Pregnancy without antenatal screening bloods?

[Sushirolls]

Morning, this is my first post and I'm just after some reassurance please x

My daughter is coming up 15 weeks in her first pregnancy, but is extremely needle phobic, so she's been unable to tolerate any bloods being done for screening.

We've tried desensitisation in the past with a nurse (long time before pregnancy), even with meds to try and relax her, but her fear takes over and she just cannot do it 😢

I'm very proud of her for trying to get past this for the sake of her baby, she got as far as having the tourniquet on, but then was in such a state that her mw said she wasn't going to push it and distress her further.

My daughter has had her 12 week scan which we were told was normal and all as it should be 🎉 and she is booked for another scan next week at coming up 16 weeks and for a consultation with a consultant. This is afaik, due to her medical history (history of epilepsy & hydrocephalus).

I'm just wondering if anyone else has been through pregnancy without the bloods being done and everything turned out ok, going purely on scans?

Thank you for any advice, sorry this is such a novel!! X

No experience I’m afraid but will this be the case for all needles? As whooping cough and flu vaccines are also recommended and what if she needs a cannula during/after labour?
Also, do you or her know her blood type?

Thank you for your reply x

Yes, this is the case for all needles 😢 she won't be having any injections either. She is hoping that if she needs any intervention during labour, that she will be in enough pain to override her flight or fight response.

She's had a lot of medical procedures during her childhood (Inc brain surgery), so I expect that they should know her blood group. My daughter also has tactile aversion, which doesn't help. She did try desperately to "suck it up" but she has such a strong fight or flight due to extreme phobia.

The labour/birth does worry me, as my daughter is going to be limited to gas & air only, though as I said before, the mw said they'll knock her out if it comes to it, if they need to intervene and are unable to.

Obviously, I haven't voiced any of this to my daughter, as I don't want her to worry.

In my area, doctors and midwives can refer needle phobic women to a psychologist. We find it often helps. There are women who go through with no blood tests but it is not great because of the risk of missed conditions. At birth, it limits your options. Eg no epidurals or iv fluids without a huge amount of stress. Managing emergencies is also tricky.

I didn’t have antenatal blood screening , because I felt I couldn’t have gone through with a termination if a problem had been picked up. Therefore, if I knew there was going to be problems after birth I would have spent all the pregnancy worrying.

Also I felt that the screening only picks up certain diagnoses, and it could be deemed false reassurance that everything is ok. I was right about that because completely different diagnoses came to light after the children were born.

Saying that screening is there for a reason, and helps the Drs plan in case of illness in the neonate. So you do have to think it through from both sides, and preferably not decide against it because of the actual jag involved. Will she go through with the jag on the basis it may help her child?

Mayhew, she hasn't seen a psychologist, but did have a nurse visiting at home, to try and desensitise her and help her get over her phobia. At one point she had given her enough medicine to knock an elephant out, to try and relax her enough to even try to touch a butterfly clip, but it didn't even register as her anxiety around needles is so high 😢

Noimagination, my daughter has some learning difficulties herself and a history of hydrocephalus and epilepsy, so she is adamant that she would keep her baby regardless of any disabilities anyway. I agree that it would probably just cause her more worry during the pregnancy. I've also heard of drs thinking there is a problem and then the baby is born healthy, so maybe it's best she doesn't know 100% ... I don't know 🤔 On the flip side, it's helpful to know in advance if there may be issues 😩 Due to my daughters SN, we've been told that she comes under the radar of SS to make sure she has support, and obviously she has all the support she needs from my husband and I too. My daughter is still living at home and I've just been made redundant, so I'm around to help, 24/7 x

It isn't a conscious decision to refuse them, she's tried but just can't get past her phobia 😢

I’d encourage her to find out her blood group. Most people are rhesus positive but in the event that she is rhesus negative, she’d normally be offered some anti d injections to protect from rhesus disease (I’m not sure if this protects the mother or the baby). In all likelihood she won’t need it but it might be worth checking.

I’d also have a discussion with her re injections for the baby. There’s a little bit of time to think about the main ones, I think the first is at 8 weeks but in most cases vitamin K will be offered as an injection at birth. I think you can request them as drops instead but that will need to be done in advance (at least it does in my hospital).

No, I realise it’s the phobia. Just whether it being for the baby helped her find the strength to go through with the tests. It all sounds very complicated.

But the blood group point is a good one, it would possibly matter for future pregnancies, and in case of emergency it would be good to know her blood group anyway

If she is a negative blood group that can have huge implications on future pregnancies. I would keep up trying to find a way to help her overcome her phobia. Hypnosis?

It sounds like she needs to have another try at desensitisation. She might be motivated to benefit the baby. Screening for fetal problems is only a small part of maternity care where needles are involved.

I was severely iron deficient in pregnancy number one and vitamin d deficient too, despite a pretty decent diet. It's not just the downs testing, as op says there is also the blood group risk, it's her choice but there is a downside if it can't be managed. Hope you are able to find a solution and congratulations on her pregnancy!

Thank you all, for your replies x I really do appreciate them, as I can't voice any of my worries to my daughter as I don't want to worry her x

I'm 99.9% sure she's O Pos, and I'm sure that the Dr/mw would have said something by now if there was an issue as they know about her needle phobia and she's had extensive surgery etc in the past, so there will be a record. My daughter has her appt with the consultant next week, so I will make sure I clarify and I will ask about hypnosis too. There will be no issue with vaccs for little one, as my daughter isn't against them, just cannot tolerate them herself. If she can't face holding the baby for them, either his/her dad can do it, or I can 😊

My other worry is that as my daughter was deemed or (I had a placental abruption without bleeding, and IUGR for 4 weeks, so I was induced 3 weeks early with her), she has always been diddy, so I worry incase her pelvis is too small for a natural birth.

Thank you again for listening to my ramblings x

Or = prem (stupid auto correct!)

I would be more worried about the health implications for your DD and her baby during labour and delivery. ‘Knocking her out’ without a cannula (gas induction) would be dangerous for both her and the baby.

May I suggest she requests an appointment with the obstetric anaesthetic clinic if your hospital has one, she could then make a plan for delivery with the anaesthetist.

Congratulations on your soon to be new grandchild and you sound like a lovely supportive Mum, I am sure you will be an great asset to your daughter in the coming months.

I don't have much to offer regarding the other areas of concern but just wanted to say that I didn't have any antenatal testing with my two younger kids - I was 28 and 30 when they were born - just had the scan and they were fine. I had it with my current pregnancy since I am now old (37). I think choosing not to have screening is perfectly reasonable whatever the rationale behind the choice.

There seems to be an idea here that the antenatal blood test screening only looks for possible problems with the baby, and so isn't an issue if you wouldn't terminate - but this isn't correct. The blood screening in pregnancy also looks for serious diseases like hepatitis, HIV and syphilis, all of which would require specific care, and checks iron levels, which is important because anaemia in pregnancy can be serious. They also need to check your blood group.

I just wanted to add this not because it changes things for your daughter, OP - if medical staff think the stress it causes her outweighs the benefits of the test then fair enough - but because I didn't want anyone else reading this test and thinking that there's no need to have blood tests if you don't want the screening for fetal problems.

Even if there is a record of her blood group they can't cross match blood unless they have 2 recent samples due to antibodies in the blood. She could have universal blood in an emergency tho.

Fair enough not being able to tolerate routine bloods, but if she was ever to become ill, they will need to find a way to overcome her fear. Definitely look into hypnosis, maybe see the GP sooner rather than later to get a referal. There is no way she can get through her hole pregnancy without any needles at all.

If your daughter is just frightened that the needle will hurt, she can have ametop cream put on the skin first, which contains local anaesthetic and will numb the area completely in less than an hour. She then wouldn’t feel the needle at all.
If it’s a more general phobia of the whole process, then hypnosis or desensitisation might be worth trying.
The midwife is quite wrong to suggest they could just “knock her out” if necessary, without using a cannula. Gas induction on a full term pregnant woman is incredibly dangerous and risks aspiration of gastric acid into the lungs. If your daughter needed an emergency Caesarean, the only safe option would be a spinal anaesthetic, or an intravenous induction of a general anaesthetic with pre oxygenation and cricoid pressure until safely intubated.
Obviously, you hope that the delivery will be uneventful, but as you mention your daughter possibly has a small pelvis, then you need a contingency plan for her needing a c. section, and how that could be achieved.
I echo the PP who suggested you meet the obstetric anaesthetist at a clinic appointment and discuss all this in depth. I’m a retired anaesthetist myself, and would have been horrified to be crash called to the labour suite for a section on a patient refusing needles, with no plan in place!

The most important thing is she tells her midwife and consultant at the earliest opportunity of her needle phobia . Staff are used to dealing with this not uncommon problem .

Have no suggestions but if she isn't able to have her bloods take the baby Have bloods take At birthfor hiv, hepatitis etc. Just in case you were unaware

Take = taken

Thank you again, for all of your replies

I don`t think the mw was just being blasé about knocking her out, I think she was probably trying to calm her as she was very distressed from attempting to have her bloods done. I think the mw was just trying to calm her fears that they would do whatever it takes, to make sure baby is safe in an emergency.

We have tried desensitisation without success, in the past, but I am going to suggest it again, as well as hypnosis when we see the consultant next week. I will also enquire about a plan of action in the event that things dont run as smoothly as we hope. It isnt a fear of pain, its a true needle phobia <img loading="lazy" class="inline-flex mumsnet-emoji" alt="Sad" src="https://www.mumsnet.com/build/assets/sad-q5SIe0Cq.png"> even with a nurse coming regularly, she couldnt even progress to touching a butterfly clip or the tubing.

BFF, youre right to remind those who may read this thread, that it isnt just about screening for abnormalities, but also the health of mum

in any procedures in the past, my daughter breathed in something in a mask which took seconds, so that they could give her a GA. Obviously, that probably won`t be an option in an emergency.

After all of this, fingers crossed that everything is text book and I`m worrying about nothing

Here is the little trouble maker!

I declined them all with my 3rd. I already knew I was rhesus negative, does she know if she is or not?

In a true emergency, if it's delivery related she can be given a ga and the baby delivered that way. Obviously they will try not to but it does and can happen

In an emergency they wouldn't just "knock her out" and do what is needed to save the baby. Until the baby is born it has no legal right to life and the mothers wishes take priority. If she said no due to her phobia they would have to accept no and couldn't do a thing about it.

The main issue with not having screening bloods done is they won't know her iron level and so if she becomes anaemic it will go untreated and they won't know her blood group. If she is rhesus negative it can have massive impacts on the pregnancy, if rhesus positive it's not an issue unless she needs a transfusion as they will need a current sample to safely transfuse. If she declines then they have to accept that no matter what.

Could she continue her sessions working on her phobia so that hopefully it's managed by the time of birth?