Screening for ‘choice’

A few weeks ago I wrote an article published by Mercatornet comparing how abortion, which was brought onto UK statute books, supposedly for emergency and desperate case circumstances only, with the so-called safeguard of requiring the signature of two  independent doctors, has been automatically built into the health care system, meaning that in all stages in pregnancy women are presented with the virtue of our age – choice.

It’s inevitable that if assisted suicide is eventually enacted into legislation, euthanasia will drift exactly the same way. Any decent or civilised society should not be putting the option of whether or not to kill another person on the table, let alone committing the act for you.

I mentioned before how this incorporation of abortion into part of the package of ‘health care’ options offered to pregnant women, not only violates the Abortion Act itself, under the terms of which one might expect the request to be led by the woman herself, rather than suggested by the clinicians. My experience of the past few weeks, which to be fair is no different or more outrageous than in previous pregnancies, more than illustrates this.

This time I have been fortunate, there has been no doctor or midwife attempting to hector or pressure me into considering abortion on the grounds of not having adequate spacing between the children. Two years ago, I remember sitting in tears in the midwife’s office as she loudly tutted and suggested that I really ought to think about what I was doing and consider counselling for abortion and sterilisation while I attempted to pacify two bored and noisy toddlers as I hadn’t been able to arrange childcare for that particular appointment and had been told that there wouldn’t be another slot available for another 5 weeks. In the pregancy prior to that a self-identifying Catholic GP had proceeded to lecture me about how the Church was wrong about contraception and abortion and again suggested abortion, this time as a cure for acute morning sickness.

So actually this time has been a picnic, but nonetheless abortion has been subtly suggested as an easily accessible and acceptable pathway. Many readers will note this approvingly, however when so many women find this such a difficult and heart-wrenching decision and suffer agonising physical and emotional consequences, it is worth asking on those grounds alone, along with the  irrefutable fact that abortion ends a life, whether it ought to be treated so lightly on the NHS. It’s always there, always looming over you as an option, and for most women has the effect of adding pressure and really having to justify continuing with a pregnancy.

So let’s consider what happened to date. Firstly, I couldn’t manage to get the obligatory GP appointment wherein I turn up and say “OK doc I’m pregnant, I’ve done a positive test” and they say “right okay and you are fine with that?”, I confirm, it gets typed in on the computer screen along with dates, and from there I am allowed to proceed to book in with the midwife. The GP appointment does nothing useful for the pregnant woman, there are no blood tests, no care plan suggested, it’s nothing other than a gatekeeper appointment for those who have perhaps experienced an unplanned pregnancy or are undecided. If you are pregnant, happy about it and want to proceed straight to midwife, in my surgery, it is not allowed. With 4 children and a lot on my plate, it’s an unnecessary hassle.

Due to holidays and an early threatened miscarriage I managed to circumvent that particular rigmarole, helped by the fact that I had presented at the Early Pregnancy Unit who had directly booked me in for a 12 week scan, rather than having to go via midwife. It meant that a swift appointment needed to be found with a midwife to ensure that I had a set of notes with me and so they managed to slot me into a cancellation without first seeing a GP.

But even at the Early Pregnancy Unit, before I had even been scanned to find out what was actually happening with my uterus, the very first question I was asked, was whether or not the pregnancy was planned, which seems something of an insensitive irrelevance when a woman wants to know exactly what the status of the embryo or foetus (from 8 weeks) is.

I wanted to know whether or not the baby was miscarrying. Did it really matter at that point whether or not it was planned, or would it have affected my treatment? The only possible reason for that question was to discuss abortion options if necessary or work out whether or not it was worth attempting any preventative action which could save the baby.

The next question was “do you accept the pregnancy?”, which was fatuous. Either a woman is pregnant or she is not, regardless of whether or not she accepts the fact. It’s a clear euphemism and again presents an option on the table for a woman to think about. Why should the first thing that a woman anxious that she might be miscarrying a baby be asked, is whether or not she planned her pregnancy and whether or not she ‘accepts’ the baby.

I’ve said before, this question always reminds me of the questions asked of parents in Baptism and is for me a public confirmation and affirmation of the life inside, but nonetheless it was a disconcerting irrelevance. Would this happen in the diagnosis of a terminal disease. “Do you accept the prognosis and traditional plan of palliative care?”. Putting a big fat elephant in the room as to whether or not you are truly making a ‘moral’ choice by selfishly continuing with your life until its natural end.

From there on everything proceeded smoothly and as I said earlier in the week on Conservative Woman, I declined the option for Downs Syndrome screening.

One of the comments in which a woman claimed that I had no idea what I was talking about, did give me pause for thought as she outlined how a diagnosis could be helpful even if you were not planning on abortion, as Downs carries lots of risks for the child in utero. Technically a care plan should be tailored to ensure the safety of both mother and child, but when you are faced with the screening options, this is never specifically outlined in terms of your decision making and many women report being given very little in the way of positive support or information when told that their child has a genetic abnormality.

 Indeed the leaflet warns that once you have had the screening, you cannot turn the clock back and that unless you are prepared to cope with the stress of knowing that you have an increased likelihood of a child with Downs, or are prepared to consider a further diagnostic test (with a 1-2% chance of miscarriage) then you might be better off not having the screening at all.

Screenshot 2014-08-29 10.08.10

I declined because I didn’t want to be worrying about it. If the baby has Downs then while it will be far from easy, especially  as I already have a number of children. I’d rather meet the challenges and difficulties as and when they come, rather than spend sleepless nights worrying about hypothetical scenarios. Furthermore the leaflet states that the primary purpose of all the risky invasive tests is to detect Downs Syndrome, although other conditions may be discovered.

Screenshot 2014-08-29 11.13.01

So the scan went ahead yesterday. As predicted, I was asked to confirm whether or not I wished for the nuchal translucency test for Downs, which combines a screen result with a further blood test. When I said no, I was pretty candid about it, stating that the only thing that I was hoping to see on the monitor was a live baby after what happened last year.

The sonographer was very sympathetic, but nonetheless they said that she would still measure the nuchal translucency, i.e. the amount of fluid behind the baby’s neck to see whether it was within normal parameters. An increased amount of fluid is a strong indicator of Downs Syndrome. If the measurement was high, she would inform me in order to give me the option to change my mind about having the full screening!

It turned out that the measurement was well within normal limits. That doesn’t mean that the baby definitely does not have Downs Syndrome, but in all probability there is a lower risk.

I’ve been left feeling disconcerted as though I somehow went back on my word. When they told me that they would measure the fluid anyway, I should have firmly stated “look I’m not interested either way” but at that point, when you are lying on the table, there is a sense of having ceded control and powerlessness. I just wanted them to hurry up and switch on the equipment so I could see whether or not there was still a heartbeat.

I also have to confess to a slight sense of relief which goes to show that even the most pro-life amongst us are not immune from the insidious pressure and notion that a Downs Syndrome diagnosis is a catastrophic thing. All of which adds to the stigma, both for sufferers themselves and their parents, which Dawkins did his best to stoke, adding unrepentantly that he’d only upset a small minority, in any event. If the NHS didn’t make such an issue of flagging up Downs Screen for pregnant women, going so far as to suggest that it can be such a problem that women ought to consider risking their baby’s life, most probably wouldn’t give it much of a thought.

It’s not that I reject the idea of pre-natal screening or wish to demonise those who opt for it, but surely it ought to be offered purely for theraputic reasons, to alleviate and treat conditions, either in utero if possible, or to prepare future healthcare strategies and plans for mother and child, rather than continually  present the issue of whether or not the child ought to live. Screening the unborn for disabilities does nothing to help advance research into therapies to help sufferers.

It doesn’t feel as though the NHS has got the balance right, when they are being so proactive in terms of continually presenting abortion as a consideration.

6 thoughts on “Screening for ‘choice’

  1. Good column, Caroline. Thoughtful and insightful – and yes, if NHS staff are behaving that way, they have indeed got the balance wrong.

    Problem is, they would probably not realise it even when it is pointed out in simple terms; it is now seen as simply ‘doing the job’.

  2. Thank you for an excellent article. The word ‘choice’ makes me wince. It means ‘ the State is not at fault the individual must take the blame’. They won’t get off that easily!

  3. Caroline, how many scans does the nhs offer now, used to be one at 20 weeks, then two with the first offered 12/13 weeks. What is the real purposef of the early scan? Is medical intervention offered on any significant scale or is it a situation that the scanning facilities became available and using the human desire to see the baby in the womb, a conveyor belt has been set up for ‘choice’.
    I hear it is now possible to pay for 4d babyscans, but if you really want to see the baby’s face this may be a safer route than the nhs scan of internal organs? This type of whole body screening is not generally offered once a child is born. Ultimately what benefit has the existence of ultrasound really offered mother/baby? Curiosity?

  4. As an elderly multipara, pregnant at 42 with twins, I was asked, “How do you feel about this?” when the test came back positive, I was offered the option of and declined amnio on more than one occasion, the fluid behind the babies’ necks was measured carefully more than once (no consent asked), and by the time the dear babies were born, medical staff had wound me up so tight on the subject of Downs’ that I heaved a huge sigh of relief at having cleared what everybody seemed to think was an enormous, insuperable obstacle. So I didn’t ask or look for any other problem. I believe that this delayed the twins’ diagnosis of learning disability by years, to what is now my great grief.

    I’ve spent several years since, going over the past, absolutely sure that I’d have welcomed the babies even if there had been much worse problems involved, but how I wish that the harassment about Downs hadn’t blinded me to the possibility of the presence of other problems.

  5. How lovely to read that you are expecting a little baby again. Congratulations! Enjoy your pregnancy Caroline. God bless both you and your unborn little one. I will pray for you at Mass on Sunday.

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