Genetic testing has become the norm, rather than the exception as increasing numbers of women are becoming parents after the age of 35. From mid-thirties through a women's forties, the chances for abnormalities increase dramatically.

For example, prior to the age of 35, the chances of having a child with down's syndrome are smaller than the risk of miscarriage from the procedure which tests for it. But at 35 years of age, a woman's statistical probability of having this complication of pregnancy become equal to the risk associated with the amniocentesis procedure. After this point, risk of chromosomal abnormality increase dramatically into a woman's mid to late forties. Still, it is far more likely that a woman at 45 will indeed have a healthy, normal child. (A point that sometimes loses its place in the mound of statistics, but is worth remembering!) And the birth of a special needs child, can occur at any time, precipitating a life-changing event in any family's life cycle.

Psychological factors involved in genetic testing

By far the most common procedure pregnant women over 35 use is the amniocentesis, performed between the 16th and 18th week of pregnancy. The chorionic villus sampling which offers earlier detection (at 10-12 weeks of pregnancy) of chromosomal abnormality is also a common test which many women of this age are choosing, even though the risk of miscarriage is higher with this intervention than the amnio test.

For most women, the reason to use this earlier detection test is psychological. Should they receive bad news, terminating a pregnancy before 12 weeks looms less traumatic. And shortening the period of emotional stress caused by "not knowing" if everything is all right may play a factor in women who are at greater risk abnormalities due to family medical history.

But psychological variables are not contained to the timing of genetic testing alone. For some, whether to even have a test is not only a psychological, but a moral issue. Our mothers often wondered, or even worried, whether their unborn child was "all right" within the womb. But it remained a mystery to them. Have you ever heard the saying, "Careful what you ask for you might get it"? This is the psychological dilemma now facing many women in their standard course of prenatal care.

What decision is right for you and your family?

Genetic counseling is a relatively new field. A skilled genetic counselor is trained to help you sort through the risks specific to you, and help you consider your options. Psychologically, women make different choices based on their personal beliefs, their perception of their own risks, the accuracy of the tests involved and their perception of their ability to cope with a potential special needs child.

Factors in continuing a pregnancy...

Working in therapy with women who have chosen to continue a pregnancy that showed signs of possible abnormality has revealed to me that if a woman feels accepting of what kind of child she has and believes she will be able to cope with and benefit from such a mother-child relationship, she does not terminate the pregnancy. In these cases, however, the woman also believes that her child's situation may be mild, rather than severe, as often the degree of the problem cannot be identified from the prenatal test.

Religious and personal beliefs, as well as support from family members and a positive experience with disabled children also impact these women towards this choice. When the decision is not based on firm religious beliefs, a mother may also be influenced by the effects that a special needs child will have on the rest of her family, especially children. Will they suffer or gain from the experience? This is an answer only the parents can decide and are most qualified to do so because they know their own personal resources and limits.

Counseling can help you determine whether your lifestyle and psychological make-up help rather than hinder your adjustment to parenting a special needs child. One advantage of having genetic testing, even if you do not believe in terminating a pregnancy, is to help parents prepare for a special needs child. Particularly, if there is medical history which indicates a greater likelihood of a genetic problem.

Reactions involved in choosing to terminate

Working with women in therapy who chose to terminate pregnancies in which genetic risk was identified carries predictable stress. Guilt arising from the decision can haunt a woman, particularly in her next pregnancy. This should be anticipated, and counseling during the early part of a subsequent pregnancy, particularly through the period of testing should be obtained.

Dealing with guilt

An example was a first time mother who terminated her pregnancy at 16 weeks, following a positive test for Down's Syndrome. She did not avoid the childbirth, (an option whereby the fetus is removed from the womb with the mother unconscious) but proceeded with a fully conscious labor and delivery of her small child. She and her husband held and mourned her baby after birth in a very courageous acceptance of facing her situation and the decision she and her husband made. The following year, she came for counseling due to premature labor, which began at the same time she had terminated the first pregnancy. Guilt and tears flowed as she expressed her great emotional pain. With support, she was able to accept her past actions, but not allow them to keep her from loving the new baby on the way. Guilt had caused her to feel unworthy of motherhood, a reaction that kept her apart from the child she now carried. Her early contractions abated, as her guilt eased, and her amnio test showed a healthy child. With therapy, she was able to sustain and deliver two healthy children she now loves and cherishes.

This situation brings up some of the process of working through tough decisions that can arise with the choices we are now presented with in modern science.

Disagreements

We live in a time of great information which causes us to make more responsible decisions. But disagreements arise about the definition of "responsible action". This is especially problematic if the husband and wife disagree about whether or not termination should occur in the case of a positive test result. Or the manner in which a pregnancy should be terminated. Certainly the woman must make choices pertaining to her own body. Still, a husband's needs when in conflict with her decision will be a major stressor on the marriage and should be handled with the help of a family counselor knowledgeable about prenatal choices.

Responsibility is a personal choice, defined and based on deeply held beliefs and commitments. Our families are like gardens. We nurture each other's growth and development. Can we choose what to plant, or feel is necessary to weed out of our garden? Apparently so. The question each of us must answer is ..do we not have the right to plant what we want, and weed out what we do not? These are deeply personal and psychological questions which some find easier than others to address.

Like any other parenting decision that will arise in the future, the answer that is right for you is the one you make together. Be prepared to reach out for help along the way, especially if your genetic test comes back positive. Genetic counselors and family therapist experts in the prenatal period and parenting fields can support you in working through the emotional repurcussions to the choices medical science has now made available to us .

What is the "right" choice, however, is personal. And our decision shapes not only our lives, but the lives of our family members, too. For some the answer of whether to test is an easy one. For others, not. But when a test comes back with possibilities for genetic problems, the choices get harder for almost everyone. With choice comes responsibility and commitment to that choice. With commitment comes maturity. Prenatal testing can introduce a course of soul-searching. But isn't that what parenthood requires?