Question about medical ethics/morality, miscarriages, and Down syndrome

[jack63]

@MrsAngelala Thank you for your interesting and helpful response. I definitely learned something from your response.

I looked through your old threads. I’m sorry for your loss. It seems like at one point you may have received some bad advice on these threads. For whatever it is worth, I think CAF has gotten better in the last year. It has calmed down and they do a better job of monitoring posts when people get Catholic teaching wrong.

 

[Anicette]

If you have learned your pregnancy is affected by Down Syndrome, why would take additional precautions to make sure the baby is successfully delivered? Is the miscarriage perhaps the natural outcome?

There is no way to prevent a miscarriage anyway. So there is no need to take additional precautions to avoid a miscarriage than all the precautions that pregnant women take for an average pregnancy.

I personally don’t see the point of doing extra monitoring to make sure that the child is still always alive, and i will probably refuse. If the child died, he died.

That being said, it is not because the child may have down syndromen or any others issues that we need extra risk of miscarriage. Their life is as precious as any other child in the woomb.

In that perspective doing a amniocentesis is problematic, because it increase the risk of miscarriage. In fact many faithfull Catholics would refuse to do this exam.

If we stongly suspect a health problem that is related to down or other, I may be moral to take some things for a more safe delivery for him, if he can be harm by childbirth. Such as doing it in an hospital that ican provide care for babies with health problem, for exemple, so we don’t take extra risk of death by not enough medical support.

Also, is it best not to do the Down Syndrome test in the first place?

I am absolutely convinced that it is best to not test for any chromosomal abnormalities. First, it is almost only done to detect and abort the child (almost all the detected down children are aborted). If we absolutely refuse any abortion, many health professionals would recommand to not do any test.
Second, apart amniocentesis (and now the new blood test), many tests for down syndrome are just statistics and put a lot of stress for in almost all case nothing.

Third, knowing it can put a lot of depression on the couple, and a lot of pressure upon them to have an abortion from doctors, family and relatives. It can make the couple fight if someone want an abortion and the other don’t. It is usually the end of an happy, innocent pregnancy.
That’s why I have never done any test for it- whether it is through ultrasound or blood test.

We should trust God and accept what the child can be.

 

[Anicette]

Are families under pressure these days to do genetic testing on their unborn children?

It is of course not always the case…
But for the majority, yes, people are abolutely under a very hard pressure to do genetic testing for eugenic reasons and legal reasons. If a child’s disability is discovered after the birth, despite exams done, or because the parents hadn’t been proposed exams, they can go on trial against the health provider because the the lost opportunity to have an abortion. And usually the doctors/hospitals would have a heavy financial penalty.

Surely, it was certainely better on your days for this point.

 

[jack63]

If the medication she is referring to is progesterone, she is correct in my experience. I had an NFP trained Dr who prescribed it, when I had to switch to a non-NFP physician he would not prescribe it, he had me wean off and refused further blood tests.

This very interesting and unexpected. I googled progesterone, and most medical sites says it helps woman become pregnant and helps the pregnancy process during the first 2-3 months of pregnancy.

1. Why would medical doctors ever be hesitant to prescribe progesterone?
2. Why would a doctor in an NFP environment be more likely to prescribe progesterone than in an non-NFP environment?

 

[Pattylt]

I personally don’t see the point of doing extra monitoring to make sure that the child is still always alive, and i will probably refuse. If the child died, he died.

I just have to make one comment here. IF the child dies before delivery, it is extremely important to KNOW that. If the child doesn’t immediately get delivered, it places the mother at a huge risk for death herself. So, any known high risk pregnancy does need extra monitoring. This does not necessarily mean amnio or blood tests but does include the doctor checking on the fetus and perhaps ultrasound.
Thanks…

 

[Anicette]

Oh you are very pessimistic!

First, miscarriages are very common in the first trimester, and all pregnant women are followed with, said, weekly blood tests or ultrasound to know if he still alive. We are instructed to wait until some symptoms to consult.
Secondly, after, if the foetus stopped to moove for some days, I am sure that I, or the majority of women would notice it. In this case we know that we can/ or should consult quickly.

If the child doesn’t immediately get delivered, it places the mother at a huge risk for death herself.

It does not always a necessary that he get delivered immediately. It does not necessarily place the life of the mother at a huge risk so quickly.

In many cases of miscarriage the woman has the option to wait until the complete miscarriage, if there is no immediate risk rather than to have immediately a D&C procedure or an induce birth…

I am sure that if there is no much risk, the doctors would not give the option of tests etc and would monitor ALL pregnancy very very often. It is not the case.

 

[NeedANap]

I am not a doctor, so I can’t be really sure, but quite a bit of information on NFP and progesterone supplementation comes from the Saint Paul VI institute, my Na-Pro doctor followed a chart of progesterone levels that they had developed. So that may be one reason why an NFP physician might be more likely to prescribe.

When my physician moved the other doctors at her practice said they weren’t trained so they weren’t comfortable continuing to prescribe. The new OB I had transferred to said he felt the evidence wasn’t strong enough so he didn’t prescribe it.

 

[Annie]

I would say that miscarriage can also affect a mother physically. For example, I knew someone who hemmorhaged potentially fatally (they used medicine to stop it) when she had a baby or miscarriage. If she had known she was at a higher risk for miscarriage, she might have taken care to limit travel to places far from a hospital (camping in the mountains, for example) then she might have otherwise.

 

[QwertyGirl]

Since genetic testing does not change outcomes, I’m also deeply concerned that its only accomplishment (purpose?) is to feed the abortion machine. No, thank you.

I had genetic testing done while pregnant. While I never would have considered an abortion, I wanted to be fully prepared for the circumstances I was to be handed. Had the problem we suspected as a possiblility had been a reality, I would have needed a lot of support, not just with an infant, but throughout the entire lifetime of the child I was bringing into the world. Decisions would need to have been made, and the sooner the better.

Luckily everything turned out to be fine and I delivered a fully healthy baby. If I had chosen to have a second child, I would have taken the exact same steps.

 

[jack63]

@QwertyGirl Thank your for your response. I very much see where you are coming from.

A family member of mine had genetic testing done on their unborn child. They found a problem. They still had their child. Part of my motivation for this thread is that situation. The family was under loads of stress during the pregnancy. I often wonder if that stress and its effects on the mother made what might have been a manageable genetic problem much worse. In other words the stress may have affected both the health of the mother and child in a very negative way.

 

[QwertyGirl]

In my case, the suspected abnormality could have been significantly mitigated with fetal surgery (while the baby was still in utero). Of course, at the time, it would have been very risky surgery. Decisions would need to be made.

I am a person who always wants the facts, and wants them earlier rather than later. I like to face problems head on, with the understanding that some things don’t turn out favorably.

Other personalities may prefer to put off bad news for as late as possible, especially if they know there will be nothing they can do to help the situation. I don’t think everyone is the same, and I don’t think there is a right way or a wrong way, necessarily.

Keeping stress at a minimum during pregnancy is very important. For me that meant having as much of the truth of the situation as I could, and that included medical testing. Others may need to take a different approach.

 

[jack63]

but quite a bit of information on NFP and progesterone supplementation comes from the Saint Paul VI institute, my Na-Pro doctor followed a chart of progesterone levels that they had developed. So that may be one reason why an NFP physician might be more likely to prescribe.

I did some digging on this and found a fascinating article from the Catholic News Agency that confirms what you said. I’m going to need to think about this further.

There is also point of contention between pro-choice advocates and those that use progesterone. Basically, a progesterone supplement does the exact opposite of what an abortion pill does.

https://www.catholicnewsagency.com/...c-research-on-progesterone-in-pregnancy-29042

“The research that we’ve done here has identified progesterone as a significant factor in pregnancies who are at risk for miscarriage or premature labor. We’ve been using it here for three decades safely and effectively, and our outcomes are very good with that,” Kenney told CNA.

Dr. Thomas Hilgers, founder and director of the Pope Paul VI Institute, contributed to the existing research on the subject throughout the late 1980s-90s, she said.

While hundreds of doctors have been trained in Hilgers’ methods, the FDA has never approved the use of progesterone in pregnancy for the prevention of miscarriage. As a result, it is not part of the standard of care followed by most doctors in the majority of pregnancies.

The abortion pill is actually a two-pill regimen. The first blocks progesterone in the woman’s body, and the second, taken 24 hours later, induces contractions to expel the fetus.

“A medical abortion is just a forced miscarriage. It makes absolute scientific sense that progesterone is the hormone that should be given when you give [women]
a medication that basically blocks their progesterone,” she said. “It’s frustrating to me that these pro-abortion people are saying that this science is completely bogus, when we have studies like this [Birmingham study] that prove the absolute essential nature of progesterone to support and maintain pregnancy.”

 

[Anicette]

While hundreds of doctors have been trained in Hilgers’ methods, the FDA has never approved the use of progesterone in pregnancy for the prevention of miscarriage. As a result, it is not part of the standard of care followed by most doctors in the majority of pregnancies.

And it shouldn’t be. Progesterone use may be associated with higher risk for some births defect. It should only be used when a past of miscarriage and progesterone problems is detected.
The article agree after:

“Synthetic progesterone is associated with certain types of birth defects. But the form used by Kenney and Raviele is bioidentical – it perfectly matches the progesterone made by the woman’s body herself, and it does not carry the same risks associated with synthetic versions.”

 

[jack63]

They talk about how progesterone is not FDA approved, and how there are limited results showing its effectiveness.

Then they make the distinction between synthetic progesterone and bioidentical progesterone. The article says synthetic progesterone causes problems, but bioidentical progesterone does not. They quote no scientific results to justify this though.

Honestly, this progesterone use seems pretty scary in some ways.

 

[Anicette]

I am aware that Hildgers’s protocol speak of bioidentical progesterone versus “synthetic” progesterone, but I don’t know what the difference is. Is a scientistic person can explain us, thanks you.
In both case, it seems artificial progesterone, not something that had been extract from a woman’s body…

You are right a objective study is needed to affirm the claim, if she exists.

Honestly, this progesterone use seems pretty scary in some ways.

I agree with your feeling if that become a standart use for all pregnancies. And more as I am someone with a child who has a congenital defect associated with progesterone’s use (although I have never took hormones).

We have also past scandals such as distilbene, so we need to be carreful. And that’s seems the position of doctors who don’t prescribe any medication to pregnant women unless it is unavoidable.

 

[jack63]

What is strange from the few posters here, is it seems that progesterone is being used as a standard prescription for all woman who are pregnant in a NFP facility. Maybe I’m wrong. I hope so. It would be interesting to here from others on this.

It should only be used when a past of miscarriage and progesterone problems is detected.

Agreed. It doesn’t make sense to use progesterone other than if there is a very specific reason such as past miscarriages.

One more thing…I did a search on CAF about “progesterone”. It is certainly not the first time it has been discussed relating to pregnancy. In fact, there are a few threads on the subject. I never knew about this at all.

 

[Anicette]

What is strange from the few posters here, is it seems that progesterone is being used as a standard prescription for all woman who are pregnant in a NFP facility. Maybe I’m wrong. I hope so. It would be interesting to here from others on this.

I don’t think it is the case, and hope, as you, that you are wrong.

But I haven’t a NFP only doctor.
For the prescription, in my sense, it is Napro doctors how can followed the prescription of bioidentical hormones described in the article, not all nfp doctors.

 

[Jen7]

I could talk for an hour about progesterone! But if I’m reading it right, the OP’s question has more to do with ordinary vs extraordinary medical intervention. Must we seek out a specialist to help nurture a fragile pregnancy, or may we forego the additional pregnancy support and let nature possibly lead to a miscarriage? The topic seems to have veered towards “well, what can be done to prevent a miscarriage anyway?!” But I think it misses an important point. What if we know we CAN do something to prevent a miscarriage? I, for example, know someone who NEEDS bioidentical progesterone supplements. Without them she will miscarry every time. We recently discussed this situation: if she finds out she’s unexpectedly pregnant in spite of attempting to abstain during her fertile times MUST SHE begin supplementation… or may she let nature take its course? I feel this is similar to the OP’s question. And I don’t know the answer. My friend & in our private conversation concluded with “could you live with yourself if you didn’t supplement?” We both answered “no.” But nicely the hypothetical situation hasn’t happened. Still, it is a question worth asking: because we possess the means to prevent some pregnancy losses, MUST WE? I would enjoy hearing others weigh in here…

 

[jack63]

I could talk for an hour about progesterone! But if I’m reading it right, the OP’s question has more to do with ordinary vs extraordinary medical intervention.

You right that my original post had more to do with ordinary vs. extraordinary medical intervention to prevent a miscarriage. With that being said I’m not a stickler on strict OP relevance. I think the discussion of progesterone is still pretty relevant, and it is a fascinating discussion. I’d be especially interested in how often progesterone is prescribed in a NFP environment vs. a non-NFP environment and the reason for the prescriptions.

 

[jack63]

I, for example, know someone who NEEDS bioidentical progesterone supplements. Without them she will miscarry every time. We recently discussed this situation:

I’m sorry for your friend’s struggles. I find it interesting and a little comforting I’m not the only one who thinks about this stuff though.

Still, it is a question worth asking: because we possess the means to prevent some pregnancy losses, MUST WE? I would enjoy hearing others weigh in here

As I think about this, I would lean towards the position that perhaps we are not morally obligated to prevent miscarriage in every case. It is a difficult question, and my area is certainly not medical ethics. To me the mechanism that causes the miscarriage would be very important to understand.

For example, based on my OP, if there a characteristics of an unborn child that are not that compatible with life, what is the mechanism by which the mother miscarries? Is the female reproductive system advanced enough to sense that there are characteristics in this unborn child that are not compatible with life and pull progesterone thereby naturally forcing a miscarriage? Is there any research on this anywhere? Is there a grey area in this natural sensing system? For example, the child may live, but there are characteristics there that are still not “that” compatible with life, so a mother’s body naturally forces a miscarriage.

What is the cause or reason your friend miscarries? What is the mechanism? For example, let’s say she is older, her first 2 pregnancies went well, but as she got older her 3rd pregnancy was a struggle and she needed progesterone to maintain the pregnancy. I think this would be relevant to the discussion. Years ago, a pregnancy could put an especially older woman’s health at risk. Could the miscarriages even be a survival trait for an older woman? On the other hand, if this is a young woman in her 20s who really struggles with miscarriages, that is another story. Another thing to consider is whether there are potential birth defects associated with progesterone use? From what I’ve read, the answer is “maybe”.