Charting Waters With Prenatal Testing Options [Part I]

Prenatal Care: Viewing It Through A Critical Lens

With all the technological advancements in the modern-day health care system, it's highly unlikely that there is a medical condition for which a testing option has not been developed. A myriad of screening tests are now available at the disposal of a pregnant woman today, many of which are classified as being "routine and mandatory" by care providers, making it all the more imperative that the processes, implications, limitations and subsequent results of these tests be comprehended by women, at least at a fair level of understanding. Thankfully, the tides are shifting and there is an ever-increasing awareness about the and autonomy of mothers and their rights to informed choice and consent within the health care establishment. However, it is still a common occurrence that the majority of pregnant women--the real consumers indeed-- are lacking crucial knowledge in this area, which is a strong indication that further steps are required to disseminate pre-test information and proper counseling, so that they are well prepared to undertake wise decisions for themselves.

Reflecting On The Past & Present

Modern prenatal care, introduced in 1902 by Dr. J. W. Ballantyne, began as a vision for effective preventative treatment aimed at reducing incidences of congenital anomalies and fetal diseases, and thereby enhancing pregnancy outcomes. It has spurred an organized movement in the United States for a standardized approach to obstetrical surveillance of all pregnancies, despite their relative risk status. Routine prenatal care does offer its benefits and opportunities to identify secondary symptoms that are associated with complications of pregnancy, which can be further investigated with detailed laboratory analyses. However, it can be argued that not all pregnancies present themselves with these issues. Thus, in order to better serve pregnant women and their babies, and also to save them from unwanted and unpleasant short and long term consequences, a more effective care model needs to be devised--one that separates cases of true complications from those that can be reversed with adequate therapies, henceforth integrating multidisciplinary modalities to improve and enhance these outcomes. 

With its constantly changing and evolving parameters (aiming primarily at identifying eclampsia during pregnancy, and then expanding its criteria to include detecting infant mortality, and then further on as a means of reducing cases of prematurity and low birth weight), the goals of increasing prenatal visits with advancing gestation, coupled with the administration of routine tests, has been a subject of scrutiny and critique. Conventional maternity care (which was championed in the United States and subsequently its governing principles applied globally--including Middle Eastern and Sub Continental countries in their own health care paradigms), if at one instance is blamed for turning ‘pregnancy from a natural event into a medical problem’ (Seccombe, 1990, p. 181), and for delivering 'care that is provided with such high tech flourish, that the pregnancy outcomes are among the worst' (Strong, 2000), yet at other occasions is put to question with some alarming statistics. According to a 2002 report from Maternal and Child Health Bureau (MCHB), the United States ranked 28th in infant mortality rates among industrialized nations. Japan, Hong Kong and Sweden had infant mortality rates half of that!

Weighing Directions Amidst Manifold Choices

It's quite overwhelming when you are hit with the realization that there are some crucial decisions to be made when it comes to the array of diagnostic tests that are accessible today. Parents become apprehensive, while some feel hopelessly indecisive, for the best route to partake that ensures the health and well-being of both the mother and the baby. A simple--yet profoundly contemplative--formula to navigate during these decision making processes whenever one finds themselves in a fix over a test/procedure/intervention, is to follow BRAIN, an acronym that stands for Benefits, Risks, Alternatives, Instincts & Istikhara*, and to consider if doing Nothing maybe an option too. 

[*Istikhara: A prayer seeking guidance from Allah (swt) by Muslims in times of indecision. This suggestion incorporating it into the B.R.A.I.N acronym appears first in AMANI Birth Book authored by Aisha al Hajjar.]

On these lines, we will be following with a closer look at some of the most basic testing options out there, the information they supply, their benefits and risks, and their limitations in the upcoming segments of this post.