S/O How many non-stress tests do AMA women really need

[Anonymous]

Anonymous wrote:Why are you so opposed to NSTs? They’re really not that big of a deal and take about 20 minutes. I’ve had them starting at 36 weeks for all three pregnancies due to white coat hypertension (I was under 35 for all of the pregnancies) .

OP here. I didn't know white coat hypertension was a term! brilliant. If they keep pushing NSTs on me, I might end up having it. On a serious note, I'm sorry to hear you had this problem.

[Anonymous]

OP, I would just recommend that you either accept your dr’s recommendations or move to another practice that is more in-line with your thinking. Don’t stress yourself out for the rest of your pregnancy by fighting with your doctor. It’s not worth it.

[Anonymous]

I had twice weekly NSTs for white coat hypertension too. I was 34. I think the tests started at 32 weeks.

It was kind of a pain, but I guess I found it reassuring. I was very afraid of stillbirth and liked the idea of knowing baby was doing ok.

I could also have refused-you can refuse anything.

[Anonymous]

Anonymous wrote:OP, I would just recommend that you either accept your dr’s recommendations or move to another practice that is more in-line with your thinking. Don’t stress yourself out for the rest of your pregnancy by fighting with your doctor. It’s not worth it.

I'm not fighting, I thanked them and acknowledged the recommendation, and declined to go for six weeks in a row. I'm happy to go once or twice.

I was just wondering whether this was standard practice or not, solely for AMA. (I already know it's not rooted in evidence.)

[Anonymous]

I never had one, birthed at age 41, nearly 42. Saw regular obgyn though, not MFM.

[Anonymous]

Anonymous wrote:I never had one, birthed at age 41, nearly 42. Saw regular obgyn though, not MFM.

My labor started spontaneously at 39 weeks. I’m guessing if I thought over they may have done a stress test. I was informed that I would only be permitted to go to 41 weeks before induction.

I guess if it were me I would find out why they felt like I needed it. If you’re doing kick counts and checking heart sounds at home, seems like you’re pretty in touch and would get in touch if there was a concern.

[Anonymous]

I had both my kids at AMA. For my second, at 37, they made me do the non stress test at 40 weeks. Induced at 41 weeks.

[Anonymous]

Anonymous wrote:I had both my kids at AMA. For my second, at 37, they made me do the non stress test at 40 weeks. Induced at 41 weeks.

OP here, at 40 weeks it might make some sense.

I had a great appointment today with a different doctor at the same practice. She said it was true that the chances of catching something with a once-weekly NST were probably smaller than the chances of a false positive that leads to unnecessary intervention. She also said to keep close attention to fetal movement patterns, and just get into a cab immediately and come in if I had a concern. That (fetal movement patterns) was the one thing that was strongly correlated with outcomes. She called the NST "unreliable" in low risk pregnancies (although they have their use in high risk situation). I walked out very happy and understood.

[Anonymous]

There is more evidence in favor of antenatal testing in women over age 38 as compared to home doppler use or fetal kick counts. Stop using evidence based practices only when it serves your purpose.

If you want antenatal testing, do it.
If you don’t and you think you know better then your doctor and SMFM, don’t.

If you are going to “agree” please do it closer to the end of your pregnancy.

Also, the website you wanted folks to read up on has basic information which is incorrect including the definition of stillbirth. (Gestational age of 20+ weeks not 24+ weeks). If the author can not even get this simple fact straight, how can you trust her critical evaluation of the evidence which is also outdated?

[Anonymous]

Okay, I agree with everything you said. These tests are bs and designed to make money and cover asses. Advocate for yourself. Push back. Good luck.

[Anonymous]

Fwiw, the midwives at MCA in Maryland have as their standard practice weekly NSTs plus fluid checks by sonogram for all women with due dates over age 35 after 36 weeks. I just turned 35, had a healthy first pregnancy a few years ago, and am otherwise in good health / low risk.

Between the sonogram with the tech or OB plus the (and they emphasize this) AT LEAST 20 min of NST, I’m looking at weekly appts over an hour. It’s definitely going to eat up precious leave before the baby arrives..

[Anonymous]

At age 35 I had to go every week starting at 38 weeks. At 43 weeks they forced me to induce. Baby healthy, happy and fine. Now a thriving high schooler.

[Anonymous]

Anonymous wrote:15:11 PP thanks for sharing your experience! I definitely want the epidural and don't mind the medical setting but I am a researcher and have done my homework: there is no solid evidence to support NSTs as a way to identify fetal distress or low oxygenation. The only issue where there is some seemingly reliable evidence for women over 40 is that going past 41 weeks gets meaningfully more risky than inducing before then.

20:00 PP I was 36 the first time around at GW and did not have any non stress tests...

I was 43 with my second child, also had the weekly NSTs/ultrasounds, which I was glad to have and get an extra look at the baby. I was induced because at an exam on my due date it was discovered I had low amniotic fluid. I had an epidural and absolutely pain-free and easy birth despite being induced. Easy recovery as well. It was bliss compared to my experience with my first. I wouldn't worry too much about getting induced if you also plan on the epidural.

[Anonymous]

Anonymous wrote:At age 35 I had to go every week starting at 38 weeks. At 43 weeks they forced me to induce. Baby healthy, happy and fine. Now a thriving high schooler.

They let you go to 43 weeks????? That is INSANE. How sure were you about your dates.

OP - I would not go past 40 weeks at age 40. Not worth the risk to me

[Anonymous]

Anonymous wrote:There is more evidence in favor of antenatal testing in women over age 38 as compared to home doppler use or fetal kick counts. Stop using evidence based practices only when it serves your purpose.

If you want antenatal testing, do it.
If you don’t and you think you know better then your doctor and SMFM, don’t.

If you are going to “agree” please do it closer to the end of your pregnancy.

Also, the website you wanted folks to read up on has basic information which is incorrect including the definition of stillbirth. (Gestational age of 20+ weeks not 24+ weeks). If the author can not even get this simple fact straight, how can you trust her critical evaluation of the evidence which is also outdated?

+1

Reading one article on the Evidence Based Birth website written by an advanced practice nurse who has no background in obstetrics or midwifery and who has an axe to grind based on her own self-admitted poor delivery experience, and who only presents at natural birth conferences, not medical ones, and whose literature reviews reflect clear bias and omission of information that would counter the narrative she’s trying to prove, doesn’t make you an expert, OP. It makes you a person seeking an information source to validate your own perspective and poor choice.

If you have concerns about the care being recommended, talk to your OB, don’t seek validation from DCUM. If you don’t want to have extra testing because you believe that a bad outcome can’t happen to you or your baby, just own your decision and accept that you and only you have to live with the consequences if something goes wrong. Having babies at older ages comes with greater risks. The hell of having a stillborn baby is nothing I would wish on anyone. If there are tests designed to avoid that or other bad outcomes that are the standard of care, and you are choosing to decline them because of one article online, that is your choice to make for your baby and your body and your risk to run.