Someone suggested to me that I write a post about the triple screen/quad screen test offered to pregnant women. (See links below for more background) Warning: this raises some very controversial issues.
I am going to start by saying I am not a parent, and I have never been pregnant. I have never been faced with the situation of deciding whether or not to have prenatal screening done. I want my readers to understand the position I am writing from – I have no idea if facing the situation would significantly change my views or not. That being said, you have no idea if my facing the situation would change my views either, so please don’t try to tell me that it would change everything. You have no way of knowing that about me.
The triple screen or quad screen test is a blood test given in the second trimester of pregnancy to measure the levels of three substances (triple) or four substances (quad). Those substances are AFP, hCG, estriol, and inhibin-A (this is not measured in the triple screen test). Combined with other factors like age of the mother, these measurements allow for an estimation of the chances of certain abnormalities (Trisomy 21, Trisomy 18, and other chromosomal abnormalities as well as neural tube defects)*. In other words, these tests do not diagnose problems, they indicate further testing may be necessary.
Many people decide not to have this screening done. They say that even if they knew the results, they would carry the pregnancy to term regardless. Other reasons may be that insurance does not always cover the test and that the mother is of a young enough age that the risk is low. While I understand this attitude, I can see a lot of reasons to get the test.
If you are one who would consider aborting a pregnancy, the test is a no-brainer. There are a lot of reasons why you might abort a pregnancy when told there’s a high chance your baby would be born with a handicap or debilitating genetic/chromosomal disorder. Everything that I’ve ever read says raising such a child is exhausting. Most people do manage to find a bright side – one woman’s description indicated that every victory is fantastically exhilarating – but they freely admit it’s very difficult.
Financially speaking, a handicapped child will likely be a burden if only because they will be your child for the entirety of their life. In addition to this, there may be medical complications, surgeries, or other problems. There will be either an opportunity cost equal to that of the income that a parent would make if not caring for this child, or, in the case of hiring a nanny there is the direct cost of the nanny’s salary.
Emotionally speaking, the toll of raising such a child is not something everyone is willing to pay. Emotional exhaustion, relationship stress, self-blame, self-pity, being unavailable to have another child – all of these are possible outcomes. Add to that the possibility of stress that would come from knowing you and perhaps your spouse are the only people willing and able to love and care for this child for the rest of their life. If you die, what will happen to them? I imagine that could be an incredibly stressful thought.
In the case of some chromosomal disorders, the problem isn’t always how exhausting it will be to raise them, but how long before they will die. Will you be letting your child be in pain for all of their short life? Will you be able to withstand the emotional toll of losing your child at a young age after watching them suffer for most of their life?
Do not think, even for a second, that I advocate for the screening of all children and the destruction of those that might be a drain on parents or society. I think it is fantastic that many parents are willing and able to love and cherish any and every child they give birth to. I think it is fantastic that children with mental handicaps are able to grow up without being treated terribly, institutionalized or called “the village idiot.” If you are someone who, when you become pregnant, is committed to carrying to term and raising the child, that’s wonderful. Good for you. Still, I think you should consider having first trimester screening or the quad test done. Why?
Even if you would never consider aborting a fetus, for whatever reason, these tests can be valuable. Special needs children have special needs. To know ahead of time that your baby may be born with Downs or Edward’s can only be helpful. If you are given the chance to prepare, there will less of a shock when you find out. If you are prepared for such an outcome, and your baby is born completely healthy against the odds, you only have cause to celebrate. From my perspective, knowing what to expect would make life easier.**
Finally, if you do consider aborting, I don’t think there’s anything wrong with it. As I mentioned, special needs children can be exhausting. If you decide you are not emotionally prepared to raise such a child, you are making a responsible decision. If you feel financially ill-equipped to raise such a child, you are making a responsible decision. If this outcome fits in your moral framework, do not allow others to make you feel ashamed. It is important that you believe you made the right decision within your own moral framework. Whether or not it fits into someone else’s framework isn’t particularly important.***
*Trisomy 21 is Down Syndrome; Trisomy 18 is Edwards Syndrome (this is what Rick Santorum’s daughter has); neural tube defects include spina bifida and anencephaly.
**I do fully accept that not everyone feels this way. I don’t understand why, but I do realize it.
*** I should probably point a couple of things out: I don’t advocate this approach for everything. I am not making a blanket moral statement. This fits in my moral framework for a variety of reasons, perhaps paramount of which is that what I’ve read suggests fetuses don’t feel pain.
Quad Screen description at americanpregnancy.org
Triple Screen description on the University of Minnesota’s Medical Center page.
First trimester screening description on the University of Minnesota’s Medical Center page.