“But what if the test is wrong?”

On one of my email lists, we were recently discussing amniotic fluid levels — how low is too low, what can be done for low levels, etc., and one woman told her personal experience. She had a non-stress test in which the technician said her amniotic fluid level was so low she’d have to be induced that day. Stunned, she said the first thing that came to mind — “What if the test is wrong?” That, in turn, stunned the technician, because no one had ever asked that question before. She said, “Let me check again,” and to her surprise, the second measurement was twice as high as the first one, and an induction was not indicated.

I’ve said it before and I’ll say it again — get a second opinion! (Sometimes even from the same person.)

One question to keep in mind with this sort of thing is always, “What’s the false positive rate?” Because if a recommendation is made to you to induce or perform a C-section or have some other intervention based on one thing alone, and that “thing” is wrong almost half the time, then how confident can you — and the doctor, for that matter — be in the diagnosis and subsequent intervention. If, however, there is a low false-positive rate, then you can be more confident that your diagnosis is indeed accurate. Getting a second opinion, or relying on two or more factors reduces the margin of error. Some doctors are more willing to err on the side of caution — after all, they’re not going to have to recover from abdominal surgery, and performing a C-section may make them feel lawsuit-proof. But it’s your body, your baby, and your choice, so you need to know how often they’re wrong on average.

Another question would be, “What are my options?” Some doctors might say, “You don’t have any.” But if you press and ask, “Can I wait a day?” or, “What happens if I refuse?” you may hear some different answers. Very likely, they’ll pull out a worst-case scenario in which it’s possible your baby may die. And they may be absolutely right; but they may just be exaggerating the situation to get you to go along. It comes down to how much you trust your doctor’s opinion. This is where it becomes important to get a second opinion, do your own research, find out your own options, etc. You may find out that declining the intervention raises the risk to your baby astronomically, and you would be stupid to refuse; or you may find out that your doctor was astronomically exaggerating the increase in risk, and you may be comfortable with the slight increase in risk to avoid the risks of the intervention.

Another question to ask includes questions about the rate of complications in the scenario. It’s one thing for doctors to say that having some medical condition or refusing some intervention “doubles your risk” — which sounds very bad — but it’s another to find out that the “risk” is still only 1 in 50,000 (which is double the risk of 1/100,000). Sure, nobody wants to be that one, but that means that 99,999 mothers and babies are subjected to an intervention which also carries risk. It’s about perspective — a balance — a trade-off between two different courses of action. Nothing in life is guaranteed (except death and taxes); and there are risks and benefits for every course of action. It’s up to you to choose which risks are acceptable for the proposed benefit.

And certainly remember to ask, “What if the test is wrong?”

One Response

  1. Good Point. I would not start treating diabetes with medication with only one sugar level or pharmaceutical treat blood pressure with one abnormal level… so what is the rush with birth?

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