Our Bodies, Ourselves (82 page)

I had a CVS [chorionic villus sampling] 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 impairments give us both 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.

© Keith Brofsky / Getty Images

Three types of tests screen for or diagnose disorders in the fetus:

•
Genetic carrier testing
is blood tests that can be performed before you get pregnant or in early pregnancy. The tests determine if you or your partner is a carrier of diseases that can be inherited by your children. Examples of genetic carrier tests are blood tests for sickle-cell anemia or cystic fibrosis.

•
Screening tests
measure the likelihood that your fetus has a particular condition but cannot tell for certain whether the fetus has the condition. Examples of screening tests are ultrasounds and “maternal marker” blood tests. Screening tests are typically used to determine if a diagnostic test is necessary.

•
Diagnostic tests
give a yes-or-no answer, identifying whether the fetus does or does not have a particular condition. Examples of diagnostic tests are amniocentesis and chorionic villus sampling.

It is important to note that none of the tests guarantees that the baby will be healthy; instead, they are designed to ask, and answer, one specific question, such as: “Does my baby have cystic fibrosis?”

For more information about specific tests for fetal anatomy and well-being, visit the March of Dimes (marchofdimes.com) and see the chapter on prenatal testing in
Our Bodies, Ourselves: Pregnancy and Birth
.

Before choosing whether or not to have any test, find out what information the test is capable of providing and its advantages and disadvantages. Ask your health care provider, and do your own research, to find out the following:

• Does the test pose any risk to you and/or your developing baby?

• Why is this test recommended for you? Are you in a group that makes you or your baby more likely to have this condition?

• When can you expect the results to come back?

• How reliable is this test? What is the incidence of false-positive results? If you get a result described as abnormal or unusual, what kind of follow-up testing or counseling will be offered?

• What are your options after receiving the result? Are there any treatments available for you or for the fetus if the result is abnormal?

• How much will this test cost? Will your health care insurance cover part or all of the cost of this test? If not, can you get any financial assistance?

Additional questions for tests that give you information about the baby's characteristics:

• Would knowing that my baby will have a particular condition make a difference in my decision to continue my pregnancy? If so, how?

• What do I know about life with these conditions?

• Would knowing any other characteristics detectable by prenatal testing, such as the sex of my baby or the identity of the father, affect my decision about continuing my pregnancy? If so, how?

Prenatal visits rarely provide enough time to discuss preparation for labor, birth, breastfeeding, and early parenting in detail. Childbirth classes can help fill this gap. In the past thirty years, childbirth education has evolved. Today, women can choose from Lamaze, Bradley Method, ICEA, Birth Works, HypnoBirthing, Birthing from Within, and mindfulness-based childbirth preparation methods, among others. Childbirth classes teach you about the process of labor and birth and offer techniques to help you relax and cope with it.

Techniques that improve confidence can help you prepare to cope with labor sensations. Meditation, visualization, movement, and rhythmic techniques are tools you might use to help ride the waves of labor.

Hospital-sponsored classes tend to focus upon medical interventions and are less likely to give you details about all of their risks and benefits or your rights. Seek out an independent childbirth educator to get unbiased information and help with making decisions and having a childbirth experience that meets your needs. A doula may also provide you with one-on-one education and preparation classes. If these options aren't available or are unaffordable, arrange a get-together with pregnant friends to explore childbirth information and stories together. Many large cities have independent childbirth educator or doula organizations that can provide a list of alternative class options. Childbirth education organizations can often direct you to educators in your community, and some of their websites include directories.

Some women have preexisting medical conditions such as diabetes, high blood pressure, epilepsy, autoimmune disorders, HIV, or heart or kidney disease that increase the risk of problems during pregnancy. Others begin pregnancy healthy but develop a complication that needs closer monitoring, such as placenta previa, preterm labor, gestational diabetes, or preeclampsia.

When I first became pregnant, I envisioned having a healthy pregnancy and a natural birth with midwives—I'd already done that once before. But after experiencing serious bleeding in my seventh month of pregnancy, I was diagnosed with placenta previa. I spent the rest of my pregnancy on bed rest, hospitalized for most of that time, and eventually gave birth by emergency C-section when the bleeding started again. I never wanted to have hospitals, high-risk specialists, and surgeons so involved in my pregnancy, but I am eternally grateful that they were there when I needed them
.

If you have a high-risk pregnancy, you may need to be seen by or consult with an obstetrician, maternal-fetal medicine physician, or relevant specialists and have more frequent prenatal
visits or adjust your daily activities. But even though your risk of complications during pregnancy is higher, you may not actually develop any worrisome complications.

Some of us are labeled “high risk” but are actually healthy, and with good supportive care we can expect to remain healthy and give birth safely to healthy babies. Being considered high risk can affect our confidence and expose us to extra testing and procedures that we may not need. If you don't think you are high risk, talk to your care provider about what that means for your care. If you believe a high-risk label will limit your choices unnecessarily or lead to overuse of interventions, consider switching care providers.

If your pregnancy requires attention from a specialist, a midwife or family practice doctor may still be able to provide the general care you need.

Becoming pregnant as a teenager can present many challenges. Younger teens (thirteen to fifteen years old) have a higher rate of complicated births, but you can help prevent problems by taking good care of yourself and getting support.

It will be especially important that you gain enough weight, so don't diet while you are pregnant. If getting enough food is difficult for you, contact the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in your community or call your
local food bank.

You may have many plans to make as you prepare to give birth. You will need to know where you and the baby will live, and you may need to figure out how to stay in school or at your job, arrange for health insurance, and ensure that you will have enough money. It can seem overwhelming. The more helpful people (family, friends, the baby's father, school counselor, public health nurse, social worker, midwife, or nurse-practitioner) you can surround yourself with, the better. They can encourage you to be and to stay healthy, to feel positive about pregnancy and birth, and to plan for and make decisions about your and your baby's future.

I'm 15, and when I got pregnant, it was really hard for me in school to do gym. You know, the running and all. The gym teacher was kind of mean, so I talked to my counselor, and she got me into this school that is just for girls who are pregnant. It is better for me, 'cause we just walk for exercise and everybody helps you
.

Just because you are having a baby does not mean you have to leave school. Ask your school guidance counselor or health care provider if there are schools in your community especially for pregnant or parenting students. Many communities have such schools. They may offer classes in parenting as well as day care for your baby so that you can attend classes.

I'm 16, and this is my first baby. My mom had me when she was 16, too. When I went into labor, I told my mom I wanted my little sister to be with me. She's 12. After my baby was born, I told my sister, “You are smart and pretty. Don't do this. Don't do what me and mom did. You can be anything you want.” I love my baby, but I want my sister to have a better life. Later, my midwife told me I was smart and pretty, too, and that I could do anything I want. She said I could still go to college. I hope I can. I know it will be a lot of work, but I would like to be a lawyer
.

Many of us become pregnant for the first time in our late thirties and early forties, and, rarely, even in our middle or late forties. If you are over age thirty-five, medical providers may label you as an “elderly primigravida”—a woman of “advanced maternal age”—and consider you high risk. Most of this increased risk is not related to your age itself but to the fact that older women are more likely to have health problems such as high blood pressure or diabetes, which can affect pregnancy outcomes. In addition, the risk of some fetal impairments, such as Down syndrome, increases as a woman ages. However, the vast majority of women thirty-five and older have healthy pregnancies and births.

Because you are over age thirty-five, your health care provider will offer you blood testing, ultrasounds, and/or an amniocentesis to help determine if there are any chromosome problems in your baby. For more information about these tests, see “Tests for
Fetal Impairments.”

Some of us find our age and experience a benefit as we progress through our pregnancies and motherhood:

For much of my life, I had been convinced that I didn't want kids. Then I settled into my career and found myself in a really great relationship. We talked about kids and realized that we really wanted them. We got married when I was 38, and I got pregnant three days later. . .
.

As an older mom I think—no, I know—I'm a better mom than I would have been at a younger age. I'm healthy, so I'm still able to do all the active things with the kids—biking, snowboarding. And I am much more patient than I used to be. We do struggle a bit with balancing preparing for retirement with trying to save for the kids' college, but in the grand scheme of things, that's a pretty good challenge to have
.