Do I Have to Do Everything the Doctor Recommends During Pregnancy?

Once upon a time, pregnant women were expected to do whatever the doctor recommended for their health and safety. Nowadays, we have far more information and choices at our fingertips, and we can practice "shared decision-making."

Shared decision-making is essentially a long conversation with your OB/GYN throughout your pregnancy about your care and birth vision and your doctor's well-educated suggestions. Together, you can find a safe and healthy healthcare path that is right for you.

However, old habits die hard. Some doctors prefer to have less back-and-forth with patients, and at other times, personalities may clash. Navigating the standardized way of doing things and your personal desires is tricky, but it can be done!

What Are Common Medical Tests and Practices in Pregnancy?

The first step to having a better conversation with your doctor is learning the standard prenatal tests and screenings so you can ask questions. Once you start going to the doctor, you will have a visit once a month until Week 28 and twice a month until Week 36. You'll then have one visit a week until delivery.

Each prenatal checkup will include the following:

• checking your weight

• checking your blood pressure

• checking your baby's heart rate

• urine test to look for health problems

In the third trimester, the doctor will measure your abdomen to assess your baby's growth. During the last four weeks, your doctor will check your cervix for dilation.

If you have anything unusual happen during your pregnancy (car accident, injury, pre-existing condition), are over the age of 35, or have more than one baby, you will likely have more prenatal visits.

Specific Tests and Screenings

Women now have so much information within reach through prenatal tests and screenings. Though most of the following will be highly recommended, you do not have to take all of them.

If you opt out of one or more of these tests, be proactive about asking your doctor not to test your baby after birth (unless you are okay with it). Do your research to inform your decisions and ask specific questions about the tests, side effects, and how they differ for you and your baby.

Here are the most common tests and screenings listed by trimester:

Genetic Screening

Genetic screening tests take a blood sample from the mother to detect risks or signs of possible disorders or health problems in the mother or baby. If there are red flags, the doctor will likely suggest diagnostic tests that confirm or deny those red flags.

The screening is standard procedure in the first trimester, but the diagnostic tests are offered to individuals with a personal or family history of genetic disorders or birth defects.

Here is a list of disorders one of these tests may identify before birth:

• Cystic Fibrosis

• Duchenne Muscular Dystrophy

• Sickle Cell Disease

• Polycystic Kidney Disease

• Hemophilia A

• Thalassemia

• Tay-Sachs Disease

Prenatal diagnostic tests are more invasive than the screenings. They require a sample of amniotic fluid and uterus (amniocentesis) or cells from the fetus or placenta (chorionic villus sampling), each of which requires a needle (source).

You can opt for a cell-free DNA test, which simply tests your blood for a small amount of DNA released into your bloodstream by the placenta. This noninvasive test can reveal signals of Down Syndrome, Patau Syndrome, Edwards Syndrome, or other chromosomal abnormalities (source).

Ultrasounds

Throughout your pregnancy, you will have ultrasounds to check your little one's growth and development visually. Depending on your risk level, you may have as few as three for your entire pregnancy or one a month.

When possible, ultrasounds are performed abdominally from the outside, but problems with the placenta's location or other difficulties could necessitate a transvaginal ultrasound.

During the first trimester, the first ultrasound serves to (source):

• confirm a growing fetus (and how many)

• establish a due date

• figure out where the placenta is

• examine the uterus

• catch any early signs of abnormalities

The most important ultrasound comes around Week 20 and takes a while to complete. Here, your doctor will check the following (source):

• confirm the due date

• examine the baby for abnormalities

• check the amount of amniotic fluid

• examine blood flow patterns

• watch fetal movement

• measure the cervix's length

• get an update on fetal growth

The third ultrasound happens in the third trimester to (source):

• check that the fetus is growing well

• see that the uterus has plenty of amniotic fluid

• complete the biophysical profile test

• ensure the placenta is not covering the cervix

• determine the baby's position

It is possible to opt out of ultrasounds entirely, but having this information helps ease worry for parents and prepare doctors for potential delivery difficulties and postpartum care.

Fetal Monitoring

Fetal monitoring is using special equipment to listen to your baby's heartbeat. This is done during every checkup in the third trimester and during labor to ensure your little one's heart rate is a healthy average of 120 to 160 beats per minute.

If you hear a different heart rate number during each visit, that's okay! Your baby's heart rate changes in various development stages and in response to stimuli within and outside the uterus.

During labor, a device will be stuck to your abdomen so doctors and nurses can monitor your little one's heartbeat throughout the delivery. An abnormal pattern or a sudden drop in the heart rate could mean the baby is not getting enough oxygen or some other problem.

If the heart rate continues to dip or be abnormal, your little one could be in distress and require a cesarean delivery. You can learn all about cesarean deliveries and what to expect in 15 Questions First-Time Cesarean Delivery Parents Ask.

Glucose Test

Somewhere between Weeks 24 and 28, you will undergo a glucose test to measure the level of sugar in your blood. Basically, you will have blood drawn, drink a super sugary drink (it tastes like flavored corn syrup), wait for an hour, and have your blood drawn again.

Women whose blood sugar spikes to over 140mg/dL an hour later may be asked to do a more detailed glucose test within the next couple of weeks.

The more detailed glucose test requires fasting for about 12 hours, having your blood drawn, drinking a glucose solution, and having your blood drawn a few times over the next 3 to 4 hours. And yes, this is as terrible on a second-trimester empty stomach as you're thinking.

However, failing this test means you have gestational diabetes, which could result in your baby (source):

• having a heavy birth weight

• coming early

• having breathing problems

• having low blood sugar (could cause seizures)

• having a higher risk of obesity and Type 2 diabetes later in life

• dying before or soon after birth

The woes of gestational diabetes also affect mothers (source):

• future diabetes

• having a cesarean delivery

• high blood pressure

• preeclampsia

If you have a gut problem that the glucose test will exacerbate, you can talk to your doctor about doing blood tests daily before you eat in the morning and 1 hour after each meal (finger pricks). In this type of testing, you will carefully record your blood sugar test results four times a day for a full week.

If your blood sugar shows several spikes over 140 (or even 180), your doctor will likely diagnose you with gestational diabetes, prescribe a special diet with medication, encourage exercise, and monitor your health and your baby more closely.

Group B Strep Culture

Testing for Group B Strep Culture (GBS) is done sometime in the last month of pregnancy to detect and prepare for possible serious infections in your newborn or yourself. The bacteria is found in the lower genital tract of 1 in 5 women, so doctors highly encourage this test (source).

For you, the presence of GBS could mean preterm labor, sepsis, urinary tract infections, or an infection of the placenta.

The terrifying part of finding GBS is its impact on your baby because it is likely that he or she will pick it up during delivery. For infants, GBS could cause pneumonia or meningitis--neither of which are simple treatments for newborns.

If you find that you are positive for GBS, you can receive antibiotic treatment that will help you and reduce the likelihood that your little one will contract it.

Is It Okay to Have Vaccines During Pregnancy?

Vaccines are a touchy topic in America, especially for pregnant women. Whenever you go in for a routine prenatal checkup, you will likely see posters on the wall about all these vaccines you should take for your health and that of your baby.

However, there is quite a bit of pushback on how necessary it is to vaccinate pregnant women, particularly with the COVID-19 vaccine.

Let me start this by saying, "I am NOT a doctor." I have done lots of research and held dozens of discussions with doctors over the course of my pregnancies, but I am in no way qualified to replace the conversation YOU need to have with YOUR doctor on this topic.

Every doctor has assured me that the placenta is an amazingly adept barrier between mother and fetus. So, though you would be vaccinated with a full adult dose, your baby will receive very little of it.

Furthermore, it is unnecessary to vaccinate a newborn with some vaccines that a mother received while pregnant (like the Hepatitis B and influenza vaccines). So, in theory, you could save your baby a vaccine early on by vaccinating yourself.

You should write this plan out clearly with your doctor and your little one's pediatrician before delivery to ensure your baby isn't "double dosed" by a standard vaccination procedure in the weeks and months after birth.

Which Vaccines Do Doctors Suggest for Pregnant Women?

Thanks to modern medicine, decades of detailed research, and availability, many vaccinations are available for individuals in the U.S. and around the world. In America, doctors typically suggest that pregnant women take specific vaccines (if due) because the benefits outweigh the possible consequences.

You can certainly find doctors who are far more conservative about vaccinating pregnant mothers and infants, and you can find others who fully support vaccines for these individuals.

Currently, the CDC recommends that pregnant women take the following (source):

• the current COVID-19 vaccine

• Hepatitis B (if not current)

• Influenza (in season)

• RSV (in the third trimester)

• Tdap (in Weeks 27-36)

If you are at risk of contracting a particular disease or infection in pregnancy, the CDC suggests that women take the following (but only if the protection benefits outweigh the risks) (source):

• Hepatitis A

• Mpox

• Meningococcal (B)

• Polio (IPV)

• Td

• Anthrax (if high risk of exposure)

• Dengue

• Rabies

• Tick-borne Encephalitis

• Yellow Fever

Yet there are plenty of vaccines that are not recommended---even if you are exposed to a particular disease---due to their risk to your baby in utero or a lack of information. Your doctor will work with you closely on preventative measures and treatment in such cases.

Which Vaccines Will My Baby Receive After Birth?

The first year of life includes a surprising number of checkups and vaccinations in the United States. You may even see the same vaccination name multiple times within the same year because many vaccines are broken up into doses to avoid overwhelming infant systems.

Moreover, different states and regions may have different vaccine suggestions based on the prevalence of particular diseases and infections in each area. You can always research and ask your pediatrician about each vaccine and its necessity in your area.

For example, my first child was born abroad, so his first year of immunizations is very different from that of his siblings, who were born in the U.S. Reasons for these differences abound, so it is prudent to understand why your child's pediatrician suggests each vaccine.

Here is a generalized chart of vaccines American babies receive in their first year and a half of life (source):

It is crucial to note that not every hospital goes through this routine on this timeline. Some pediatricians prefer to space vaccines out a bit more so that your little one will finish around two years old. Again, you can talk to your pediatrician about scheduling and any concerns you have.

After your little one finishes the vaccines above, future vaccines, doses, and boosters will have years between them. Only the seasonal vaccines will be available on an annual basis for your child.

How to Show Up Prepared

Showing up to a prenatal appointment and seeing a preset plan laid out in front of you with confidence from a trained authority figure (the doctor) can make it difficult to voice your opinions, fears, or desires. Some OB/GYNs are excellent at encouraging you to converse, but others are intimidating.

I've worked with doctors who assumed I knew nothing, those who didn't listen well, those who pushed for a standard despite my discomfort, and those who were attentive and caring. So, what can you do?

Ask Questions

I found a lot of comfort in doing my research ahead of time and writing my own questions. By research, I mean looking things up from credible online sources, reading books on pregnancy and a baby's first year, and conversing with nursing and doctor friends.

If you don't have connections to individuals training in the medical field, you can start with easy-to-read resources that demystify pregnancy and early child development. Early on, I found " What to Expect When You're Expecting " by Heidi Murkoff helpful for understanding the basics and forming specific questions.

The convenient "What to Expect Pregnancy and Baby Tracker" app is available for free for smartphone users and also includes tons of bite-sized information to walk you through your pregnancy. It's a nifty tool!

Your OB/GYN should also provide you with articles, websites, and other resources to better understand the vaccines, screenings, tests, and practices he or she will suggest.

Share Your Vision

Whether you envision having a natural birth with a midwife at home or a typical hospital delivery with an epidural to ease your discomfort, having a vision and communicating it to your doctor is vital to ensuring your comfort and your baby's health.

Depending on where you deliver, you may have a lot of freedom to make your prenatal care, birth experience, postpartum care, and newborn checkups your own. Here are just a few ideas to consider having an opinion on:

• natural birth or medication in labor

• birth position

• location (in water, home, hospital bed)

• people in the room (doula, spouse/partner, family members, friends, photographer)

• food and drink during labor

• to induce labor or not

• when to default to a cesarean delivery

• time in hospital after birth

• formula or breast milk

• vaccinations for your newborn after birth

• skin-to-skin contact immediately after birth or after cleanup

• having your baby taken out so you can rest at night or not

• who will stay with you in the hospital

• diet after birth

• treatment options for infant complications after birth (jaundice, blood sugar issues, low iron, and more)

When your doctor knows your vision, he or she can work with you to ensure medical necessities are taken care of while preserving as many of your desires as possible.

Speaking of having an opinion on baby stuff, preparing your home with baby products that you will actually use and enjoy is a big deal, especially if you plan to have more children! Get ahead by reading 10 Biggest Struggles with Normal Baby Products.

Bring Someone With You

If you still find it difficult to voice your opinions, fears, and desires in your prenatal appointments, bring your partner, spouse, friend, or family member to support you. Your ideas matter, so don't be intimidated!

You can even have someone on the phone as you meet with your doctor to ask questions and help support you.

Find the Right Doctor

Thanks to insurance networks and location options, finding a doctor that clicks with your personality is not easy. Nonetheless, you have the right to feel heard and respected by your OB/GYN and medical team so you can participate in your own medical care.

However, finding the right doctor can be tough. Two of my pregnancies required traveling an hour and a half away because the closer doctors would not work well with me or my insurance.

Was it worth traveling to find a doctor I could speak more freely with? Yes, absolutely! I was far more comfortable in late pregnancy and birth, which helped with blood pressure, got me through some late pregnancy complications, and ensured I was confident on the operating table for cesarean deliveries.

In a Nutshell

So, do you have to follow every doctor's recommendation for prenatal care and delivery? No, you don't, but you should do lots of research and ask your doctor specific questions to find the safest and most comfortable path for your pregnancy and delivery.

Doctors have incredible training and experience to ensure that you and your baby have a safe, healthy pregnancy and delivery. However, some practices are hot topics that you may not agree with. Voice your fears, opinions, and expectations---it's worth the peace of mind!