The Politics of Amniocentesis

I was reading People magazine the other day, and it got me thinking about the following question:

Why would an expectant mother have amniocentesis performed?

Far and away, the most important reason for doing amniocentesis must be that knowing there are abnormalities early provides the option to get an abortion.

The reason I was thinking about this question is that Sarah Palin underwent amniocentesis; I generally wouldn’t expect someone with her views on abortion to do so, given that, presumably, she would not view abortion as an option.

And indeed, when the test revealed that the baby had Down syndrome, she did not choose to abort. (On the question of Down syndrome and abortion, see also this earlier blog post.)

So what other reason would lead you to undergo amniocentesis?

I guess knowing you have a Down syndrome baby well in advance could be useful for planning. What’s strange, if Palin’s reason for doing the test was early planning, is that she kept not only the Down syndrome news a secret from her own children, but even the pregnancy itself. “Not knowing in my own heart if I was going to be ready to embrace a child with special needs … I couldn’t talk about it,” she said.

She hid the Down syndrome news even after the children were told of the pregnancy. When the baby was born, 14-year-old Willow commented, “He looks like he has Down syndrome.”

Palin’s response: “If he does, you know you will still love him, Willow. It’ll be okay.”

I find all of this incredibly strange. If knowing that the baby had Down syndrome gave Palin the time she needed to embrace the child’s special needs, wouldn’t you think that time would also have been valuable to her children for the same reason? And even after the baby is born, and Willow sees the baby has Down syndrome, the mother is still describing the situation in terms of “if he does,” when she knows the actual truth. Her explanation was that she didn’t know how to break the news.

As a parent, perhaps I err too much on the side of being honest with my kids about things. All my children were raised knowing that their older brother Andrew had died, how he died, when he died, etc. The same is true with respect to the fact that two of my daughters were adopted. When my wife catches me watching shows like COPS with the kids, she makes me change the channel, but I’ve always thought there is value in children knowing something about how the world really is.

I can understand how people would disagree with me: letting an 8-year-old watch COPS may very well be a terrible idea. But can it possibly be a good idea to hide from a 17-year-old or a 14-year-old that their new brother will have Down syndrome?

And can “not knowing how to break the news” possibly be a justifiable rationale for withholding that information?


Trish

I think decisions about when/whether/what circumstances to become a parent are extremely personal & complicated, and the only position a government can take that is consistent with that is to leave it to the individual potential parent. I distrust people who are so willing to say what all people should do about the issue of choosing circumstances in which to parent or not.

My hypocrisy detector starts binging when someone who publicly opposes abortion in circumstances as dire as rape & incest undergoes a test that is known to cause a certain percentage of pregnancies to fail - could this be some sort of not-really-abortion abortion?

I doubt that someone who is on record describing herself ready to run the country would be a shrinking mouse who could be bullied by medical personnel into having a test that is dangerous to pre-born human life usually performed for the purpose of deciding whether to continue a pregnancy. Even if amnio is being performed because of concerns about stillbirth &/or quickly-deadly conditions like Tay Saches, someone who opposes abortion & has reason to worry about a baby born dead or dying could conceivably prepare for the possibility without risking the fetus.

I would never deprive Sarah Palin of her right to choose to not have more kids than she could handle, or to avail herself of any medical technology available. But I would not vote for someone who would not allow me the dignity to make the same decisions for myself.

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steve

glad to see everyone is so neutral and compassionate on this issue! i just asked my wife who is a nurse practicioner about this. women over 35 are "highly encouraged" to have this procedure because its very likely they will have children with down. the procedure is not anywhere near 100% accurate, and my wife's best guess was that it makes no sense to prepare a family for a situation that might not happen. this also explains the "if he does (have it)" comment, as palin was holding out hope until it was official.

Steve Kirkham

Just to start on the right foot here:

For the record, though I'm generally conservative, I believe abortion should be state provided at no charge to any pregnant female. Immediately, no questions or age limits. period.

Men and women both have the right to control their own bodies.

That said...

Your article is also the height of hypocrisy. The siblings have a right to know the baby has a defect, but Sarah herself doesn't if she isn't willing to abort?

Leavitt writes:"And can "not knowing how to break the news" possibly be a justifiable rationale for withholding that information?"

Mr. Leavitt, nobody has to justify to you how they decide to break the news to their own children that their sibling will be born with a defect.

To say that this is none of your business is an understatement. Your hubris is astounding and nauseating.

Yes, you're a brilliant man who makes a living studying others and enumerating their collective private urges to the world. It's only acceptable to do for groups, not individuals.

Your article is muckraking. The only possible presidential question here is "Can the VP candidate be trusted to keep her mouth shut with vital state secrets."

Did you have a long and honest chat with your childern before they entered kindergarden to let them know that statistically they had almost no chance of living more than another 90 years? Did you also let them know that there even a real chance they'd be dead before they were old enough to have kids of their own? Did you discuss with them the rest of life's potential horrors?

The Palin couple wanted to a glimpse into the future for themselves and their unborn child. Possibly they thought they might discover something that early treatment could cure. Possibly they just wanted to have one less worry in life, since they're the ones responsible for raising this child.

And just possibly, they felt that their teenage kids had enough to worry about in life without worrying about a future that may not even happen, since childbirth isn't 100% survivable.

Perhaps the Palins also decided not to tell anyone without a need to know so they could postpone seeing their private grief on the front page of the New York Times.

If one of your children had a birth defect, would you be trumpeting it here?

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Dan

Not to bash Palin, nor to offend anyone, just a thought, The bastion of journalistic integrity the National Enquire reported the possibility of Mrs. Palin having an affair. Amniocentesis can be used to obtain DNA in order to determine paternity prenatally. I doubt this is the case, again just exhausting a possibility I did not see in a quick scan of the comments.

JD

Even at her age, the odds greatly favor a non-down child (1/60). Ex ante, the greatest advantage of the test is not having to worry about the issue anymore. Her religion forbids abortion, it does not forbid worrying about having a child with down syndrome. Even excluding abortion, the tradeoff looks like:

59/60 = happy pregnancy; 1/60 tough pregancy (1)

v.

60/60 some degree of constant worrying (2)

I don't see why choosing (1) is per se irrational.

Benizmir

Vilification of Ms Palin in a most elegant and discreet manner is the Politics of Freakonomics. Whether she deserves it or not; she deserves it not.

ilze42

I agree that she has very poor judgement in general. She took some interesting risks with the life of her child by having the amnio and flying so close to the delivery of the baby. These actions (coupled with her age)seem very inconsistent with a pro-life stance, due to the risk of miscarriage. The conclusion I reach is that she considered the abortion but feared the impact on her political career if it ever came to light.

Thanatos Savehn

The problem I suspect is that so-called liberals, or progressives, tend to be fundamentalists and so never question their secular faith (which nowadays tends toward narcissistic nihilism). Thus, they have a very hard time comprehending the constant struggle that is faith.

I don't doubt that Palin considered abortion. I don't doubt that at some point, alone with her fear, she questioned her beliefs. But now I know that she overcame her uncertainty and vanity and doubts and selfishness. And that tells me what I need to know. She didn't surrender. She fought on.

pat kelly

Steve,

Wow - it's amazing how one can destroy so much of their respect in such a short writing.

dan (a med student - correct me if I'm wrong)

Just thought I might share some helpful background - amniocentesis is not a procedure that is routinely offered to pregnant women, as it is fairly invasive, and does carry a small risk of inducing miscarriage (though that risk continues to decline as physicians get more skilled at it). Most of the time it's only done as a follow-up to abnormalities found in routine prenatal screening tests.

In the case of Sarah Palin's pregnancy, she probably had an abnormal triple screen, which is a routine blood test offered sometime between the 15th-20th weeks of pregnancy. An abnormal triple screen raises the possibility of Down's syndrome (among other things, like neural tube defects), and is commonly followed by amniocentesis as further investigation.

For most women, having this info in advance is helpful
1) in deciding whether or not to continue the pregnancy (obviously not Sarah Palin's issue here given her rigid anti-abortion stance)
2) getting a head start in planning for the child's care. As the media has noted, raising a baby with Down Syndrome takes a lot of work on the part of the parents. Now that she's on the GOP ticket, it makes you doubt whether advance planning for the child's care was really on her mind when she underwent the procedure, but let's not forget her husband's role in all this. He's raising the kid too, he needs to adjust his life to this baby's needs as well. This is of course assuming that HE knew about the pregnancy as well. As weird as this story is, I want to assume that he did...
3) just knowing for the sake of emotional preparation. I'm sure every parent plays out in their head the birth of their perfect healthy little baby. When the child unexpectedly comes out looking different, it's tough.

Additionally, since amniocentesis is typically used as a follow-up study, I can't imagine many mother's that are going to leave an abnormal triple screen result just hanging in the breeze and NOT go through with a more definitive test like an amniocentesis. You can also repeat the triple screen, but if that's abnormal again, then you'd still wind up with something like amniocentesis.

Agreed that I don't quite get the logic of not telling her other children about Trig's condition. But while it does strike me as unusual, it's their own private matter.

Other situations that call for amniocentesis: to assess fetal lung maturity as one poster mentioned above (this info affects how a doctor might manage preterm labor); to assess if there's any infection in the uterus; to assess if the mother has harmful antibodies that might be attacking the baby's blood cells. Neither of these was likely to be why Palin got her amniocentesis however.

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Sam

If Sarah Palin does not know how to break the news of her newborn baby having Down Syndrome to her children, how will she be able to "break the news" of the (inevitable) bad news that will strike the country (if McCain wins, then dies (because he's old and has cancer)) if she becomes President, to the people of America?

Or will she just hide it until it really bites hard?

*footnote: I am not sure if this comment is redundant, but I did not have time to read all 75 previous comments.

Jessica

So what's Sarah's view on the practice of medicine and medical insurance? I guess, any and all procedures should be paid for even if they are of limited medical use. Doctors, of course, always know best and can be trusted.

Also, I guess she believes that mothers-to-be are welcome to engage in risky behavior which might endanger the health of the fetus.

And that lying to your family about major life issues is OK since they have no stake in the outcome.

JenM

There are a number of heritable diseases that (as observed by an earlier poster) will likely result in either a stillbirth, or a newborn's rapid, painful degeneration to death within the first year or few. Infantile Tay Sachs, for example. Or Sandhoff disease. I can't think of good search keywords, but I know there are other metabolic disorders that have similar results.

Not that routine amnios screen for these things, but they could, if one or both parents are known to be carriers. I believe that, in general, most Americans would support the rights of the parents to decide what to do when finding that their fetus has a problem that's basically incompatible with life.

Mike

Steve,
The fact you are open with your children about everything is abhorrent. I just don't understand how you can tell them about how things really are and a) ruin their childhood, b) give them a sense of reality being 'normal' and therefore 'good,' c) expose deviant behavior of yourself, others, and potential role models of theirs that may cause them to mimic those actions, d) etc.

Or maybe the fact that you do this is none of my business and not really worth ANY OF MY BLOG SPACE.

Since there are women on this forum who have cited personal examples and examples of friends undergoing amniocentesis under similar circumstances as Sarah Palin, a discussion about whether there is any other real reason to perform amniocentesis when the mother is pro-life and NOT considering an abortion can be closed.

jz

How to understand physician priorities as reflected in their recommendations:

1st: CYA
2nd: patient's best interest
3rd: revenue potential

Todd

my wife and I have 3 kids. With each pregnancy, the OB simply tells us we are having x test, which will tell us z. They never broach what our options are if the test comes back positive or ask if we want the test. My wife and I have discussed it and while we are pro choice, she knows she could not bring herself to have an abortion, but she still has many of the tests because they are never presented as optional.

Tom

There's nothing strange at all about this. When my wife and I were expecting, we asked the ultra-sound tech to tell us the sex of our baby, not because it would have changed anything about our actions, but only because we were curious and wanted to know as soon as possible. Clearly, a 44-year old pregnant woman would know that the likelihood of having a downs syndrome child was greatly elevated, and she wanted to know as soon as possible if in fact this was the case. Why she would leave it until the birth of her baby to tell her other children is really none of anyone's business. I find it striking that so many, including you Steven, think that somehow this should be a matter for speculation. Very sad.

Bridget

"One can be pro-choice until that first ultrasound let's you hear that heartbeat. "

This is such a misstatement of the pro-choice position. Pro-choice doesn't mean "Abort! Abort!" - it means "Protect the rights of all women to make their own choices about their reproductive future". It is IN NO WAY a contradiction to be pro-choice and choose to carry a child to term, whether it has special needs or not. There are MILLIONS of pro-choice women who have never had an abortion and would never even consider it for themselves - they just don't think they should be allowed to make that choice for other women.

Unlike Gov. Palin...

Reality Check

Did it ever occur to anyone that maybe she was stressing herself to the limit in the hopes she would miscarry?

Then, if there is no baby, there would be no need for an explanation to anyone.

Moose hunting, long trips, long flights, hiding the truth from all.....

sarahCMS

The process of Amniocentesis definetly is a very contreversial one. Last week a similar articel was published, and many people agreed with the process, while others thought of it as inmoral. Depending the situation of the person, their values, etc, is that this process can be examined. Clearly those who choose to goo through with it is because their marginal benefit exceeds their marginal cost. For example a young mother, who most likely is able to have another baby if abortion happens. While probably an older women's marginal cost will exceed its benefit, since she will probably will not be albe to have another child. Situations and values vary, therefore so does decisions.