Women of Size and Prenatal Testing

by Kmom

Copyright 1996-2009 Kmom@Vireday.Com. All rights reserved.

Last Updated:  May 2004

DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your healthcare provider.

SPECIAL NOTE: It is not in the scope of this FAQ to truly cover all prenatal testing thoroughly, only to address it in general and as it concerns big moms. Kmom urges all pregnant women to thoroughly research any test before deciding whether to use it or not. Do NOT accept blindly what your doctor tells you. Ask questions and consider all sides of the issue. Testing decisions vary greatly depending on family history, medical condition, parental beliefs, etc. For more information on prenatal testing, see the many prenatal testing FAQs available online.




"The technology of prenatal diagnosis is usually presented to us as a solution, but it brings with it problems of its own...the technology of prenatal diagnosis has changed and continues to change women's experience of pregnancy."  

---Barbara Katz Rothman, The Tentative Pregnancy


All pregnant women in our technology-happy modern society face confusing choices about prenatal testing, its advantages and disadvantages, and its appropriateness for them. 

"Obese" pregnant women face even more confusion, since prenatal testing can be more difficult in this population, and the results can be more confusing. However, since they may be at a somewhat increased risk for problems like neural tube defects, they also face greater pressure than others to have these prenatal tests, even though the tests are often difficult to interpret.

This section is an attempt to present an overview of the basic prenatal tests most pregnant women in the US are pressured to have, including Ultrasounds, the AFP/Triple Screen Test, Gestational Diabetes tests, and under certain conditions, Amniocentesis.  It is further designed to address the special concerns that women of size might have in taking these tests---their fears, any special equipment that might be helpful, the controversies over interpretation of results, whether large women have a higher rate of so-called 'false-positives' on certain tests and why, etc.

It's important to remember that discussing prenatal tests can be simple or incredibly complicated, depending on the degree of detail that is needed and the point under discussion. This FAQ is NOT intended to be a full explanation of all the intricacies of taking and interpreting various prenatal tests, but rather a discussion of them as they pertain to "obese" women instead. 

A brief description of the test, its purpose, and the procedures are given for each, but the majority of the information is about the specifics of large women and the test. If you need more detail about statistics, interpretation of results, rates of 'false-positives', etc., then be sure to research the many websites devoted to prenatal testing online.

It is also important to realize that most women take these tests without fully considering all of the implications of the test.  Most women think of these as a simple blood test, a cursory part of prenatal care.  They don't consider that intimately wrapped up in the question of prenatal testing is the moral dilemma of abortion and the thorny issue of eugenics. Barbara Katz Rothman points out: 

The history of prenatal diagnosis has roots in the eugenics movement...part of its history has been an attempt to control the gates of life: to decide who is, and who is not, fit to make a contribution to the gene pool.

Katz Rothman is by no means arguing against the use of prenatal testing; she actually presents a number of compelling reasons to consider it.  Her writing is a fair and balanced look at the intricacies and difficulties of this issue.  But she has found through extensive interviewing of parents involved in such testing that most of them were simply unprepared to confront the scope of the types of decisions presented by prenatal testing, and that choosing such testing often changed the way a woman experienced pregnancy in subtle ways.

Parents who are considering using prenatal testing need to be sure they really understand the following issues BEFORE the test takes place: 

More on these kinds of questions is available on other websites about prenatal testing, but it vitally important that parents think about these issues BEFORE they decide whether or not to test.

Readers may feel that there is a strong anti-testing bias in this FAQ.  It is true that Kmom's own experiences with many of the prenatal tests (detailed in the FAQs) have largely been negative and this has caused her to reassess her initial opinion of prenatal testing.   However, Kmom is not against all prenatal testing; she has chosen to use prenatal testing before,  and if she were to have more children, would continue to use certain tests (though not all).  

So although Kmom is not a fan of universal routine testing and urges women to carefully consider the risks and benefits of each test, she fully supports whatever informed choices women make about prenatal testing.  She understands and supports when women opt for prenatal testing, and she understands and supports when women opt out of prenatal testing.  

However, Kmom is strongly concerned that so many women enter into these tests without understanding all of the implications of the tests.  Part of the purpose of this FAQ is to help women understand the pros and cons of each test, the risks and benefits of each, the scenarios they might face should their screening test come back positive for possible problems, and the possible choices involved with each test.  And because the overall bias of our technological culture is towards doing more and more testing, Kmom feels an extra responsibility to challenge the automatic assumption that more testing is always better.  

However, by no means is she condemning testing completely, nor does she criticize those who choose to test.  Prenatal testing has certain advantages and in some situations can be a great help.  She is simply pointing out that the issue is far more complex than most clinicians would have patients consider, and that parents need to ask themselves the hard questions before they begin the process.  Similarly, parents who opt out of testing need to also ask themselves hard questions about the implications of that decision too.

Finally, it's also important to note that none of these tests are mandatory. Although many women are simply told that they will be taking these tests, it is ALWAYS your right to decline any or all of these tests. Just because you are 35 or over, for example, does not mean that you HAVE to have an amnio, and just because you are "obese" does NOT mean that you have to have the AFP/triple test, an amnio, or the gestational diabetes test.  Conversely, it is also your right to request certain tests if they are important to you.  

You have the right to accept or decline any test or treatment during pregnancy. It is YOUR body, and YOU have the ultimate choice. Research the issues carefully so that you make an informed choice, and then either request or decline the test, based on your individual needs and values. 

Don't let any provider try to bully you into (or out of) tests---listen to their counsel, do your own research, and then MAKE YOUR OWN CHOICES.

And as always, best wishes to you whatever you decide.    --kmom

Copyright 1996-2009 KMom@Vireday.Com. All rights reserved. No portion of this work may be sold or reproduced, either by itself or as part of a larger work, without the express written permission of the author; this restriction covers all publication media, electrical, chemical, mechanical or other such as may arise over time.

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