ANSWER

Dear Wendy,
Your dilemma precisely sums up the problem with prenatal diagnostic testing. First of all, diagnostic testing puts the focus on problems that can occur in babies' development during pregnancy. Even though many mothers can retain a sense of blissful optimism, if you receive worrisome test results, or if you have had any prior experience with childbearing crisis, or if for any other reason you are well aware that bad things do happen, then this focus on looking for problems can be extremely stressful.

Secondly, when screening results aren't squeaky clean, the health care practitioner is obligated to follow-up, even when a test is notorious for yielding "false positive" results -- false alarms where in most cases, further testing reveals that the baby has really been fine all along. For example, in your case, a result of "bilateral dilation of the renal pelvis" is a common result that only indicates to the lawsuit-cautious doctor the need for further testing, and is not an indication of bilateral hydronephrosis. There is another test for bilateral hydronephrosis that can be carried out in a few more months, and most likely, further testing will show that your baby's development has been healthy and normal. But in the meantime, this testing process puts you through a wringer of needless worry for your baby. This is truly unfortunate, considering your baby is most probably just fine.

Thirdly, prenatal diagnostic testing is not a perfect indicator of what is going on with your baby. Even with the latest medical advances, doctors cannot examine every aspect of your baby's development and condition. They can only rule out some, but not all problems. Plus, for the tests that do exist, doctors look for results in the normal range, but it's a fact that different babies develop at different rates in different areas throughout pregnancy and infancy, and just because your baby is outside the norm, doesn't mean that your baby's development is defective. Furthermore, even when a baby is truly, absolutely fine today, testing never offers a complete guarantee for what the future holds.

One way to avoid prenatal diagnostic testing anxiety is to avoid prenatal diagnostic testing. After all, prenatal diagnostic tests do not promote your baby's health, they merely identify problems, and in some cases, such as chorionic villis sampling (CVS) or amniocentesis, can actually cause problems that risk your baby's life. Nor do diagnostic tests lead to a treatment or cure for chromosomal or developmental defects. (In contrast, it is important for you to be monitored -- e.g., keeping an eye on your blood sugar, blood pressure, and signs of preterm labor -- as many maternal conditions can be treated for the benefit of your baby.) And if you absolutely wouldn't consider terminating a pregnancy, then you may well decide to skip diagnostic testing unless you want prenatal assessment so you can envision your future and possibly make important plans about the birth and care of your baby.If you just "want to know," or if your baby is at risk for having certain problems (such as chromosomal anomalies due to advanced parental age -- and even here, you can decide whether 35 is a reasonable cut off, or if 42 works better for your situation) then you must consider that you have to be willing to tolerate a certain level of anxiety created by testing. Doctors and midwives are also aware of which tests tend to give false alarms, and you can ask for information about the false positive rate, as well as the rate for complications from testing techniques, and take this into account as you balance the risks and benefits for you and your baby.Of course, even if you choose to avoid prenatal testing, this doesn't automatically eliminate anxiety, it just eliminates a specific avenue for anxiety. So, you weigh the anxiety of testing, waiting for results, and having some, probably incomplete information- against having little information and trusting fate and nature.

Finally, diagnostic testing or not, whenever you find yourself in an anxiety-provoking situation, there are steps you can take to calm yourself physically, emotionally, and spiritually. It can help to practice stress reducing habits such as deep breathing, meditation, exercise, rest periods, reducing your work load, journaling, positive imagery, or talking to a trusted friend or counselor. When you're unsure of what's happening with your baby, focus on positive assumptions, and banish the negative ones, which will only drain you. Take one day at a time, focusing on what you can know about your baby right at this moment, and dismissing those fears that arise from your imagination or catastrophic predictions for your future. Take a wondering attitude, and trust that whatever unfolds, you have the babies you are meant to have, and that you can find meaning in everything that happens to you and your little ones. Trust the process, and embrace the journey you and your baby are on.

Warmly,-- Debbie and Mara
The Childbirth Complication Expert Team