A Frank Ob/Gyn's Message

An honest assessment of all things medical and ethical.

Archive for the month “October, 2011”

Does the pill cause abortion?

Of all the harms caused to the woman by so-called hormonal “contraception,” there is a lethal harm to her children that is largely unrecognized by most. I am speaking hear of the abortifacient effect of the hormonal forms of contraception. In an age when secular medical ethics has lost its grounding in any sense of absolute truth, there are some vestiges of professional values still being taught to medial students. One of the values we are taught to uphold is that of respecting a patient’s autonomy. Accordingly, there is a standard of informed consent before we engage in any sort of treatment for a patient. This means that merely obtaining the patient’s permission is inadequate. We need to make sure that the patient truly knows what he or she is consenting to, hence the qualifier “informed.”

 

Tragically, when it comes to the prescribing of birth-control and related devices like the “IUD” (intra-uterine device), informed consent is exceedingly rare. Since surveys of women consistently show a majority are at least personally opposed to abortion, the most rational conclusion is that few of these women would not intentionally take a medication that causes an abortion of her own child. These same women, then are understandably devastated when they do finally learn what this drug has been doing to their bodies as well as to the bodies of the children they didn’t know they had.

 

Every medication has a “mechanism of action” (MOA) as described by pharmacologists, and some have more than one. Hormonal birth-control has 3 mechanisms of action. Two are contraceptive (in that they prevent fertilization), whereas one is abortifacient (meaning that an abortion is induced). The first contraceptive MOA suppresses the ovaries so that they are less likely to ovulate–release an egg. The second contraceptive MOA is an alteration of the cervical mucus that slows the movement of the sperm. The abortifacient MOA is an alteration of the uterine lining that prevents implantation of the young embryo that normally occurs around 6-10 days after conception/fertilization. Surprisingly, most patients and physicians are only aware of the first MOA in this list. However all 3 of these MOA’s have been regularly cited in the package inserts of micro-sized print that very few people have ever read.

 

The next question that naturally arises is “how often does the pill cause abortions?”. An accurate answer to this question is very difficult obtain. The various studies on the frequency of “break-through ovulation,” (when a woman taking the pill still releases an egg) vary from 1-20%. In the U.S., there is a known 3% sustained pregnancy rate (meaning that the human embryo survives long enough to implant and be detected by the woman). This translates to 420,000 detected pregnancies every year. Since there is very little research on the incidence of induced abortions due to the “inhospitable” or “hostile” environment of the uterine lining, we can only guesstimate how often this occurs; these children die before implantation and easy detectability. Having examined the available science on this matter, the best estimate I have come up with is that most women on hormonal contraception will have had at least 2 induced abortions caused by the drug. The important issue here, however, is not how often it causes abortions, but the fact that this occurs at all with a pharmaceutical agent marketed simply as a “contraceptive.” Hypocritically, those who claim to be “pro-choice,” have shown no interest in allowing the woman to have medically accurate information necessary to make an informed choice on this matter that intimately affects their body as well as their child’s.

 

Sincerely,

Dr. Frank

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Why didn’t anyone warn me?

G.K. Chesterton once said “In truth, there are only two kinds of people; those who accept dogma and know it, and those who accept dogma and don’t know it.”

In few areas is this reality as dangerous as it is in the current proselytism of the birth controllers. Here, I will touch on why hormonal “contraception” is a dangerous human toxin (later we can address why it is also an environmental toxin).

When a patient is at risk for initiating hormonal contraception, I have a professional obligation to warn them of the harms to her body caused by such a “medication.” Among these, the most serious are the following: increased risk of breast, cervical and liver cancer; increased risk of deep venous thrombosis (blood clots), and increased risk of stroke. Thorough analysis of the available research repeatedly shows an increased risk of pre-menopausal breast cancer (the most aggressive type) and a closer examination reveals that young women who take hormonal contraception before their first full term pregnancy are at greatest risk (more than 40% increase) after 4 years of consuming this toxin. An even less appreciated non-contraceptive harm to women pertains to cervical cancer. Hormonal contraceptives, along with HPV infection, play a significant role in the development of cervical cancer. In fact a typical woman’s risk of cervical cancer is increased by 280% after 5 years and by over 400% after 10 years of hormonal contraceptive use. With profound disappointment, I’ve witnessed that most ob/gyns and even cancer specialists are unable to appreciate this deadly risk factor even in their birth-control taking patients who already suffer from precancerous lesions in the cervix.

If my earlier use of the word “toxin” seems extreme, one should consider that in 1999, the World Health Organization’s International Agency for Research on Cancer (IARC) identified oral contraceptives as “carcinogenic to humans” in the “Group 1” category which includes the other most harmful factors such as asbestos, benzene, DES, formaldehyde, hepatitis C, HIV, mustard gas, and radioactive plutonium-239. To my amazement, the WHO reaffirmed this classification in 2005; a striking example of honesty in an organization with an otherwise poor history of integrity in matters of human reproductive health (as seen in the United Nations financial support of coercive sterilization and forced abortion programs).

Due in part to minimal reporting of this politically inconvenient scientific data, there is a tragic scope of ignorance among even the most respected physicians, scientists, politicians, and public policy makers. Because of this lack of knowledge, I never accuse other physicians of intentionally causing harm when they routinely recommend and prescribe oral contraceptives to nearly all of their pre-menopausal patients. Unfortunately, despite good intentions, they are simply doing what they were taught to do without full knowledge of the harm they cause.

The scandal of unreported information on these matters is unprecedented. The most plausible explanation is that at the highest levels of public policy, there is greater concern about supposed overpopulation than women’s health. The dogma of overpopulation and birth-control as reproductive health has blinded these religious zealots to rational science that would truly serve women. One could even argue that such high-profile organizations like the “Komen for the Cure” and others (who purportedly are raising awareness about breast cancer) through their silence on this most preventable risk factor are advancing the same epidemic they claim to fight.

Please see check these web-accessible references for use in spreading these important truths that all women deserve to know:

http://monographs.iarc.fr/ENG/Monographs/vol91/mono91-6.pdf

http://www.who.int/reproductivehealth/topics/ageing/cocs_hrt_statement.pdf

http://polycarp.org/

 

Sincerely,

Dr. Frank

Do I need birth control?

I ended my article last time with a brief introduction to the concept of lactational ammenorrhea. Again, this is that natural process where the hormones associated with milk production in the nursing mother delay further ovulation for a time. For the vast majority of women (over 98%), this spacing of fertility lasts for at least 6 months if they are exclusively breast-feeding. After 6 months, most babies are starting to eat other foods and the effect on continued breast-feeding varies from woman to woman.

The timing of this return of fertility leads us to our next topic—family planning. This term “family planning” itself is loaded with assumptions. One implication is that those who fail to do such “planning” are somehow irresponsible or even selfish. Another, is the notion that one’s fertility is somehow a dangerous thing that must be reined in and “controlled” through very deliberate “planning.” Thus, the now routine classification of every pregnancy as either “planned” or “unplanned.” Those pregnancies designated to be of the “unplanned” variety are treated entirely differently both in specific situations and in terms of social policy agendas. In fact, amid demographic statistics and epidemiological literature, such “unplanned pregnancies” are treated in the same manner as a serious disease afflicting entire populations of women. No doubt, the birth controllers have waged a very effective public relations campaign at every level of society over the past century. This social engineering has succeeded in replacing within the minds of many, the natural law based concept of fertility as a healthy condition with an unnatural fear of one’s reproductive potential. One might even say we live in a society full of “fertility-phobes,” especially among medical professionals.

Consider the following examples: At many birthing units, women are asked not just once or twice but up to 7 or 8 times before discharge what they plan on using for birth control (such was the routine where I began my training). In medical school, I recall the residents literally handing out packages of “birth control” pills to nearly every postpartum woman on their morning rounds. The implicit message being “you’ve allowed this to happen once already, so you should not let it happen again.” As if the amazing gift of a new human life is a disease that should not be allowed to re-infect the hapless woman. (Only recently have the complications of life-threatening blood clots led to the recommendation that women wait 6 weeks before starting “the pill.”)

International agencies calculate an interesting statistic called “unmet contraceptive need.” How do they arrive at their outrageously high numbers? Simple, they assume all fertile women in the country of interest have such “need.”

Finally, medical students are taught that contraception is the greatest preventative medicine. Interesting…then the worst disease must be pregnancy. If we fail in preventing the disease (pregnancy), we must act quickly and decisively to eliminate the disease (this explains why increased contraception leads to more abortion, not less–as the purveyors of birth control falsely claim). Follow this perverse logic to its conclusion: “when the human species is finally extinct, we will have finally eradicated this greatest of all diseases.” Indeed, whose religion is determined to destroy humanity with its insatiable and irrational hate?

–Dr. Frank (Ob/Gyn)

Why should I breastfeed?

Having journeyed through the entire 9 months of pregnancy, we’ll finish the topic of basic obstetric medicine with a few points on postpartum care.

Usually, a woman stays in the hospital for 2 days following an uncomplicated vaginal delivery and following an uncomplicated cesarean delivery typically she stays 3-4 days. Few hospitalized patients are as joyful and glad to be there as the woman having just birthed a baby. Fortunately for us doctors, few patients in the hospital are as healthy as most of these women. In fact, there isn’t much for us to do afterwards. If the woman’s blood type is Rh negative, she’ll need a dose of Rhogam to prevent her from developing antibodies that could harm a future baby. If she lost an excessive amount of blood, she will need iron supplements at a minimum and possibly even require a blood transfusion. Aside from these and a few other minor needs, there is usually little else to be concerned with prior to going home.

Difficulties with breast-feeding, however, is a relatively new problem in the course of human history. By the early 1950’s, successful marketing strategies for commercially produced breast-milk substitutes described as “infant formula,” had convinced an entire generation of women that bottle-feeding this new product was somehow superior to traditional nursing. As a result, what has been described as the “womanly art of breast-feeding” (see La Leche League’s book of the same name) that traditionally was passed down from mother to daughter has almost entirely been lost after two generations of effectively promotion of “formula” bottle feeding. For this reason, most women trying to breast-feed are attempting a practice that neither their mother nor grandmother have any experience with. In recent years, however, the medical community has discovered reason upon reason to fully endorse breast-feeding as the evidence mounts as to the benefits for both mother and child resulting from this practice that so clearly follows natural law. Among these advantages for the baby are: less risk of allergies, asthma, diabetes, obesity, and caries; additionally these babies benefit from passive immunity (antibody protection from respiratory, ear, and gastrointestinal infections), as well as better jaw, teeth, and speech development. Breast-feeding mothers benefit from the following: decreased risk of breast and ovarian cancer, less risk of adult-onset diabetes, less stress, less risk of postpartum depression, less cost, better mother-infant bonding, and easier loss pregnancy weight. Providentially, our otherwise sexually disordered society is regaining a more authentic appreciation of this aspect of a woman’s body as an organ for providing nourishment for infants rather than a mere an object for the amusement of men.

Finally, an important benefit that is less appreciated (even among most physicians) is that of natural fertility spacing. Women who exclusively breast-feed their infants have a 0.5-2% chance of conceiving a new child (an effectiveness much greater than most contraceptives). This is due to a natural phenomenon known as lactational amenorrhea. In fact, women rarely had births closer than 2 years apart prior to the introduction of “baby formula.” Next time we’ll embark on a more thorough discussion of family planning and contraception.

–Dr. Frank (Ob/Gyn)

Do I really need an epidural and pitocin?

With this post, we’ll begin a discussion of birth itself. As a medical student during my wife’s first pregnancy, I read a book entitled Husband Coached Childbirth, which would profoundly influence my future career path. I was deeply moved by how the author, Dr. Robert Bradley (an Ob/Gyn), encouraged the woman’s husband to play an active role throughout the pregnancy and especially the parturition. Having already grown sensitive to the suffering that many women experience during their pregnancies, I found it refreshing to discover this revolutionary vision of a husband’s role in support throughout pregnancy and the birthing process. An attitude where pregnancy and the birth process is treated as a healthy condition was a welcome contrast to the disease-centric focus of most modern medicine. With a keen eye for the various factors influencing modern man’s ideas about pregnancy and new life, I heartily welcomed this natural-law based approach to child-birth that truly honored and affirmed the dignity of women.

During the weekly childbirth education classes my wife and I attended, we prepared for what to expect and I learned how I could be most helpful and supportive as a husband. Since then, among the thousands of deliveries I’ve witnessed, my wife’s have been among a very small minority that were willingly completed without medical intervention (i.e. no pain medication or inducing agents). For some women pain medications and inducing agents are helpful and even necessary, however, I don’t believe these interventions should be considered obligatory and a routine requirement for an event (birth) that is normally a healthy physiologic process. In fact, unneeded medical interventions often lead to a chain of additional interventions with the ultimate result being a stressful hospitalization experience similar to that of a critically ill person in an intensive care unit. In fact, the number of monitoring cables and tubes attached to the woman is typically greater than required of critically ill patients in intensive care units. Many woman receiving multiple medications and interventions feel deprived of the fullness of that joy they experienced during a childbirth with fewer medical interventions.

There are two analogies that I find useful to better illustrate my perspective: 1) The role of the doctor during labor and delivery should be like that of a lifeguard at the beach. Most people get along fine playing and swimming in the water, however, occasionally someone needs the immediate life-saving assistance of the lifeguard who is attentively observing. 2) Labor is a physically intense event that is greatly aided by adequate preparation and encouragement, much like an athlete running a race. The suffering is bearable and even meaningful when the finish line is in mind, and especially when supporters give continued encouragement from the sidelines. In contrast, imagine how counterproductive it would be for family and friends to suggest that the marathon runner drop out of the race during the last mile of the race, exhausted though she may be. Finally, a Christian appreciation of the redemptive value of suffering is another factor that often influences a woman’s decision of whether or not to seek every available analgesic during the birth process. In the words of St. Paul, “straining forward to what lies ahead, I press on toward the goal,” (Phil 3:13) and “yet, woman will be saved through bearing children,” (1Tim 2:15). Similarly, an athlete willingly accepts the physical pain of intense training and especially during competition knowing that this is necessary for success. Indeed, the success is all the more glorious in light of the sacrifices and pains that were required to reach the goal now attained.

Should my labor be induced?

Last time, I discussed issues of extreme prematurity that may occur spontaneously. This time, we’ll learn about the issues of medically induced labor.

As for intentional early inductions, there are three reasons this may be done. One of these is legitimate and honorable, the next is based on misplaced priorities, and the final one flows out of a completely corrupted conscience. I will sometimes induce labor early (anywhere from 28-38 weeks) when the health of the mother and baby are in jeopardy if the pregnancy is prolonged much further. Notice that I say “the mother and baby,” not simply the mother or the baby. In the vast majority of such unfortunate situations (such as severe pre-eclampsia), early delivery is necessary for both of their health, not just one or the other. Other conditions of pregnancy that may warrant induction prior to 39 weeks if labor has not yet occurred would include the following: gestational diabetes, gestational hypertension, and cholestasis of pregnancy. We prefer to avoid inductions prior to 41 weeks in healthy pregnant women. After 41 weeks gestation, though, even women without medical complications reach the point that there is greater danger of fetal harm in letting the pregnancy continue. At this point, the baby’s nutritional needs will begin to exceed the capacity of the placenta.

Occasionally, the mother will request an induction between before 39 weeks of gestation for matters of personal convenience. Alternatively, the doctor may encourage such an early induction out of convenience for the physician. Medical research does show increased risk of respiratory difficulties for infants induced before 39 weeks gestation. Thus, 39 weeks is the threshold after which even elective inductions are considered reasonable and safe. So-called “social inductions” done for reasons unrelated to maternal or fetal health should not be performed prior to 39 weeks of gestation. However, each woman needs to understand that any induction can double the likelihood she will have a cesarean delivery.

The final and most reprehensible situation is that of an early induction (less than or equal to 24 weeks gestation) with the direct intent of the newborn infant dying of prematurity while resuscitative care is withheld. This is one of the induced abortion techniques that avoids the moral revulsion one might otherwise have with related surgical procedures that literally entail tearing the preborn baby into pieces.

This should not be confused with the necessary and legitimate early induction for a woman with an intra-uterine infection. In this tragic situation, both the mother and baby’s health are threatened by the infection. When this occurs prior to 22-23 weeks gestation, the baby can’t survive long in or outside the mother’s uterus. The ethical principle in play here is known as “double effect.” The death of the newborn infant is foreseen, but is both unavoidable and is unintended. It is important that we understand this key distinction from a direct abortion. When we properly understand this concept, we can better explain why induced abortion is never necessary to preserve the life or health of the mother. On the contrary, all direct abortions harm both the life and health of the woman being victimized.

 

–Dr. Frank

What if I delivery early?

This week, we’ll continue our journey through a pregnancy and speak about the issues pertaining to the preborn child’s development and how it is affected by the timing of delivery.

First we’ll discuss a concept often described as the “limit of viability” for the newborn. In other words, at what gestational age can the preborn infant survive outside the womb? In the past 2 decades we have seen significant advancement in the medical care available for premature infants. Preborn children as young as 22 weeks “gestational age” are increasingly being reported to be discharged from the hospital alive! (Remember this is actually only 20 weeks of “embryonic” or “conceptional” age!) An interesting point to note is that the survival at 20 weeks conceptional age depends entirely on the care given by the medical staff. In the U.S., only 19% of these infants are offered life-saving care; as a result only 6% of these infants survive. In Japan, where these children are more likely to receive resuscitative care, their survival reaches 34%!

Clearly, the chances of survival increase dramatically as the preborn child passes 24 weeks “gestational age.” In fact, the most current statistics suggest that survival without major complications reaches approximately 77% at this age. Furthermore, less than half of these children will suffer any significant longterm health problems as a result. Lung development is the critical factor during the initial transition from life inside the womb to life outside. The closer to 40 weeks of gestation the baby reaches, the less likely she will have respiratory difficulties upon birth. One of the key inventions we employ is the administration of steroids to the mother whom we suspect is in preterm labor. The steroids here are used to accelerate the development of fetal lung maturity. The use of this treatment has indeed contributed greatly to the increased survival of premature infants. In fact this treatment regimen is used for any woman suspected of preterm labor up to 34-35 weeks gestation; after this point, respiratory distress is so rare that steroids don’t offer much benefit.

 

We would do well to recognize that flawed pro-abortion logic frequently places the mother and child at enmity in an erroneous understanding of biology and medical health. Accordingly, in most modern nations throughout the world, (including the U.S.), stunningly unjust laws have permitted the outright killing of these children at the sole discretion of the mother. In an age where we fancy ourselves as being part of a civilized and just society, we can no longer turn a blind eye to these most violent forms of prejudice and discrimination. The scandal of legalized abortion today can be likened to laws that gave the slave owner absolute authority over the life or death of his slave. The preborn child today is denied basic human rights in the same way African slaves were. In fact recent case-law has treated these children precisely as property when disputes over “ownership,” arise between biological versus surrogate parents (more on this in a later column).

 

–Dr. Frank

Is my sugar too high?

This week, I’ll address the issue of screening pregnant women for gestational diabetes (or diabetes of pregnancy). Chronologically following a woman through her pregnancy, this is the next test we normally obtain at around 28 weeks (although we obtain an additional test earlier if the woman is at higher risk for this condition). The screening test most often used is called a “one hour glucose tolerance test.” While there are variations on the theme among different clinicians, this test is performed by measuring the woman’s blood glucose (sugar) level one hour following the consumption of a standardized 50 gram “glucola” drink. If the woman’s blood sugar is elevated, a confirmatory 3 hour glucose test is performed to confirm the diagnosis of gestational diabetes.

This diagnosis is quite significant because it will require of the woman major changes in her daily routine. First of all, she will need to begin checking her blood sugar on average 4 times per day. At the same time, she will have to make serious changes to her diet. These changes will usually entail the moderation of total caloric intake and keeping a healthy balance of the 3 major macronutrient categories–carbohydrates, proteins, and fats. In fact this effort to establish healthy proportions of the major food types is probably the most important intervention of all.

The American Diabetes Association recommends carbohydrates contribute no more than 33-40% of calories, protein 20%, and fat 40% of a persons caloric intake. Interestingly, these numbers are not that far off from the “Zone diet” first popularized by Dr. Sears in 1995 which recommends a 30:30:40 balance of carbs, protein, and fat respectively. From my research on this issue, both of these recommendations are good and are applicable to everyone–not just those with diabetes. In fact, we are indeed seeing obesity as a major health threat worldwide. In the U.S., over 33% of adults are obese (the official medical term for those who have passed the mere “overweight” classification). Adults in Ireland are close behind with over 20% meeting criteria for obesity. The major causes of this problem seem to fall into three categories: 1) over-eating; 2) eating an unhealthy proportion of carbs (especially highly refined starches that like simple sugars, rapidly raise blood sugar levels); and 3) an increasingly sedentary lifestyle lacking the amount of physical activity required for health of body. Excess food consumption has become a sort of modern drug taken in attempt to fill our spiritual emptiness in a society that seems to have forgotten God and the need of prayer. When is the last time you heard a sermon preached on the danger of gluttony (one of the seven deadly sins)? The unhealthy trend of dominating our diet with carbohydrates and refined starches is in part a result of junk science that for decades promoted a “low-fat” diet as the key to heart health and prevention of obesity. We are now learning that such “low-fat” diets are causing the very problems they promised to prevent. If it were not for the heavy political promotion of such diets by vegetarian advocates, an honest assessment of the medical science would have warned us of their real danger. Finally, our fallen human nature’s propensity to laziness or sloth (one of the other seven deadly sins) has been the catalyst resulting in the rapid increase in the prevalence of this global epidemic never before heard of in human history.

In summary, type II diabetes (traditionally referred to as “adult-onset” diabetes), gestational diabetes, and obesity are all closely related conditions. They can often be treated with dietary and lifestyle changes alone. Indeed, I consider medications like insulin when they are required, to be a last resort. Next week, we’ll talk about the issues related to induction of labor and elective c-section.

–Dr. Frank

Am I having a boy or girl?

This week, we’ll discuss the routine anatomy ultrasound of the baby that is generally obtained around 20 weeks “gestation” (or 18 weeks since fertilization and conception).

For many women, the only obstetric ultrasound that I find useful is this 20 week anatomy survey. By analyzing the reflection of sound waves through fluid, the ultrasound device gives us a sort of window into the womb of the mother. In fact, this remarkable technology is one of the greatest advances in obstetric medicine. In essence, it allows us to obtain the baby’s first physical exam months before he or she is born! The most memorable aspects of this exam for the mother and father are discovering their child’s gender and seeing more recognizable images of their child’s face, hands, and feet. I believe that this halfway point in the pregnancy is a milestone where the mother benefits greatly from and is encouraged by such pictures of the child whose hidden movements she is now feeling.

The clinician, however, is more focused on the assessment of the particulars of the child’s major organ systems often with a sharp focus looking for any structural signs of a possible genetic abnormality. For instance, I often receive reports pointing out an “echogenic” (more highly reflective of sound waves) areas in the brain, heart, stomach, or bowel. These findings are usually associated with healthy babies, are transient, and are of themselves medically irrelevant. In fact up to 17% of healthy (i.e. “normal”) babies will have some of these findings which are called “soft markers.” However, these findings are more frequently found in the rare cases of genetic anomalies such as Trisomy 21, also known as Down’s Syndrome. Such information of itself can be authentically useful for the mother and her physician even when the option of induced abortion is unthinkable to both. Sadly, though, much of the modern approach to obstetric care has put an inordinate amount of valuable time and resources into this antepartum (before birth) detection of aneuploidy (chromosomal abnormality). Especially in the countries where abortion on demand is legal, there has emerged a veritable “search and destroy” mission that tends to dominate the resources of routine care and academic research within obstetric medicine. In fact, in many nations, led by the U.S. example, abortions are routinely performed after 20 weeks and even beyond 24 weeks when most babies would survive a premature delivery. Suspected chromosomal abnormalities or other anatomic defects are a frequent motive of these late-term abortion procedures.

Nonetheless, I stated earlier that I do find this 20 week anatomy ultrasound to be helpful–though certainly not out of a desire to brutally dismember and destroy any child I suspect may have a genetic disease. On the contrary, certain conditions will affect how I treat the mother and preborn child for the rest of the pregnancy with an aim to preserve the health of them both. For example, an ultrasound diagnosis of a certain fetal conditions like growth restriction may require closer monitoring and even early delivery. Some structural defects can even be treated with in-utero surgery a specialty centers. Such an attitude toward promoting life has always been the noble goal of diagnosis in the Hippocratic medical tradition of “Primum Non Nocere” (Do No Harm). Recall my description of the 20 week ultrasound as the preborn baby’s first exam. Can you imagine a physician scheduling the execution your 2 year old child after he diagnoses a genetic disease during a routine physical exam? Induced abortions should be just as unthinkable.

–Dr. Frank

Is my baby going to be alright?

In the last post, I reviewed the importance of establishing a due date. The next issue we address early in the pregnancy entails assessing the woman’s overall health with particular attention to any medical problems that may affect her health and that of the baby during the pregnancy.

We start by obtaining a detailed medical history. Assuming there are no preexisting conditions such as diabetes or hypertension, we then proceed to run a series of routine blood tests. The only ones that are really necessary for most women is a blood type, blood count, and urine culture. The blood typing will assess for any risk of developing antibodies against the baby’s blood cells. This is a serious complication that could occur during a second pregnancy if the woman’s Rh type is negative. Fortunately, this condition called “hemolytic disease of the newborn” is now very rare precisely because we test for and preventively treat women who may be susceptible. Women who are “Rh negative,” will receive a medication called “Rhogam,” around 28 weeks gestation in order to prevent her body from developing antibodies against her preborn infant’s blood cells. The success of this routine test and treatment is truly one of the best success stories in modern obstetrics, wherein the incidence of hemolytic disease of the newborn is rarely seen anymore. Next, the blood count test will assess for any underlying anemia which may need to be treated. Finally, the urine culture will test for any undiagnosed urinary tract infection which during pregnancy is more likely to spread to the kidneys.

The other routine testing is controversial and often lacks sound scientific rationale. These can be divided into two categories. The first is that of infectious disease testing (for the variety primarily transmitted by sexual contact).

In the U.S., most obstetricians will routinely test for gonorrhea, chlamydia, hepatitis B, syphilis, and HIV. In my experience, it is highly unlikely that a woman will have any of these infections if she lacks both symptoms and potential exposure based on her history. The pertinent history is whether she has abused IV drugs like heroin or whether or not she is in a mutually monogamous sexual relationship (as in a faithful marriage). Rather than utilizing the rational approach of simply basing our testing on the individual patient’s actual risk factors, we have resorted to the politically correct yet inefficient, wasteful, and unscientific approach of assuming all our patients are IV drug abusers routinely engaging in sexual relationships with multiple partners. I have never even met another physician who has diagnosed HIV, syphilis, or hepatitis B in a woman based on these “routine,” tests alone in a woman without known risk factors. Ye,t we continue to use this approach rather than run the risk of being labeled “ judgmental,” for utilizing these tests only on the women known to be at risk. During an era of ballooning health care costs, this obvious waste or resources should certainly be addressed. We may even have to let go of our social engineering agenda of treating all manner of sexual activity and perversions as normative. To do so, however, would run the risk of exposing the common sense truth that certain behaviors entail commensurate risk that pose real physical danger to a woman and her preborn child.

The second type of routine prenatal testing is even more problematic in terms of medical legitimacy. I am speaking here of those tests used to supposedly assess the risk of having a child with a genetic or other congenital defect. Among these are the “triple screen” (recently replaced in most areas by the “quadruple screen”), nuchal translucency ultrasound (often done in combination with a serum PAPP-A test and HCG), amniocentesis, and chorionic villus sampling. These tests can be grouped into two categories.

The first would be that of the non-invasive “screening” tests, which will actually only provide a statistical number giving a particular % risk of having a child with Down’s Syndrome for instance. Among this first group are the “triple screen,” the “quadruple screen,” and the nuchal translucency (NT) ultrasound combined with a PAPP-A/HCG blood tests. The relative advantage of these tests is that they are non-invasive in that they pose no direct risk of harm to the baby. The major drawback to this group of tests is that they are very inaccurate and misleading. For example, a cut-off of 1/250 or 0.4% is often used to give a woman an “abnormal result.” In other words, 99.6 % of women given this “abnormal” test result have perfectly normal children; yet, for the rest of their pregnancy they live with the fear and anxiety that something might be terribly wrong with their child. Many, if not most, of these women will feel obliged to proceed with the next level of testing–the invasive and diagnostic.

The only definitive prenatal testing that is truly diagnostic is also invasive and poses risk to both the mother and baby. The most widely available test in this category is amniocentesis. This procedure requires piercing the woman’s abdomen, uterus, and the fetal amniotic sac with a long needle in order to obtain fetal cells from the amniotic fluid. This test poses risk of infection to mother and baby as well as the risk of miscarriage. The next test is even more invasive and entails inserting a long cannula through the cervix to obtain a piece of the placenta for testing purposes. While this test is more accurate and can be done earlier, it also carries even greater risk to mother and baby.

Why, one might ask, would we recommend such tests to our patients? The answer is quite simple, yet unpleasant. We offer them out of fear that a woman might have a child born with a genetic defect who would then sue us for wrongful life! This sort of medical liability would be based on the woman not being offered all of her “options,” in regards to prenatal testing. In the U.S., an entire field of “pseudoscience” has been dedicated to various techniques and schedules of prenatal screening and testing. They have as their end, the earliest detection possible of genetic or congenital abnormalities. They exist directly as a result of legalized and widely available induced abortion. The early detection emphasized because more abortionists are available to perform and women are lest resistant have to early abortions. Therefore, women should be aware that if induced abortion is not a procedure they would consider, there is no good reason to procure one of these early screening tests. We must acknowledge, however, that it has been argued that information by itself is a good and even an abnormal result could be helpful for the mother not pursuing abortion by allowing her to prepare emotionally. Unfortunately, this argument overlooks the problems of inaccuracy associated with the non-invasive tests and those of risk associated with the invasive tests.

In summary, I routinely inform my patients of the availability of all these tests, yet I advise against their use. I do, however, advise them to obtain a routine 20 week anatomy ultrasound which serves the legitimate purpose of a physical exam of sorts for the preborn baby. If there are any medical conditions for which we can meaningfully intervene or prepare for, we are typically able to detect them during this ultrasound. My patients are most appreciative of this frank, no-nonsense counseling that treats them as responsible adults able to make informed decisions. Contrast this with the overbearing “paternalism” imposed by the wasteful “one-size fits all,” approach promoted by the mainstream medical profession. Next time, we’ll step into the much less controversial matters of the diagnosis and treatment of diabetes in pregnancy.

Sincerely yours,

Dr. Frank

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