Initial Prenatal Testing Options

Below are common initial prenatal lab testing options and explanations. Blood draws and typically done in-office and sent to St. Luke’s / Aspirus labs. People can also choose to have their blood drawn directly at the St Luke’s lab.

*Please do not take your prenatal vitamin or other supplements on the day of your blood draw as these can skew lab results. You can take them after the blood draw.

Labs included in your midwifery package with me: Blood type, RH factor, Antibody screen, Rubella immunity, CBC, Ferritin, Iron serum, TIBC, Hepatitis B, STI testing, HIV and Urine culture.

Blood Type, Rh factor

Knowing blood type and Rh factor are helpful in the rare case a blood transfusion is needed. Also, a negative Rh factor would prompt us to have a larger discussion about risk factors and possible interventions. Only 15% of European decent are Rh negative, 8% of African descent and 1% to 3% of Asian descent.

A deeper dive about negative Rh factor with Dr Sara Wickham’s article.

Antibody Screen

This is checking for an immune response where antibodies in the blood could potentially attack the baby’s red blood cells. These antibodies are more likely to show up in Rh negative blood types. But, it can happen with other blood factors as well. This is typically repeated around 28 weeks.

Rubella Immunity - German Measles

We are checking for rubella antibody levels because rubella during the first trimester can cause serious problems for the baby.

CBC with Differential

This test gives us a lot of helpful information about your blood. Below are a couple examples of what the CBC shares with us.

Hemoglobin: Portion of the red blood cell that carries oxygen. Ideally, this number drops a point or two around 28 weeks showing us that the blood volume has expanded well. We want this number to be 10 to 14 for a homebirth.

Platelet count: This shows us blood clotting abilities. It’s important that platelets are with a normal range for homebirth.

Ferritin

Ferritin is stored iron. Pregnancy requires a lot of iron. If our stored iron is low, even if our hemoglobin is within normal, we can feel: tired, anxious, restless legs, crave ice and may feel extra short of breath. In pregnancy ferritin is ideally 30 to 80. Many people come into pregnancy with low ferritin and once we know this we can come up with a plan to increase iron stores.

Iron Serum

Iron currently circulating in the blood. This can help us determine type of anemia if there is an anemia present.

TIBC: total iron binding capacity

This shows us the open binding sites on the cell. This is another helper when figuring out which types of anemia someone has.

STI Testing: As a midwife I come in contact with many bodily fluids and am at risk of contacting whatever the client carries. I ask that people be mindful and respectful of this fact by being open and honest about risk factors.

Hepatitis B

Hepatitis B is a viral infection that causes inflammation of the liver. This can be managed to reduce the chance of transmission to the baby.

STI testing: Syphilis, Gonorrhea and Chlamydia.

STIs left untreated can transmit to the baby can cause a variety of complications. If we are aware of an STI, it can get treated which benefits your health and your baby’s health. The testing can either be done in a urine culture or with a vaginal swab.

HIV

With treatment and care HIV transfer to baby can be reduced. I would want to have a very clear plan in place to reduce risk for everyone involved and would need the client to be getting co-care with a provider who specialized in monitoring pregnancies where HIV is a factor.

Urine Culture - not a blood draw

Asymptomatic urinary tract infections are more common in pregnancy because of physiological changes that take place. We like to check at the initial prenatal to make sure a silent infection isn’t present.

These are not included in the midwifery package but can be added for the ‘cash price’ of the test:

Vitamin D

Vitamin D is low in most people in Minnesota and Wisconsin. Vit D is important for brain development, bone health and many other things. Low vitamin D can play a role in anxiety and in blood sugar instability.

Ideally Vit D is between 50 - 80. I recommend my midwifery clients take a minimum of 2000 - 4000 iu daily if they don’t know their levels.

Vit D needs increase in the postpartum during the breastfeeding phase: supplementing 6400 iu daily gives the infant 400 iu via breastmilk. This is a good thing! More info

HgA1C

This is accurate until 13 weeks. This test measures the average blood sugar levels over the past three months. If someone finds they are coming into pregnancy with high blood sugar levels, we can start addressing this right away through: changing the order that we eat our food (veggies and protein before carbs), correcting nutrient deficiencies, adding a 10 min walk after meals and possibly adding supplements.

If someone has an elevated HgA1c in the first trimester there is an almost 98% chance they they will fail the glucose test around 24 to 28 weeks. If we know in advance, we have more time to work to bring the blood sugars within normal range. Here’s a podcast if you’d like to know more.

Thyroid Testing

Some people may be coming into pregnancy knowing they have thyroid issues and will ideally be working with a provider that knows how to manage this in pregnancy. Some people may discover or develop thyroid issues in pregnancy. If I see signs of possible thyroid issues I will voice them. You are always encouraged to voice your concerns - you know your body best. More info here