd definitely work with a client who refused it - I'd actually prefer it!
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I refused it as well as many of my clients refuse it. It's so freaking ridiculous. Do you have a family history of diabetes? Do you have a good diet? This test is so...sorry, I can't even talk about it right now. Do your research and then make the choice that feels right to you. If your dr. gives you too much grief about it, change to one that will be supportive of your RIGHT to informed refusal.
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I would like to know who thought up the GTT, honestly! I mean c'mon, let's make a pregnant woman fast and then pump her full of sugar on an empty stomach...and then 'Oh, Gee...there seems to be a problem here"
__________________ Marilyn, Mommy to Elijah Blaze
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Follwing my and my calling to midwifery...someday I'll get there!
Student Midwife
I refused the GTT w/my 1st MW. She was okay w/it since I was very healthy, good diet & no history. I don't eat refined sugar at all so I was not about to down a sugary drink to have my blood tested. No thanks.
I am also RH-. DH is + so for my first babe I was 'scared' into taking the 28 wk Rhogam and then had to PP since DD was +. For my 2nd, I refused the 28 wk. dose and only took the PP dose since DS was also +. ANd my MW agreed with my opinion that this dose (28 week) was unnecessary.
I researched the available 'rhogam' shots and decided that I only wanted the specific J&J filtered 'Rhogam' shot. You have to get a Rx for the one you want, BTW or you'll just end up w/the one the hospital stocks. I have a huge problem w/taking the shot, but right now, I'm not comfortable enough to refuse them all together.
Do you know, Loveslabor, is your spuse/partner Rh+? Most often times they don't even check the mate's bloodtype. They just assume that he is +. It's just customary most places to automatically give a Rh- mom the shot. It's worth checking out. If he's not, then you have nothing to worry about.
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I asked them to check the babies father with my last pregnancy, because I am - and wanted to avoid the rhogam if he was - too, ( each of my kids have different fathers), my doctor told me if I wanted it done, he should go donate blood and find out that way, as the Dr. couldn't do it for that purpose.
The "policy" is to administer rhogam to every - woman at 28weeks and PP even if the babies father is - too, because there COULD be a chance that you were wrong/lying about who the father is... can you imagine.. I was soooo mad he would even suggest I didn't know who I was sleeping with....
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With my first child, the blood test done on DH incorrectly identified him as Rh-. We did not have prenatal RhoGam after that birth, and I had spotting during the pregnancy, nor did we test the cord blood at birth for my son's blood type.
During my second pregnancy, it was discovered that DH is actually Rh+, but it's not Rh, it's another factor that isn't tested for on the more simplistic blood typing tests. However, it behaves like Rh+ blood, and Rh- blood does interact badly with it. This information, combined with some other factors we had at the time that I am uncomfortable disclosing online, led us to a decision to receive prenatal RhoGam during that pregnancy. Our second son was tested after his birth, and as he was positive, I did opt for the shot after that birth (both this birth and my first birth were homebirths).
This pregnancy, I am not receiving prenatal RhoGam unless I have cause to do so, and my OB is fine with it. Like he had a say in the matter. We'll test the baby at birth, and if this kid's positive like my other two, we'll go ahead.
Regarding the GTT, if there is a concern, I'd rather monitor diet and check blood sugar levels than overload on sugar. Way to make me beyond ill. My OB with this kid actually doesn't do the GTT. We're expecting a big baby anyway. Family history of large babies, not to mention my own other two being no small potatoes (8lbs 9oz at 38w, and 9lbs 4oz at 40w), and they know we're expecting it and won't push a glucose stick for the baby at birth.
I refused it as well as many of my clients refuse it. It's so freaking ridiculous. Do you have a family history of diabetes? Do you have a good diet? This test is so...sorry, I can't even talk about it right now. Do your research and then make the choice that feels right to you. If your dr. gives you too much grief about it, change to one that will be supportive of your RIGHT to informed refusal.
Unfortunately I'm in the Kaiser healthcare system and have limited choice of doctors. I can't even imagine that anyone employed by Kaiser will be ok with be ok with me skipping the test. I'm really not looking forward to refusing the test. Ugh.
I have always taken the GTT in the past and always fail the one hour, but then pass the long dreaded 3 hr tests. This time, I am totally refusing the GTT! I HATE that test!! Nothing better then getting dizzy and nauseated from drinking that nasty mess and having to have your blood down and peeing every 30 mins for 3 hours!! urgh!
I figured there is no need for it, my midwife doesnt seem to have an issue with it either. My only concern is that I'm overweight as it is,(so I have been told by OB's in the past I'm at a huge risk, don't know if that is really true) but I'm not the one to eat alot of sweets anyways, I tend to eat more healthy when I'm pregnant.
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Unfortunately I'm in the Kaiser healthcare system and have limited choice of doctors. I can't even imagine that anyone employed by Kaiser will be ok with be ok with me skipping the test. I'm really not looking forward to refusing the test. Ugh.
Isn't it sad that we have to fight for our right to excersice informed choice? I'm so sorry you have to deal with this. This is exactly why I don't believe in institutionalized care for the most part. Care is not necessarily determined according to what is best for mother and child, and leaves no room for individual differenced. Instead, care is based on what is best for the institution, and fear-based decisions are dominant. Care like this is SOO unsafe! This makes me very sad You have to do the safest and best thing for you and your baby, and that includes refusing unecessary and unsafe interventions which often starts with refusing unecessary tests and procedures. Just remember that Doctors and care providers for the most part operate under what is best for them and their practice/institution, NOT what is best for you and your baby as individuals. Knowing and accepting that this is the case may help you have some perspective when dealing with them. YOUR responsibility is to yourself and your child, so expect them to bully you, but you do not have to accept it. Or I should say, you do not have to consent to medio-legal based procedures.
Do you have any other options for care
__________________ Marilyn, Mommy to Elijah Blaze
Birth doula, currently on hiatus
Follwing my and my calling to midwifery...someday I'll get there!
Student Midwife
When, at my first post Christmas meeting the scale showed that I'd been a naughty girl over the holidays, my midwife started discussing GD testing. I assured her that I knew exactly why I had gained that weight, that GD is endemic to pregnancy anyway (all pregnant women's body break down sugars increasingly slower as they get closer to 40 wks, making every pregnant woman technically GD) and that I was committed to eating a healthy diet and if there were more problems with out of control weight gain, we could revisit the issue. She wasn't entirely happy but it was ultimately my decision.
I would recommend that when your OB brings up the issue, you politely request the evidence for such a test. Is your weight gain out of control? Do you have any other symptoms of uncontrolled GD? Assure him that you'd like to opt out of routine testing but would be happy to test if there arises an actual medical need.
I tend to think that if we approach our care providers with reasonable attitudes, information from decent sources supporting our positions and reasoned aruments against the routine part of the testing, good doctors will support our decisions. Frankly, it makes their job easier, doesn't it? I'd also make sure you know what the recommendations of the governing body for your OB are. I know that the SOGC publish their protocols on their website. Perhaps the corresponding US body does the same? It would be nice to know what exactly their recommendation is before approaching your doc with the info you gather.
Good luck.
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I would like to know who thought up the GTT, honestly! I mean c'mon, let's make a pregnant woman fast and then pump her full of sugar on an empty stomach...and then 'Oh, Gee...there seems to be a problem here"
!!!! My feelings exactly! Ok, so I have NO family history of diabetes, gestatinal or otherwise, and I had no problems as far as GD goes in my last two pregnacies, so should I refuse this test as well? I hate sugar, and I cried last time I had to do the test because I had been working so hard throughout my prengancy to eliminate processed sugars from my diet (I know this sounds odd, but my holistic dr explained to me tha sugar was the cause of my cystic acne, brittle nails and hair, and porr diegstion...he was right....darn it! lol). Sure enough, a couple days after they made me drink that nasty stuff, I broke out so badly and so painfully....it was aweful...and oh, gee, by the way, my test reults were normal!
How does one go about repsectuflly refusing this test? And at the same time gain respect from her dr? (there are NO midwives in my area, and even if there were, I'm considered high-risk b/c I have a history or preterm labor and contrax in my other two pregnancies...)
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Quote:
We'll test the baby at birth, and if this kid's positive like my other two, we'll go ahead.
My OB with this kid actually doesn't do the GTT. We're expecting a big baby anyway. Family history of large babies, not to mention my own other two being no small potatoes (8lbs 9oz at 38w, and 9lbs 4oz at 40w), and they know we're expecting it and won't push a glucose stick for the baby at birth.
You have to do the safest and best thing for you and your baby, and that includes refusing unecessary and unsafe interventions which often starts with refusing unecessary tests and procedures. Just remember that Doctors and care providers for the most part operate under what is best for them and their practice/institution, NOT what is best for you and your baby as individuals. Knowing and accepting that this is the case may help you have some perspective when dealing with them. YOUR responsibility is to yourself and your child, so expect them to bully you, but you do not have to accept it. Or I should say, you do not have to consent to medio-legal based procedures. 
!!!!
