On 24/03/2012 03:34, Ellen Rubin wrote:
> PTP:  I was contacted by a pregnant woman who is nursing her 18 month old 2-3 times daily and is scheduled to have an amnio at 15 weeks.  She is currently 12 weeks pregnant.  The amnio is elective but highly recommended by her doctor because she is 38 years old and has Graves Disease which can impact fetal development.
>
> The OB has recommended weaning the 18 month old because he fears nursing will cause contractions after the amnio and cause a leaking of amniotic fluid.  Mom wonders how valid this concern is.
>
> Any thoughts?  Information?  Research?
>
Two thoughts, both about the amnio itself:

1. Bit confused by his reasoning.  Surely amnios only check for 
chromosomal abnormalities and the abnormalities caused by Graves' 
disease wouldn't be chromosomal?  As I understand it, the fetal problems 
caused by Graves are with the fetus's thyroid function, which an amnio 
wouldn't check for.  I could well be missing something there.

2. Never mind what he recommends - how does *she* feel about having the 
amnio?  I do feel this is an area where doctors often seem to get pushy 
beyond what is actually their business.  The how-to of prenatal 
diagnosis of fetal abnormality is a medical decision, and often that 
leads both doctors and patients to lose sight of the fact that the 
*whether*-to is a personal decision.  How does she feel about the 
possibility of fetal abnormality and how she would handle this?  Would 
it change her decisions about the pregnancy?  How much does she know 
about the different abnormalities involved?

I think a doctor can advise on the medical issues - the odds of finding 
a chromosomal difference on amnio in an individual woman's case, the 
risks of amnio, the details as to what will be involved - but it is then 
entirely the business of the parents, possibly with the aid of someone 
skilled in counselling (which may or may not be the doctor) to weigh up 
what those factors mean to them personally (how they feel about the 
possibility of a disabled child vs. having an abortion) and reach their 
decision.  It always skeeves me when I hear about a doctor 
'recommending' an amnio.  I don't think it's a doctor's remit to 
'recommend' that sort of test; I think it's a doctor's remit to advise 
on the pros and cons.

As for risks of uterine contractions triggered by nursing at this stage 
of pregnancy, my understanding is that there is practically no real 
research into the matter but the risk is theoretically low, for reasons 
found on Kellymom.  However, there simply isn't enough data to be able 
to tell her categorically that it's OK.


Best wishes,

Sarah Vaughan
MBChB  MRCGP

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