38. In My Country, Part IV

I asked S to return, to discuss results of antepartum screening. Four pregnancy "hormones" are measured and in a complex equation compared with the results of other women whose outcome is known. The results: for every 71 women the same age and weight as S, with the exact same results, 70 had normal babies and one had a baby with Downs syndrome. So her risk of having a baby with Downs Syndrome estimated at one out of 71. Using age alone as the predictor, one would estimate her risk for Downs at about one out of 200. I offer her an amniocentesis--withdrawing fluid from the amniotic sac, containing cells sloughed off from the fetus, which can be nurtured, after a couple of weeks yielding enough DNA to give a definitive answer. Problem is that the procedure has a 1/400 risk of miscarriage. It's always a tough call. S immediately declines the amniocentesis, a decision entirely consistent with her earlier request for an elective cesarean delivery. Baby comes first.