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So many of today’s pre-natal tests are now considered “standard medical practice” – but do they in fact need to be standard pregnancy practice? Once you get onto the medical bandwagon everything done during pregnancy takes on those labels, whether valid or not, necessary or not.
With all this testing and screening now being the norm for most pregnancies, one would think that thoughts of stillborn babies, maternal death or disabled infants would be less prevalent in women’s minds today. But in fact the reverse is true. This modern medical preoccupation with “knowing” what’s going on inside the belly, I believe, has caused far more detriment to women’s attitudes to birth than it has provided benefit. The promoted and supposed necessity for pregnancy tests. and their often ambiguous results (not to mention the occasional misdiagno-sis), has introduced new types of anxiety in mothers. Several common examples of this are:
• The MSS blood test, done between 9 and 12 weeks of term (protocol varies in different states), indicates only increased risk of particular foetal abnormalities. Confirmation of any suspected condition cannot be made without a full diagnostic test like CVS or amniocentesis sometime later in the pregnancy. CVS can only be done from 11 - 12 weeks. It carries a 1 - 2% miscarriage risk. Amniocentesis has a lower risk of miscarriage (0.5%) but cannot be done until 16 - 18 weeks. Therefore, in such cases, there can be as long as 9 weeks of uncertainty and worry for the parents, caused by such unnecessary procedures with their often ambiguous preliminary diagnoses.
• The Nuchal Fold Test, a highly specialised scan for indicators of genetic abnormalities which is interpreted by a computer, must only be taken between 11 and 13 weeks from the time of conception. If a woman is not totally sure of her conception dates then the results of the test can be compromised. Full confirmation of any indicators cannot be made without a follow up amniocentesis, which is unable to be done prior to 16 weeks and which takes an additional 2 weeks of culturing to provide the result. That’s a potential 3 - 7 weeks of uncertainty and anxiety for the parents.
• Both MSS and Nuchal Fold are screening only. If any deviations from “the norm” are discovered, it cannot be determined at that point if the baby is actually genetically abnormal. In fact, | |
19 out of 20 women who get a “positive” result (indicating a risk of abnormality) will not have been carrying an affected baby(11). That leaves a lot of couples putting themselves through a lot of needless anxiety. Overhanging both these situations is the spectre of a possible mid-term termination at about 18 - 20 weeks if it is decided that the “abnormality” is not desired.
There is nowadays much reliance on the process of ultrasound to “discover” the foetus’s age thereby pinpointing the expected due date (EDD) but in fact ultrasound is only accurate to a week either side at 18 weeks. But maybe there was a light bleed a few weeks after the last normal period. Was that a period or not? I have a very long cycle so I’m not sure when my ovulation would have been. How pregnant am I really? Rather than having faith that their baby will come when ready, this lack of precision is seen by doctors as a problem to be solved so that something definitive can be written in the EDD column on your card. Babies are not all growing at the same rate, therefore such dates are only approximate indicators of growth and readiness for birth anyway. As everyone becomes more and more attached to some expected date, an unexpected labour at 38 weeks can catch everyone unawares and may be seen as cause for concern. Conversely, if the due date comes and goes with no signs of labour this can equally lead to anxiety, excessive monitoring and ultimately induction.
So many women have this popular “date anxiety”. But I don’t believe these concerns are actually their own but induced by the rational, pregnancy-by-numbers approach we see today. People assume that doctors and their high tech medical procedures and pronouncements are infallible, whereas we are constantly shown that they are not. Of course, there have always been worriers – “What if my baby has Downs’ Syndrome, what if my baby is upside down, what if it is twins”. What if, what if, what if. But I suggest such worries would be better dealt with by counselling and the emotional support of family and friends, than by enlisting the whole maternal population into regimented pre-natal testing, all on the basis of a few “what ifs”.
Yet beyond even the best laid plans, Mother Nature still reigns supreme. Even the most well planned, frequently monitored, and best prepared pregnancy can have totally unexpected outcomes. Whilst some would see that as a challenge to monitor the process even more, control the process even more, and intervene in the process even more, I believe that we should in fact prepare ourselves more, both physiologically and
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