Bi-Weekly NSTs?

[bisous]

Anyone BTDT? This is a new (as in this year) Kaiser program for women over age 35. I will need to start going to the OB two times a week for an NST. I'm pretty stressed out by this--I have four other kids.

Your thoughts?

[marymoo86]

That seems a bit excessive? Certainly it is supposed to be bimonthly? I had to do weekly NSTs at week 36-40 due to age. No way could I have done 2 - those appts are 2 hours long (or were for me).

[KLD313]

I did and it was a huge PITA. I did it because I was refusing an automatic c-section at 39 weeks due to GD. What happens if you refuse?

[AngB]

I did b/c I have an ugly medical history (severe early onset preeclampsia and HELLP, IUGR, classical c-section, neonatal death all in my first pregnancy). With DS1 I also had GD which was just icing on the high risk cake.

They were nice with DS1 because they were really relaxing and it was comforting to be closely watched after my first preg. (They take your bp and check fluid levels with NST's for my practice). With DS2 it was more of a pain to find care for DS1.

I do think it's a bit excessive for them to do them 2x a week for only AMA as a risk factor. Maybe ask if they could do once weekly BPP's? (A biophysical profile is a more extensive test to ensure the well being of the baby. They look at an NST strip, the fluid levels, muscle tone, movements, and practice breathing or something like that, I forget all of the criteria but basically they watch the baby for up to a half hour.) A "passing" NST is considered reassuring for 2-3 days. A "passing" BPP is considered reassuring for 5-7 days. So a once weekly BPP "should technically" be acceptable in lieu of twice weekly NST's, but I can't promise they will go for that.

[JBaxter]

I was 41 when I had Jack I had weekly ones after 32 weeks. I wouldn't do more often I had no issues other than my age and Jack was big. BP good he moved well etc

[BunnyBee]

I was AMA when I had my last baby in 2013, and the doctor didn't do a single one. Without other risk factors or bad feelings, I would opt out. I can't imagine trying to find childcare (or drag 4 kids there) 2x a week. Even the regular appointment was a PITA!

[specialp]

I have done weekly and I would try to do it weekly if possible, but twice a week does sound excessive.

[JBaxter]

Mine were my regular appt. The doc popped in looked at everything and sent me on the way. I had the same sono tech who worked for the office. She recorded them all on a DVDr for me.

I was AMA when I had my last baby in 2013, and the doctor didn't do a single one. Without other risk factors or bad feelings, I would opt out. I can't imagine trying to find childcare (or drag 4 kids there) 2x a week. Even the regular appointment was a PITA!

[specialp]

Just to add my exprience, my NSTs were done on a separate floor and not in my doctor's office and lasted about 20-60 minutes depending on if the baby was cooperative or if they needed to "buzz" to get the movement. I then went 2 floors down to see my doctor which was usually pretty quick. It just not something I would opt out of if I didn't have to.

[PZMommy]

I had NSTs every 72 hours starting at 32 weeks. As much of a hassle as it was, I much rather be closely monitored. As it turns out after failing one at 36 weeks, I was sent for a BPP, and failed that and was delivered. My little guy was in distress and I never would have know had it not been for the tests.

[egoldber]

How many weeks are you? Any other risk factors?

[TxCat]

I had a high-risk pregnancy for different reasons for both pregnancies and had twice weekly NST's for both - really one was an NST and the other was usually a BPP. Time depended on baby and physician. Make sure to make your appointments at times when the baby is active, or eat something just before so that baby is more likely to be active. If baby was active, I was usually in and out of the office in less than an hour.

Any time my physicians recommend extra monitoring I accept it. I have had patients with only one risk factor, or no risk factors, lose babies at term, including one woman where the demise was diagnosed the morning of her scheduled c-section. It's devastating. Also , I will say that Kaiser is usually ahead of the curve in incorporating new, evidence -based recommendations into practice.

Good luck with your decision.

[bisous]

I'm going to do it. One NST will be at the same time and location as my weekly doctor visit. Once I get babysitting for a visit, I might as well stay a little longer (OB said about 20 minutes longer). It isn't super easy to get into the doctor two times per week but I am grateful for the extra piece of mind.

That I know of, this is not because of any particular risk factors I have except for my age. My friend who sees the same OB (we're both Kaiser and due within a week of each other) is also my age (37), no additional risk factors and will be having bi-weekly NSTs. I guess they just want to be really careful.

It doesn't sound fun, but I'm going to try to see if I can make it work. I've made it so far and want to go the distance, KWIM?

Thanks for all your input!

[JBaxter]

I would ask them why. Ive had 2 after 36 and they didn't blink with myson I had at 36. Are they doing it just for revenue? I agree weekly but with no other risk factors except you are 37 ( but have had successful pregnancies in the past) i would at least question it.

[llama8]

I had weekly NST done with DD1. She was big, breech, and I had an anterior (backwards) placenta so I never felt her move. It was annoying, but I found it to be worth it for peace of mind (I had a 17 week loss that we found at the 20 week ultrasound prior and unexplained).

Twice a week does sound a bit much, but I wouldn't opt out unless I really couldn't make it without severe hardship. Peace of mind and monitoring are good things. I would question them on why and if it is really necessary for it to be that often.

[bisous]

I would ask them why. Ive had 2 after 36 and they didn't blink with myson I had at 36. Are they doing it just for revenue? I agree weekly but with no other risk factors except you are 37 ( but have had successful pregnancies in the past) i would at least question it.

Definitely not for revenue. The way Kaiser works (at least my plan) is that this pregnancy will cost me exactly $250 including all prenatal visits, screenings, blood draws, hospital stay, anesthesia, doctors etc.

[shweethart]

I did starting at 30 weeks with MODI twins. It was on a different floor of the hospital. They sent me to L& D twice for false alarms. It was tough but I stuck it out. I'd be afraid not to. Thankfully grandparents watched ODS at these times.

[abh5e8]

right, but your ob office will charge (and kaiser will pay) for each visit and nst.

op, i would ask for some info on exactly what the risks are and what the improvements are in similar patients with such extensive monitoring. i've never heard of that, especially given your lack of any precious complications.

[abh5e8]

duplicate post

[bisous]

right, but your ob office will charge (and kaiser will pay) for each visit and nst..

I don't think they will actually. My doctor is at the Kaiser facility and my understanding is that they are compensated the same regardless of how many exams they perform. I could be wrong but I think they work on a salary basis. Although I haven't found this to be the case, the problem is more often that Kaiser doctors are unwilling to order exams/tests as they are supposed to act as gatekeepers to keep unnecessary testing down so...

But I'm going to do the tests. It IS my 4th pregnancy, will be my fourth c-section and I am (barely) in that advanced maternal age category...

It just seems like a lot of doctor visits! At least it is only 10 minutes away and it is free.

[georgiegirl]

Wow, I'm 39, so definitely AMA, and the only time I had a NST was at 40+4. (I had a BPP too). If you have no other risk factors, my group only does it if you go past your due date, which I did.

[TxCat]

I don't think they will actually. My doctor is at the Kaiser facility and my understanding is that they are compensated the same regardless of how many exams they perform. I could be wrong but I think they work on a salary basis. Although I haven't found this to be the case, the problem is more often that Kaiser doctors are unwilling to order exams/tests as they are supposed to act as gatekeepers to keep unnecessary testing down so...

But I'm going to do the tests. It IS my 4th pregnancy, will be my fourth c-section and I am (barely) in that advanced maternal age category...

It just seems like a lot of doctor visits! At least it is only 10 minutes away and it is free.

OB care is usually billed on a global fee, so I doubt that the NSTs are being recommended by Kaiser as a way to gin up fees.

[TwoBees]

I don't know what's routine, but IRRC, my doctor said I would need NSTs twice weekly starting around that time, based on my history. Not quite sure how I'm going to manage that with work and childcare, but I guess I'll deal with that when the time comes. AS much of a hassle as it might be, I'd rather be closely monitored and have the chance to get to full term (or closer to full term than with DD1).

Please keep up updated!

[stinkyfeet]

I had GD in my last two pregnancies. During both pregnancies, I had NST's once per week even though I was AMA (35 yo) at during my most recent pregnancy which was a few months ago. All three of my pregnancies were typical vaginal deliveries with no complications except GD.

Perhaps they are having you do it twice weekly because you are AMA AND it is your 4th C-section. I am unfamiliar with c-sections, but I do know that my SIL was advised against not having any more children after her 3rd c-section due to the scarring and state of her uterus. Maybe your docs just want to make sure you and baby are ok under similar stressed conidtions since the baby grows rapidly in the third trimester?

In either case, I know that all the OB appointments are a PITA, but they will be over soon, and you will have your little baby in your arms before you know it! :)