Older mamas and testing

[melixxa]

I'm 40. I'm pretty dead-set against amniocentesis (I think!) but I'm also pretty sure I want to get a quad screen in combination with a 20-week ultrasound.

I'm just wondering what other older (or "older") mamas are planning test-wise and how they came to the decision, how they view the test situation and their chances of risks. My midwife was telling me yesterday that she thinks the age-related risk thing is incorrectly reported or presented or emphasized - or something (I totally let this slip by me as we had so much else to discuss - it was our first appt. - and I felt so nauseated the whole time). Any thoughts?

[CathToria]

I will be 37 when I deliver this baby. I find that my age FREAKS out the OB's in my MW's practice :eyesroll . I feel like I am getting a lot of pressure to test, but i am still not doing anything that is not medically necessary. I did agree to a higher res u/s at 20 weeks with a high risk u/s center. But I am not doing amnio or afp (I've heard that the high rate of false positives can be even higher in older mamas) IMO, they want more testing to cover their own a$$

Good luck making your choices!

[sm3247]

I'm probably not considered "older" but my feeling is that some tests do more harm than good. If you get the us or afp, keep in mind that there is a fair chance that there will be a sign of something wrong and will be more pressure to test with something like amnio. My own concern about amnio is that I would get more accurate information than with other tests, but there is also approximately a 1-2% chance of miscarriage caused by the procedure. For me, that is just too high.

With any test, you should ask yourself whether the results would change what you're doing. If not, remember that you always have the option to decline.

Congratulations on your pregnancy!

[heveasoul]

I will turn 37 almost one month after baby's edd. I declined on the blood screens, and on the cvs, but I after much agonizing, reading, and discussion, I did go for the 20-week u/s. Thankfully the results were good, with no ambiguity that would lead to further testing.

The pp stated how I approached the decisions: will the results change anything?

As for the screening for chromosomal abnormalities, I decided we wouldn't do anything different - as in, we would not terminate, and we would still want to proceed with a hb. I felt the m/c risk wasn't worth it, plus the risk of false positives, plus the fact that my age itself would bump me up into a higher risk range. It was a leap of faith we decided to take. I felt in my heart that all was ok.

As for the 20-week u/s, it was very tough. In the end, I felt that if I was that undecided (all the way up to the waiting room), perhaps I needed to do it. If there had been a heart defect, we would plan for a hosp birth, and if there was spina bifida or a diaphragmatic hernia, in-utero surgery might have been an option. I had the technician keep it as brief as possible for what she had to check for, and neither dh nor I wished to prolong the procedure just so we could see the baby.

Thankfully, everything showed to be fine, and I doubt I will have to make any more tough testing decisions.

I also believe that the numbers are unfairly/incorrrectly represented. I feel and look young and healthy, and although I caved to the fear-mongering of the 20-week u/s, I otherwise wish to treat this pregnancy as healthy as any 23-year yr-old's. :)

An interesting comment my 71 yr-old mother made...of course, there was no such thing as prenatal testing when she had her pregnancies, and she remembers in her village back in Portugal that women continued to have babies until they couldn't (ie 40s and 50s), and she doesn't remember there being much fear or negative consequences surrounding these pregnancies. Ok - anecdotal, but still...makes ya think.

Good luck - I know it's not easy.

[MommytoL]

I personally declined all the tests. You are at risk of false-positives with the blood screening just because of age. In other words, many tests really aren't that accurate at an older maternal age.

I did go to the high risk doctors for my u/s and they showed no "soft signs" of anything, so off we went. I had my first babe at 37 and ended up delivering with the high risk docs because of a premature rupture of membranes, so it was nice to "know" the docs since I did my early u/s with them in my first pregnancy.

Don't let anyone pressure you--do what you feel is right.

Carol

[Kerlowyn]

I had a baby 2 years ago at 39, and I will have another one in a few weeks at age 41.
With both pregnancies, I declined all testing.
For DH and I, it was an easy decision. No matter what, we would not terminate due to a poor outcome. Some of the tests are too risky for me. With the vast amount of information out there, should our baby be born with an issue, we can get the information we need right away.
I am also leery about the hight rate of false positive results.
The midwifery practice I go to supports my decision 100%. They will ask a woman if she would like any testing, will give her the info about it, but if you decline, they are fine about it. No woman is put into 'high risk' just because of her age.

It's all about your comfort level. I can understand how it is a difficult decision for some.

[wasabi]

I'm not an older mom but I have done research on these tests in making my own decision to decline them. I did want to agree with PP that they already have an abysmal false positive rate that only goes up with your age. If you get a positive you are going to face huge pressures to have a more definitive test like amnio or CV sampling. For me I decided against them because I wasn't willing to take the risks of the more invasive testing and I didn't want to have to live with the worry if I got a false positive. On top of that I'm low risk and wouldn't terminate. Is your age your only risk factor? You might want to ask yourself what you're willing to do if you get a positive to help you decide if it's worth the worry and stress.

good luck
robyn

[AmyB]

During my 1st pregnancy I was 40 and I got all the tests This time around I am 43 and I am seeing a direct entry midwife and have only had one ultrasound.

I have had some intense pressure from friends and family who are mainly worried about Downs syndrome. An aunt by marriage had a severely retarded son with Downs and I frankly do not think I would be a suitable parent for a Downs child so I suppose I should have had the test. I confess that I had a couple of days of remorse about that once it was too late for an abortion.

I don't know if I can explain exactly why I didn't do the amnio, but during my 1st pregnancy it seemed like the notion that we could control things caused more problems than it solved. I got stuck with a needle pretty much every time I went into the Drs office, and usually the Dr would tell some terrifying story about some bad thing or other that might happen. When I was in labor the hospital insisted that all kinds of of "just in case" treatments were needed. I let them do some of it and I am positive they did more harm than good. The experience of my first pregnancy was pretty much constant worry about impending disaster. I spent a lot of time crying.

So this time around I'm overreacting in the opposite direction by not doing one single thing "just in case". When a crisis actually happens, then I'll do something to deal with it. Until then I'm assuming that everything is just fine.

--AmyB

[Meli65]

I was 35 when pg with ds, and we did a nuchal translucency test, which is pretty rare (available in NJ, at any rate). You get an u/s early on and they measure the size of the back of the fetus's neck -- apparently if everything tests out all right your risk factor goes way down (like, from one in 100 to one in 600) so we decided the odds were in our favor and declined all further testing. (Although we did have a couple more ultrasounds -- there was some concern about my cervix as I had had a LEEP procedure several years earlier).

This time I am 39 and will confess the idea of birth defects really scares me. Ds is such a wonderful child, and we like our life as is -- although I am very AP, I still enjoy my selfish pleasures a LOT and like my space and time alone (when I can get it). Still, I feel that the die has been cast at this point and we have to do whatever we have to do -- I chose to get pregnant, knowing that things don't always go perfectly, KWIM? So, no tests for me (I think -- maybe an u/s at twenty weeks).

[napless]

I had my first child at 36, my second at 38, and I'm pregnant again at 41. I declined all screening tests each time. Dh and I discussed the issue seriously and both agree that we would not terminate - so there seems no reason to test.

(Actually, the first time around I was thinking along the lines of "maybe it would be better to know so we would be prepared". My midwife gave me good advice: She said that couples she has known who knew in advance that they would have a Down's baby were then anticipating the birth of a "Down's baby". Those who didn't know, gave birth to a "baby" who just happened to have Down's.) That made sense to me.

We'll deal with whatever comes!

[melixxa]

Thanks for the replies. It's interesting and instructive to hear other people's situations.

My first pregnancy was very much like AmyB's: lots of testing, lots of anxiety, lots of crying. I felt stressed out during most of my pregnancy and I really wonder how much of an effect that had on my (stressful) labor.

No is going to pressure me to have any tests done this time, and I'm definitely getting fewer than last time. Maybe I won't do the triple or quad screen at all. The u/s is the only one I'm sure of. My mom had me when she was just shy of 41, and I will be 2 months shy of 41 when I have this baby.

I know it's anecdotal, but I love that story about the women in Portugal having babies until no more came and not as many problems as one might think. Yes, we live in a medicine-testing-technology-and-science-induced time of anxiety, don't we? I have chosen to go with a direct entry midwife exactly because I don't want my pregnancy to be completely shaped by all this hoo-ha. On the other hand, I want to be as safe as possible. It can be hard to balance.