In the wake of the failure of the Blunt amendment, Rick Santorum (and many of his ilk) are is still on about government and employers paying for services that Saint Santorum deems morally and religiously wrong. This of course still means contraception and prenatal testing, because apparently morally and religiously objectionable only applies to women’s reproductive health. Ah, but I digress.
I was thinking specifically about prenatal testing this morning as I was running, especially the absurdity of making people pay for prenatal testing when it has so many applications beyond abortion. I was wondering if Santorum and his wife knew about their daughter’s genetic problem before her birth and if they did how that knowledge helped them to prepare? And then I thought about all the parents I have seen along the way who have been helped by knowing. And then I thought of someone who could have been helped by prenatal testing. Me.
No, not during my pregnancy (prenatal diagnostic for triplets is not that accurate, nuchal translucency is about all you get). Nope, I’m thinking way back to when I was a fetus. You know, back in the dark ages.
You see, I was born a healthy 8 lbs 12 ounces and continued on my merry way with no health issues (unless being precocious and mouthy are now included in the DSM-V) until I had a skateboarding accident at the age of 10. After spending a night in agonizing pain (why I wasn’t taken to the hospital is a potential source of many posts) I was eventually seen in the emergency room and required an urgent angiogram (a large intravenous placed in my right femoral artery and then contrast injected during x-rays to look for the source of bleeding). Scary shit for a 10 year old. Back in those days there were no fancy diagnostic tools such as ultrasound, CT scans, or MRIs. Bleeding was diagnosed the good old fashioned way: large bore catheters, high-dose radiation and contrast!
In the end I had a busted spleen, but was managed conservatively. However, the angiogram also revealed I had a bum left kidney. More invasive tests showed an obstruction in my left ureter (the tube that drains the kidney), which had probably been there from the get go. Over time, urine backed up and my kidney was damaged. Badly enough that a few months later my left kidney was removed. The old fashioned way where they basically cut you in half and split you open. Yeah, it hurt.
However, in an alternate reality where my mother was afforded the luxury of prenatal testing my obstructed ureter would almost certainly have been picked up on the 18-20 week ultrasound that is part of prenatal testing. At birth I would have had an ultrasound to confirm the obstruction and it would have been corrected, typically with a minimally invasive procedure (a stent to open the tube). A day surgery. But what if in this alternate realty my parents had not been able to afford the ultrasound because their insurance was not required to cover prenatal testing?
With prenatal testing I would had been able to avoid all the radiation I accumulated getting IVPs every year after my nephrectomy until the modern miracle of ultrasound (I’ve had 6 or 7 IVPs and I’ve always wondered if this affected my fertility). I would also have avoided an assortment of other nasty tests. I’d have two kidneys, be able to take ibuprofen, and not have the whopping scar that can only be described as a shark bite.
With prenatal testing I also wouldn’t have that little fear that nags at the back of my mind now and then: what happens if my one kidney fails?
Dr. Jen Gunter 
Having lived in two countries with largely government-run health systems (Australia and the UK) and a country where, unless you’re a local you need private health insurance or you’re screwed (the United Arab Emirates), I say government-run healthcare is fantastic and well worth spending our tax dollars/pounds on. If it wasn’t for free pap smears in Australia, I could have died in my 20s of cervical cancer.
Now I live in Britain, I hope to have a baby soonish and because of a serious back problem, it won’t cost me a penny to have a pregnancy physiotherapist, OB/GYN and elective C-section.
I am yet to hear any coherent or compassionate argument from any conservative as to why striving for universal healthcare is a bad thing.
Correct prenatal testing may have helped in our situation but, I’ll need your opinion. Before my son was born an ultrasound was performed and the tech asked my wife if she was diabetic. When told “no” and asked “why?” the tech responded, “no reason”. The ultrasound showed that my son was a huge baby, I don’t believe that my wife’s OB/GYN reviewed the ultrasound results. My son suffered a prolapsed cord and subsequent seizures due to his lack of oxygen and score of 0 for more than several minutes. He was life flighted to another hospital and spent 3 days on cooling therapy and 10 days total in the hospital. He is now visited by a child development specialist, a physical therapist, and a speech therapist once a week until he is three as a part of a state program.
I bring the story up for two questions (thanks for hanging in there). My wife and I were dropped from our insurance a month before the birth because of a premium payment that was a week late two months prior. It may surprise you to know that it was a government ran insurance company for the military called TRICARE. The $35,000 hospital bill was picked up by state Medicaid which we normally do not qualify for financially but, because it was a pregnancy we were not declined. It is a personal shame for me to admit that we relied on government aid especially when in my opinion we could have been self sufficient and afforded a normal birth.
Again my questions, I realize that you are a doctor and not a politician, plus I don’t believe that our politics match up completely and I’d really like to have my comment approved and answered..so I will ask straight forward questions…1. Could our situation been avoided if the OB/GYN reviewed the ultrasound and made the decision to perform the C-section earlier? and 2. Your blog heavily promotes government ran healthcare systems…are they better in your opinion? Do you prefer state medicaid patients to blue cross blue shield ones?
I’m a board certified ob-gyn physician and would like to address your question. The size of a fetus does not dictate an elective c/section unless the baby is estimated to weigh greater than 10 pounds, a condition called fetal macrosomia. However, from your description, it appears that your son might have been in a breech position because of the prolapsed cord. If your ob-gyn had reviewed the u/s and detected a breech presentation, he or she could have elected to perform a c/section based on what we call fetal malpresentation (the breech position). Hope this clarifies your issue.
L. Burke-Galloway, MD, MS, FACOG
Author, The Smart Mother’s Guide to a Better Pregnancy
Thank you, it does to a degree. I’d like to think that if the u/s taken 2 days prior to the birth showed a breech position that the tech would have sounded the alarm. The “official story” was that he somehow managed to push himself back causing the cord to push forward which caused the cord to be caught between the inside of the birth canal and his head. I’m ignorant of the field so the story makes some sense to me…although I have a gnawing feeling in my gut that there is something more to the story. At anyrate, thank you for your insight, it’s much appreciated.
I see how the legislation restricting women’s rights frustrates you but this is a stretch. Ureteral seal can only be diagnosed with level 2 ultrasound by a specialist. My husband was born with it, at 28 weeks, losing his kidney in the process. That was 30 years ago. When I was pregnant we had to go out of town to see a prenatal urologist who looked for that specific defect. Nothing standard about that. Thankfully my son is fine but you should know that this is genetic. Mysteriously, my water broke at 28 weeks so he’s a preemie, just like his dad. All that said, thanks for sharing your story anyway!
Surely it would be extremely prolife for this sort of prenatal testing to be covered for anyone who needs it? Ah, but then the extreme elements of the prolife movement would just say that it’d cause women to have more abortions for “frivolous reasons” or “convenience”. Or they’d still insist that they were somehow paying for women’s lifestyle choices and if she didn’t want to risk conceiving a child with a kidney problem, she should have kept her legs closed. And then my head would again connect with the desk (and I’d also again be reminded why it’s great to live in the UK – for now, for as long as the NHS isn’t completely neutered by the current government…)