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their clients towards routine testing. 51
A further irony is that most women
choose to have prenatal screening in
order to receive reassurance that their
baby is healthy. Yet, for all the stress,
time and money that is consumed by
the prenatal diagnosis industry, neither
these, nor any other pregnancy tests currently
in use, can tell us with certainty
that our babies are normal and healthy.
Major conditions such as cerebral palsy
and autism cannot be detected by any
existing method, and physical abnormalities
involving the heart and kidney,
some of which are severely disabling,
are also unlikely to be picked up through
any screening method.
The trick of technology
Prenatal diagnosis represents incredible
and continuing advances in technology,
yet there is a sleight of hand — a
trick, perhaps — that is being played
out on pregnant women. We are told
that prenatal diagnosis will increase our
choices, but, as these tests become more
available, women are feeling that they
have less choice to refuse the testing.
We are already, through social attitudes,
individually responsible for our children’s
development, and now we are
also becoming responsible for producing
a healthy baby at birth. As one
woman comments, ‘I knew it was my
responsibility to make sure I was not
going to give birth to a handicapped
child. But that meant taking the risk of
losing a healthy baby. I am responsible
for that too.’ 52
Finally, as we look more deeply, the
parallels between prenatal diagnosis and
medicalised childbirth become increasingly
obvious. Both industries are centred
on high technology and its superior
knowledge, and both consider women’s
own feelings and instincts about their
body and their baby to be inferior and
unreliable. Women who choose either
path are at risk of a cascade of intervention
— from induction to caesarean or
from screening to abortion — with pressure
to conform to medicalised ideas
of ‘the right decision’ at each point. As
one woman notes ‘...once you get onto
the testing trap you have to get to the
end’. 53
Where does this end take us, as
individuals and as a society? Is prenatal
diagnosis liberation or the beginning
of a ‘slippery slope’ towards selecting
babies on the basis of socially acceptable
characteristics? How will the ‘new
genetics’ impact prenatal diagnosis, with
the huge amount of information that
will soon become available about our
unborn babies? And does it, as Rothman
(1988) suggests, make every woman feel
that her pregnancy is ‘tentative’ until
she receives reassuring news?
The answers to these and other questions
are as yet unknown, but what
is certain is that this technology will
become more ‘advanced’ in the coming
years, and our choices more complex.
Mother Nature, like many women who
are enrolling in these tests, does not
know whether to laugh or cry.
Sarah J Buckley is a trained GP, writer on
pregnancy, birth and mothering and currently
full-time mother to her 4 children. Her own choice
has been to avoid prenatal screening, even with
her 4th baby, born when Sarah was 40. She lives
in Brisbane, where she is currently writing a book
on Ecstatic Birth, due for publication in 2005. You
can contact her at sarahjbuckley@yahoo.com
Further Reading
Prenatal Testing — Making Choices in
Pregnancy. Lachlan de Crespigny with
Meg Espie and Sophie Holmes. Penguin
Melbourne 1998.
The Tentative Pregnancy. Barbara Katz
Rothman, Pandora, London 1998.
Which Tests for my Unborn Baby? —
Ultrasound and other prenatal tests. 2nd ed
Lachlan de Crespigny with Rhonda Dredge.
Oxford University Press, Melbourne, 1996.
Informed Choice brochures — Looking for
Down’s syndrome and Spina Bifida in Pregnancy
(for women) and Antenatal Screening for
Congenital Abnormalities — Helping Women to
Choose. (for professionals) MIDIRS and NHS
Centre for Reviews and dissemination, UK,
1999.
Prenatal Testing — to risk or not to risk. Elaine
Dietsch at www.birthinternational.com
Endnotes
1. Kelly J, Bean C (eds). Australian Attitudes Allen and
Unwin, Sydney, 1988, p5.
2. Rostant K et al — Survey of the knowledge, attitudes
and experiences of Western Australian women in relation
to prenatal screening and diagnostic procedures. Aust N
Z J Obstet Gynaecol. 2003 Apr; 43(2):134-8
3. Mulvey S, Wallace EM. Levels of knowledge of Down
Syndrome and Down Syndrome testing in Australian women.
Aust N Z J Obstet Gynaecol. 2001 May; 41(2): 167-9.
4. Green J.M. Serum screening for Down’s Syndrome:
experiences of obstetricians in England and Wales.
BMJ. 1994 Sep 24; 309(6957): 769-72.
5. Lachlan de Crespigny with Rhonda Dredge.Which Tests
for my Unborn Baby?- Ultrasound and other prenatal
tests. 2nd ed. Oxford University Press, Melbourne, 1996
6. Wapner R et al. First Trimester Maternal Serum
Biochemistry and Fetal Nuchal Translucency Screening
Study Group. First-trimester screening for trisomies
21 and 18.
7. Royal Australian and New Zealand College of
Obstetrician and Gynecologists (RANZCOG) and
Human Genetics Society of Australasia (HGSA) joint
statement. Antenatal Screening for Down Syndrome
(DS) and other Fetal Aneuploidy http://www.hgsa.com.
au/ retrieved 15/6/04.
8. CDC — Centre for Disease Control, Economic Costs
of Birth Defects and Cerebral Palsy — United States, 1992
Morbidity and Mortality Weekly Report September 22,
1995 / 44(37); 694-9. At http://www.cdc.gov/epo/mmwr/
preview/mmwrhtml/00038946.htm accessed 26/5/04
N Engl J Med. 2003 Oct 9; 349(15): 1405-13.