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Pregnancy - Amniocentesis: Worth the Risks? May 2014

Your doctor has done some inconclusive screenings indicating some statistical probability of certain conditions such as Down syndrome or spina bifida. A more definitive test was offered called an amniocentesis. Very probably, all sorts of questions are going through your head, unless you’ve already thought this through beforehand.

Some questions you may have include, “What is this test? What are the risks? What are the potential benefits? What am I supposed to think about all this? How should I feel? Ultimately, what decision should I make?”

In this article we will examine these questions and hopefully acquire a better understanding of the issue so as to make the best decision possible for ourselves, our partner, and our child. We will approach this topic from a philosophical perspective. The hope is that, with a clear thought process, we can experience less uncomfortable feelings of anxiety and uncertainty.

DISCLAIMER: Neither Caprigon, Devtome, nor anyone affiliated accepts any liability. The individual is responsible for his/her own medical decisions and any possible consequences. This article is for educational purposes and is not intended to represent nor replace the advice of any credentialed healthcare professional.

Because medical practitioners can be rather assumptive, and in many cases possibly eugenics friendly, it may have not even occurred to you to ask yourself this question until now. This is perfectly understandable but perhaps next time you will consider the following questions:

  • Why did you consent to the initial screening?
  • How well did you think it through?
  • If there is a next time, will you consent to the screening again? *
  • Why?

Your health is your responsibility. Your family’s health is also your responsibility, hopefully shared equally by a loving partner with similar values. It is up to you, and your loving partner who you trust, to do the best you can. Nobody else can, or will, accept responsibility for your actions. Try not to let this stress you unduly, however. Unproductive worry can only complicate matters further.

It may be helpful to consider what a particular woman decided in her situation. She already knew she was at a higher risk, statistically, of having a Down Syndrome child but opted out of the initial blood work. In the New York Times article being cited, you will note that she does not claim her decision was necessarily right for everyone. She explains why she made her decision without judgment of others: http://parenting.blogs.nytimes.com/2010/09/14/deciding-not-to-screen-for-down-syndrome/?_php=true&_type=blogs&_php=true&_type=blogs&_r=1

What it Is

Amniocentesis is described as an invasive procedure where a twenty-two gauge spinal needle is inserted through the abdominal and uterine walls into the pocket of amniotic fluid within the amniotic sac. This usually requires ultrasound to be used during the operation. About ten to twenty milliliters is removed or one milliliter per week of gestation. 1)

In common language, they stick a relatively thick needle into your tummy into the tiny sac containing the unborn baby to extract critical nurturing fluids for laboratory testing. This is done in an attempt to determine, more or less conclusively, if the unborn baby will have certain types of birth defects. It is acknowledged that amniocentesis is unpleasant and dangerous which is why blood work suggesting possible conditions is needed to justify it.

What the Risks Are

Far from being a safe and routine procedure, Amniocentesis has a number of risks. As the procedure consists of breaching the nurturing environment of your unborn baby within your womb, this should be no surprise. According to the Mayo Clinic, some of the risks include the following: 2)

Miscarriage

The Mayo Clinic attempts to minimize concern by stating that the elevated risk is slight and sighting statistics claiming between one in three hundred and one in five hundred chance. These numbers are dubious in light of studies showing that about one in four, possibly higher, of all pregnancies end in miscarriage so it could be difficult to assess how much greater the risk becomes when, what could be characterized as a needle attack, on the womb is involved. 3)

Needle Injury

Aside from the obvious concern of human error or even possible incompetence, Mayo Clinic points out that during the amniocentesis, your baby might move an arm or leg in to the path of the needle. I t should be kept in mind that the whole procedure is done, usually, with the aid of ultrasound but otherwise done blindly. Another way to put this is that the doctor may jab the unborn baby with the needle.

Amniotic Fluid Leak

Once again attempting to minimize concern, Mayo Clinic claims this is rare thought they cite no statistics. They admit, in a sterile academic fashion, that if the leak doesn’t seal, it could lead to “orthopedic” problems for the baby. In other words, even if the test indicates no serious physical abnormalities with the child, the procedure itself can potentially cause some.

Rh Allele Complications

If you are Rh negative but your gestating child is not, conducting an amniocentesis can increase the chances of your immune system attacking your baby’s cells with antibodies. This is due to the possibility of the fetus’ Rh positive blood entering the mother’s bloodstream. A drug would be given to you in an attempt to prevent this particular problem.

Infection

The procedure has been known to “trigger a uterine infection.”

Transmission of Infection

If you have an infection, such as hepatitis or HIV, amniocentesis creates an opportunity for the infection to be passed on to your unborn child.

Potential Benefits

If abortion is in accordance with your beliefs as an acceptable behavior, at least in some circumstances, amniocentesis can help you make a decision. Though true morality may indeed be absolute, it is difficult to argue against abortion in cases where the unborn child may have a high risk of suffering to an extraordinary degree. However, even children with spina bifida, for instance, can oftentimes survive into adulthood and live out “normal” lives. 4)

That having been said, some of the conditions the test can verify can be extremely debilitating and even fatal. Spina bifida, to expand on that example, can be really painful and debilitating. If your view on this issue is relative, even to a small degree, amniocentesis might seem like a good idea but statistical probabilities of risk versus benefit must be considered and weighed with a clear mind because abortion may amount to, at best, a mercy killing.

Aside from considering whether or not to end the life of your unborn child, there may be little benefit in getting the test performed. Perhaps it could help you prepare for a special needs child beforehand, but that is about all the research on this article could uncover. The test is mostly used to verify whether you should consider having an abortion or not. Depending on your stance on abortion in general, understanding this could be the determining factor on whether or not you consent to the procedure.

If any Devtome member can find, or think of, any other possible benefits, they are more than welcome to list them in this section.

Coming to a Decision

If you have already consented to the initial screenings and the results come back with some concerns, there are different factors which may influence your decision to go through with an amniocentesis. When arriving at a conclusion, a number of things should be taken into account. Not the least of which is the philosophical method you use for determining whether or not it would even be ethical or moral to do so. A morally absolute belief may have possibly prevented you from doing the initial screening is the first place but this may depend on your specific circumstance. If you tend to rely on morally relative methods, such as hedonistic calculus to make a decision, the statistical probabilities must be balanced using a sort of cost/benefit analysis.

Moral Absolutism

The idea here is that, though life is full of gray areas, ones principals and ethics should not be. You may already have established firm guidelines through your religion or through analysis of your instincts and intuition that may help you in this scenario. You may find that principals based on your religion, cultural traditions, and/or gut feelings are most adequate.

If find you do not have an ethic covering this sort of decision, you could attempt to use a mind-experiment universalizing the different possible ethical stances in an attempt to determine the most moral one but be forewarned that your conclusion may change depending on the depth of your understanding of the issue. Attempting to universalize in this situation could lead to eugenics-based thinking which, throughout modern history, has proven to be ineffective and even morally abhorrent on close examination.

That having been said, universalizing can expose errors in morality imposed by one’s culture. For example, if your culture claims it is moral to give your children to a ruling priest class to be sacrificed on top of a pyramid to make sure the sun comes up, many would agree that the cultural norm is not truly normal. Universalizing this, we would ask ourselves, “Would the world be better if everyone had their babies killed on top of a pyramid or if nobody did?”

If you believe that abortion is wrong under any circumstances, you may have avoided the initial screenings in the first place unless you felt there was value in it outside of considering termination. This is an example of what can be termed moral absolutism which does not necessarily take into account potential consequences. An argument supporting this sort of ethical reasoning was posed by Immanuel Kant where he points out that we cannot ever accurately predict what the consequences are going to be. There is always a degree of uncertainty.

Hedonistic Utilitarianism

A mindset we probably all adopt, perhaps quite wrongly, hedonistic utilitarianism relies on hedonistic calculus to quantify the morality of an action. This is a fancy way of saying that to determine what the most moral action, ethic, or policy is, you can weigh the amount of potential harm to yourself and others against the amount of potential good. 5) The weakness of this approach resides in the way it can be used to justify what may not be truly moral. Moral relativism has a tendency to find its way into the equation.

Moral Relativism

Moral relativism is an attitude that true morality is not an absolute but rather depends entirely on one’s culture or other arbitrary set of standards (such as valuing the collective over the individual). It has been demonstrated time and time again to be a thinking error yet it persists to this day. Using the Socratic dialectic, it is easy, remarkably easy, to expose the irrationality of relativistic beliefs.

When you come across an individual that claims, “Of course morality is relative to culture. What is right for us may not be what’s right for others in a different society.” The thing to do to expose thinking errors is to ask questions like, “What about the elephant crunch still used by some cultures in India where they torture the animal into submission as a training technique. Is that morally okay just because their society says it is?” They may insist that it is. You keep asking questions, “how about forced female circumcision?” and so forth. Eventually you will find an example where the subject you are questioning will have to admit, unless they’re completely psychopathic, is wrong regardless of what the specific culture says.

Understandable Moral Frailty

So ideally, we try to avoid using hedonistic calculus but it can be difficult to avoid. We are all human animals attempting to survive by thinking ahead to predict possible consequences. However, oftentimes we can come to much the same conclusions as we could using a more morally absolute angle by carefully examining the issue from all sides, taking all available information into account.

If you find yourself falling into this trap, and cannot extricate your moral reasoning from an attempt to predict consequences, it may be helpful to weigh evidence very carefully. Understand that, whatever you decide, you will have to live with the outcome; whatever that may be. It may be advisable to explore the testimonials and opinions of others online. This is one of many forums which can help examine different points of view: http://www.healthline.com/health-blogs/fruit-womb/amniocentesis-not-without-risk

Reflecting on this Information

Having read this article in its entirety, the views of the author may be inferred but ultimately the decision is yours. Hopefully the essay has helped you to clarify your own thoughts. It is sincerely wished that, whatever you do, you will rest easier having more thoroughly explored the topic of amniocentesis.

Health | Reproduction | Disorders | Philosophy


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