Tuesday, July 25, 2006

Decisions, decisions

So we decided not to do the first trimester screening (nuchal translucency scan plus hCG and PAPP-A bloodwork) after all.

Initially, I was pretty gung-ho about the screening. Extra monitoring! More information! Another ultrasound! How could I possibly say no?

Except...then I started to think about it. And realized that I want to avoid having an amnio or CVS unless absolutely necessary. (Basically--I don't want to anger the uterus. Not based on anything any doctor has recommended--just my own gut feeling.) And I did a little research, and learned that for the majority of women whose first-trimester screening results indicate that further testing is warranted, subsequent amniocentesis shows a normal pregnancy. And that the false-negative rate is also quite high.

So I realized that, if I refused to have an amnio, a positive screening result would only cause me (probably unnecessary) anxiety...and a negative result would be no guarantee of a "normal" baby. Finally, my risk of having a baby with Down Syndrome based on age (33 when the baby is due) is about 1 in 600, while the risk of miscarriage from amnio is about 1 in 200--and given that my miscarriage risk with UU is higher than average anyway, I just can't take the chance.

My husband didn't want to have the testing done at all. Again, as with the selective reduction discussion, we bump up against his Catholic schoolboy upbringing and his extreme discomfort with any path that could lead to termination. There were some very tense discussions in the electriclady household for a couple of days. Ultimately, my own uncertainty about the screening combined with my husband's adamant opposition combined to make the decision--well, not exactly clear, but less murky in one direction.

Here's where we get into some grey area. I would never be so arrogant as to say, "I would never terminate a pregnancy,"--I would hope that, in the worst case scenario, my husband and I would have the courage to make the right choice for our baby--and as I've said before, I'm pro-choice all the way. Yet I have to admit that I'm uncomfortable with the idea. (Not that anyone else is comfortable with it--you know what I mean.) Perhaps what I'm really afraid of is having to make the choice, and in my own cowardly way, by avoiding testing, I'm trying to avoid being presented with that choice.

If I'm being totally honest, I should also admit that had my husband been very strongly in favor of testing, it's possible I could have been convinced to have it done.

We won't get the triple/quad screen either, but we will have the standard Level II ultrasound at 18-20 weeks. I hope that the ultrasound will catch any major issues that we'd need to deal with prenatally or immediately at birth (heart problems, neural tube issues). Anything else--well, we'll deal with it when it comes.

(This is not meant to imply anything negative about those who choose differently from me--only to explain my own thought processes. No flames, please.)


Anonymous Erin said...

We did exactly the same thing you did, turning down pretty much all fetal testing except the 20-week u/s. I just couldn't fathom doing a test that might lead to a test that has a risk of m/c after all we'd gone through to get there. Especially since we had no risk factors. We figured that any major abnormalities would show up at the u/s, and we'd deal with them if necessary.

I hope that you're feeling comfortable with your decision. It's a tough one to make!

10:17 PM  
Blogger Rachel Inbar said...

I decided to do the testing. My nuchal translucency was good, but later the triple screen said my risk was 1:150 and I did decide to go for amnio (I even wrote about it while I was waiting for the results). My risk was higher to begin with, since I was almost 37 when my baby was born. I had my doubts as to whether I should go for the amnio & my husband & my mother both later told me that they were more worried about the amnio itself than about the results.

Some of my SILs have chosen not to have any testing (except for regular ultrasounds). The one I wouldn't pass on is the glucose tolerance. I regret not having insisted on the 100g test after my initial test came out borderline. At almost 39 weeks I discovered I had gestational diabetes & needed to be induced quickly to avoid a c-section.

At age 32, these tests probably mostly add unnecessary stress.

7:28 AM  
Blogger MoMo said...

As you read in my blog--we were on the fence about the test. We went ahead and took the test on Monday and we are still waiting for the results. We had lots and lots of discussions about it too-we decided that we will just take it one step at a time.

I don't think you have anything to worry about, especially with your age!

9:14 AM  
Anonymous Lexie Ann said...

We had the test done. Then the amino. The test came back slightly elevated and amino normal. I will also be 33 when the baby is born. If I had to do it all over again I am not sure I would.

9:31 AM  
Blogger Robber Barren said...

These are very courageous decisions, and they sound like the right ones for you.

Just for survey purposes: We had the early risk assessment test (nuchal translucency plus bloodwork) and are waiting for results, but the ultrasound part looked good so that was reassuring. Yesterday my doctor talked about the AFP (or maybe the quad screen) as if it was a foregone conclusion that we'd do it, but I think Ezra and I will discuss it further before then.

10:18 AM  
Blogger Heather said...

I get being unsure about it. We did decide to do the test next week, but only because I'm a planner and if there is something that I can worry about before the baby gets here I might as well let the worrying begin!! (J/K) No, really, I think it is totally a personal choice and I'm sure not one you came to lightly.

3:39 PM  
Anonymous Watson said...

Good for you for being very intentional and thoughtful about all of this...many of my friends have just gone ahead with all the testing, based on their dr.'s recommendations, without thinking through the ramifications, so I applaud you for doing what's right for you, your husband and your baby :-)

5:44 PM  

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