Dr. Bai Consulting

I called the lab every day to ask for a update. This test result can only first be sent to the clinic not to the “patient.” I really hate that a pregnant woman being called as a “patient.”

False alarm

In psychology, we call a false signal — noise, a false positive, a false alarm. 7 days.

The test results shown that everything is fine. There is no significant finding from the fetus’ DNA. The previous suspicious test result, indicating higher risk of a chromosomal disease can be canceled now.

What did I learn from this series of tests and sufferings?

1. I question myself and the modern technology of prediction and wanting to control much.
2. The consequence should be considered before conducting a test
3. Clinical procedure is not hard math. It does not depend on logic or facts. Rather, probability and chance.

Prediction and Controlling

When I was in school, I learnt about an advancement in technology, namely artificial rain. The whole debate points were on “whether human can replace god” and if it has a negative impact on nature and the eco-system.

I asked myself many times, why did I agree to exercise the screening tests. Tests are like police at the border control. If you pass, you would not even remember this uncomfortable moment. If not, one would always remember it as one’s freedom being restricted by an authority against one’s free will. It is very scary.

Decision making

I was very certain that my fetus is fine and I am fine. The test is like buying insurance. No one buys a life insurance imagining self’s accident or death. It is rather an “in-case that… .”

It turned out to be horrible and very costly. I was showing some trends of depressive symptoms and I was not motivated to do anything else. I thought although all kinds of scenarios. I even called to figure out if individual could take the “aborted bones and blood and meat” back home to bury the fetus.

I tend to over-think and over-analyse any situation. But I wonder if anyone else could just hold and live and wait for the next test result as if nothing happened. As rational as it should be, as the experimental method told me.

No one can take back any decision in life. What one can do is to correct it for the future. To this end, I would say, if abortion is no option for you, there is no need to do any of these tests. Or if you want to do these tests, go for the more accurate one, although it costs more money. And if time and money allow, just do all of the non-invasive tests at the same time.

The next part, I will talk about how the cost will be covered by my insurance company and make a brief conclusion.

Positive blood test result

So basically the doctor and the result told us that “judging from one value, I am bearing a higher likelihood to carry a fetus with Trisomy 21.” And how high is this likelihood? 1:74 What is the average ration? 1:300

placeholder: the test result

The doctor repeats again and again that this finding does not entail that our fetus is not healthy. What it indicates is a likelihood. A statistical likelihood. A chance.

She said that the physical formation of the Nuchal translucency (NT: Nackentransparenz) did not find any noticeable sign. It is from her experience that she could say, if the blood test is positive, and the NT looks good, the chance that the fetus ok is high. When the blood test is negative and the Nuchal scan does not look good, then the chance that the fetus might have chromosomal disease is then higher. In short, she relies on/ has trust in the Nuchal scan result.

My partner asked her, “what does [to be healthy] mean at all in this context?” As far as I understand, here we only talk about Trisomy 21, a.k.a. Down Syndrome. What he wants to know whether it would be a physical or mental disability and if so, how severe it will be.

The doctor kind of deflected this question. She is indeed right. This test result, bearing a 90% accuracy, does not conclude anything about my fetus. Neither does the report indicated anything clearly. It only states that “this test result needs further clarification.” Rather how this value in my blood behaves in comparison to others in the statistical model. And I am sure that this test cannot tell more specific about the individual development in the future.

What are the next options?

Options are to take that second test, the more expansive, genetic blood test as suggested from the beginning (link to Part I-X). And if that result would also be positive, then Amniocentesis will then be suggested. That genetic test introduced a near 100% accuracy on detecting Trisomy 21 (99.9%). And if we do that, my blood sample will be taken and then we will need to post it to the company ourselves.

This cell-free fetal DNA test has to be practiced by practican and the result will only be sent to them, not to the client. It takes about 3 working days.

My emotional state

I would describe myself at that moment, impatient, stressed, indifferent. I somehow distanced myself far from the actual situation. The rational part of me and the scientific training part of me, I know that the first test result nearly did not say anything. The “bearing a fetus” part of me was in full denial. I was angry, tough and ready to fight. Yes, like any female mammal with a baby.

On top of it, I am not the most patient person on the planet. Each of these tests requires a certain amount of execution steps and waiting time.

NOW!

I asked if we could be tested now. If not, I could come by before the end of the afternoon session. As mentioned in Part II, the whole team was very much on our side. They let us wait and plan to test me immediately.

In addition, the doctor wanted to practice another ultrasound examination. Even in the most undefined mental state, I was still able to ask her about the necessity of this practice. She told me that she wants the actual length of the fetus on the day of blood sampling.

But I was only here three days ago. …

Anyway, I agreed.

Ultrasound number 5 within two months??

I asked my partner to wait outside as the clinic is small and full of only female human beings waiting. The assistants invite him to stay. We were sent to the lab room. I again had to sign a contract and the nurse asked whom of us will filled in the bank account to be charged later.

To wind the tape forward, in fact within three days, my fetus had grown about 1 cm longer. And last time my partner was not there. It was nice that he could see our fetus on that day despite the situation.

For me, it was very very bad. Or mixed. I was happy that it grew, of which the doctor suggested that it is a good sign, a growing fetus is a good indication of a healthy development. The bad part was that I saw its brain.

The doctor also careful examines the Nuchal translucency and said that nothing is suspicious till that moment. I was playing delightedful, or nothing had happened. I expressed my gratitute and we went to post the box.

To post my blood in a box

This is a commercial deal, this test. It comes with a test kit, some papers and a paperbox and a waterproof envelope. The assistant packed it and gave it to us. My partner kept wanting to go to the next DHL express station to speed up the delivery process. And I told him that it will end to the same result if I pay more for a Morning Express at our local post office.

I convinced him to let me first ask at the main post office and if not, we will drive further. So we took our bikes and went home to take the car.

It was a box of my blood. Two tubes.

Anyway, at the main post office, the man was kind and told me that it is a Postbox Number at the envelop so I cannot send it as an express package. If I insist, I can pay for tracking this box, but it does not speed up the delivery process. So I decided to let it go. As a “normal letter.” Yes, my biological information in a paper box.

To leave the city

I asked my partner if we could leave the city? On our way, I called the company to ask what would happen if the blood sample stay in the post office over the weekend. She told me that this sample can stay 7 days from sampling till reaching the lab.

It is really quite something. All these genetic test and human information.

We went to IKEA and the restaurant was only open till 15:30 during the weekdays. We left to the exit for hotdogs and wraps.

Am I traumatized?

I cried a lot. In rounds. At any moment when I thought of anything related to a potential lost or an abortion. Now that I think of it, I never thought of anything related to a disorder or any kind of person with disability in the future. What I really did not want was that this fetus, after three months living with us, leaving my body.

to be continued…

What if you and your partner have different opinion?

As there is no history of genetic disorder in my family neither in my partner’s family, I was more in favor of not doing any of these tests. My reasons are 1. I would like to avoid unnecessary medical visit, blood or smearing sampling 2. I do not think that my fetus is unhealthy 3. Even so, I would not consider an abortion. So my mental strategy is in fact to believe that my fetus is healthy and live as how it is.

As for my partner, he suggests that if some disorder is predicted, he would like to be informed early. I understood that he would also not go for a termination of pregnancy. And this test would be more like just in case.

We talked to our midwife about this. And I said that I am not interested, whereas I will still do it so that he will feel more informed. Then my partner complaint afterwards that I put it in a way as if we do not have any consensus.

We talked it through and I contacted my gynecologist and informed them that we would choose the combined NT-Messung test (combined blood test with Nuchal scan). The assistance then moved my appointment from the afternoon to the morning. I guess that because the lab picks up blood sample in the morning.

At that time, I already thought that luckily I contacted them promptly before my scheduled appointment. If I would have waited till the appointment, then I will need to pay an extra visit and the screening test will be delayed some days or weeks again.

On the screening appointment

On that day, the nurse ran a routine prenatal care: measuring my weight and blood pressure. I had to sign some agreements and payment papers. A part of it which costs 100 EUR, I need to pay immediately in the clinic, by cash or bank debit card. The rest of the cost will be sent to me related to the blood sampling test. It was a Monday morning.

Are you ready for the positive test result?

If you are like me living in Germany during this whole covid-19 time, you know well that a positive test result is nothing but bad.

Thursday afternoon, I saw a voice message left on my phone. The doctor called. The message was left around 12:50 before the lunch break, and end of the morning session. She said that “the test result shows some noticeable finding. Please contact us directly.”

This clinic is open 5 days a week in the morning, but only two afternoons, namely on Mondays and Thursdays. I was so lucky to hear this message on a Thursday afternoon, within an hour before the afternoon session reopens. Otherwise, I would need to wait until the next morning to reach anyone in this clinic.

I tried to put myself together and decided that I will go in person. I called my partner who also coincidentally has his shift on this day till around 14:30.

At 15:00, we both appeared at the door of the clinic.

In Germany, I often struggle to know if I could just go somewhere, or if it is better first to make an appointment to avoid a closing door or a rejection in my face. This happens too many things and kills my courage. This time the severity was implicitly agreed among all.

As it is Covid time, it also states at the front door that no accompany is allowed. We entered together and I said “The doctor called.” Then we were asked to be seated nearby the reception instead of the regular waiting room.

This clinic is ran by two gynecologists. The one at the afternoon shift was the one who practiced the NT test on Monday. The one who called was another one.

We were invited to the speaking room very fast. The doctor even had my medical record already beside her desk as if they were expecting us sooner or later.

She addressed to my partner “it is good that you are also here.”

Me too, in fact.

to be continued…

During one prenatal care visit on my 10th pregnancy week, the nurse handed over two prenatal screening test options to me. She told me that I can take my time to read over the information and decide if I would take one of them or none at all.

The first one is a combined NT-measure (kombinierten NT-Messung); and the second one is a cell-free fetal DNA test (zellfreie kindliche DNA).

I. The first one comes as a letter to patient, from the print or quality of copy, it must have been used and practiced since the early days. A summary of this letter translated into English:

With the increase of mother’s age, the likelihood of a chromosomal disorder (Down Syndrome) also increases. For this reason, an invasive Amniocentesis test (invasive, take a sample from the amniotic water) is offered to women over 35 years old. However, only 30% of the sicked children are related to the age boundary. The other 70% are from mothers younger than 35 years old.

By this combined NT-Messung test, a specific ultrasound examination plus a blood test will be taken place during 12. to 14. pregnancy week. This invasive test has a ca. 90% accuracy and can avoid an invasive test, such as Amniocentesis.

On the upper corner of this letter, it states 130 EURO, 11-13-16 SSW (pregnancy week)

II. The second one is in fact a commercial brochure from one provider of such a genetic test. As the first one, it is non-invasive, and according to this brochure, this type of test (99.5% accuracy) provides a higher accuracy of detection as for the first one (85-90%) for detecting Trisomy 21.

This test requires also blood sample, and in fact only blood sample. It costs 199-334 EUR depending on the test option (Trisomy 21, 18, 13, XY chromasons-related tests).

So, now, what would you decide for?

i. To take the first test only
ii. To take the second test only
iii. To take the first and the second test
iv. To take none of them

What do you take into consideration when making this decision?

(1) Opinion of the partner, (2) opinion of the experts, (3) information on the internet, (4) the price, (5) the accuracy

And what do you plan to do if the test result would be positive?

to be continued…

Durch Interkulturelle Berating helfen wir Ihnen, Ihre ostasiatischen Partner, Familienmitglieder, Klienten zu verstehen: ihre Psychologie, ihre Kultur und ihr System.

Using various intercultural counseling methods, we help you to understand your East-Asia partner, family member and clients: their psychology, their culture and their system.

透過跨文化諮詢，協助您了解您的伴侶，家人和客戶：心理，文化，和系統。