In the last 30 years, there has been an explosion of tests available to pregnant women in the industrialized nations. While basic prenatal and birth care may be difficult to access for families in poor nations, pregnant women in most of the world have an overwhelming variety of testing choices available to them. The time elapsed from experimental to routine has shortened in all areas of life, including health care, and especially in prenatal care.
Historically, the main purpose of prenatal care was to watchguard the mother’s health and life. It was recognized that the baby’s health and well-being were best served by keeping his mother healthy. Any assessments of the baby’s health that could be done were extremely indirect, and the condition of the baby was not really known until after birth.
We now have many ways to assess the health of the infant during the prenatal period, and for some conditions we even have treatments that can be applied prenatally. There are even more treatments that are available to an infant once born. Also, for some conditions, the choice of place, time, or route of delivery might be critically important. However, most testing that is done in the first half of pregnancy is done with the thought that a mother might choose to abort a baby with potential health issues. “Non-directive counseling” is the standard of care when informing a family about their choices after a diagnosis of any problem with their unborn – and that means that the counselor and health care provider(s) must advise the mom/family of not only the diagnosis and implications, but also the availability of interventions including abortion, fetal surgery (if applicable), post-birth interventions (if applicable) – and must not by any means be seem to be pressuring the family to choose one option over another. Prenatal diagnosis for fetal conditions has opened up a Pandora’s box of ethical dilemmas for families and health care providers, and for society in general.
Part of the problem may be that in general the kinds of testing available are poorly understood .Let me offer a few basic definitions and explanations.
Screening refers to tests done to determine the statistical risk of the condition being screened for – at a certain statistical risk level, a diagnostic test is recommended. This is a ‘positive’ test. A positive does NOT mean that one actually has the condition.
Screening tests are usually developed because t
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