a Midwife's Kaleidoscope

General Bloodwork

• Blood Type and Rh Factor - This test determines your blood type (A, B, AB, O) and Rhesus factor (Positive or Negative).  This test is routinely performed in pregnancy because a birthing parent with a Negative Blood Type who has a fetus with a Positive Blood Type can cause Rh incompatibility and she may have complications in future pregnancies. Rarely, ABO incompatibility can occur as well. There are interventions and practices that may reduce the risk of future complications.

 

• Rh Antibody Screening - For birthing parents with a negative Rhesus factor, antibody screening can identify if Rh sensitization has occurred.

 

• Complete Blood Count - ​The complete blood count gives a picture of your overall blood 'health.'  This include white blood cells, red blood cells, iron levels, clotting factors, etc.

 

• Hemoglobin and Hematocrit - Hemoglobin and hematocrit levels indicate iron function and are part of the complete blood count.  These levels may be retested throughout pregnancy to diagnose or monitor anemia.

 

• Rubella Immunity - This test shows whether you have an immunity to Rubella, either through having had Rubella or having had immunizations.  Contracting rubella during pregnancy can be dangerous to the fetus, which is why this screening is done.

 

• Hemoglobin A1C - For women who are already diagnosed with Diabetes, the Hemoglobin A1C test can help monitor ongoing blood sugars. It is also useful early in very early pregnancy for ruling out pre-pregnancy diabetes. It is not considered a good diagnostic for Gestational Diabetes Mellitus.

 

• Syphilis Screening* - Syphilis is a sexually transmitted infection. S​creening tests are for an antibody that may indicate a syphilis infection. Syphilis infection during pregnancy can cause infection of the fetus leading to miscarriage, stillbirth, or severe newborn infection. This test is not a diagnostic, and if shows positive, will require further testing to confirm results.

 

• Hepatitis B and C* - Hepatitis is a blood born infection that is transmitted by sexual contact or sharing blood.  It can impair your liver function and can be transmitted from parent to babe during birth. If this infection is diagnosed, your care provider will help you support your body to be as healthy as possible, to reduce the risk of transmission to the baby.

 

• Human Immunodeficiency Virus (HIV)* - HIV is a blood born pathogen that can be contracted by sexual contact or sharing blood. Screening is highly recommended in pregnancy so that if the parent carries the virus, her health may be protected during pregnancy and transmission rates to the babe may be reduced.  The test performed is a screening test only, and must be followed up with a second test to confirm diagnosis.

 

• Gestational Diabetes Mellitus (GDM) Screenings - Oral glucose tolerance tests, postprandial glucose tests, or random glucose tests are all utilized to screen for GDM.  Your midwife will discuss which test, if any, is most appropriate for you.

 

Genetic Screening

• Genetic screening is offered to all clients, regardless of risk factors. Individuals with known genetic differences within their own or their family history or those who are 'older' when they conceive are at higher risk of having a baby with a genetic difference. There are many screening options available to parents desiring genetic screening during pregnancy. Screening is available from your midwife for many defects via bloodwork and ultrasound. Using more invasive techniques such as amniocentesis or chorionic villus sampling requires seeing a perinatologist (a specialist in high risk pregnancies). A perinatologist is also recommended for genetic counseling anytime a screening test done with your midwife returns positive.

 

Urine Screening

• Urinalysis - Urinalysis continues to be routinely performed either by urine dipsticks or by sending urine to the lab. This test indicates levels of protein, ketones, luekocytes, glucose, nitrites, PH, and specific gravity of the urine. The reliability of urinalysis as a screening tool as being questioned, so results are always interpreted with caution and followed up with further testing. ​

 

• Urine Culture and Screen - A urine culture can detect a Urinary Tract Infection (UTI).  UTIs often have no symptoms during pregnancy and can cause pregnancy complications if left untreated, including kidney disease and preterm labor.

 

Genital Swabs

• Group B Strep (GBS) Screening - This is a screening test for a strain of strep that colonizes in the vagina, and levels of GBS infection can change from time to time. If colonization levels are high in the month prior to birth, treatment is recommended to reduce rates of transmission to babe at birth. Rarely, the baby can contract GBS at high enough levels to lead to GBS disease. GBS disease, although rare, can lead to serious complications.

 

• Gonorrhea and Chlamydia* - Gonorrhea and Chlamydia are sexually transmitted infections that can be transmitted to the babe during birth. One of the main concerns with these bacterial infections begin contracted to the babe is blindness. This test can also be run via urine.



* a note on Sexually Transmitted Infections (STIs) - Many individuals believe they are not at risk for an STI, however as we write about here anyone who has unprotected sexual contact of any kind is at risk for an STI. Your midwife can help you evaluate your risk, obtain comprehensive testing and teach safer sex practices.