I’ve come to dread the word a bit. Amniocentesis. It’s a big word, sure, but it brings up more thinking and emotion for me now than any word of so few letters should. I’ve been re-reading the Thomas Covenant series by Donaldson and I can hear/see Saltheart Foamfollower chuckling about the human need to wrap so large a story into so small a word.
Without getting into the ethics of amniocentesis, which I am sure to do in a few posts in any case, it’s a shortcut to say that my principal objection against amniocentesis is that you take a risk with the pregnancy only to get information that is primarily useful in determining to abort the baby.
There are few topics more likely to cause dissension in a room of people than abortion. So let’s talk about that shall we?
In today’s world it seems that if you are a person who does not believe in ‘pro-choice’, you are a religious fanatic who is against the rights of women to control their own bodies. At best you are deluded, at worst you are a misogynist pig.
in my recent Biomedical Ethics class up at UBC we covered abortion quite thoroughly. The professor was one of the writers of the book that we used (Debating Healthcare Ethics) and in the book each of the writers stated their position on the topic. (and on all other topics covered, I suggest the book to get a good grounding in the ethics of healthcare decisions). It made discussion focused and of good quality since we knew the baseline position and could choose to defend or assail at whim.
So I’ll start with my position on abortion. I don’t like it. In fact, if the decision were left up to me, there would only be two situations that allowed abortion; significant threat to the mother, and imminent and painful post birth death for the fetus. Considering the difficulty in knowing about the second situation without invasive and dangerous tests (back to amnio), I’ll ignore it to focus on the first.
I accept, however, that it is not my place to make a decision to abort or not to abort for others. Unless of course I have a significant and vested interest (ie: I am the father). Each woman has the right to determine what happens in her own body. I would like to believe that she will make decisions on baby with consideration for the wishes of the father of the baby, but I accept that this is not always possible, or even desired.
For me the point of change comes from when the baby leaves the mother’s body. It isn’t at conception or implantation; it doesn’t happen when the fetus has a heartbeat or experiences sensations. A woman owns her own body, and as long as the fetus is in her body, she owns that too.
Without getting into Veronica’s position on abortion, she can do that, I can say that as it relates to our baby in her body she agrees with my basic position; abortion is bad. In fact, she goes one step further than I do and doesn’t consider significant threat to herself as a reason to abort. From some point the life of the baby in her body became more important than her own life.
A nice aside, but now back to amniocentesis.
Dr Patel again pushed for amniocentesis in our meeting. From my notes:
- amnio. 4% chromosome problems, 4% microarray problems.
His argument went along the lines of there was an 8% chance that there were still “bad problems” that could be found by amniocentesis and since the test was only 0.5% chance of spontaneous miscarriage, it makes sense to get the amniocentesis.
I asked him about the second IPS blood draw since the results of that rule out Trisomy 18, 21 and open neural tube defects. If we get that, are we still at 8%? The answer was no. Now it is 1-2% chromosome problems and 4% microarray problems.
Again, Dr Patel sees enough value in getting that data that he considers it to be worth the risk.
Collectively Veronica and I think he is full of shit. What value is there in finding out the baby has Downs Syndrome, or Trisomy 18 defects (unlikely survival passed 1 year of life), or open neural tube defects? When the baby is born we can learn this information. If the baby only has moments, or hours or months to live after birth, surely we can see that or test for that once he has been born and without putting his life at risk.
Imagine doing an amniocentesis test, having the baby miscarry, and then finding out that there was nothing wrong. 1 in 200 amniocentesis tests result in miscarriage. How many of those miscarriages happen to babies who do not have problems found by the test in the first place?
Then Dr Patel tossed something else out in trying to justify the test. Thinking about it I know that this is the thing that he said before that stuck with me and had me considering amniocentesis even though I couldn’t come up with a good reason for it logically. He said that if we found out there was a life threatening condition for the baby, he would not want to put Veronica through the risk of a c-section or high risk delivery.
That hit me like a ton of bricks when I finally got around to thinking about it clearly.
In my mind, abortion is bad unless there is a significant threat to the mother.
Here’s the reality, Veronica has to have a c-section. We’ve known that since Lachlan was born. The doctors told us it wasn’t going to be a choice of VBAC, we were simply going to do the c-section. When we were discussing getting pregnant again, this was one of the things that we went back and forth on. It was my primary reason for thinking that we shouldn’t have another baby. The risk to Veronica is simply too high. Each c-section delivery is a risk to the mother. Not just the immediate surgical risk, but also the life long consequences risk. There are risks to both the baby and the mother. But we talked about it and while I’ve held my concerns I agreed with her that the odds were low of a major risk, and we really do have the space in our lives to love another child.
So, yeah, I’ve gotten past the whole risk to Veronica in having a baby. I might take the risk with my body, but I wouldn’t take the risk with her body. She is willing to take the risk with her body and wants to. And I agree with her decision and support it. The decision to have a baby knowing that we are going to need a c-section.
But, to have a c-section knowing that the baby is not going to live? Risk Veronica for nothing? Now I’m stuck in my own ethics again. If I knew, 100% that the baby was going to not survive, would I want to risk Veronica in having a c-section? Does abortion become viable in this circumstance? In fact, does abortion become required in this case?
What would I do if the baby was in me, and I was making this decision with my own flesh and blood on the line?
Is there now a reason to get an amniocentesis? Should I find out if there is something wrong with the baby so that I can take actions to help protect my wife from an unnecessary and dangerous surgical procedure?
I don’t have an answer to these questions right now. I’m still working through them.
As always, your thoughts are welcome.