Pregnant? We Can Help.

Are we detecting problems that can't be fixed?

The main goal of prenatal testing is the prevention of birth defects, but what began as a medical sub-specialty to allow early treatment of diseases, and to prevent fetal death, quickly became a "search and destroy mission." Now doctors uncover conditions for which there is no known cure, and they detect diseases like Huntington's that will not show up for many years. Most times the only "cure" is therapeutic abortion, but just who is being cured?

And, what about sex selection abortions? There is no disease, only the "malady" of being female. India and China report alarmingly high numbers of abortions after amniocentesis or ultrasound reveal the baby is a girl.

An article in the Western Journal of Medicine (9/93) discussed the present state of prenatal diagnosis and treatment. "Currently . . . actual benefit to the fetus or to the expected child can be achieved in only a few situations . . . . Unfortunately, prenatal testing has not yet led to meaningful therapy for fetuses affected with most of the conditions that can be identified. . . . The power to diagnose fetal conditions exceeds the power to treat them and probably will for a long time to come. Although future investigation may well lead to therapies for many genetic conditions and therefore be of benefit to fetuses and children, the conditions that are now most frequently diagnosed prenatally are ones that will, most likely, never be amenable to meaningful therapy."

The article concludes, "Selective abortion of the affected fetus will remain an important alternative." The New England Journal of Medicine (326:18) also noted that the consequence of prenatal diagnosis has been an increase in the number of elective abortions.

Still, doctors are having tremendous success treating some maladies while babies are still in the womb. Although they are in experimental stages, these surgeries and procedures often succeed precisely because the baby is still developing.

Do tests save lives?

It has been argued that without prenatal testing, women over 35 or those at risk of passing on some abnormal genetic trait might abort every pregnancy. Prenatal testing can relieve these parents' worries. It can also make a positive difference in the delivery room by correcting due dates, identifying multiple pregnancies, and alerting doctors to pregnancy complications.

Because of new prenatal surgical methods, lives have been saved or enhanced through the detection of correctable anomalies. And, when treatment is not possible, prenatal diagnosis enables families to prepare emotionally and logistically for the birth of special needs children. They avoid experiencing shock at their child's birth and are better able to bond with him or her.

Still, the argument can be made that the philosophy behind prenatal testing promotes abortion. In a Science (11/12/93) article on a neonatal screening program in Pennsylvania, the comment was made that knowledge of their newborns' potential or present problems could cause parents to "develop a different outlook on a child destined to die." The same could be said of prenatal screening.

Doctors Steven Clark and Greggory DeVore have noted that "many couples consider the principle purpose of prenatal diagnosis to be its ability to allow them to terminate an abnormal gestation at an early stage." In an Obstetrics & Gynecology article (6/89) they said that some parents "change their minds and elect termination when an abnormal result is confirmed, even if they previously thought such a decision impossible."

The American Journal of Public Health (3/87) said, "Increasingly, prenatal diagnosis procedures and selective abortion are considered standard components of complete obstetrical care." Many people would not consider one without the other. Indeed, there is some evidence that women who participate in prenatal diagnosis are predisposed in favor of abortion. One study claimed to have found that abnormal test results do not necessarily affect attitudes toward abortion, but it did not survey women who refused to undergo prenatal diagnosis. Do women reject such screening because they also reject abortion?

Is society being set up to accept mandatory prenatal screening? Health care reform could dramatically effect the number of people choosing prenatal testing and abortion. If abortion were to be federally funded, but long-term care for special needs children were not, would parents feel pressured to abort?

Is abortion therapeutic for the family?

A Nature article (11/26/92) began with the story of a woman who had a disturbing amniocentesis report. She and her husband were crying in the doctor's office. The doctor asked, "What's wrong? Why are you in tears?" When they explained they were upset that their baby was going to die, the doctor replied, "That isn't a baby, it's a collection of cells that made a mistake." Wasn't it the doctor who was mistaken? Surely he knew that by the time a woman has an amniocentesis at four or five months, and the results are in, she is half-way through her pregnancy? That "collection of cells" has a heartbeat, brain-waves, fingerprints, and can suck his or her thumb.

Studies have shown that doctors' attitudes about abortion and knowledge of fetal anomalies is crucial to the decision parents make. Beyond that, the parents' beliefs concerning the sanctity of human life are vital. Parent's who are ambivalent about abortion often blame their difficulty deciding what to do on the technology, or on pro-lifers. One couple who was interviewed by the New York Times (1/27/94) told of the turmoil they were thrown into by an unfavorable diagnosis. They said that "vocal relatives who opposed abortion" added to their confusion, when it could be said that their own willingness to consider abortion caused the confusion in the first place.

Surveys have compared parents who have aborted an affected baby to parents who lose a child during pregnancy or shortly after. Their experiences of grief are similar, but parents who abort find more difficulty mourning (Obstetrics & Gynecology 8/93). Their grief is "complicated by the fact [they] actively decided to end the pregnancy" (New England Journal of Medicine 328:23). Parents who abort report more feelings of isolation, alienation, and fear of rejection by people who might not approve of their decision. While it supports the idea that abortion for fetal anomaly does not necessarily improve parents' outlook, this finding also challenges the Christian community to lend a hand to parents who bring "differently-abled" children into the world.

Another study sought to measure the impact of abortion on the brothers and sisters of the affected baby. Social Work in Health Care (10:1, 1984) noted that this is a "crisis event for the family." Siblings who are not told of the pregnancy and/or abortion decision sense their parents' turmoil. Those who learn about an abortion exhibit sadness, guilt-feelings, dependent behavior, difficulty sleeping, regressive behavior, loss of appetite, boredom, school problems, separation anxiety, and anger. Researchers say this experience can also create insecurity in children, causing them to wonder what might happen should they become ill or fail to meet their parents' expectations.

Perhaps a survey should be done of parents who carry to term a pregnancy they know will end in the baby's disability or death shortly after birth. Anecdotal evidence supports the idea that it is healthier to allow the child to live as long as possible. Those who are able to see, touch, and name their newborn children, are better able to cope after they are gone. In the words of one mother, "We didn't have to also deal with the guilt of causing his death." This family cherishes the memory of the son they knew for only a little while, secure in the knowledge they did nothing to shorten his life.

Future of prenatal testing

A New York Times article (2/5/94) underscored the shift in attitudes away from testing aimed at helping the baby to testing aimed at preventing the birth of an abnormal baby. Women in their 20s and early 30s are demanding amniocentesis, far younger than the recommended age of 35 or older. Many doctors consider these tests unnecessary and warn they could cause the miscarriage of a normal baby.

Undaunted, these women say they would rather risk losing a normal pregnancy than suffer the "trauma of having an abnormal baby." Clearly, they go into the procedure prepared to end their pregnancies. Medical ethicist Arthur Caplan defends them, saying, "There is no morally defensible reason not to offer even a 25-year-old woman the opportunity to have amniocentesis and leave the decision to her." However, one argument he overlooks is the personhood of "abnormal" children. Should they be killed because they are imperfect?

Doctors justify offering the test to young women because of the high cost of raising a "defective" child, even though the tests cost $1000-2500 and insurance doesn't always cover them before age 35. One said, "A reasonably conservative estimate is that it costs $100,000 for just the first year of a Down Syndrome baby's life." Some doctors will even falsify records to make insurance companies pay for the tests. Reports show there are fewer Down Syndrome babies being born every year, yet many parents consider these children priceless additions to the family.

If health insurance providers do pay for extensive pretnatal and other genetic tests, will they put subtle pressure on the parents to abort disabled unborn babies? Or will they help parents choose life?

Problems for pro-life physicians

Doctors who support abortion are more likely to offer their patients prenatal testing. Some consider it immoral to carry a defective baby to term. But what about doctors who oppose abortion? Should they offer these tests, or inform patients that they are available? What should they say to parents when a problem is found? Should pro-life students enter this field? If a pro-life doctor does not offer prenatal testing is he or she liable for malpractice?

In coming years, these questions will become more pressing. In order to make room for special needs babies, doctors - and all society - will need to reassess their attitudes about handicaps and the cost of treatment.

Methods of prenatal testing

• Amniocentesis. Detects many, but not all, abnormalities in the womb. Done between the 14th and 20th week of pregnancy. Amniotic fluid is extracted and examined for various signs of problems. Drawbacks include a small risk of causing pregnancy loss and the possibility of misdiagnosis. Abortions after amniocentesis are especially cruel since babies are farther along; also a greater risk for the mother.

   

• Chorion Villi Sampling. Developed in response to problems with amniocentesis, CVS is a more definitive test. Performed earlier in the pregnancy (between 9.5 and 12.5 weeks), it enables treatment of the baby or earlier, somewhat safer (for the mother) abortions. Chorionic villi are tufts of hair-like tissue on the placenta that contain information about the baby. CVS itself may cause limb defects. Also, it cannot detect all the defects that amniocentesis can.

• Ultrasound. Non-invasive tool to determine a baby's gestational age, detect multiple pregnancies, locate the placenta, diagnose anomalies, evaluate fetal well-being, and guide treatment. Very accurate detecting malformations among high risk groups, including those associated with chromosomal abnormalities. Detects a baby's movements long before the mother feels them.

• Maternal serum screening. The mother's blood is tested during weeks 15 to 20 of pregnancy. Checks for abnormal levels of three or four biochemical markers that might indicate the unborn baby has Down's Syndrome, anencephaly, spina bifida, Trisomy 18, or other problems. The American College of Obstericians and Gynecologists recommends this test to all pregnant women under 35 years of age. Also offered to women over 35 who want to avoid the risks of amniocentesis.

• Percutaneous Umbilical Cord Sampling. A sample of fetal blood is taken from the umbilical cord from 18 weeks gestation onward. It is used to detect certain inheritable diseases.

• Fetal tissue sampling. Samples of fetal skin, liver, and muscle are analyzed for defects not found through CVS or amniocentesis. Some pregnancy loss expected.

• Preimplantation diagnosis. Prior to implantation, in vitro fertilized eggs at the four- to eight-cell stage are checked for abnormalities. Advocates say the technique avoids the stigma of abortion and could prevent many diseases. Those who believe life begins at conception say discarding abnormal embryos is unethical. Another problem is accuracy. Also, it is not yet known what, if any, long-term damage might be caused by manipulating cells at that stage. An alternative to preimplantation genetic diagnosis would be biopsy of the egg before fertilization.

Related articles:
When does the unborn look human?
What About Abortion for the Baby's or Mother's Health?

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