How to manage anxiety about pain during common pregnancy tests

March 30, 2021

Robyn Horsager-Boehrer, M.D. Obstetrics and Gynecology

Tests such as ultrasounds and blood draws during pregnancy provide important information about the health of mom and baby.

Taking an at-home pregnancy test is likely the first of many routine tests you’ll experience during pregnancy. Most are painless, but some tests may cause discomfort or minor pain.

It's normal to feel nervous about what lies ahead, especially if this is your first pregnancy. The main thing to remember is that the information from your blood work, physical exams, and screenings makes it possible for us to provide you and your baby with the best care.

We've put together a list of some common situations and tests during pregnancy, as well as self-soothing tips to prepare for a smoother, more comfortable visit.

First trimester (less than 14 weeks)

Blood testing

You’ll discover there’s a lot of blood testing done during pregnancy – blood counts to detect anemia, determining your blood type, and screening for certain infections, especially at an early visit. Some testing will be repeated later in pregnancy.

If you can't stand the sight of needles or blood, you’re not alone. A study from the University of Michigan found that 20 to 30 percent of young adults have a fear of needles. Passing out at the sight of blood can be an automatic nervous system response.

Please tell the person taking your blood if you get lightheaded or faint during blood draws. We can recline you or ask you to lie down during the draw to prevent injury from falling. The provider can also use a topical anesthetic to numb your skin.

You might want to look away during the draw and take slow, deep breaths to relax. If it helps, distract yourself with music or a video on your phone. No need to feel embarrassed – we understand!

Pap smear

Many women only need this routine well-woman exam every three to five years, compared with the annual exam of the past. Pap smear exams are safe during pregnancy.

If you need a Pap smear, your health care provider will insert a speculum into your vagina and use a small brush to wipe the surface of your cervix. We collect cervical cells to analyze them and check for precancerous cells.

Women often describe the feeling of a small pinch or cramping, but everyone’s pain threshold is different. Ask your doctor if you can take an over-the-counter pain medication such as Tylenol an hour before the exam to reduce discomfort. Deep breathing can help you stay calm and relax your pelvic muscles. If you feel pain, tell your doctor.

Frequently testing for infections like chlamydia and gonorrhea will take place at the same time your pap test is done. If you've recently had a Pap smear, ask if that testing can be done with a urine sample instead.

Ultrasound

Ultrasound uses high-frequency sound waves to create an image of the baby, which helps us check for normal fetal growth. Ultrasounds can be done transabdominally (the ultrasound wand is passed over the stomach) or transvaginally (the wand is inserted into the vagina).

A transvaginal ultrasound often can provide a clearer view, especially early in the pregnancy. It gets us closer to the uterus without the barrier of abdominal tissue. Your doctor may recommend this method to check for early fetal heart activity, identify the source of abnormal bleeding, or diagnose an ectopic pregnancy.

The lubricant gel we use may be cold against the skin. That's the most uncomfortable part, patients report, so many Ob/Gyn offices keep the gel in a warmer. You may feel pressure from the wand, but most patients with no underlying health concerns do not find the exam painful. If you feel uncomfortable or need a break, tell your provider.

Nuchal translucency screening

This screening involves two tests that help determine whether the baby might have a genetic condition such as trisomy 21 (Down syndrome) or trisomy 18 (Edward’s syndrome):

An ultrasound to check the back of the baby's neck for extra fluid or thickening
Blood work to measure the amount of two substances found in the blood of all pregnant women: pregnancy-associated plasma protein-A (PAPP-A) and human chorionic gonadotropin

During these tests, use your self-soothing methods and communicate with your doctor. Based on the findings, your provider may recommend additional tests to verify the diagnosis. Generally, this involves more imaging and blood work, neither of which should be any more physically uncomfortable.

Chorionic villus sampling (CVS)

If your baby might be at increased risk of a genetic condition, you may choose to get diagnostic testing in the first trimester. CVS involves testing cells taken from the placenta. It can be performed using either a small catheter inserted through the cervix or with a needle through the abdomen. When done transabdominally, the doctor will usually numb up the skin prior to insertion.

Second trimester (14 to 28 weeks)

Amniocentesis

Some women wait until later in pregnancy to have diagnostic testing for genetic conditions. Amniocentesis helps to diagnose chromosomal disorders. We do this by inserting a long, thin needle through the abdomen and into the amniotic sac to collect a small sample of amniotic fluid.

Transvaginal ultrasound to measure cervical length

Generally, the shorter the cervix, the higher the risk of preterm delivery. We measure the cervical length with transvaginal ultrasound to potentially offer interventions that may reduce that risk. Having a short cervix doesn’t mean you will deliver early, just that the risk is higher.

Glucose testing

Abnormal glucose levels – the amount of sugar in your blood – may indicate gestational diabetes, which affects between 2 and 10 percent of pregnant women.

Checking your levels start with a two-step glucose challenge test. First, you’ll drink a sugary solution. An hour later, we'll draw a blood sample from your arm to measure your blood sugar.

If your blood sugar is elevated, you may need another type of glucose tolerance test. You’ll be asked to drink only water the day you get the test. Your provider will take a blood sample from your arm, and then give you a sugary solution to drink. Your blood will then be taken and tested hourly for the next three hours to measure the glucose levels in your blood.

If you’re diagnosed with gestational diabetes, we’ll discuss how to control your blood sugar with diet and activity. If that doesn’t work, you may need insulin therapy, which includes frequent injections or pills and finger sticks to monitor your blood sugar.

Third trimester (28-plus weeks)

Cervical exams

Your doctor may recommend a cervical exam if you have signs of complications such as premature delivery, infection, or heavy bleeding. A cervical exam can also help to determine:

If you are leaking amniotic fluid
Dilation (how wide the cervix has opened) or effacement (how thin the cervix is)
The position of the baby

Group B strep culture

Group B streptococcus is bacteria found in the lower genital tract of approximately 25 percent of women. This infection usually doesn’t cause a problem outside pregnancy. But it can make mothers and newborns very sick.

We check for group B strep by collecting samples from your vagina and rectum with a cotton swab. This test may be uncomfortable, but it shouldn’t be painful. If the test comes back positive, we’ll give you IV antibiotics during labor to destroy the bacteria and help prevent it from spreading to the baby.

TDAP, COVID-19, and flu vaccination

Whooping cough is a very real danger to infants, who can’t be vaccinated until they’re 8 weeks old. However, babies whose moms get the Tdap vaccine during the third trimester of pregnancy are much less likely to become ill.

We recommend that women get a Tdap booster – which protects against tetanus, diphtheria, and pertussis – during every pregnancy. This is because the level of antibodies in your body declines over time.

If you’re pregnant or trying to get pregnant during flu season, get your flu shot and protect yourself and your baby against one more infection. We also recommend that pregnant women who want a COVID-19 vaccine get one.

Labor, delivery, and postpartum care

The final pregnancy test you’ll face is labor and delivery. Giving birth will involve some discomfort during labor, delivery, and/or postpartum, no matter how you deliver.

During labor, most women will have an IV inserted to deliver fluids, oxytocin, or antibiotics. If needles bother you, ask about getting a topical refrigerant or small injection of lidocaine before having the IV placed.

When it comes to managing labor pain, my colleagues and I have written about many strategies patients can use, including:

Going under general anesthesia is not an option for vaginal delivery. The risks are too high, and your ability to push is key to successful delivery.

Getting an epidural can relieve much of the pain of labor, but it still needs to be placed in the spine. While a local anesthetic can be used before insertion, positioning the needle may be uncomfortable.

Having a scheduled cesarean section (C-section) trades labor discomfort for post-op pain management. Multimodal pain control is the current best practice after a C-section, and many hospitals have enhanced recovery after cesarean (ERAC) protocols in place. You will receive minimal narcotic pain killers, and we will recommend that you use over-the-counter products such as Tylenol or ibuprofen to control pain.

Your body will need time to recover after giving birth. Talk with your doctor about how to treat post pregnancy problems such as lacerations, constipation, or back and abdominal pain.

Knowing what is ahead can help reduce the fear of the unknown and better prepare you to face pregnancy experiences with confidence. Discuss your concerns with your provider in advance – we're happy to help put your mind at ease

To visit with an Ob/Gyn, call 214-645-8300 or request an appointment online.