Prenatal pap smear and pelvic exam??

[misspriss]

I still can't see why being pregnant necessitates more frequent PAP smears than non pregnant women? If 3 years is a safe interval for healthy women, what does pregnancy change?

 

[knobby]

I still can't see why being pregnant necessitates more frequent PAP smears than non pregnant women? If 3 years is a safe interval for healthy women, what does pregnancy change?

If they do find an infection with a pap smear it can be treated before the baby is born with pregnancy safe medication. Otherwise your baby would be exposed to the bacteria, virus, etc... So that is why being pregnant changes things and the 3 year interval for nonpregnant women is not applicable.

 

[Mrsgoodhart]

So true. Plus not all infections of the female genital tract are STDs anyways, just in case anyone reading this thread thinks otherwise.

This! I think this is what I was trying to get at the whole time. You have have an infection, doesn't mean it's an STD.

 

[pgfairy]

I still can't see why being pregnant necessitates more frequent PAP smears than non pregnant women? If 3 years is a safe interval for healthy women, what does pregnancy change?

It's because while you're pregnant the results are slightly less reliable due to natural changes to your cervix. So they do it more often to be sure you're clear.

 

[misspriss]

I suppose. I trust my doctor though.

I noticed pretty much everyone in this thread is in the US though, I'm pretty sure I've heard they DON'T do them in the UK while you are pregnant. Are they just less likely to have infections/cancerous cells? Is it because their health department has decided it is not useful/necessary?

From babycenter, your first prenatal appointment in the US:

Here are the basics:

A thorough physical
A pelvic exam, including a Pap smear (unless you've had one recently) to check for abnormal cells, which could indicate cervical cancer
Possibly a culture to check for chlamydia and gonorrhea
A urine sample to test for urinary tract infections and other conditions

From babycentre, your antenatal appointments in the UK:

What other antenatal checks will I be offered?
Your midwife or doctor won't carry out internal examinations during your appointments.

from NICE (found no information on PAP smears):

1.5.3 Pelvic examination

1.5.3.1 Routine antenatal pelvic examination does not accurately assess gestational age, nor does it accurately predict preterm birth or cephalopelvic disproportion. It is not recommended.

But I'm not in the UK, I've just heard it on this board and it is supported by what I've read online. Since the NHS makes decisions based on necessity, not profit, and the US healthcare system is a profit machine, when I see extra things that are not required in the UK it makes me wonder. Like 10 appointments (7 if you are a second time mom) vs 14 in the US? Just wondering why it is considered "essential" here to some people, where entire other countries with what I would consider "equivalent" levels of healthcare (or better!) don't?

Either way, my doctor is my caregiver, and she offered to let me wait until after deliver as I had one 1 year before, so well within the 3 year limit. My prevous doctor, when I asked him when he needed to see me again, in 3 years? He said no next year. However, back when I got almost free healthcare at planned parenthood, they said every 3 years was sufficient. I think it's a profit thing really.

 

[knobby]

I don't fear having a pap smear during pregnancy. It is a very low risk test. I'd say if you feel comfortable having a transvaginal exam, then a pelvic exam and pap smear should not be a problem. There is evidence that having a pap smear is important for pregnant women:

Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis

Increased prevalence of human papillomaviruses in the lower genital tract of pregnant women

US vs UK? I think the US has a very prophylactic/preventative approach to prenatal care. Also, our government doesn't have as much influence over what the standard for health care should be compared to the UK. Medical research performed by medical doctors rule our health care. Private insurance pays for most people's health care. In the UK medical care is paid for with taxpayer dollars so the government's influence over what is done and not done is huge. Their medical research is also hugely government funded. If they can find a reason to not make something a standard of care that will save them money, why wouldn't they?

I only posted this thread to ask when others have gotten their pap smears so I know roughly when I can expect to have one done. I really didn't want to debate over whether or not someone should have a pap smear and didn't expect that I would have to defend my decision to have one. Everyone should make health care decisions they are comfortable with. If you are comfortable not having one done, then that's your choice and your right.

 

[misspriss]

I don't fear having a pap smear during pregnancy. It is a very low risk test. I'd say if you feel comfortable having a transvaginal exam, then a pelvic exam and pap smear should not be a problem. There is evidence that having a pap smear is important for pregnant women:

Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis

Increased prevalence of human papillomaviruses in the lower genital tract of pregnant women

US vs UK? I think the US has a very prophylactic/preventative approach to prenatal care. Also, our government doesn't have as much influence over what the standard for health care should be compared to the UK. Medical research performed by medical doctors rule our health care. Private insurance pays for most people's health care. In the UK medical care is paid for with taxpayer dollars so the government's influence over what is done and not done is huge. Their medical research is also hugely government funded. If they can find a reason to not make something a standard of care that will save them money, why wouldn't they?

I only posted this thread to ask when others have gotten their pap smears so I know roughly when I can expect to have one done. I really didn't want to debate over whether or not someone should have a pap smear and didn't expect that I would have to defend my decision to have one. Everyone should make health care decisions they are comfortable with. If you are comfortable not having one done, then that's your choice and your right.

Well, I'll start by saying I'm not comfortable with vaginal probe ultrasounds, if that is what you are referring to by a "transvaginal exam", my doctor did a quick feel of my uterus, but it was quick she didn't irritate my cervix. I'm also not comfortable with frequent vaginal checks during the late 3rd trimester or labor either!

See I see the funding situation differently. The NHS has to be very transparent with their research and recommendations, as they are using public money. I don't think many pregnant woman in the UK feels they are getting less than adequate prenatal care, where I in the US feel I am being forced to accept more care than I'd prefer. The US, on the other hand, no one knows who is funding the research, who is paying, who is profiting from the results. It's not even clear what the guidelines for care are, where I can go find the UK care guidelines with a quick internet search. Much less transparent. And you can guess, in a profit based industry, your best interests may not be the most important thing to someone.

I don't mean to debate either, I simply posted some recommendations and everyone was SO quick to say "oh but not for pregnant women!" and I wanted to know why. Didn't mean to turn it into a debate or anything.

 

[knobby]

I don't think many pregnant woman in the UK feels they are getting less than adequate prenatal care, where I in the US feel I am being forced to accept more care than I'd prefer.

Yes, I meant transvaginal u/s. And drs can't force any treatment or exams that you don't want. So if you ever feel that way switch drs.

 

[misspriss]

I don't think many pregnant woman in the UK feels they are getting less than adequate prenatal care, where I in the US feel I am being forced to accept more care than I'd prefer.

Yes, I meant transvaginal u/s. And drs can't force any treatment or exams that you don't want. So if you ever feel that way switch drs.

I was harassed at the ultrasound place for not consenting to transvaginal at 11 weeks (totally necessary). It's not forced, I just don't see why I have to come in every 4 weeks! Also, if I were in the UK, a homebirth would still be an option for me having a VBAC. Because I am in the US, I will be forced into a hospital birth, most likely forced into continuous monitoring, probably they will attempt to force me to accept an IV. Yes, I can decline all these things, but I can't have a legal midwife attend a homebirth for me (which is fine in the UK), and I will have to fight tooth and nail to decline other things that are "hospital policy" for VBACs. Don't act like I can just turn down anything I like as if they were asking me if I want fries with my meal, it isn't like I can "just decline anything I don't feel comfortable with"

 

[knobby]

I was harassed at the ultrasound place for not consenting to transvaginal at 11 weeks (totally necessary). It's not forced, I just don't see why I have to come in every 4 weeks! Also, if I were in the UK, a homebirth would still be an option for me having a VBAC. Because I am in the US, I will be forced into a hospital birth, most likely forced into continuous monitoring, probably they will attempt to force me to accept an IV. Yes, I can decline all these things, but I can't have a legal midwife attend a homebirth for me (which is fine in the UK), and I will have to fight tooth and nail to decline other things that are "hospital policy" for VBACs. Don't act like I can just turn down anything I like as if they were asking me if I want fries with my meal, it isn't like I can "just decline anything I don't feel comfortable with"

A transvaginal exam is needed early on for accurate measurements, especially if you don't have a full bladder needed for an abdominal ultrasound. If I were uncomfortable I would have just waited till they could do an abdominal.

If you want a VBAC you should definitely research it and figure out how to make it work for you. I briefly checked Arkansas VBAC laws. If midwives can't do VBAC deliveries in your state and you need to be in a hospital to do a VBAC, you can limit the monitoring to what you are comfortable with. Again, nothing can be forced. No one is going to hold you down and force you to have an IV. They can advise you to have one if they feel it is needed, that is it.

Here's a thread I found about VBAC in Arkansas: https://www.mothering.com/forum/85-mississippi-louisiana-arkansas/1290488-vbac-arkansas.html

And this conversation here seems to indicate that there are midwives in Arkansas who are practicing unlicensed due to the state restrictions: https://www.mothering.com/forum/85-mississippi-louisiana-arkansas/1286298-vbac-midwife-ar.html (they can practice unlicensed but "...no external body that can verify training or education, and pregnant women and families must assess qualifications for themselves. Unlicensed midwives do not use oxygen, IV therapy, or anti-hemorrhagic medications and do not suture.")

 

[minties]

There are no smear/pap tests or pelvic exama in pregnancy in New Zealand. Not sure why your pelvis would need poking at?

 

[misspriss]

A transvaginal exam is needed early on for accurate measurements, especially if you don't have a full bladder needed for an abdominal ultrasound. If I were uncomfortable I would have just waited till they could do an abdominal.

A transvaginal is rarely needed after 8 weeks. NT scans are done at 12 weeks, I've never heard of them needing to be transvaginal. Certainly at 11 weeks abdominal would be sufficient to measure CRL. And yes, my bladder was humongous. With DS, I was obese, didn't have a full bladder, and we got what we needed abdominal at 6+3. I weighed less, and was prepared with a full bladder. Here is the picture from the abdominal scan, does it look like we needed to go TV?!

If you want a VBAC you should definitely research it and figure out how to make it work for you. I briefly checked Arkansas VBAC laws. If midwives can't do VBAC deliveries in your state and you need to be in a hospital to do a VBAC, you can limit the monitoring to what you are comfortable with. Again, nothing can be forced. No one is going to hold you down and force you to have an IV. They can advise you to have one if they feel it is needed, that is it.

Here's a thread I found about VBAC in Arkansas: https://www.mothering.com/forum/85-mississippi-louisiana-arkansas/1290488-vbac-arkansas.html

I am definitely planning to go VBAC. I have researched my butt off about it. I already said I am being forced to do it in a hospital in the first place.

I've heard PLENTY of stories of women being physically forced to remain lying in the beds on their backs for labor, with bruises to prove it. I don't feel like I should have to fight tooth and nail and "not consent" to everything in order to have the birth that I want. It isn't FORCED, but it is strongly coerced.

ETA: I'm using the Dr Jones listed in that link waited long and hard for an appointment with her!

And this conversation here seems to indicate that there are midwives in Arkansas who are practicing unlicensed due to the state restrictions: https://www.mothering.com/forum/85-mississippi-louisiana-arkansas/1286298-vbac-midwife-ar.html (they can practice unlicensed but "...no external body that can verify training or education, and pregnant women and families must assess qualifications for themselves. Unlicensed midwives do not use oxygen, IV therapy, or anti-hemorrhagic medications and do not suture.")

In Arkansas, licensed midwives don't do those things either, FYI. They are not the same as UK midwives. The only difference in an licensed and unlicensed is that an external body verifies their training and education.

I would not want someone unlicensed being my medical care provider, I'd rather go unassisted personally.

Anyway, I think you just have a very high view of the American medical care system, that I simply don't share. Maybe we're different, maybe it's experience. I just know, if I could I'd rather be in the UK for prenatal care, by leaps and bounds. Or heck, I'd rather be in Texas at least. Anywhere else.

 

[knobby]

Misspriss, it all comes down to your relationship with your doctor. There needs to be trust. You obviously don't trust your doctor and are aggravated and very angry with your experience so far and should probably seek someone who you can trust, is compassionate, has your needs and wants in mind always, and is your #1 advocate. I have full trust in my doctor; I trust him with my life. We have an amazing patient-dr relationship and he is the reason I am pregnant right now - he was the only dr to correctly diagnose the reason for my recurrent miscarriages and treated it. When I have an appointment with him it is like I am his only patient - he gives me his time and answers all my questions. He really truly cares. It is not about money with him. He was actually emotional when he did my last ultrasound and saw healthy heartbeat and everything measuring right. He was so happy for us and said this is why he loves his job. When talking about treatment (like my surgery or when I had to choose between a D&C or natural miscarriage - I chose natural) he makes sure this is what I want and there is never any pressure.

Not every American doctor is money grubbing and evil. Not every doctor forces unwanted treatments on their patients. And if anyone feels this is how their doctor is then they need to find someone else because that's not okay. There are plenty of great doctors out there.

 

[misspriss]

Misspriss, it all comes down to your relationship with your doctor. There needs to be trust. You obviously don't trust your doctor and are aggravated and very angry with your experience so far and should probably seek someone who you can trust, is compassionate, has your needs and wants in mind always, and is your #1 advocate. I have full trust in my doctor; I trust him with my life. We have an amazing patient-dr relationship and he is the reason I am pregnant right now - he was the only dr to correctly diagnose the reason for my recurrent miscarriages and treated it. When I have an appointment with him it is like I am his only patient - he gives me his time and answers all my questions. He really truly cares. It is not about money with him. He was actually emotional when he did my last ultrasound and saw healthy heartbeat and everything measuring right. He was so happy for us and said this is why he loves his job. When talking about treatment (like my surgery or when I had to choose between a D&C or natural miscarriage - I chose natural) he makes sure this is what I want and there is never any pressure.

Not every American doctor is money grubbing and evil. Not every doctor forces unwanted treatments on their patients. And if anyone feels this is how their doctor is then they need to find someone else because that's not okay. There are plenty of great doctors out there.

How many times have I said *in this thread* I trust my doctor!?! What made you think I didn't? The ULTRASOUND tech and my doctor, are two different people, they don't even work at the same office. Never once have I said I have an issue with *my* doctor. My doctor and state law are separate things. I have an issue with the healthcare situation in my state and country, not my doctor. The requirement to have 14 visits, made by an board of doctors across the US, not my doctor.

I never said doctor's themselves were money grubbing, but the entire medical industry is a huge profit industry. Why else does the hospital charge $113-300 for a urine dipstick pregnancy test? (mine and my sister's experiences, required before radiology treatment in ER). It's not doctor's who force VBAC policy, it's hospitals and insurance companies. It's all about minimizing hospital liability so they don't lose MONEY. There are lots of great doctors, but not as many great hospitals and pretty much no great insurance companies.

 

[knobby]

How many times have I said *in this thread* I trust my doctor!?! What made you think I didn't? The ULTRASOUND tech and my doctor, are two different people, they don't even work at the same office. Never once have I said I have an issue with *my* doctor. My doctor and state law are separate things. I have an issue with the healthcare situation in my state and country, not my doctor. The requirement to have 14 visits, made by an board of doctors across the US, not my doctor.

Misspriss you are the one who talked about the fear of being forced to have IVs. Of being forced to give birth in a certain position. Of being held down and bruised. If you trust your doctor, you would trust they wouldn't let this happen to you. Nurses can't just jab IVs in. They need drs orders for an IV first. If you don't want an IV you should establish that with your dr. And I would hope that your dr, if you trust them, would not work in a hospital environment where nurses hold down patients and cause bruising. That's abusive.

You said:

I don't feel like I should have to fight tooth and nail and "not consent" to everything in order to have the birth that I want. It isn't FORCED, but it is strongly coerced.

So I said you should change drs if you don't trust your doctor won't treat you this way. Why would you have to fight tooth and nail if you trust your dr? If you trust your dr then relax already.

You're so angry and I don't know why. You have gotten upset enough that you've derailed a thread where I was only trying to get a simple answer from others about when they got their pap smears. If it didn't apply to you, then you should not have responded.

 

[misspriss]

How many times have I said *in this thread* I trust my doctor!?! What made you think I didn't? The ULTRASOUND tech and my doctor, are two different people, they don't even work at the same office. Never once have I said I have an issue with *my* doctor. My doctor and state law are separate things. I have an issue with the healthcare situation in my state and country, not my doctor. The requirement to have 14 visits, made by an board of doctors across the US, not my doctor.

Misspriss you are the one who talked about the fear of being forced to have IVs. Of being forced to give birth in a certain position. Of being held down and bruised. If you trust your doctor, you would trust they wouldn't let this happen to you. Nurses can't just jab IVs in. They need drs orders for an IV first. If you don't want an IV you should establish that with your dr. And I would hope that your dr, if you trust them, would not work in a hospital environment where nurses hold down patients and cause bruising. That's abusive.

You said:

I don't feel like I should have to fight tooth and nail and "not consent" to everything in order to have the birth that I want. It isn't FORCED, but it is strongly coerced.

So I said you should change drs if you don't trust your doctor won't treat you this way. Why would you have to fight tooth and nail if you trust your dr? If you trust your dr then relax already.

You're so angry and I don't know why. You have gotten upset enough that you've derailed a thread where I was only trying to get a simple answer from others about when they got their pap smears. If it didn't apply to you, then you should not have responded.

I had a traumatic birth with DS, which is probably where my fear and anger comes from. I had a different doctor with DS, who was not mean, but I did not end up with the birth experience that I had planned on. I'm sorry if you get the wrong idea from my posts.

And it did apply, I got one a year before my first prenatal appointment and my doctor let me skip it until after the birth.

 

[MamaLoCo]

How about you two agree to disagree?

 

[misspriss]

Anyway, I think you just have a very high view of the American medical care system, that I simply don't share. Maybe we're different, maybe it's experience.

How about you two agree to disagree?

Exactly, we just see it differently. I'm glad she's happy with what she has.

 

[pgfairy]

I don't want to respark any kind of debate but I wanted to address your question about the NHS vs the US private system with regards to pap smears (I don't want to even go anywhere near the scan issue because I have no experience of that in the US).

Basically there is a happy medium in there somewhere. In the UK they really don't DO preventative medicine all that well because it's a drain on the systems funding so they are pretty resistant to any sort of screening or unnecessary testing.....in the US if you go to a doctor they will rule out some of the maybe less common but worse possible diagnoses from the get go. In the UK if you have a serious illness you could be treated like it's just something minor for YEARS before a doctor will test for something more serious.

So with the smears they really go in a severe direction about not doing it regularly. And do you know what, the statistics they quote aren't wrong, it's an incredibly small number of women that actually have issues when they're younger than about 40. But of course if you're one of those incredibly rare women you could end up pretty sick by not getting tested till then (I think they've lowered it and started inviting women over 25 every three years now but it was really bad when I first moved here).

Long story short, I think if you have been having them regularly before your pregnancy and you haven't ever had one come back with problems, there really isn't any point in getting one now it's not like you're going to develop a problem BECAUSE you're pregnant.

On the other hand if you're like me and you've had severe changes come up in the past and had to have part of your cervix removed and you're due for your yearly one to keep an eye on things, you should be able to get one done. (and trust me I had to throw a screaming hissy fit to get one here in the UK at all).

You shouldn't have to fight either way in my opinion, both systems are flawed.

 

[pgfairy]

I don't think many pregnant woman in the UK feels they are getting less than adequate prenatal care, where I in the US feel I am being forced to accept more care than I'd prefer.

Also, yes. Yes they do feel like they are getting less than adequate care. A lot of the time.