The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Timing of Prenatal Tests

When do you recommend it? And what tests. Standard labs? HIV? HSV? Wet mount?

I don't even see some of my Mexican women until 37 or 38 weeks (as this is when they've arrived in my city) I can NEVER obtain any records from Mexico so I have to go on the info they give me or retest. What tests would you deem as appropriate?

Had one Mexican woman whose HGb fell to 7.6 by term. Nothing seemed to help and she was very uncompliant. "Vitaminas make me vomitos" She told me. I transported her just for that reason even though my gut told me she'd do fine. It did earn me brownie points with the back-up doc.

I'd be interested to see others recommendations. How about testing for hemoglobinopathies. Anyone do this routinely?

My own approach is to make the decision of what labs , and when to order them individually. After taking history, noting gestational age, and the preference of the client ,it becomes more clear when and what to order.

For the most part, my clients come in early in the pregnancy. If they are basically healthy, and comfortable, I think that a pelvic exam and a stick would be a rude way to say, "hi".

But if there is any reason for concern, or if she presents initially at 35 weeks, I recommend doing it at the time of the first visit, but give her the option of coming back in just a few days. I'm surprised at the number of women given this option that will refuse labs on the day of the first visit, but will return as soon as the next day.

I normally do just a prenatal profile, a pap , gc and chlamydia, offer HIV, HBV, triple screen, strep b culture. I let clients know that they can refuse the genital cultures. I usually do about 30 to 45 minutes of lab counseling before doing any labs. That's another reason why it may be more convenient to do it on the second visit. I've probably already spent 90 minutes with her.

I know that some wait until after the first heart beat to do labs, but I think that sends a negative message. Also, if the woman is having good pregnancy symptoms you can be pretty sure things are okay.