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Peace of Mind


Okay, now what we’re going to spend the rest of our time talking about are optional routine tests. We’re going to talk specifically about ultrasound and how ultrasound can be used to look at the baby’s structure and to screen for chromosome problems. And we’re going to talk about blood tests on the mom; we call them maternal serum screening, where we can test things in your blood stream that help us to look at the baby’s structure and the baby’s anatomy and the risk for baby’s having chromosome problems.

And then, at the end, after discussing ultrasound and blood tests on mom, we’re going to spend a little bit of time talking about two specific genetic conditions called cystic fibrosis and sickle cell anemia. And give you a little bit of information about that because those are all things that we can test for.

Now my question is this, “Why do those tests? Why just have a routine ultrasound on everybody? Should we do an ultrasound on everybody? Does that really help me help you take home a healthy baby or does it help the baby’s chances of growing up and being healthy?” So for example again, testing a mom to see if the baby has a risk for chromosome problems — does that help the baby? What do you think? Yes. It would seem like it, wouldn’t it? I just went through a whole bunch of tests that should help you and help your babies. Well, guess what? These tests don’t really help you have a better chance of taking home a healthy baby. I’m talking about just doing an ultrasound on everybody, or drawing your blood to test a baby for birth defects. It doesn’t really change anything. It doesn’t seem intuitive, but think about it. If the baby had a chromosome problem, when does that happen? Early. It happens at conception. Can we change it? Not necessarily. Right?

So, if the tests don’t really help me, as a provider, help you have a better chance of taking home a healthy baby, then whom might the test benefit? Parents. The Parents. Yeah. You, as parents, exactly. So I guess the question is, what do you hope to gain from testing? Not everybody will choose to do all these tests. Some will choose some, and some will choose others, and some will choose not to do them. But if you’re going to do the test, you know what’s the possible benefit of doing screening, for example, to find out if a baby had a chromosome problem before the baby was born? How could that help? Prepare yourself if it is, in fact, true. Yeah, yeah. So if you knew something, you could get ready for it. I think this is very useful as a couple, as a family. Good. So it can give you some knowledge, gives you some preparation.

But what do you do if a baby has troubles? Some people would choose not to continue the pregnancy. Now let me spend just a second talking about how that works in the military. First of all, we don’t do pregnancy terminations for baby reasons in the military. We can’t in our system. You can’t do a pregnancy termination in the military hospital for baby problems, nor can you pay for it with TRICARE or military funds. But you still have the right as a parent to have a pregnancy termination if you chose to do so; you just have to pay for it yourself outside of the military system.

Now, I don’t want to dwell on the concept of pregnancy termination because it’s difficult to talk about. It’s kind of a yucky subject. But here’s the thing, knowledge and preparation and consideration about whether you should continue or not are really the two questions that are addressed by whether or not we should do some of the screening. So that was the issue. If somebody comes along in the office and says, “You know here’s a test to test for birth defects. Would you like the test?” Most people say, “Well sure.” The problem is that what are you going to do with the information? Is it going to help you? Is it going to help you make decisions about what to do? Some people, like I said, are upset even thinking about the idea of pregnancy termination and wouldn’t even think about it. So for moms that feel that way, for example, there may be a lot less reason to do some of these screening tests. Okay, and we’ll address that as we go a little bit more.

But of course nobody wants or is expecting to have an abnormal result, right? And if you do the test, what are you hoping to get out of it? Information. Peace. Okay. That was awesome. It’s funny that you said peace. Peace of mind, isn’t it? Almost every time that I ask this question, somebody says, “I’m after peace of mind.” Doesn’t it go back all the way to that first question? Is the baby okay? Right, and you need some reassurance and so we do these tests to reassure ourselves that the baby is okay. We’re after peace of mind. It’s funny that everybody says that. Enough people say it that I’ve got a slide that says it, because that’s what happens. We’re all after peace of mind because we expect and hope that we’re going to get some reassurance that things really are okay in there.

The problem is, this is kind of what I was getting at earlier. There’s a price to pay for peace of mind. It has to do with the fact that these tests — the screening ultrasound and blood tests — are what we call screening tests. Now screening tests are different from diagnostic tests. A diagnostic test is a “yes or no” test. A screening test is a higher or lower risk test. So, let me give you an example. How do we screen for breast cancer? Anybody know what do we do? A mammogram. Yes, a mammogram is a screening test. Yeah, exams. You know we used to teach moms about doing self-breast exams, right? We do mammograms at the right age or with certain risk factors or family history. And we do all these things to screen for breast cancer. Why do we do it? Because it helps us, right? It helps moms to have a better chance of doing well. 

Let’s say you’re in the shower one day and you’re just washing off and you notice a lump. Does that mean you have breast cancer? No. Not really, right? Most lumps are benign, actually, that’s non-cancerous. Most people have biopsies and it’s no big deal but it’s an incision, so there’s a small chance of an infection or bleeding. You know in rare cares you could get a bad enough infection to lose a breast or something. It’s a fairly common and fairly benign procedure, but it’s not without some risk. Do you see the point? The screening tests tell you about higher or lower the risk and the diagnostic tests tell you “yes or no.” So screening tests aren’t completely accurate. In fact, again, most breast lumps are benign.

But the point is that there is a price to pay for peace of mind. There’s a price to pay to know yes or no because most yes or no tests are invasive. Okay? So you’ve got to think as you get ready to do testing, not only am I going to do screening but what am I going to do if the screening test is positive? Am I going to be willing to have the invasive test? All right. So does that make sense? Any questions about screening tests versus diagnostic tests?

When is a good time to get these screening tests done? Thank you for asking. We’re going to talk about times. There are some times you can do them early and some times later on in the pregnancy. So if I don’t get to that question then come back at me and make sure I get it, all right? All right. All right we’ll come back to it.