Pregnancy & Birth

Introduction to Prenatal Testing

For many of us, the months of pregnancy are filled with anticipation, mental preparation, and fantasy about life with our child-to-be. We dream about the child’s and the family’s future. As prospective parents, we might imagine our child smiling, walking, talking, playing, going to school, making friends, playing sports, falling in love, leaving home, taking a job, and someday also becoming a parent.

Often we have many expectations about what our lives will be like with a new child. We imagine a child who will give us joy and possibly make us proud someday. Perhaps we are counting on sharing our favorite interests with our child. We might wish for a girl because we think we will be closer to her than we would be to a boy. Or we might prefer a boy this time because we already have a girl.

Ever since the 1970s, it has been possible to get information during pregnancy about characteristics of the developing baby. In recent years, the number of tests available to pregnant women has multiplied, allowing increased scrutiny of the fetus. Usually, women choose prenatal testing to learn about health problems, diseases, or disabilities that might occur, but sometimes women want to know the baby’s sex or to learn for sure who the father of the child is. As technology changes, more and more information about the baby will likely be available through testing—future height or predisposition to health problems that may occur in later life.

Some prenatal tests provide information about characteristics of the developing baby, while other tests give information about the mother’s health. Prenatal tests that provide information about your health, such as blood testing to find out if you are anemic, have gestational diabetes, or are HIV-positive, are important because they detect conditions that often can be treated. (For more information about them, see Chapter 4, “Your Developing Pregnancy and Prenatal Care.”)

This chapter focuses on tests that detect information about the developing baby. Because learning about the health of the fetus is the most common reason that doctors or midwives offer testing and is usually why women want it, this chapter concentrates on testing for conditions that can affect the health of your baby. The chapter also raises questions about other information that tests can provide.

Tests are available for a variety of conditions—some considered “mild,” some considered “severe,” and some that affect life expectancy. If you learn through prenatal testing that your baby will likely be born with a correctable, treatable, or lifelong impairment, you may want to make special plans before the child’s birth. Or you may decide to end the pregnancy if you know that your future child would have a disabling condition.

While prenatal tests may offer useful information, they also raise concerns. Rarely, some tests lead to miscarriage or have other adverse effects on women and babies. Even when they do not cause medical problems, tests can create anxiety and expense and add to the medicalization of pregnancy and birth.

I was really nervous when my husband and I were about to have the ultrasound to determine the sex of our baby. Part of me wanted to change my mind and not go through with the ultrasound. I was thinking, “Can this test cause any harm to the baby, even though the doctor said no? Do I really want to know the sex after all? How will I know how to decorate the nursery? Is this really the halfway point? We can finally choose a name and start identifying the baby by name.” I had so much on my mind I couldn’t relax.

I had a CVS [chorionic villus sampling; see page 121] done, which was both physically and emotionally painful. We found out there were some irregularities, so I ended up needing an amnio as well. It turned out the irregularity was some fluke in the test, and we finally got a clean bill of health [for the fetus]—six months into the pregnancy. The waiting was excruciating. To be pregnant but not be able to let yourself feel the joy and hope of it was truly horrible.

Tests for fetal traits give us the opportunity and the responsibility to decide whether we want to become parents of a child with a particular set of characteristics. Some of us may decide that we don’t want this information. Others of us will be extremely eager to know all we can about our developing baby. Your doctor or midwife may strongly recommend testing, but it should not be automatic; decisions about testing are up to you.

As you consider testing, think about what you want to know about the fetus during your pregnancy and how knowing might influence your actions and decisions. Decisions about whether to have prenatal testing and what to do about the results are very personal. Many factors, including your feelings about parenting, disability, and abortion; your upbringing; and the community you live in, will influence your decisions. The way that your health care provider presents your options can also influence you.

In addition to raising difficult personal decisions, prenatal testing raises ethical questions for society. As more tests are available, will there be increased pressure on women to abort any fetus with an impairment? Will fewer resources be available for those of us who choose to continue such a pregnancy? Does the ability to test for disabilities and for sex foster a tendency to try and create children to order?

Our choices, whatever they are, will shape our society and the way it understands parenthood, children, family, health, disability, and choice. In this way, our decisions about testing are both private and public, personal and political.

End of excerpt
Excerpted from Chapter 7: Prenatal Testing in Our Bodies, Ourselves: Pregnancy and Birth  © 2008 Boston Women's Health Book Collective