Posted by My OB said WHAT?!?.
Jan
21
Posted by My OB said WHAT?!?.
“You Don’t Have A Choice.”
“You don’t have a choice.” – OB to mother who declined the Glucose Tolerance Test.
There are 50 comments to this post.
v had this to say,
Jan 21, 2012 @ 10:36 am (Quote)
I was told this too. After refusing anyway I was told it was for *their* insurance security. Which I don’t care about enough to do the test when I had even said I use strips at home. And had the numbers with me.
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Nic Reply:
January 21st, 2012 at 10:58 am (Quote)
they always pull the insurance thing…”If u do not agree to this n that, u may be subject to full responsibility of the entire bill!” ok then, so, I start to drink it, make myself puke it up all over…test OVER! I then agreed to a ‘normal’ blood sugar test with normal food etc…I will sit in ur office with a good book & normal foods, I’ll even let u plan that, but never again will I drink that sugar crap liquid!
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I was told the same thing, and that the OB would no longer accept me as a patient if I refused. Since there were a limited number of OBs nearby who would take my insurance, and since I liked him otherwise, I went ahead and did it.
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jaed Reply:
January 21st, 2012 at 10:49 am (Quote)
Not legal. Doctors cannot dump patients on no notice except in special circumstances (e.g. patient is physically dangerous to the doctor), and “declines a medical test” is not one of them.
A doctor can decide to no longer care for a patient for pretty much any reason – but must give notice and help find another provider, and cannot cut off care to the patient’s detriment. Dumping a woman in mid-pregnancy would, I think, count as “detriment”. 
Consider reporting him to your state licensing authority.
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Mandie Reply:
January 21st, 2012 at 10:45 pm (Quote)
They gave me a 30 day notice. They told me it was because I was high risk and didn’t take the GTT test, and I was a VBAC, so WHEN my uterus explodes I wouldn’t make it to their hospital anyway. I was 30 weeks at the time and since they were only my backup plan, I went on to have an amazing home birth!
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Amelia Reply:
January 24th, 2012 at 5:49 pm (Quote)
My aunt birthed twins (one at home, one at hospital after transfer after labor stalled) in 1983. She received prenatal care from her midwives, obviously, but also the doctor at the health department–who did, indeed, dump her while she was pregnant. Yes, let’s dump the uninsured woman pregnant with twins. Stellar care decision there. You’d think things would have improved!
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Margarett the Oklahoma Midwife had this to say,
Jan 21, 2012 @ 10:52 am (Quote)
That comment sums up in 5 words what is so desperately wrong on maternity care today…..
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Jenny Islander had this to say,
Jan 21, 2012 @ 10:56 am (Quote)
See, this is where being a big middle-aged fat lady helps. The one time a young doctor tried this on me, I stood up way tall, put my chin down, and just looked at him over my glasses. Result: one wilted twerp.
Of course, I knew I was staying home to have my baby, so I didn’t have to worry about him taking his revenge in the delivery room.
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With my 1st, I drank the orange stuff. I didn’t hate it, but it wasn’t wonderful either. With my current PG, I was offered the choice of the orange drink, a 16 ounce Coke (no way! Ick!) or 12oz of no sugar added grape juice. The hardest part of the test for me was keeping my 5yo in line for an hour at the birthing center. (He just doesn’t listen or behave well for me, and I had videos, coloring books, cartoons on my phone, toys, etc, to keep him occupied but he just won’t behave which is a whole other topic and why he won’t be in the delivery room with me.) I actually wanted to take the test this time because I could feel my blood sugar bottom out a lot, but apparently everything’s OK.
But, telling a mom they have no choice? Bull!
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Why do people refuse the glucose test? Is there a safety concern or something, or is it just that drink that has to be had before (Mine was like an ultra sweet lemonade, not too bad)
I never considered refusing it the first time around, but so many of you had, I was wondering why and whether I should look into it further.
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Carmen Reply:
January 21st, 2012 at 2:50 pm (Quote)
You should look into EVERY test done pregnant or not. You are pregnant, ingesting something (“like an ultra sweet lemonade”, what exactly are you putting into your body & possibly passing to your child?), and they are taking your blood. Questions should be asked. These tests are done wrong a lot of the time which results in misdiagnosis & unnecesareans.
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Amanda Reply:
January 21st, 2012 at 2:56 pm (Quote)
I took it during my first pregnancy and it made me horribly sick. I declined for my second pregnancy. During my third pregnancy, the OB wanted me to take it but I refused. I don’t believe it is healthy for a pregnant woman to fast and then drink sugar. That is not normal. The OB for my third pregnancy offered a modified test – which I’ve done ever since – in which I eat normally, then have something sweet before having blood drawn. I’m happy witht hat.
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abba12 Reply:
January 22nd, 2012 at 12:10 am (Quote)
I suppose that makes sence. My test didn’t really involve a fast though, I mean I guess it did, but I hardly noticed. They made my blood test first thing in the morning, so I literally got our of bed, got dressed, and went to the doctors skipping breakfast, drinking the soda in the car (We were about a 45 minute drive from my doctor), and then going for breakfast straight afterwards. Since I didn’t know better back then, my body was perfectly used to a sugary or carb filled breakfast after a night of not eating, the fact it was this soda simply regulated the amount.
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SculptorAlison Reply:
February 14th, 2012 at 4:55 pm (Quote)
That’s what I did with my second pregnancy. With my first, I drank the glucola but my midwives (a hospital practice) didn’t tell me to fast. The woman at the lab was pissed at me and threatened that I’d have to take the test again, but I told her that I’d followed the instructions that were given to me. I can’t imagine how sick I would have been if I’d been fasting.
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Heather P Reply:
January 21st, 2012 at 3:06 pm (Quote)
Its not really that accurate. How does it really tell how you are metabolizing sugar if I never, ever fast then shock my system with a rush of glucose on a regular basis.
I had HG my first pregnancy and I don’t know how I was able to choke down the bottle of glucola without vomiting. For the rest of the day I felt shaky and horrible. It was bad enough not being able to keep down any food the rest of the day, but being over-sugared on top of starving was way worse.
My second pregnancy I ate a healthy breakfast, then an hour later checked my blood with a finger poke. It was much easier on my system.
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abba12 Reply:
January 22nd, 2012 at 12:20 am (Quote)
So you never have a pancake breatfast, or sugary cereasls like fruit loops or this american one, lucky charms with the marshmallows in it? No waffles or any other carb and sugar based breakfast meals? Cause if you do, then you do fast your body (overnight) and then give it a sugar hit. If you actually don’t eat carb based breakfasts and instead eat protein based ones then I can see how it would be a shock to the system.
Having said that, I’m sympathetic to your experience, I also had HG, however was fortunate enough to be able to manage liquids well, so drinking it wasn’t too bad. I also already had a high sugar diet because, at the time, I didn’t know better and any energy was good energy when I couldn’t eat much, so in my case it really wasn’t too bad except for the car trip to the doctors.
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Jane Reply:
January 22nd, 2012 at 9:21 am (Quote)
The sugar drink is just carbs, though. Most people have a breakfast that doesn’t consist of *just* carbs. Even if you’re having a bowl of Lucky Charms for breakfast, you’re probably having it with milk.
They do intentionally create an overload situation with the GTT, and it’s not something most women do in their regular diets.
A better equivalent would be sleeping overnight and then chugging a Sprite first thing in the morning.
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Jade Reply:
January 22nd, 2012 at 4:52 pm (Quote)
When I was pregnant I wasn’t fasting overnight, I was eating every time I got up for a toilet or vomit break.
When I did the GTT I was already passing out and vomiting before I got ther (very low BP and HG), I continued to do so throughout the hour that I was there, they still insisted on drawing my blood. They then asked that I come back and do the test again. Same deal this time except that after the 2nd test I wasn’t well enough to walk out of the hosptial and had to be admitted so that I could receive fluids.
I was never even offered the test with my 2nd pregnancy and I would never have it again anyway.
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Heather P Reply:
January 23rd, 2012 at 12:36 pm (Quote)
Yeah, no. Sugary breakfasts are not part of my normal diet. When I was pregnant I was lucky if my breakfast would stay down at all.
That morning I did the GTT, I fasted overnight then woke up to the glucola. Keep in mind I had HG so my daily intake was spotty anyway. I threw up most of my dinner the night before. I felt so terrible by the time they drew my blood that the food I ate afterwords I threw up also. I ended up missing work because I was so sick, weak, and shaky.
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Kortney Reply:
January 21st, 2012 at 3:15 pm (Quote)
It’s not entirely accurate – if you are truly concerned about diabetes or low blood sugar, it’s much more accurate to take regular blood sugars and do a random one with a challenge – having a pancake breakfast and then getting your glucose done in an hour at a lab. Much more accurate.
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abba12 Reply:
January 22nd, 2012 at 12:13 am (Quote)
My father has type 2 diabeties, which to my understanding increases my chances of GD, especially as until recently I had a very sugar filled diet. So I think for me personally some sort of test is in order. Thanks for the info about regular tests, perhaps I can just borrow dads home tester for a week or two, (the little stabber to cause blood flow scares me though! lol)
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Kortney Reply:
January 22nd, 2012 at 12:17 am (Quote)
Absolutely – GD is a real thing and has real consequences. I don’t think people should necessarily avoid the test, but the GTT is not accurate at all in some cases. I have no risk factors and so chose to do the regular glucose screening. If those had come back high or abnormal, I probably would have had the GTT test done just to confirm. Everything in moderation with informed consent!
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Kate, Ren's Mama Reply:
January 22nd, 2012 at 7:48 am (Quote)
That’s what I chose to do this pregnancy, Abba. I felt like the standard GTT is not particularly helpful, since it’s really just a snapshot of a contrived circumstance. So I bought cheap glucometer at the pharmacy (which came with 10 test strips) and I tested my own blood sugar twice a day for 5 days. My husband is Type 1 diabetic, so he helped me interpret the results. So what I ended up with was a much more comprehensive picture of how my diet and exercise affect my blood sugar, and a stronger confidence that I DON’T have GD. Plus it was *much* cheaper and less stressful than spending 2 or more hours at the doctor’s office!
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Aron Reply:
January 22nd, 2012 at 6:30 am (Quote)
I actually was just researching this the other day for school (nurse-midwifery). The oral GTT requires rapidly drinking 100 grams of sugar (the modified version starts with 50, then adds another 50 if the blood test comes back questionable). That is a LOT of sugar – more than most people can tolerate (insulin-wise) even with the worst diets. That’s the point, to max out capacity and see how the body responds. It makes a lot of people (pregnant or not) sick, and it has a high false positive rate. Having the client fast overnight then eat a high sugar meal (pancakes and orange juice, for instance) is easier to tolerate and a more reasonable approximation of their sugar metabolism.
The American Diabetes Association, US Preventive Services Task Force, American Healthcare Quality & Research, and other organizations state that there is NOT enough evidence to recommend the oral GTT on EVERY pregnant woman (by glucola or pancakes). They all advise offering it to women who have increased risk of developing GD (family history of diabetes, certain ethnic backgrounds, etc.) and to women who have questionable or elevated results of random finger-sticks checks. (Two elevated finger-sticks is considered indicative of GD and warrants further testing.)
ACOG, however, disagrees with all the evidence and advises performing the OGTT on ALL pregnant women regardless of risk factors. It’s a CYA thing. The fact that the test has a quite high false positive rate is ignored by them. The consequences of misdiagnosis include unnecessary medication and pressure to induce for suspected “large” baby.
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KittenLynn had this to say,
Jan 21, 2012 @ 3:07 pm (Quote)
I dont know if things are different to much but where i live i never had it. I dont know if it is because i live in canada or i had a preemie.
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channa leah had this to say,
Jan 21, 2012 @ 3:17 pm (Quote)
MINE 
to make this all the better I mistype d the submission this was a MIDWIFE! My first birth with her was wonderful, amazing and I really loved her. I switched to her at 26 weeks though after the gtt. I thought because she was so wonderful and laid back she would have no problem with me skipping it. (it made me so sick the previous time dh had to take off work take a cab to me and drive me home!!! Now I had a 10 month old to think about and i really didn’t want to take the test this time around. I offered to do finger sticks every day/several times a day for as long as she wanted. I even offered to pretend I failed ad go to diabetic counseling!!!
She refused saying No way in H#LL she would let me do that and to be her patient i would take the test no choice! I ran out of her office crying. When I was scheduling the follow up appt (she was standing there and I did not want to confront her at the moment i was too emotional. they gave me the drink and told me I needed ot drink it 45 mins before my next appt.
to make this even longer (I might mess up other submissions i made here) I called the next day for my records. I needed to come in and sign for them I made the appt for when the midwife was not there. I came in and one of the amazing drs in the practice saw me and asked me what happened. I explained to him and he was shocked. asked me if I would give the other dr in the practice a try (honestly the other dr is one of the most awesome laid back people I have ever met! (the dr I was specking to no longer did ob) I said I was willing but it would be really weird with the midwife and I didn’t know how to handle it. He said they can make all my appts when she was not there. The next day dr#2 (the one i made the appt with called just to figure out what happened I explained the whole situation to him 9including my willingness to do finger sticks and diabetic counselling over taking the stupid test and he hit me with a crazy doosey of “Why didn’t you just lie to her and tell her you drank the drink when you didn’t you could hav ate normallty and tested your sugars before coming in and given her the numbers she wanted… sometimes drs just need to be lied to!” I was in shock but in love with him lol!
I went on NOT to deliver with him but only because I had a vag breetch i wanted to deliver naturally and he had no experience in it. he 100% supported me in seaking out a dr that was and even did all my follow up care and they always make sure my appts i don’t have to se that midwife ever again!
Crazy the midwife was a witch but the dr was awesome. I have so many awesome stories I can tell about this dr its crazy!
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Jane Reply:
January 21st, 2012 at 3:21 pm (Quote)
Wow! I’m glad the doctor asked why you wanted to transfer care. He sounds very accommodating, and it’s a shame he didn’t deliver vaginal breech. You know what would ahve been perfect? If he’d asked to be paged to watch the person who did attend the birth of your breech baby!
Thanks for sharing your story!
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channa leah Reply:
January 21st, 2012 at 3:34 pm (Quote)
believe it or not i had to be delivered OUT OF STATE to find someone who would take me on! I am in long island In the Csection capitol… I made an appt with a dr in Hackensack who wanted to induce me the next day DD1 was only 5#s and dd2 was already measuring almost 7. I was also a 1.5+ hour drive from the hospital and more in traffic so he wanted to be able to actually deliver me.. in the end THAT night (night before my induction) my water broke at 3 am. we were able ot drive the 1.5 hours out of state to the other hospital and I had an amazing natural delivery! Wished my ob would ahve been there but then again this other guy was sooooo awesome too. i didn’t get a chance to ask him how he did birth I just didn’t want a C so as I started pushing I asked him (do you do episotomies? he lauged and asked “what is this the dark agesd.. why would i cut a perfectly healthy mother? I LOVED HIM.
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Sheva Reply:
January 21st, 2012 at 5:33 pm (Quote)
Congrats on your breech birth! Can you share his name and where he works for other moms here?
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channa leah Reply:
January 21st, 2012 at 5:47 pm (Quote)
Dr. Yaakov Abdelhak out of hackensack university hospital. he even asked permission to train in a resident (I am typical VERY anti people in the room but i felt i needed to give a resident this opportunity.) the resident did 99% of the delivery/maneuvering while he was watching /telling her what to do
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Tee Reply:
January 21st, 2012 at 5:52 pm (Quote)
It is so wonderful that you felt comfortable enough with this doctor to allow him to have a resident not only watch your birth, but participate so heavily! I don’t like having a lot of people observing or “practicing” on my in a hospital/medical setting, either, so I know where you’re coming from there.
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What’s interesting to me is all the people who had to fast prior to taking their GTT. My midwives just told me to not eat any carbs prior to coming (they suggested an egg or sausage). I ate two scrambled eggs and a sausage link before I went, and not only did the glucola not make me sick, I passed with flying colors. I can’t imagine, though, if I’d had to fast. That would have been horrible.
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Heather Reply:
January 22nd, 2012 at 11:32 am (Quote)
Fasting increases the risk of fail, because your sugars won’t have been stable and your body is going to react in desperation, especially with no protein to break it down. You NEED protein to break down sugar.
My midwife had me do it with grape juice and while I was bouncing off the walls, I still passed.
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My (past tense) Dr did the same when I told her I was considering declining. She then played the dead baby card and told me if I didn’t have the test, she’d treat me as if I had it anyway. She then proceeded to roll her eyes at me, while I, in tears, tried to discuss my reasoning with her. Have refused to see her again, seeing another Dr in the (large) practice instead. Wish I could afford a homebirth and good midwife! Sorry your experience with her was so terrible. But glad you got to have Dr Awesome!
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I do the test – my midwife has me drink 16 oz of regular orange juice 1 hour before the blood draw, which she does herself in her office. Also, she never told me to fast. Would such a test be more accurate(and more healthy)?
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jaed Reply:
January 22nd, 2012 at 10:52 am (Quote)
If you’re looking for insulin resistance, not necessarily more accurate. The single blood draw will tell you less than multiple draws, and so will ad libitum food (that is, eating your normal stuff) before the sugar challenge. Also, OJ does not necessarily have a standardized amount of sugar. So it’s a little looser test.
But sounds far healthier. The standard test is more an “overload this person’s capacity to deal with carbohydrates and see just how high we can make their serum glucose” approach, which strikes me as A Bad Idea at any time and particularly during pregnancy.
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I was going to refuse the test this time around, but being a kidney donor and having a family history of gestational diabetes I decided to. My midwife brought a form with all of the information on the tests we could do, go to a lab and drink the nasty orange soda stuff, test myself at home, or not do it at all. I went with testing at home. Super easy to do! All I had to do was just not eat in the middle of the night, test my blood first thing in the am, an hour after having a big breakfast, and then an hour after that. She even loaned me a glucometer to do the tests. I wish I would have known with my first that one could even refuse the test. I had to do it twice because of a mix up and thought I was going to die from lack of food and then drinking that nasty stuff.
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I think it’s weird how Nazi-ish many doctors/nurses/midwives are about this. I even had an office worker insist I *had* to do it even though I ALREADY HAD TYPE 1 DIABETES! I was like, “No, Dr. L know’s I HAVE diabetes.” And she was like, “EVERYONE has to take the test, sweetie,” And I was like, “Uh, no, absolutely not. I already know my blood sugar could end up high enough to put me into DKA if I drink that stuff without insulin, so let’s not do that my baby, Mmkay?” I mentioned it to the OB when I saw her and she was like, “Yeah, we already know the results of THAT test!”
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My midwife just had me eat a breakfast with bread/fruit/OJ/protein and then test with a strip test at home.
I passed fine.
I had to go to the local Hospital for a NST and they insisted I do it their way because they refused to acknowledge her results. I refused and they pushed and I gave in to shut them up. Felt like crap after, dizzy and light headed.
Never again.
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Amber had this to say,
Jan 23, 2012 @ 11:42 am (Quote)
I got this same reaction from the nurse when I declined the glucose screen. My midwife asked why I had objections and was fine with my monitoring blood sugar at home. I laughed when the nurse said I “had to” and she said she was going to talk to the Dr. So I guess I got tattled on.
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sprybuzzard had this to say,
Jan 25, 2012 @ 7:40 am (Quote)
We should always have the choice for which tests we take or decline. I decided to take the 2 hour test (as was standard for my midwife practice) and ended up failing my fasting glucose by one point, and passed the 1 and 2 hour draws. Since I’ve been monitoring for a week I found out what makes my sugar go high but I haven’t figured out how to keep my fasting sugars low enough in the morning. They’re apparently not too high because I wasn’t called by the GD councilor yesterday. I thought it was fortunate for me to know this because I didn’t know how much certain foods really do affect my sugar, it allows me to make better food choices.
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i’m pregnant w/ baby #3 right now and refused the gtt. i had gd during my last pregnancy, and they think i had it undetected w/ my first (failed the gtt, but passed the 3 hour test w/ flying colors; when ds1 was born though, he showed many typical signs of a baby whose mother had uncontrolled gd), so i told my doc’s office that i would NOT do any of the testing at all, but i was more than happy to go on the gd diet and monitor my blood sugar. they said that was a smart alternative and were happy i’d thought it out so well. i started testing my glucose at 14 weeks, and now, at 19 1/2 weeks, the gd is kicking in (my numbers started going up even though i hadn’t changed my diet at all). so i’ve changed how i eat to accommodate my condition (no more cereal for breakfast, sad day), and we’ll go from there. i’m sure i’ll end up on meds before i have this baby, but that’s ok. i’m willing to do what i need to have a healthy baby. the thinig i think is funny is that if i hadn’t refused the gtt, i’d have gone 2 months w/ gd before doing the test. i’m glad i took the route i did so that my baby will be as healthy as possible when he or she is born in june.
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Unless you’re planning to restrain me, force the glucola down my throat and draw my blood against my will, I’m pretty sure that I do have a choice. I’ll exercise it now by choosing a different doctor.
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Ann S Reply:
January 21st, 2012 at 10:27 am Ann S(Quote)
You said exactly what I was going to say. There is always a choice. It needs to be informed choice, but choice is there.
I am impressed the doctor didn’t play the “dead baby” card. *giggle*
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Sephia Reply:
January 21st, 2012 at 10:32 am Sephia(Quote)
Exactly. Although, whenever I saw an OB and they “ordered” the GTT, I’d be given the papers and told where to get the test done and then just never go. They never asked me about it, and I never got it done.
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Nic Reply:
January 21st, 2012 at 10:55 am Nic(Quote)
hahaha…that’s what I did with the referral to the high risk doc; as I was exiting my regular ob’s office, the clerk gave me the paper packet with directions & an appointment card on top for the high risk place (they had the nerve to make the appointment for me without even asking me MY availability or schedule!) … I called them from my cell in the OB’s parking lot to change/cancel; they asked when I wanted to reschedule it to & I told them I did not have my calendar handy bc of where I was; they just said ok, & for me to call back later, which I never did. BTW, not only is this particular ‘practice’ full of a bunch of negative, condescending, threatening nasty jerks, they are always so , well…poot-headed. …plus my insurance does not cover them & I figure it’s some kind of conspiracy anyway to have me go there as well as regular ob…btw, I am p12g7 & 40+ years old … which they seem to think puts me in the high risk category, esp after a full frank breech & er c-sec with baby #2 over 15 years ago, then a vbac 11 months later in my van with 10 minute labor! YOU have rights & U always have a choice!!!
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