Managing Conditions, Medications and Test Results

Setting Up Your Care Structure, Part 2

How I keep medications, ongoing conditions and test results straight when several people are involved, and how I get mismatched instructions and unclear results resolved in writing.

Key points

About 9 in 10 women take some type of medicine during pregnancy, and about 7 in 10 take at least one prescription. Keep one master list, with doses, vitamins and supplements, and update it every time something changes.
Iron deficiency becomes more common as pregnancy progresses, but estimates vary by population and definition. ACOG recommends routine anemia testing early in pregnancy and again at 24 to 28 weeks. Ask whether your symptoms, history or blood count also call for ferritin or other iron studies.
One study found apparent failures to inform patients, or to document informing them, about 7.1% of clinically significant results. For every test, ask what it will answer, how you’ll hear the result and what would change your care.

The bottle said oral

At about eight weeks into my first pregnancy, my new specialist wrote to me about starting progesterone for the bleeding I was having. The message ended with a warning: “NOTE: if may say ‘oral’ but DO NOT take orally. Only place vaginally.”

The warning was needed. I was already taking progesterone, 200 mg by mouth every day, because that’s what my previous OB had prescribed and what the bottle said.

I missed my specialist’s call, so I called the OB-GYN emergency line and my pharmacy. Both confirmed I could insert the same pills vaginally, starting that night. Then I asked the question I really cared about: “Will there be any impact on my hormone levels if I stop oral progesterone and start vaginal? I’m worried that a large dip in the progesterone levels in my blood could be bad.”

Months later, in my third trimester, progesterone was still in my after-visit instructions and refills were still arriving. I asked if that was an error. My doctor’s reply called it “a system error, as we discussed no longer needed.”

The mismatches kept coming through that pregnancy:

Different people gave me different stop dates for an antibiotic.
After one prescription, I asked whether I’d been given the right medicine at all.
When I had bleeding, I asked whether my aspirin was still appropriate.
At 36 weeks, my daily antibiotic was switched to a different drug, and I received a message titled “REMINDER – STOPPING MACROBID.”

Each discrepancy took another call or message to resolve, and each one was mine to notice. Together, they taught me not to trust any single piece of paper to be current.

Why it happens

Your medication information lives in at least five places: the bottle label, the pharmacy’s records, the portal’s medication list, your after-visit summary and whatever your clinician tells you. They drift apart. A medication gets stopped in conversation but stays on the portal. A refill renews automatically. A label shows the standard route while your doctor intends another.

Some differences are intentional. Clinicians sometimes prescribe a medication by a route or schedule that differs from the label; some uses of vaginal progesterone are examples. But the prescribing clinician and pharmacist need to confirm that the particular product, route and dose are appropriate for you. Don’t guess which instruction is current or change the route yourself.

A plan for every ongoing condition

For anything that lasts more than one visit, such as anemia, high blood pressure or recurring infections, I want four things written down:

The goal: what number or result we’re aiming for.
The check: when it’s retested.
The next step: what we try if the treatment isn’t working.
Who owns it: my OB, a specialist or both.

My iron shows why. In my first pregnancy, I was anemic for months. I took my iron tablets as prescribed, and my levels didn’t come up. I asked whether IV iron or a referral to hematology, the blood specialists, made sense, and I ended up requesting the referral myself. At 35 weeks, the same week I had COVID and strep, my doctor wrote that my “iron still low – so as mentioned in last message, increase the oral iron to twice a day – you will need stool softeners.” IV iron came into the plan that week. The hematologist couldn’t see me in time because of the infection, and my baby was born within weeks.

In my second pregnancy, when iron shots didn’t raise my levels, my OB referred me to hematology for infusions without my asking. The difference was a next step that someone else was watching for.

Infections get their own post: “Urinary and Vaginal Infections in Pregnancy.” Blood pressure is in “Preeclampsia: Know the Numbers.”

Test results

Near the end of my first pregnancy, my chart said it plainly: “Always with normal testing.” Twice a week, every scan and every nonstress test came back reassuring.

I was grateful every time. And I still had questions no one had answered.

Two questions

The growth. Earlier in that pregnancy, I asked whether my baby’s growth percentile had been decreasing, and whether there was anything I should be doing. My doctor replied with the numbers: both estimated-weight measurements fell roughly in the 50th–70th percentile range. The reply said there wasn’t much to conclude from early second-trimester measurements, and recommended another growth scan in two weeks to see the trend. Then: “There is nothing to do – except as you should always regardless keep a balance diet, hydrate and keep taking the aspirin.” I had the numbers. What I wanted was help understanding what they meant for the pregnancy I was having.

The heart rate. After one ultrasound, I read the report and saw a fetal heart rate of 149. In the room, we had watched it read 171. I wrote to my doctor and asked whether the report could reflect what we saw, and whether 171 was in the normal range. I sent that message two days before I was admitted for my induction. I don’t see a reply to it in my records.

The other question, why I often couldn’t feel my baby move even when scans showed movement, has its own post: “Counting Your Baby’s Movements.”

What each test answers

A reassuring test is a snapshot. It tells you your baby was doing well at that moment. It doesn’t answer every question, and it doesn’t cover a change that happens later.

A nonstress test checks whether the baby’s heart rate rises with movement.
A biophysical profile looks at movement, muscle tone, breathing motions and amniotic fluid, plus a nonstress test.
A growth ultrasound measures size and growth over time. One percentile tells you less than the direction across several scans.
A Doppler ultrasound measures blood flow through the umbilical cord and placenta.

These descriptions follow ACOG’s guidelines on antepartum fetal surveillance, as summarized by the American Academy of Family Physicians.

What I ask for now

My results over time, not just today’s.
What each test will answer, and how a result would change my care.
An explanation first when a report doesn’t match what I saw, and a correction if it’s an error.

What works for my body

I take things consistently when they’re easy to take. If something is unpleasant, I’ll miss doses, so I tell my doctor and ask what else would work.

Prenatals count too. Liquid vitamins have always worked well for my body. One I’ve used is Pink Stork Liquid Prenatal. When I’ve switched prenatals, I’ve noticed my body react. So when I’m considering a new one, I read the label to see how much of each vitamin and mineral I’d actually be getting, and bring the bottle to my doctor before I start it.

I don’t start, stop or change anything without my doctor’s approval. That doesn’t mean I show up empty-handed. I read, I compare products and I bring what I’ve found.

My medication list

I ask “until when?” for every prescription.
I get disagreements resolved in writing, by the prescribing clinician or the pharmacist.
I keep one master list, vitamins and supplements included.
I add up my totals. If I take separate iron, vitamin D or folate along with a prenatal, I add the amounts so I’m not doubling up without knowing it.
I clean up the portal. When something is stopped, I ask for it to be removed from my active list and for refills to be cancelled.
I use my pharmacist to review the full list, supplements included, for timing and interactions.
This time, I’ll check every line of my discharge instructions before I leave the hospital.

Take this back

To discuss with your care team:

What is this for, and how will we know it’s working?
The label says something different. Which route, dose and schedule should I follow?
When do I stop this, or when will we review it?
Will you check my ferritin as well as my hemoglobin, and when?
If this treatment doesn’t work, what’s the next step, and who decides?
What will this test tell us, and what would change based on the result?
What do my growth measurements look like over time, and what would concern you?
This report doesn’t match what I saw. Can you explain the difference, and correct it if it’s an error?
Can you update my portal list so it matches what I’m actually taking?

To discuss with the people in your life: Will you come to the appointments where we review results? After the birth, when I’m exhausted, can you be the one who checks the discharge list against what I’m actually supposed to take?

Next in the series: “What Good Care Feels Like, and What It Doesn’t”