Each midwife will have a system to ensure that you receive any relevant labs during your pregnancy. She may draw the labs herself at her office, at your home, refer you to a physician, or have you go to a laboratory to have labs drawn.
Routine Tests
Midwives routinely offer the following prenatal tests for women in early pregnancy.
CBC – A CBC (complete blood count) is a blood test that counts the number of cells in your blood. Red blood cells (RBC) shows if you have anemia or not. Anemia decreases the amount of oxygen available to you and your baby and can be corrected with supplementation and dietary changes. White blood cells (WBC) are part of your body’s immune system. If the WBC count is high, it means your immune system is working to fight an infection, such as the cold, the flu, or a urinary tract infection. They can also be high from emotional and physical stress. During pregnancy, the white blood cell count normally increases. The CBC also checks the number of platelets in your blood. Platelets are necessary for blood clotting.
ABO/Rh – Your blood will be tested to determine your blood type and Rh factor. The ABO blood types include O, A, B, or AB. The Rh factor is simply a protein found on the red blood cells and are genetically determined. When present, a person is Rh positive. When absent, the person is Rh negative. Eighty-five percent of the population has a positive Rh factor. The remaining fifteen percent of the population has a negative Rh. Being Rh negative does not normally affect someone’s health, but you will have to have further testing to check for antibodies during pregnancy.
Antibody Screen – This blood test screens for the possible incompatibility between maternal and fetal blood. If you are Rh negative, you may develop antibodies against your baby’s Rh positive blood. RhoGAM will be offered to prevent this condition.
Rubella Titer – This blood test determines your immunity to rubella. Although most women have been immunized against rubella, protection may decrease over time. The disease can be devastating to a fetus if a mother contracts rubella during pregnancy.
RPR (rapid plasma reagin) – is a blood test that detects exposure to syphilis.
Hepatitis B – A blood test that detects exposure to hepatitis B. Hepatitis B is a liver infection that presents a risk to infants, midwives, and anyone else exposed to your blood during the birth.
HIV Screening – HIV is a virus that attacks the immune system and causes acquired immunodeficiency syndrome (AIDS), which can be passed to the baby. Some midwives may request that you have HIV screening with your initial laboratory work to determine your risks and eligibility for out-of-hospital birthing. Additionally, some states require their licensed health providers to arrange HIV testing.
The test is not a test for AIDS. It tests for antibodies to the HIV, the causative agent for AIDS, and shows whether you have been exposed to the virus. A positive test result does not mean that you have AIDS but that you are at a significantly increased risk of developing immune system problems.
If your test results are positive, your midwife will counsel you to seek appropriate medical care, support, and treatment for yourself and your baby. They will do their best to make referrals to medical, social, psychological, or legal services that will be helpful to you.
Chlamydia and Gonorrhea – Chlamydia and gonorrhea are sexually transmitted infections (STIs) caused by bacteria. Anyone who is sexually active can contract these infections. If you are at risk, you can be screened for sexually transmitted infections in early pregnancy and receive antibiotic treatment if needed. To screen, a vaginal swab or urine specimen is collected.
Risks of chlamydia and gonorrhea to baby
A baby can contract a severe type of conjunctivitis (pink eye) caused by gonorrhea or chlamydia infection in the mother’s body. Because of potential damage, many states require that their health care providers administer newborn antibiotic eye ointment. In most cases, parents can safely decline this procedure when a mother does not have gonorrhea or chlamydia.
The only way for a newborn to contract conjunctivitis from chlamydia or gonorrhea is if the mother is infected. If you do not have chlamydia or gonorrhea, the newborn cannot contract it.
Urine Culture – Your midwife may recommend a urine culture at your initial prenatal visit or as indicated to check for the presence of bacteria associated with a urinary tract infection (UTI). A UTI is when bacteria enter your urethra, which can spread to your urinary tract – including your bladder and kidneys.
While most women will have symptoms of a UTI, others will have no symptoms – so doing a urine culture will help identify any problems early on. Unfortunately, pregnant women are more prone to UTIs. Another reason for doing a culture is that the screening method of using a dipstick may not always catch a UTI.
Non-invasive cell-free DNA prenatal testing – This DNA test screens for certain chromosomal abnormalities in the fetus. Click here to learn more.
Other Tests to Consider
Please discuss your preferences concerning the following additional tests with your midwife.
PAP Screen – tests for abnormal cervical cells, which requires further screening for cancer.
Vitamin D Levels – can be offered with your initial labs or anytime in pregnancy. It is highly recommended that you check your vitamin D levels.
Early Gestational Diabetes Screen – This test may be offered if you have risk factors.
Ultrasound – Ultrasound is often used by physicians to estimate the due date, but it is most accurate between 11 and 13 weeks. A first-trimester ultrasound may also be performed to check on fetal well-being and pregnancy issues, such as ectopic pregnancy, miscarriage, or maternal bleeding.
Understanding Your Labs
In most cases, test results are sent directly to your midwife or collaborating physician via fax or direct transfer to your electronic chart. Having access to your electronic chart will enable you to look at your results. If you do not have access, ask your midwife to make a copy of the results. If you have questions, go over the labs with your midwife at one of your prenatal visits.
Having lived in Puerto Rico, I learned a new system of drawing blood and obtaining results. Here, care providers do not draw blood. Everyone goes to a laboratory – and there are tons of them in Puerto Rico. The provider may or may not have recommendations for a lab. In that case, the patient is free to pick the lab clinic.
When the results are ready, they do not send them to your care provider. Either you have to pick them up yourself or request the lab clinic to email or fax them to you. Once you have them, you can drop them off at the provider’s office or bring them with you at your next visit.
What I like about this system? It gives patients more autonomy and a better understanding of what lab results look like.
American College of Obstetricians and Gynecologists: Routine Test During Pregnancy / Frequently Asked Questions. ACOG.
Centers for Disease Control. Conjunctivitis (Pink Eye) in the Newborn. CDC. June 4, 2015.
Grow by WebMed: First Trimester Tests During Pregnancy. Website.
