Over the last couple of weeks, we have been discussing the idea of prenatal testing and the midwife’s role in it. All of our discussions are polite, and our prof challenges us to think about things from all angles which is lovely. However, all of our conversations are also very challenging.
Will a test change the outcome for me?
What will I do with the results?
How does race and ethnicity relate?
How does socio-economic status affect a woman’s decision?
How do partners influence decisions?
So many ethical and moral questions for one woman to ask herself nowadays. That’s not even considering the volume of questions a midwife needs to ask herself when trying to sympathize with a client.
Tests & Timing
The interesting thing is that the discussion to test or not to test occurs early in pregnancy (often before 18 weeks), and at this point surrounds only a prenatal screen. If you say yes to the prenatal screen (which is essentially just a blood test) the results give you an estimation of the likelihood of disability in that pregnancy. The results can be either “more likely” (positive screen), or less likely (negative). Where is the harm in saying yes to to a blood test?
Well, the problem is getting the results of that blood test could change the course of your pregnancy, and sometimes people aren’t prepared for that. If the test comes back as a higher likelihood for disability, then the woman needs to consider a further prenatal diagnostic test: amniocentesis or diagnostic chorionic villus testing. She doesn’t need to do this further testing, but suddenly, you’re playing with higher stakes decisions. Were you ready for that?
“Screening is normal, no worries. Oh, it’s positive, now what?”
Informed Choice and Personal Values
Our class discussions focused on how midwives are just opening the window for a pregnant person to get information. Only the future parents can know what to do with that information.
Unfortunately, the blood test is becoming so routine that the implications of what it might mean are being left out in some care settings. As it turns out, that prenatal screen – the simple blood test – does actually require a good, informed discussion by health care providers, without being scary. What the screen/diagnostic tests are, what it could mean, types of results, etc. (And it basically needs to happen on the first visit!)
The Midwife’s Role
All this to say that I think the midwife’s role is virtually invisible. You need to be able to describe the testing, but keep your opinion to yourself. Opinions on this topic fall all over the map, making this decision so deeply personal that a midwife can’t possibly advise a client on what they should do. Not only because all of our clients are different and unique, but because your view might be completely opposite to what the client would want, and if she follows your advice and regrets it … well, that’s not something I would ever want.
I learned that each women needs to give a big think on what her personal values, beliefs, and wishes are, and that there is no way I as a midwife could ever guess what might be best for her. There are too many possible outcomes.
I don’t want the blood test.
I want all possible tests to be very informed.
I will only get an amnio if the screen comes back positive.
I have no family, so I need to know as much as possible about this pregnancy.
The results of any test wouldn’t change my love for this baby.
As a result, for health care providers, every word, every conversation, every detail informs. I just hope all midwives and obstetrical health care providers show compassion and support a woman in her decision without GUIDING her to a specific one. And really … I hope I can do this informed choice discussion justice when the time comes.