Thursday, September 23, 2004

High Risk Pregnancy OR The Biggest Needle I Ever Saw:

So my prenatal clinic experience wasn't quite what I had expected. I thought I was shadowing a midwife who would wear a batik skirt and show me how to gently feel for a fetus' heart beat in the womb and have all sorts of baby-whisperer capabilities. Instead, due to a last-minute change, I was sent to a clinic that until last week had been called the "High Risk Pregnancy Center" which is for women who are HIV+, IV drug users, genetic disease carriers, diabetics or over 40. On Monday they officially changed the name to the "Antenatal Diagnostic Center" which is a lot less terrifying-sounding but equally technical.

There were no batik skirts.

There were, however, a bunch of highly competent nurses working there. The clinic is nurse-run but there is a perinatologist (a fetus doctor) on call to consult and perform amniocenteses. An amniocentesis is a test that looks at a fetus' DNA for signs of chromosomal abnormalities e.g. 3 #21 chromosomes = Down's syndrome. Many people know this involves a big needle but do you know HOW big? It's about a half a foot long! They take this horrible thing and jab it deep within a woman's pregnant belly. I felt a little queasy watching but all of the women were very stoic and none of them jerked away from the needle. V. Impressive.

The nurses themselves do less-invasive tests including ultrasounds and fetal monitoring. One nurse allowed me to try out the ultrasound and I managed to find a hearbeat and was very pleased with myself.

I followed several patients through their appointments and by some wonderful coincidence, all of my patients received good news: the first woman found out her fetus did NOT carry the markers for Down's syndrome an earlier test had revealed; the second woman's overload of amniotic fluid had somehow disappeared and she was sent home to wait for labor to start on its own and the final patient I observed found out that her fetus' lungs were sufficiently mature at 36 weeks she would not have to worry about pre-term labor.

I also observed a genetic counselor meeting with a couple to discuss what screening tests they would require and what they would do with the results of tests i.e. would they abort if the fetus were found to be impaired. The interview was odd, though, and I felt as if a genetic counselor should be able to talk about this delicate matter more confidently. I couldn't ask the counselor "Wow - why are you so bad at this?" of course. Luckily, though, the counselor talked to me about why the session seemed so strange. Hospital X is Catholic and they do not perform abortions nor do they counsel this choice but they will provide "referrals" (I'm not entirely sure what this meant). Most people who come to the hospital are Catholic and understand this. However, the couple that I observed were Jewish and the genetic counselor felt obligated to be a bit more forthcoming than usual i.e. state explicitly that there's not much point in having certain tests done if they're not prepared to terminate the pregnancy.

I found this totally bizarre. What's the point of having a genetic counselor who doesn't counsel? It seems to me like a fairly obvious professional conflict of interest. At the end of the day, though, it was priceless to meet a genetic counselor who couldn't use the word "abortion" or "terminate the pregnancy" or even, the most euphemistic of all, "induce early labor".

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