Once upon a time in a fairy tale land that now seems far, far away, young people fell in love, got married, and started a family. But the idea of “starting a family” has taken on new meaning as pregnancy has come under the rubric of technological control. Increasingly, it is not about having children but about “making babies.” With the advent of technology and its encroachment into the world of prenatal care, “tests” and “prevention” have replaced “touch” and “protection,” and pregnancy has become an aggressively managed 9-month illness that culminates in delivery. A time of joyous anticipation has been transformed into a period of anxiety-laden responsibility—responsibility for producing a perfect product.
This phenomenon is about to escalate as leaders in the American College of Obstetrics and Gynecology are now advocating a new addition to the armamentarium of obstetricians: universal prenatal genetic counseling. In an article in this months Obstetrics and Gynecology entitled, “The Case for Universal Prenatal Genetic Counseling,” the authors argue that the array of available genetic information and testing is expanding exponentially and far outpacing the ability of an obstetrician to keep abreast and to provide accurate prognostic information to expectant parents (note that the adjective “expectant” also takes on a new ring of anxiety). Therefore, prenatal genetic counseling should be part and parcel of every pregnant woman’s prenatal care package, as is the current prenatal screening.
Indeed, we do indeed have lots of data, and an increasing number of tests and options for providing us with even more data, but skepticism queries: do we have knowledge? The two are not the same. Do we truly know which of the many genetic variants that we might be able to identify are meaningful or significant? Furthermore, what recourse is available at this point for addressing any of the variants that might be identified? The answer: none but destruction of the potentially imperfect specimen.
No doubt these recommendations are spawned from legal considerations: the desire to protect practitioners from litigation for an inability to give adequate informed consent and resultant charges of wrongful birth that might ensue. Such a desire is noble, but then one must ask: who are we in fact treating? Are we treating babies or our own professional and parental anxieties?
No doubt, technology has benefited many expectant parents and their children, but this once again becomes an issue of boxes—of putting everyone into the same undiscerning “prenatal box.” It is certainly “democratic;” but it is unlikely that every parent needs or desires such information. Furthermore, we will be laying enormous and overwhelming responsibility and guilt on the heads and hearts of many parents unnecessarily, and in the process, will be stealing from them the anticipatory joy of child-bearing–or have we done so already? And how many discarded healthy babies will be left in the wake, when, in the midst of uncertainty we err on the side of responsible caution, allowing our anxiety to rule by eliminating potential problems?
The eternal ethical question arises: just because we can, should we? Yet, is it possible for us to ignore what we “know” or think we “know”?
Will our children never know the joy of a “normal” pregnancy? Will they never again have the luxury of having children in blissful ignorance? I fear that this new anxiety- and responsibility-ridden micromanaged way of making babies–rather than having children–will, for them, become the “new normal.”