Monday, September 24, 2007

The Triple-Screen Test

It's about that time when we have to figure out our feelings about the Triple Screen (aka AFP) test. This test screens for abnormalities that may indicate Down's Syndrome, spina bifida, or trisomy-18 (see more here). This has not been an easy decision, but we have ultimately decided not to do the test. This is especially interesting because in our previous pregnancy we were all for it.

Here's how it works: if you have the screen, you'll get a result which will indicate whether your child has a higher than expected risk of having one of the three defects mentioned above. The test for this first stage of screening is a simple blood draw - fairly uninvasive, no huge discomfort, no risk to mother or baby. If that test comes back "negative" - meaning, the baby's chance of having one of those defects is lower than expected - you're done. If, however, it comes back "positive", further testing is recommended. Further testing is an amniocentesis, which carries a 1 in 200 chance of miscarriage.

After a "positive" result, which I might reiterate does not prove the existence of any defect - merely that your baby has a higher than expected risk - you get the amnio and then wait a few weeks for the result. Presumably, stressing out the entire time. The results of the amnio will definitively tell you whether the baby has one of the defects or not, and which one it is. At which point, you can decide to terminate your pregnancy - or spend the remainder of it preparing to birth a child who is quite different from what you previously planned for.

After going through a miscarriage, I am more sure than ever that I would not choose to voluntarily end a pregnancy. After our loss, Chris and I both agreed that although it was a painful experience, we were glad to have had the pregnancy at all. Carrying that logic through, I believe at this stage of my life that I have to be grateful for whatever child God sees fit to give me - whether it's one who abruptly dies as an 11-week-old fetus, or one who doesn't survive his first year of life due to trisomy-18, or one who is born with Down's or spina bifida, or one who - can I dare to hope - is born perfect, healthy, and normal in every way. I have to believe that whatever happens in our family, happens for a reason.

Lest you think that I've gone completely off the deep end, let me temper my faith-based statements with a little scientific reality. I do believe in God, and believe that he looks after me and the tiny being in my body. However, that doesn't mean I step off a curb without looking, blindly trusting that God will stop all the cars on the highway and offer me His divine protection. I look after myself as best I can, and I take advantage of what science has to offer me in the way of testing, information, health care, and life-saving procedures. But what I've come to believe in terms of this particular triple-screen test is that it cannot offer me anything positive.

What would a positive screening indicate? A possible problem. Would I be brave enough to get the amnio, knowing it could well mean the loss of my pregnancy? If I did get it, and the baby survived, and the result was positive again - could I terminate? Would I use the information to do anything differently for the remainder of my pregnancy - other than worry endlessly and thus damage my own health and the baby's?

What good could this test possibly do for me?

The only answer is that it could come back negative, and offer Chris and I some peace of mind, knowing that (as far as we can tell) everything is just fine. But I already trust that it is - or that, if it isn't, there's a reason and a plan and that in this case, my version of "just fine" and the Universe's definition of same just don't mesh. In my book, that's no reason to put ourselves through any more stress than necessary.

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