Prenatal Testing and Informed Consent

Issue 120, September-October 2003

From the book Mothering Magazine's Having A Baby, Naturally: The Mothering Magazine Guide to Pregnancy and Childbirth edited and published by Peggy O'Mara with Wendy Ponte. Copyright © 2003 by The Philip Lief Group, Inc. and Mothering Magazine, Inc. Reprinted by permission of Atria Books, an imprint of Simon and Schuster, Inc.

Birth goes best if it is not intruded upon by strange people and strange events. It goes best when a woman feels safe enough and free enough to abandon herself to the process.
-Penny Armstrong and Sheryl Feldman, A Midwife's Story

Even if you have not given birth before, you are probably already familiar with the terminology of prenatal testing. Words like sonogram and amniocentesis have become a familiar part of our general vocabulary.

There is a good reason for that familiarity. It is because many of these prenatal tests, originally created to test certain high-risk pregnancy situations, have become standard practice for all pregnant women. While you may think that these tests can do no harm, some of them have never been thoroughly studied for safety to mother and baby, and may present physical risks to both. Relying on prenatal tests to ease your concerns may also create an atmosphere of worry and anxiety, just what you had hoped to avoid by taking them. Results can sometimes be vague and, what's worse, misleading.

As long ago as 1974, the American College of Obstetricians and Gynecologists (ACOG) recommended that its members take great care to obtain informed consent from their patients before proceeding with any tests or treatments. ACOG was careful to distinguish between consent and informed consent. In other words, patients should fully understand what will happen to them and their unborn children before proceeding blindly with any type of testing or treatment. This is particularly important now, years later, since many tests are prescribed by physicians who assume that their patients understand what the tests are meant to assess, as well as their risks to mother and baby.

Informed Consent
Informed consent means much more than just showing up for a scheduled ultrasound or amniocentesis. You have the right to:

Understand in detail how the procedure is administered.

Understand all the risks associated with it.

Know what the alternatives are: is there another test or procedure that poses less risk?

Carefully consider the physical and emotional impacts.

Feel free to say no to any tests you don't feel are necessary.

Before you can decide to give informed consent, you need to understand the tests and procedures that are routinely administered during pregnancy-ultrasound, the triple screen, amniocentesis, and chorionic villus sampling.

Ultrasound
Ultrasound, or sonogram, was originally developed during World War II to detect enemy submarines. This diagnostic technique has replaced X rays, now known to be dangerous, as the method of choice to view a baby inside the uterus. Ultrasound uses sound waves to create a two-dimensional image of the baby that is suitable for viewing.

Why Is Ultrasound Used? Ultrasound is used in two ways. One is to investigate a specific concern. If a woman has a family history of a medical condition, or if another test indicates risk, an ultrasound may be recommended. More commonly, however, ultrasound is used as a routine procedure performed on almost every pregnant woman to screen for potential problems, even if she is not at any particular risk.

How Is Ultrasound Done? During ultrasound, a device called a transducer that produces high-energy sound waves is either run across your belly or, in very early pregnancy, inserted into the vagina, where a heartbeat can be detected earlier. The sound waves then reboun