A Sacramento nurse addresses stigmas attached to non-invasive prenatal testing | Opinion

Imagine this: You just found out that you or your partner are pregnant, and your overwhelmed with emotions. You start thinking about prenatal vitamins, making your first provider appointment, car seats, cribs and breast pumps. But have you started thinking about genetic screening? If not, include this on your to-do list.

As a women’s health nurse practitioner in a very busy OB-GYN office, I routinely answer these questions and explain the value of a simple genetic screening blood test that is available to all pregnant people called a non-invasive prenatal test. Oftentimes, patients may come in with a small — or large — amount of research they have done themselves regarding what these tests are.

According to the American College of Obstetrics and Gynecology, we, as providers should offer this early genetic screening test to all pregnant women regardless of risk factors, and I do. However, many times the standard counseling I provide my patients is vastly different from providers at different locations in our community, across the state and across the country.

I have heard stories of health care providers “gate-keeping” valuable information from patients based on personal beliefs and opinions, which could fundamentally violate the Nursing Code of Ethics we are all guided by — autonomy, beneficence, justice and non-maleficence. The argument that non-invasive prenatal tests can be used as a tool do determine whether or not to terminate a pregnancy false. These tests were never designed to make decisions about termination and should never be used as a determining factor.

Non-invasive prenatal tests simply help expecting parents make informed decisions with all of the readily available information. As the name states, the tests are non-invasive (using a maternal blood draw after 10 weeks gestation) to screen for common genetic abnormalities such as Down syndrome, Edwards syndrome and Patau syndrome in addition to determining fetal gender. Studies have shown that this testing does not increase rates of termination and has lower rates of invasive testing, such as an amniocentesis or Chorionic Villus Sample.

Non-invasive prenatal tests were designed to manage high-risk pregnancies and deliveries, and empower patients and their families to make the best decision for them. The information offered from these tests to pregnant women enables them to use data to make informed decisions. Non-invasive prenatal testing does not fundamentally or ethically alter a pregnancy outcome as one might fear, and no patient is forced to do follow up testing — that remains a decision to be made by the patient and their family.

We, as providers, are here to educate our patients on both the benefits and risks, helping patients decide what might be the best course of action for their unique situation. In the end, it is always a decision made by the patient.

Standardized patient education regarding non-invasive prenatal testing is a novel idea that has begun to take root. Modeling pregnancy-related patient education in the Netherlands and the United Kingdom has illustrated the stark shortcomings in prenatal care in the U.S. In both the Netherlands and the U.K., all pregnant persons are offered a dedicated 30-minute appointment to review testing options, read handouts and watch an educational video. These are easy, affordable ways we can ensure informed decision-making for everyone.

In my practice, we have an educational video for each person to view before their first appointment. This has proven successful, with the video opening doors to deeper conversations, including between patients and their partners. By providing our patients with a standardized educational video, we have minimized provider bias. When both patient and provider can enter a conversation with a standard of knowledge, this can allow for richer, more engaging conversations for all.

Difficult questions resulting from the confirmation of a positive non-invasive prenatal test allow for preparation and planning throughout the remainder of the pregnancy, including finding a specialist for after delivery, preventing delayed care or diagnosis. Will each expectant person make a decision that their provider agrees with? Absolutely not. But, to me, offering test data to patients in an open, honest, trusting manner ensures an ongoing relationship that will be therapeutic and effective for years to come.