Saskia Balke-Hom­berg

Pre­natal dia­gnostics: pre­natal ex­ami­na­tions of my baby 

Pre­natal dia­gnostics: ethics versus the de­sire for se­cu­rity

Ex­pec­ting par­ents want an un­com­pli­cated pregnancy. Most pregnant women make use of pre­natal dia­gnostics in order to be able to await their child with a good fee­ling. Yet the ma­jo­rity of all ba­bies are he­althy. If you still want to use PND, you should dis­cuss your po­si­tion towards pre­natal dia­gnostics with your partner be­fore the first ul­tra­sound and whe­ther you share si­milar ethical be­liefs. For ex­ample, use the fol­lowing over­view to talk to your partner about whe­ther you con­sider PND with all its con­se­quences to be useful and what de­cisions you would make.

Prenatal diagnostics

Pos­si­bi­li­ties of pre­natal dia­gnostics

  • Some di­se­ases, such as dia­phrag­matic hernia or a thi­c­kened bladder, can al­ready be treated in the womb [1].
  • The star­ting con­di­tions for the child’s life can be ea­sier in the case of cer­tain ill­nesses or disa­bi­li­ties if the fa­mily makes use of coun­se­ling sel­ling ser­vices at an early stage and pre­pares for the spe­cial fea­tures.
  • The birth re­gis­tra­tion can al­ready take place in a spe­cia­lized clinic in order to en­sure the best pos­sible in­itial care, if for ex­ample a heart de­fect is iden­ti­fied.
  • An in­con­spi­cuous re­sult re­as­sures the par­ents-to-be and re­lieves them of worries and stress.

Li­mits of pre­natal dia­gnostics

  • Only a small pro­por­tion of pos­sible di­se­ases can be de­tected and treated by PND.
  • The ex­ami­na­tions can reveal or con­firm a sus­pi­cion or an in­cre­ased risk of a mal­for­ma­tion or di­sease. However, they cannot pre­dict the se­ve­rity or fur­ther causes of the di­sease.
  • In­con­clusiv ex­ami­na­tion re­sults can place a heavy psy­cho­lo­gical burden on the par­ents and se­verely dis­rupt the bond with the child.
  • In the case of a se­rious ill­ness, the par­ents may be asked to make a de­cision about con­ti­nuing or ter­mi­na­ting the pregnancy which they then have to make.

Make in­formed choices from the be­gin­ning

Pre­natal dia­gnostics have be­come common in gynae­co­logy. Ne­vertheless, ex­pec­ting par­ents who do not want to be con­fronted with the pos­si­bi­lity of an ab­or­tion should ca­re­fully con­sider which ex­ami­na­tions they would like to have car­ried out. Sup­posed ab­nor­ma­li­ties can set a ma­chinery of fur­ther ex­ami­na­tions in mo­tion, lea­ding to gru­e­ling wai­ting times for test re­sults and so­me­times se­verely af­fect the re­la­ti­onship with the partner and the child. With many ex­ami­na­tions, false alarms are pos­sible, which lead to un­ne­cessary un­cer­tainty and stress for the par­ents to be. At the same time, par­ents are lulled into a false sense of se­cu­rity if an ab­nor­ma­lity is not de­tected.

De­cisions need time — other­wise there is a risk of guilt

For ex­ample, as soon as a tri­somy 21 dia­gnosis is made, the ma­jo­rity of ex­pec­ting mo­thers do not want to con­tinue their pregnancy. Ne­vertheless, the con­se­quences in such a case need to be ca­re­fully con­si­dered. “De­cisions made too quickly can lead to dif­fi­cult, de­layed or pa­tho­lo­gical mour­ning pro­cesses, or the mis­guided mour­ning leads to never-en­ding fee­lings of guilt and am­bi­va­lence,” as Sa­bine Hu­fen­diek of the Pro­tes­tant Cen­tral In­sti­tute Berlin re­ports in a pro­fes­sional ar­ticle. [5] The jour­na­list Mat­thias Thieme, the fa­ther of a daughter with Down syn­drome, also points out the points ne­glected by the pu­rely me­dical view of pre­natal dia­gnostics: “The mo­thers and fa­thers learn not­hing about life with such a child, about the po­ten­tial for hap­pi­ness and ful­fill­ment.” [4]

You have the right not to know

In the con­text of scree­ning or PND, you can de­cide for yourself what in­for­ma­tion you want to re­ceive and how de­tailed the in­for­ma­tion should be. For ex­ample, you have the right to con­sciously de­cide against ul­tra­sound ex­ami­na­tions. You can also agree with the doctor that you only want to be in­formed about age-ap­pro­priate de­ve­lo­p­ment du­ring the basic ul­tra­sound ex­ami­na­tions, but not about mal­for­ma­tions. [6] However, this re­quires your si­gna­ture, which re­leases the doctor from his or her ob­li­ga­tion to pro­vide in­for­ma­tion.

Con­clu­sion: Pre­natal dia­gnostics

The me­dical view is not ne­cessa­rily the de­cisive one

Pre­natal dia­gnostics can reveal cer­tain di­se­ases and ab­nor­ma­li­ties at an early stage, but it can also be very un­sett­ling. Above all, it is a pu­rely a me­dical point of view. From a sci­en­tific per­spec­tive, the mo­dern pos­si­bi­li­ties of PND are reve­aling and pro­mi­sing. But then there is the emo­tional, in­di­vi­dual, human level that makes pregnancy a highly com­plex event in the lives of ex­pec­ting par­ents. To make a well-founded de­cision about whe­ther and how you want to use pre­natal dia­gnostics for your own be­nefit, it is a good idea to have an in-depth dis­cus­sions with your doctor, your mid­wife or at a pregnancy coun­sel­ling centre. This will help you to streng­then your own in­tui­tion.

You can find more in­for­ma­tion about the me­thods and risks of pre­natal dia­gnostics in the se­cond part.
» Pre­natal dia­gnostics: Me­thods

 

About Fer­tilly

At Fer­tilly, we have made it our mis­sion to ac­com­pany cou­ples (ho­mo­se­xual and he­te­ro­se­xual) and sin­gles on the way to ful­fil­ling their child wish. In doing so, it is im­portant to us to create trans­pa­rency in the area of fer­ti­lity ser­vices, to pro­vide in­for­ma­tion and know­ledge on the to­pics of pregnancy and fer­ti­lity and to help you to find the most sui­table Fer­ti­lity Center. Through coope­ra­tion with first-class Fer­ti­lity Cen­tres and cli­nics in Eu­rope, en­qui­ries about Fer­tilly are given pre­fe­ren­tial tre­at­ment. This means that our pa­ti­ents avoid the usually long wai­ting times and get ap­point­ments more quickly.

If you would like more in­for­ma­tion about Fer­ti­lity Cen­ters, suc­cess rates and prices, please con­tact us using this ques­ti­onn­aire. We will ad­vise you free of charge and wi­thout any ob­li­ga­tion.

  • An­swer the first ques­tions in the on­line form in order to book an ap­point­ment. This way we can better ad­dress your needs du­ring the con­ver­sa­tion.

  • We will find the best con­tact person for your in­di­vi­dual needs. Sche­dule 20 mi­nutes for the con­sul­ta­tion.

  • We will in­tro­duce you to the right fer­ti­lity clinic from our net­work, make an ap­point­ment and ac­com­pany you until your wish for a child is ful­filled.

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Sources:

1. https://www.wissenschaft.de/umwelt-natur/operation-im-mutterleib/
2. https://www.g‑ba.de/downloads/83–691-324/2013–07-01_Merkblatt_Ultraschall_Heft.pdf
3. Jan­vier, Annie., Farlow, Bar­bara , Bar­rington, Keith (2016): Pa­rental hopes, in­ter­ven­tions, and sur­vival of ne­o­nates with tri­somy 13 and tri­somy 18. In: Ame­rican Journal of me­dical ge­ne­tics, Jg. 172, H 3, S. 279–287
4. Thieme, M. (2016): El­tern als Se­lek­tierer. De­batte Pränataltests und ihre Folgen. In: taz, die ta­ges­zei­tung, 28.11.2016, www.taz.de/!5357522/ (26.6.2019)
5. Hu­fen­diek, Sa­bine (2019): Be­ra­tung zwi­schen Be­funden und Be­finden – Paare in der Be­ra­tung. In: Vor­trags- und Work­shop- Samm­lung und Fach­ta­gung‚ Ver­ant­wor­tung leben – ohne Zweifel geht es nicht‘, S. 70.
6. https://www.g‑ba.de/downloads/83–691-324/2013–07-01_Merkblatt_Ultraschall_Heft.pdf, S. 8