Lab Work

All labs are drawn in the comfort of your own home. Occasionally, under special circumstances, your midwife may need to send you to the lab to have labs drawn.

Most labs are sent to Quest Diagnostics for testing. Some insurances may require labs to be sent to LabCorp. Your midwife has accounts with both labs, and the lab bills your insurance for you.

INITIAL LABS

Complete Blood Count (CBC): This test gives us a picture of how healthy your blood is. It includes your white blood cell count, your red blood cell count, your iron levels, and your platelets. These things are all important in growing a baby, and your midwife will work with you to get everything at its best if any of these are out of the normal range. For more detailed information about a CBC see the mayo clinic’s description.

Blood type and Rh factor with antibody screening: This test determines your blood type and Rh factor (ex: A+, O-). If the mother’s blood type is Rh negative (ex: O negative), and her partner’s blood type is Rh positive (ex: A positive), an antibody screening is repeated at 28 weeks, and a Rhogam injection is given if needed. If Rhogam is declined, another antibody screen will be performed at 36 weeks. For more information about what happens when you are Rh negative, read the National Institute of Health’s article on the subject.

Rubella titer: This test checks the level of antibodies in the blood against the German measles virus. If a woman becomes infected with German measles (rubella) during her pregnancy, her developing baby could be at risk. Avoiding people with high fevers and rashes during pregnancy is always a good idea, especially if you are not immune to rubella. Most women are immune from having their vaccines as a child.

Syphilis screen: This test checks for the presence of syphilis infection. If present, treatment can be started right away so that the baby is not harmed. Syphilis is treated with a simple antibiotic.

Hepatitis B screen: This test checks for infection with the Hepatitis B virus, which can be passed to an unborn child. Healthcare workers are especially encouraged to get a HepB screening.

HIV screen: This test checks for HIV (human immunodeficiency virus), which can lead to AIDS (acquired immunodeficiency syndrome). If a woman is found to have an HIV infection, she can be treated during pregnancy, which will reduce the chances of her passing the virus to her unborn child. Here is a fact sheet on HIV in pregnancy.

Pap smear: This test checks for abnormal cervical cells, which could indicate cervical precancer or cervical cancer. It is coupled with a pelvic exam to check on all of the structures of the pelvis and vagina. The American Cancer Society makes these recommendations about pap smears.

Gonorrhea and Chlamydia cultures: Both of these infections, if present, must be treated to prevent infection of the baby at birth. Babies with these infections in the eye can go blind. These infections, if left untreated, can also lead to preterm rupture of membranes (water breaking).

Urinalysis: This test examines the urine for the presence of bacteria, sugar, or protein. It is usually performed at each prenatal visit. A urine culture is sent to the lab at the first visit, as well as in the third trimester of pregnancy.

28 WEEKS

Hemoglobin: This test, coupled with hematocrit, tests the iron level in your blood. It is normal for pregnant women to have slightly lower iron levels than non-pregnant women, but it is very important to keep your iron stores at a healthy level. Low iron, or anemia, can make you feel tired, make you have cravings for non-nutritional substances like ice or clay, and is a very important factor at birth when it comes to blood loss.

Gestational Diabetes screen: A glucose tolerance screen is performed following ingestion of 50 grams of carbohydrates. That’s a fancy way to say that you eat some carbs, and we test your blood sugar levels an hour later. This is the check for a condition of pregnancy called gestational diabetes. If your blood sugar levels are too high at this test, you will then go to the lab for a 3-hour test to verify the results of the 1-hour test. If your blood sugar is still high, special efforts will be necessary to maintain your blood sugar at a normal level. This can often be accomplished with diet changes but may require medication or insulin. In the vast majority of cases, gestational diabetes resolves following delivery, although women who develop diabetes during pregnancy are at a higher risk of developing Type II diabetes later on in life. If you would like to read more on the topic, check out the March of Dimes article on Gestational Diabetes.

Urinalysis: Another urine sample will be sent to the lab to check for the presence of a urinary tract infection, which can cause infection of the kidneys and/or premature rupture of membranes (water breaking) if left untreated. Sometimes, a urinary tract infection doesn’t have any symptoms.

36 WEEKS

Hemoglobin: Blood iron levels will be checked one more time to check for the presence of anemia. If your iron level is low, it will need to be treated throughout the remainder of the pregnancy.

Group Beta Streptococcus (GBS, Group B Strep) swab: A vaginal swab is done for this test (which is a long Q-tip inserted into the vagina). If the bacteria is present, you can be treated during labor to prevent infection of the baby during the birthing process. Dr. Aviva Romm has written a very informative piece on GBS outlining the definition, pros, and cons.

Urinalysis: A urine sample may be sent to the lab to check for UTI.

GENETIC SCREENING

Your midwife will offer you genetic screening during your pregnancy. If interested, there are a variety of screens available to you at certain times during your pregnancy. Depending on the results of the screen, follow-up testing may be recommended, including an ultrasound, another blood screen, chorionic villus sampling (CVS), and/or an amniocentesis.