When you’re 41 and pregnant – you face some important questions during your first trimester. Actually – they’re the same questions you face if you’re 35 and pregnant. At 35 – you officially enter the ranks of “AMA” – Advanced Maternal Age. By 41 – you unofficially become “an old pregnant lady.” Or at least that’s how I characterize it.
The questions you face revolve around first trimester screenings, and genetic testing. You don’t HAVE to do either. No one will make you. But many moms want to do at least some type of screening to try and get a picture of their baby’s (or in my case, babies’) health. You can opt to do only do screening – and find out what your risk factor for having a baby with Down’s Syndrome and other trisomies is – or you can opt to go further and undergo diagnostic testing – after which you’ll get clear cut answers about whether or not your baby has a genetic or chromosomal defect.
Initially – my husband and I decided we would go forward with diagnostic testing. During the first trimester – the test that is available is called a CVS test – CVS stands for chorionic villus sampling – and you can find out more about the test here:
At the time I scheduled the test – I felt strongly that I wanted to KNOW if anything was wrong. I wanted to know if one or both of the babies had a chromosomal issue. I wanted to know if they were healthy and I could breathe a sigh of relief. I wanted to know their genders! And so, I scheduled the test .. and tried to ignore the little sliver of fear I had that something would go wrong. Because unfortunately – the test does carry with it a slight risk of miscarriage. That risk is made even more slight by seeking out a very experienced practitioner, and I did, but still. The risk was there. According to some the risk is 1 in 500 – others say it’s as small as 1 in 1000. But couldn’t help but wonder … what if I was “number 1000?” (Hypothetically speaking, of course!)
Still, I kept the appointment. Up until the day before the test when I called to say “I’m chickening out. I don’t want to go through with the CVS test.”
The person on the other end of the phone understood – but she encouraged me to keep the appointment – so that I could have an intelligent conversation with a genetic counselor and thoroughly understand my risks, based on age and a comprehensive health history, and also so that I could undergo less invasive (and less accurate) first trimester screening. The screening would involve something called a nuchal translucency or NT scan of both babies – and blood work for me.
I went to the appointment. I had done loads of my own research – and was able to have an intelligent and forthright conversation with the genetic counselor. She was supportive and non-judgmental as far as my decision to skip the CVS. BUT.. since I was going to have the NT scan right then and there – my husband and I decided that we WOULD go ahead with the CVS test IF the NT scan looked wonky.
During an NT scan – the ultrasound technician measures a pocket of clear fluid found on the back of the developing baby’s neck. The test can only be performed during a certain window of opportunity during the pregnancy. You can find out more about the test here:
We knew we were looking for a measurement of under 3. We decided if the measurement for either baby came back at 3 or more – we would go ahead with the CVS test right then and there. When I got into the room, the ultrasound tech asked “so, are you having the CVS test?”
“Well, we’re not sure,” I replied. “We want to see what the NT measurement is first.”
The tech looked like she smelled a rotten lemon. Clearly, she thought the 41 year old patient on her table was foolish for not opting to have the test.
“Well, doctor so and so is the BEST,” she told us. “In fact I’ve told him he CAN’T retire until I get pregnant and he can do MY CVS test!”
Hey, terrific for you lady. You do whatever you want once you’re pregnant and faced with these types of decisions. But all I can do is what feels right for ME… and so that’s how we proceeded.
The babies were scanned. Both came back with NT measurements of 1.1. That’s excellent. “We’re happy with those measurements,” we told the u/s tech. “We are not going to do CVS test today.” And with that – I hopped off the table, and we went on our way.
I still needed to get first trimester blood work – so headed to the lab – and had a blood draw. The lab would then go on to measure HCG levels – and something called PAPP-A. These two values – coupled with NT measurements and one more value – my age – ultimately are all calculated together to form a picture of overall risk of Down’s Syndrome or another chromosomal anomaly.
When my blood work came back – my overall risk was calculated to be 1 in 315. That may not sound great when compared to a younger woman – but going by my age alone – my risk was 1 in 82 for Down’s Syndrome and 1 in 53 for other trisomies. Based on NT scan and blood work results – my risk had lessened considerably. I was satisfied with those results – and comfortable with what had been a very personal decision — that only my husband and I could make, together. Which is what I would tell any other “AMA” couple – you have to do what YOU are comfortable with; do your research, and make the decision that feels right for YOU.