In What Scenarios Are Pregnancy Test Mandatory?
September 21, 2016 9:01 AM   Subscribe

Is anyone familiar with practices/policies/laws/cases surrounding mandating a pregnancy test either in the medical environment or in other cases? I am interested in anecdotes, personal opinions, as well as pointers to articles or other resources.

Here's what got me thinking about this:

I'm female. Recently I was being prepped for surgery. The nurse asked me if I had had a hysterectomy or tubal ligation. I said that I had not had either. They told me that if I had neither, I had to submit a urine sample for a pregnancy test. I protested, and said that I did not have sex with men. This explanation wasn't satisfactory. I was told I had to take the pregnancy test. Considering my dread of the upcoming event, I complied. What was especially upsetting to me was that I would be taken at my word that I did have a hysterectomy, but not that I was not sexually active with men. I also felt my privacy had been invaded (a feeling that I know was unfairly heightened by the fact that everyone in the pre-op room -- the patients and the nurses -- were male).

After Googling a bit, I learned that doing across the board pre-op pregnancy test is considered good practice. Listen, I can see why. I can see that my humiliation is less important than baby human. I can also see that no one wants to end up dealing with a medical malpractice suit. But it does seem like perhaps the hospital's fault could be absolved by having the patient sign a statement that they did not require a pregnancy test for stated, valid reasons.

This has got me thinking about other, far more problematic scenarios where women are asked to submit to pregnancy testing. Googling reveals that the shittiness and illegality of mandating pregnancy testing in the hiring process, but are their other arenas in which this has come up? And has this happened to any MeFites?
posted by theefixedstars to Health & Fitness (49 answers total) 2 users marked this as a favorite
 
Military: It's my understanding that before basic training and before every deployment, female service members take mandatory pregnancy tests.
posted by roomthreeseventeen at 9:05 AM on September 21, 2016 [3 favorites]


My friend was taking Accutane or something like accutane where she had to take a pregnancy test to prove she wasn't pregnant, then sign a sheet saying she would not get pregnant during treatment and should seriously consider terminating said pregnancy if she did get pregnant.
posted by greta simone at 9:08 AM on September 21, 2016 [16 favorites]


Regular pregnancy tests are considered mandatory for some drug regimens (Accutane comes to mind, but there are surely others).

Every time I have a radiology test done (including MRIs, which are not harmful to developing fetuses), I am asked to verify that there is no chance I am pregnant.* I am given the opportunity to waive a pregnancy test if I cannot verify this, though.

I've also been asked to take a pregnancy test every time I've been in the emergency room, although now that I think about it, this test was used to aid in diagnosis and not for modifying my treatment.

*I always balk at this, because my chances of being pregnant are approaching zero, but are not zero.
posted by i_am_a_fiesta at 9:11 AM on September 21, 2016 [3 favorites]


After Googling a bit, I learned that doing across the board pre-op pregnancy test is considered good practice. Listen, I can see why. I can see that my humiliation is less important than baby human. I can also see that no one wants to end up dealing with a medical malpractice suit. But it does seem like perhaps the hospital's fault could be absolved by having the patient sign a statement that they did not require a pregnancy test for stated, valid reasons.

I feel you're being a bit uncharitable regarding the hospital and the doctors' motivations here. Yes, they might be able to avoid a medical malpractice suit by getting you to sign something (though that in itself is debatable - laws in states vary as to the extent that you can sign away your own rights for this kind of thing). But they might just want to avoid having a terrible situation arise, just on purely human grounds. I understand why you felt not trusted, but people do lie about these things - it would be irresponsible of them to proceed with the procedure without such a test, when it costs so little.
posted by peacheater at 9:12 AM on September 21, 2016 [28 favorites]


...And even if you can sign away your rights, you can't sign away your child's. A birth-defected child could bring his or her own lawsuit against the cheapskate doctor who just wanted to save a dollar on a pregnancy test.
posted by Hatashran at 9:17 AM on September 21, 2016 [4 favorites]


And there are situations in which someone is pregnant without knowing it. Rare, but it happens.

I get your frustration. I'm a 41 year old cancer patient who hasn't had sex in two years and I still have to take the test. (Although as mentioned above there are some things like CT scans that I can just sign something saying I'm not pregnant.) It seems dumb, but not insulting. Super weird that they'd let you get all the way to the surgical room first, though.
posted by MsMolly at 9:18 AM on September 21, 2016 [1 favorite]


At least in 2000, the Peace Corp required a pregnancy test before a woman would be sent overseas, even if they stated they were a virgin.
posted by Candleman at 9:19 AM on September 21, 2016 [1 favorite]


But they might just want to avoid having a terrible situation arise, just on purely human grounds. I understand why you felt not trusted, but people do lie about these things - it would be irresponsible of them to proceed with the procedure without such a test, when it costs so little.

and

...And even if you can sign away your rights, you can't sign away your child's. A birth-defected child could bring his or her own lawsuit against the cheapskate doctor who just wanted to save a dollar on a pregnancy test.

From a perspective of choice and reproductive justice (a perspective I try to always at least consider, particularly as a medical provider for pregnant women and women of childbearing potential) -- when given all of the relevant information, women are responsible enough to make decisions about whether or not to find out or disclose their pregnancy status, and whether or not they want to use that information when making healthcare decisions for themselves.

Although none of this answers the OP's question, which is: in what situations are women required to take pregnancy tests.
posted by i_am_a_fiesta at 9:23 AM on September 21, 2016 [11 favorites]


Leading up to donating bone marrow, I had to take several blood pregnancy tests. The drug regimen you're on for donation is not approved for use during pregnancy. They even did a quick test the morning of donation.
posted by ThePinkSuperhero at 9:27 AM on September 21, 2016 [1 favorite]


I can see that my humiliation is less important than baby human.

It's not just the fetus who is affected or who is being considered. Pregnant bodies are different, and miscarriages are dangerous (to the mother).
posted by bq at 9:45 AM on September 21, 2016 [8 favorites]


It's worth noting that self-reported sexual activity is notoriously unreliable. About one percent of teen mothers in one study insisted repeatedly that they had never had sex, even after they had had children. If one of those women had ended up on the operating table while they were still in denial, it could have been a life-threateningly dangerous situation for both mother and fetus.

Just ignoring the danger seems untenable. Expecting intake nurses to carefully parse every patient's responses and decide who's trustworthy and who's not seems like it would be ineffective and begging for biased treatment to creep in. It's hard to see how there's a better solution than requiring universal pregnancy testing.
posted by firechicago at 9:46 AM on September 21, 2016 [36 favorites]


I had to take a pregnancy test when I was in an ER many years ago being held for potential emergency surgery, despite telling them that I couldn't be pregnant. And they (inaccurately) thought I'd had a hysterectomy.

Clearly, there was some incompetence at play, but them thinking I'd had a hysterectomy didn't get me out of it. I suppose that could have been just another screwup on their part, though.

I'm sure there are solid reasons behind mandatory testing, but it's probably not insignificant that the test cost me $400. I'm sure the people working the ER aren't motivated by that, but that might be some motivation for the hospital to have broader mandatory testing policies than necessary.
posted by ernielundquist at 9:58 AM on September 21, 2016


What was especially upsetting to me was that I would be taken at my word that I did have a hysterectomy, but not that I was not sexually active with men. I also felt my privacy had been invaded (a feeling that I know was unfairly heightened by the fact that everyone in the pre-op room -- the patients and the nurses -- were male).

I assure you, if there was a way of verifying a hysterectomy or a tubal ligation that could be done as quickly and inexpensively as a pregnancy test, they would absolutely apply that solution and not take you at your word about it.

I've been pregnancy tested prior to a number of diagnostic procedures and prior to being given several different treatments. Basically any time that a) being pregnant could cause or complicate the symptoms I experienced or b) that the treatment could negatively impact a pregnancy-in-progress.

When I was a teenage virgin it did feel extremely insulting, but nowadays I remember the half-cocked, abstinence-only ideas some of my friends had about what "sex" meant as teens and realize that to a doctor my virginity claims were basically meaningless.
posted by We put our faith in Blast Hardcheese at 10:01 AM on September 21, 2016 [10 favorites]


They make EVERYONE take the pregnancy tests in these mandatory scenarios, not just people who seem untrustworthy or might be queer or whatever you're worrying about.

The times I can recall having to have them are:

1. Anytime I wanted a prescription for hormonal birth control. They won't prescribe it if you might be pregnant, and this is determined by pregnancy test, not the patient saying they couldn't possibly be pregnant. And keep in mind that a lot of people are prescribed HBC for non sex related reasons.

2. In college I participated in a birth control related academic study (this was during a time when I identified as lesbian and hadn't had sex with a man in years) and, yes, all subjects of the study were required to take a pregnancy test because a pregnant subject would have thrown off the results.

I think it's odd that you would have to take a pregnancy test in a routine surgical situation, but if the surgery could impact a pregnancy, or a pregnancy could impact the success of the surgery, then yeah, they will make you take a pregnancy test.

It's not so much that self-reported sexual activity is unreliable, it's that there's an easy, cheap, and convenient test to answer what is ultimately a yes or no question. You're either pregnant or you're not, and it's a matter of about five minutes to find out.
posted by Sara C. at 10:02 AM on September 21, 2016 [3 favorites]


[Folks, let's leave the discussion about whether it's a reasonable policy in the OP's case, and focus on the "in what other scenarios" question. Thanks.]
posted by LobsterMitten (staff) at 10:05 AM on September 21, 2016


True Story:

My friend is an assistant/nurse type person for a particular ocular surgery center here in town. You have to take a pregnancy test before they will do whatever the surgical procedure is/give you anesthesia.

They had a lady come in and test positive for being pregnant but she insisted she was on birth control. They retested, were trying to figure out why it could be positive when this person was insisting that she was on BC. Finally someone asked her what her birth control was.

"Depo shots."
"When was the last time you had a shot?"
" . . .a year ago?"

Yeah, that is not how any of this works.

People can be very, very unreliable narrators of their own lives, with zero intent about it.
posted by Medieval Maven at 10:06 AM on September 21, 2016 [14 favorites]


I had to do a blood test (urine test was not enough) when I had a hormonal implant put in (for birth control purposes).

Prior to an x-ray or mri, I have been asked if I am or if there is a chance I am pregnant, but my word was taken in those cases.
posted by freezer cake at 10:07 AM on September 21, 2016 [1 favorite]


Women going to Antarctica need to take pregnancy tests. (or did as of a few years ago)

Probably other hard-to-rescue-from military deployments, space shuttle, that kind of thing.
posted by LobsterMitten at 10:15 AM on September 21, 2016 [1 favorite]


Just as anecdata, I don't think ER pregnancy tests are standard across the board. I was in the ER a few weeks back, and the only time they asked about pregnancy was before they wanted to take an X-ray. I said I was currently on my period, the tech said, "Good enough," and I got the X-ray without another word. I was actually a little surprised at how nonchalant they were about it.
posted by Diagonalize at 10:19 AM on September 21, 2016


I just had one before a cataract surgery - their policy is everyone under 55. It's only three weeks later, but I bet I'll be having another one for my second surgery. They didn't ask about birth control, menopause, sterility (medical or otherwise). We all pee in a cup the same.

Although you might be considered reliable, there's no way that everyone is. And there's no way for them to know the difference.

And their policy is 55 - which seems like a pretty broad stroke. But it's a liability and safety issue, so it's hard to find much fault with it.
posted by crankyrogalsky at 10:44 AM on September 21, 2016


In 1985, my family (US) hosted an exchange student (Sweden). For this 17yo to start high school in the US, she needed a vaccine that for some reason hadn't been provided before she left Sweden. For that vaccine to be administered, they had to do a pregnancy test. This was in her first week in the US, with a host family she was trying to make a good impression on, who had to drive to a different clinic because our very rural one was not prepared, and was reputedly very embarrassing for her. If I had not been a kid in 6th grade at the time, I would have remembered what vaccine it was - according to this list, perhaps MMR.
posted by aimedwander at 10:50 AM on September 21, 2016


Anecdata: I have had a hysterectomy and was still required to take a pregnancy test, when I was in an unfamiliar hospital where they didn't have my records. I wasn't thrilled, but I didn't fuss too much. The policy of a blanket requirement makes sense to me.
posted by backwards compatible at 11:04 AM on September 21, 2016 [1 favorite]


But it does seem like perhaps the hospital's fault could be absolved by having the patient sign a statement that they did not require a pregnancy test for stated, valid reasons.

Patients lie. They lie all the time. They lie constantly.

"Mrs Anonymous, is there any chance you might be pregnant?"

"Absolutely none; my husband has been deployed for 12 months."

Mrs Anonymous is in fact pregnant with her postman's child.

"Teenage Anonymous, is there any chance you might be pregnant?"

"Absolutely none; I am not sexually active."

Teenage Anonymous was recently sexually assaulted, has told nobody including her parents, is in absolute denial about the assault, and is in fact pregnant.

"TheFixedStars, is there any chance you might be pregnant?"

"Absolutely not; I do not have sex with men."

TheFixedStars actually doesn't have sex with me, has a 0 pregnancy risk factor, and is of course not pregnant.

"Dr. Whomever, did you ask the patient if she was pregnant before you administered the drug that caused catastrophic birth defects that are going to cost your insurers $6.2 million US dollars over the course of this child's lifetime?"

"I did."

"Dr. Whomever, given the enormous risk to any fetus, did you verify this with a simple two-minute urine test before performing procedure X with tragic consequences?"

"I did not."


So basically, that is why everyone with a womb and of child-bearing age pees on a stick. That changes not at all however that there are a lot of groups of women for whom this is offensive or invasive.
posted by DarlingBri at 11:05 AM on September 21, 2016 [17 favorites]


My daughter was in the hospital last december (she was 14 at the time) for a staph infection and they ran a pregnancy test as part of the labs.
posted by Annika Cicada at 11:19 AM on September 21, 2016


It's standard practice to give a pregnancy test before an IUD insertion.
posted by mskyle at 11:28 AM on September 21, 2016 [1 favorite]


Accutane. When my sister took it she not only had to have a pregnancy test but they sent her home with pictures of what a deformed baby would look like (just little shadow outlines) if she did get pregnant. So weird!
posted by jessamyn at 11:38 AM on September 21, 2016 [1 favorite]


Actually, I just got an IUD a few months ago and they skipped the pregnancy test because I was 10 weeks postpartum. It would have been quite unlikely for me to be pregnant, I'll grant, but it certainly wasn't "immaculate conception" level improbability. I was surprised they didn't do a urine test just in case.

I came in to say Accutane but looks like others beat me to the punch.
posted by the marble index at 11:38 AM on September 21, 2016


It's standard to require a pregnancy test before any radiation exposure (Xrays, CT, radioactive iodine administration for hyperthyroidism, radiation therapy, etc.) One of the senior surgery faculty at my medical school kept a printout in his office of a CT scan scout film of someone's abdomen showing an 8-month fetus. It was someone they had thought had a ruptured appendectomy and they took her word that she couldn't be pregnant and rushed her in to the scanner. As it turned out, she was in labor. He kept the film there to remind himself to stick to the process.

It's standard to require one before any surgical procedure, as certain anesthetics and big changes in circulating blood volume can be problematic for an embryo/fetus.

Any time you're going to get medications that are contraindicated in pregnancy (Accutane, certain classes of antibiotics, anticoagulation medications (especially warfarin), chemotherapy, hormone blockers like tamoxifen, hormonal birth control/contraceptive implants, just as a few examples)

Basically, as a population, people's definition of "sexually active" is so broad and their ability to accurately determine whether they might possibly be pregnant is so iffy that it's much easier to substitute a five-minute, fifty cent urine test in favor of a ten-minute conversation about what they consider "sexually active" and the nitty-gritty details of exactly how they use contraception.
posted by The Elusive Architeuthis at 11:46 AM on September 21, 2016 [9 favorites]


A few years ago, I had a really bad cough and cold that I was worried was the flu. The doctor wanted to do an x-ray to rule out pneumonia, and refused to do it without me doing a pregnancy test, even though I was pretty adamant that I was not pregnant.

FWIW, this was an urgent care clinic in a college town. I've told a few people in health care about this experience and their universal reaction was basically that health care professionals assume people, especially young people, lie about their sexual activity and use of birth control to health care professionals.
posted by lunasol at 11:57 AM on September 21, 2016


Just to add to the chorus, we diagnosed a pregnancy on renal biopsy last year. Patient was referred with "nephrotic syndrome" by her GP, we were scanning her kidneys to do a biopsy and found an eight month old fetus. She actually had pre-eclampsia. Still insisted she wasn't pregnant and hadn't had sex for over a year, even with the baby waving back at her on the screen. We don't routinely test people for pregnancy because renal problems usually cause infertility, but perhaps we should start.
posted by tinkletown at 12:04 PM on September 21, 2016 [11 favorites]


Not only do you need a pregnancy test for Accutane, but you have to sign documents stating you will use TWO forms of birth control (part of the iPledge program).
posted by TinWhistle at 12:07 PM on September 21, 2016 [1 favorite]


You might be interested in downloading the app Figure 1, which is kind of like facebook and Instagram mashed up for medical providers. This debate comes up fairly regularly, though unfortunately there's no particular hashtag I can refer you to. The "obstetrics" category is usually a good source for "surprise!" x-rays, at least.
posted by teremala at 12:16 PM on September 21, 2016 [2 favorites]


I know someone who had to take one before they would perform a hysterectomy, but that was the doctor's policy and may not always be the case.
posted by soelo at 12:21 PM on September 21, 2016


On the birth control front: I had to take two at Planned Parenthood before my first IUD was implanted, but after I had my baby, my midwives took my word that there was no chance and popped a new one in at the six-week post partum visit no problem.
posted by teremala at 12:26 PM on September 21, 2016


Women going to Antarctica need to take pregnancy tests. (or did as of a few years ago)

I went to Antarctica 10 years ago, but did not have to take a pregnancy test. Maybe this is a newer thing, or did you mean, like, a scientist going to a research station? I went as just a tourist.
posted by WalkerWestridge at 12:41 PM on September 21, 2016


did you mean, like, a scientist going to a research station?

Women who work there and are going to winter over--when there are limited abilities to get you out of there if there are issues--are the ones who have to deal with this, I think.
posted by jessamyn at 1:11 PM on September 21, 2016 [2 favorites]


In addition to all the above, there are any number of situations in a Emergency Department where the pregnancy test is necessary to include/exclude possible diagnoses. The most obvious is unexplained pain that could possibly an ectopic pregnancy.
posted by SemiSalt at 1:13 PM on September 21, 2016


Participants in a clinical study, often multiple times during the course of a study.
posted by M. at 1:17 PM on September 21, 2016


People lie, there are translation issues, issues of abuse and other bad things, people who won't culturally talk about these things to a man/woman.

I personally hate it, but then I've seen people make incredibly nieve comments about sex, use condoms wrong and such. Or use the pullout method and say they never had sex. It is a mire of things, people are sometimes stupid and/or shy and the liability vs the 1 minute pee stick is great.

Only time I was upset was when I was getting my MMR through employee health and they wanted me to wait like 5 hours for my pregnancy result because they were going to send it though the hospital lab. I told them I would just get my PCP to do it and wait one minute for the result.
posted by AlexiaSky at 1:18 PM on September 21, 2016


Ooops! "Ruptured appendectomy" above should be "ruptured appendix," obviously.

Adding that a pregnancy test may be required before any vaccine containing live virus (MMR, varicella, shingles).
posted by The Elusive Architeuthis at 1:30 PM on September 21, 2016


FWIW in the UK I have never had a mandatory pregnancy test. In my early 20s I was prescribed roaccutane and remember a form I had to sign to show I had been told the risks of getting pregnant while taking the drug. Nothing other than that.
posted by peepofgold at 1:31 PM on September 21, 2016


Many prisons mandate pregnancy testing on all female inmates upon admission.
posted by SyraCarol at 1:54 PM on September 21, 2016 [2 favorites]


I had a doctor come to our house due to severe abdominal and back pain and throwing up. She felt it was a kidney infection or kidney stone but still did a pregnancy test (without my permission) even though I just had a baby 3 months ago, hadn't had sex yet and was still on the tail end of my period. She had to rule out ectopic pregnancy. And she was damn right.

I also had to have a pregnancy test in the er when I was 13 (and had never had sex!) because I had severe abdominal pain. It turned out to be a cyst.

They can't take your word for it. People might not be honest with the doctors about sex so they have to make sure.
posted by catspajammies at 2:01 PM on September 21, 2016 [1 favorite]


IANAD, but I play one in my bedroom since my health persists in becoming more and more interesting every day. I've been subjected to pregnancy tests before surgeries and MRIs, even though my hysterectomy is a matter of record. Cat scans and x-rays, they take my word. My new rheumatologist added a pregnancy test a few weeks ago. Here's why: Pregnancy causes 50-something physiological changes in the body. If anything's happening in your body that could be caused by those changes, it's got to be ruled out so you have an accurate diagnosis.
posted by The Almighty Mommy Goddess at 3:08 PM on September 21, 2016


In the radiology department at big hospital where I work they ask, "are you pregnant?" If the answer is no, great. If the answer is yes, then the radiologist will discuss consequences and patient will sign stating they understand. If the answer is maybe, I dunno, Or any kind of hemming and hawing you can either take a quick pregnancy test or reschedule the exam.
posted by MadMadam at 3:30 PM on September 21, 2016


In Canada, I haven't been required to take a pregnancy test before X-rays, including in one case with a barium swallow for gastro-intestinal contrast. I've been unpleasantly grilled by a GP about whether I could be pregnant when seeking care for abdominal pain, but ultimately I don't recall having a pregnancy test at that time, either (not sure, though, I might have).

Since you also asked for this, a personal opinion: Frankly, while I get the concern that some people aren't truthful, or have bad birth control practices and don't realize it, or whatever, I think there's also a serious element here of healthcare practitioners not being sufficiently educated about the experiences and healthcare needs of patients who are not cisgender+heterosexual, and relatedly, procedures not accommodating those needs. "Nope, I'm on birth control!" and "Nope, I don't have sex with cis men!" are in fact two completely different answers... one has room for error (all birth control methods have failure rates) and should be double-checked. The other does not have room for error and should be respected. As a queer cis female patient I've experienced not being trusted about my knowledge of my own pregnant/non-pregnant status and found it distressing... and as a nursing student I've observed the corresponding utter lack of education about sexual orientation, gender identity, and how they should impact health care.
posted by snorkmaiden at 5:43 PM on September 21, 2016 [1 favorite]


I don't always perform pregnancy tests on women of childbearing age before x-rays, although many emergency docs do. Although many folks in the medical field are extremely nervous about radiating pregnancies, the fact is that the maximum recommended cumulative radiation dose in pregnancy is approximately the amount one would get in TWO abdominal CT scans (which is immensely more radiation than in extremity x-rays or chest x-rays, see graph for illustration). So, if I need the x-ray, then I should do it whether they're pregnant or not, hence the pregnancy test does not change management and is unnecessary. And if I don't really need the x-ray and wouldn't do it if they were pregnant, I probably shouldn't be getting the x-ray even if they're not pregnant. I take a similar approach if I'm planning to give low risk medications. The 'cheapskate doctor who would save a dollar' if it weren't for potential malpractice lawsuits by a fetus really is not a thing - the cost of this test is negligible (and either way it costs nothing to a physician like myself or most other hospital employees, who are on salary).

That's my own philosophy but a lot of other folks just get it as a matter of course, and it's often obtained by triage nurses in the ED who are simply making an educated guess that it may be needed and may expedite care. This is a discussion of cases in which pregnancy tests are routinely done, but they're certainly not mandated in the strict sense of the word in almost any case.
posted by treehorn+bunny at 10:27 PM on September 21, 2016 [2 favorites]


I've had pregnancy test prior to:

-- a CT scan on my back. We were trying at the time so we had to test.
-- a hysteroscopy as part of fertility treatments. I was given the pregnancy test even though I was on birth control at the time (as part of the fertility treatment).

The latter example was particularly mortifying because I was having fertility treatment to address our <1% chance of conceiving naturally, so I feel your pain.
posted by prettypretty at 11:50 PM on September 21, 2016


I have had mandatory pregnancy tests:

- upon voluntary admission to an adolescent psychiatric ward (before I was sexually active)
- before oral surgery that involved anesthesia
- as part of routine testing during urgent care and ER visits
- before being prescribed hormonal birth control before becoming sexually active

But not
- before a mammogram (too bad, because I WAS pregnant and didn't know it)
posted by peanut_mcgillicuty at 9:27 PM on September 22, 2016


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