The Baby Decision
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b. Folks often have important family history information that can impact how they manage their pregnancy. It’s quite common for me to uncover something during a family history session, and for the couple to need more time to investigate further. Again, if they’re already pregnant, it’s a race to get this information together. Contacting relatives, tracking down old medical records, etc., can take quite a bit of time.
c. Genetic testing, especially for rare variants or complex tests can take weeks to get completed and results interpreted. It can also take time to get a complete family medical history. Calling Aunt Bertha, making sure of what conditions she’s had and when she was diagnosed is only one phone call of many that you may need to make. If you’re already pregnant, it is a race against the clock and you’ll do the best you can, but couples regularly run short on time. This is completely avoidable! Why not have the luxury of time on your side?
d. Some couples have experienced recurrent miscarriages either with their current partner or a previous one. Genetic counselors have a number of tests that they can offer a couple in this situation, and help get them a possible explanation. If they are able to diagnose their condition, they have a better chance at overcoming it.
e. If you are attempting pregnancy, but have not had any result in 6–12 months, you may want to have a fertility consult with a genetic counselor along with an OB, or reproductive endocrinologist if your insurance permits it.
3. How does a pre-pregnancy genetic consult with people with no genetic history differ from a consult with those who do?
a. The consultation itself won’t change, you will still discuss your family health history. When a couple has a more complicated history, it may take more time, and follow-up communications to get a complete picture of their risks. If the family gene (and variant) is known, then this will open options for the couple. One or both members might want to get screened for the gene, it depends on the scenario and the type of inheritance. These details can be provided by a genetic counselor, who can also coordinate follow-up testing for the couple.
b. In the event that their future pregnancy is at risk of a disorder, there are many options for the couple. They can consider IVF, and genetic screening for each embryo, and only implant the healthy ones. They can conceive naturally, and test the pregnancy directly. Gamete donation is another possibility, as well as adopting a chid. There are so many options for couples, we are very fortunate to live in this modern era where society is more supportive than ever before.
4. What recommendations or advice would you especially like to share?
a. Genetics is the ultimate form of preventative healthcare. Knowing your genes can save your life. But the key lies in getting the right test at the right time and having it interpreted correctly—all of which a board-certified genetic counselor can help you with.
5. Do you have any patient materials you created that are available for our readers?
a. I am hosting and producing a bi-monthly genetic health talk show. For folks who want to optimize their health, and stay on the cutting-edge, they can tune in to our YouTube channel: The Vibrant Gene Talk Show (https://www.youtube.com/channel/UCER-HlPrpac1wMdcKcYyXUA). Topics we have covered so far include “What Everyone Needs to Know About the Zika Virus,” and “Genomic Sequencing for Newborns?”
b. I have a number of blogposts and links to important resources on my website. In particular, I address issues surrounding direct-to-consumer genetic testing, and propose a number of thought-provoking questions for people to ask themselves before pressing the “purchase” button.
c. I encourage people who are interested in learning about genetics and things they can do to improve their health to join my social media e-learning community.
6. Do you have recommended readings, e.g., a recent book, articles published by your professional association, websites other than ACOG, your association?
a. Mother to Baby, http://www.mothertobaby.org/ is a national teratogen hotline, and free service. Anyone can call them with questions about exposures to chemicals, medications, vaccines, etc., while pregnant or breastfeeding.
b. To get more information on genetic counseling or to find a local genetic counselor: www.nsgc.org.
c. March of Dimes is also a good one.
d. Genetic Alliance—for online support groups, client advocacy and reliable information
http://www.geneticalliance.org/?gclid=CLrpmaHIi8gCFYiQHwodQeYAhQ.
e. Books tend to become dated before they’re published, so in genetics, we rely heavily on peer-reviewed journal articles on pubmed: (http://www.ncbi.nlm.nih.gov/pubmed)
7. When you were a guest lecturer in my class, you went into great details about the various kinds of tests. Is there a book, brochure or publication that maybe has all of this in a table?
a. These tests change and develop at an unprecedented rate, the information changes so quickly that I’d hate to put anything into print. For the latest information concerning genetic testing, I recommend readers visit with a genetic counselor.
8. How worried should couples be about autism and schizophrenia?
a. Autism Spectrum Disorders (ASD) and schizophrenia are both complex conditions that can have genetic and environmental factors attributed to them.
b. If there is a family history of autism, it is certainly worth looking into the details of the condition. In particular, it’s important to find out if the individual has a genetic diagnosis. It depends on the circumstance, but it may be helpful to pursue genetic testing for the client, too, and determine if they are also at a higher risk of having children with autism. If they are at an increased risk, they have many options to promote their having a healthy baby.
c. What can be done to moderate this risk? Couples have many options. For all couples, I recommend that they take care of their health. Diet and exercise can both alter the expression of their genes. Also avoiding teratogens like drugs, alcohol, tobacco can help to create healthier eggs and sperm. A fifty-five-year-old who exercises, eats plenty of leafy greens, and does not smoke is a very different personal health presentation than a fifty-five-year-old who doesn’t take care of themselves.
d. If a couple perceives that their risk of ASDs and/ or schizophrenia is too high for their liking, whether it be due to a family history or concern about age-related risks, then gamete (egg and/or sperm) donation is a possibility. Adoption is another option. I think it is also important to realize that we are learning a lot about both conditions, and by the time this generation of babies are adults, we will have novel technologies and personalized treatments that may prevent the conditions from occurring altogether.
9. How can readers find you? What services can clients receive in person and remotely?
a. I am reachable through my website: www.vibrantgene.com (press the “contact us today” green button). I may take up to 48 hours to respond.
b. Readers can also benefit by joining my e-learning communities on Twitter (@vibrantgene), Facebook (www.facebook.com/vibrantgene), and Google+ (Private Support and Information Group, “Healthy Pregnancy and Genetics”).
c. I provide private genetic counseling to individuals and couples. Through the use of telemedicine, I provide personalized consultations for preconception and prenatal care to clients locally, nationally and internationally.
I was nineteen and working as a camp counselor in Michigan when the idea of remaining childfree first occurred to me. On a cool summer night when my eleven-year-old charges were finally asleep, I basked in the silence and asked myself, “Do I really want to be a mother some day?” I had come to realize that my least favorite part of the day was the time I spent with my campers while my favorite part was the time I spent reading—alone. I wondered if I was unfit to be a mother because I preferred quiet study to rowdy kids. Perhaps motherhood and I were not compatible.
A year later I met my husband-to-be, and as we began to consider marriage, it quickly became clear that the baby question would have to be resolved before the marr
iage question. Although the idea of children had some appeal, I wasn’t prepared to sacrifice my career or my precious solitude, and I was seriously considering remaining childfree. Rocco, on the other hand, was eagerly looking forward to fatherhood. One of the oldest of six children, a member of a warm, vivacious extended family, Rocco considered children and happiness inextricably linked.
We agreed not to marry if we couldn’t reach a mutually acceptable decision. It wouldn’t be fair for Rocco to have to give up fatherhood or for me to submit to motherhood only to please him.
Since I was ambivalent rather than committed to the childfree choice, I set about to resolve that ambivalence, ever aware of the danger that I might foolishly give up my freedom in order not to give up Rocco. Over a year passed before our eventual engagement. During that time the women’s movement was picking up momentum, and both social science research and feminist literature reassured me that women could combine careers and motherhood. I also worked in a day care center where I had a chance not only to enjoy being with young children, but also to meet their parents—flesh-and-blood role models of successful two-career families. These parents were enthusiastic about their children despite the frustrations and sacrifices involved in two-career family life. Rocco and I also discussed his commitment to child care and the crucial role he could play in preserving my career and my quiet time. The upshot was that I reached a point where I truly looked forward to becoming a mother.
We waited five years after marrying before having our first child. We wanted to enjoy more freedom, finish our education, and establish our relationship. In the five years between our wedding and Marcella’s conception we earned two graduate degrees, lived in Brazil and Mexico, and traveled in Europe. We enjoyed lots of friends and activities, some shared, others apart.
We’re now in our sixties. Our two daughters are grown and married. We have a two-year-old grandson. We enjoy these relationships immensely.
Looking back, there were certainly days of overwork punctuated by temper tantrums; days when being childfree would have been easier. But our decision worked out very well for us. It has been fun seeing who are daughters have turned out to be, and encouraging their interests, passions, and creativity.
I’m happy to say I managed to build and develop my career as a psychotherapist and even start a new one as a writer, and enjoy reasonable amounts of solitude as well. All of this has been possible because of Rocco’s firm commitment to fathering his daughters and to making motherhood enjoyable for me.
I’m not sorry I waited those five years and questioned motherhood as carefully as I did. Not only did I learn about myself, my marriage, and my intense commitment to both career and motherhood, but I also learned a great deal that has contributed to my happiness as a mother. Rather than ignoring my childfree side, I used it as an ally. By talking with Rocco about the needs I thought motherhood would thwart we were able to begin working out acceptable solutions even before we married.
Had I married a different man I think I could have remained childfree and lived a happy life. I would have missed something by not having a child, but I would also have enjoyed many experiences that motherhood precludes.
A
abusive parents, 67, 214
activities
for children, 246–247
for older parents, 157
adoption
advantages, 199
disadvantages, 200
domestic adoption, 201–202
guidelines for consideration, 201
international adoption, 202
legal risk adoption, 204–205
open adoption, 203
process overview, 205–207
reasons for choosing, 200
simultaneously trying for pregnancy, 207–210
single parenting and, 184
special needs adoption, 203–204
transracial adoption, 205
adventure, happiness and, 109–110
affordability of fertility treatments, 15
Alexander, Martha, 166
All Joy and No Fun: The Paradox of Modern Parenthood (Senior), 285
All the Single Ladies (Traister), 172, 303
all-or-nothing myth, 105
alternative parenting. See gay parenting; single parenting
Altman, Mara, 283
ambivalence, accepting, 271–272
American Society of Reproductive Medicine (ASRM) website, 185
anger
about day care, 262–263
between parenting partners, 246
announcing baby decision, 232–236, 274–275
anxiety in baby decision, coping with, 21, 27
“Are You the Person I Married?” exercise, 61–62
arm-twisting in couple conflicts, 132–133
artificial insemination, single parenting and, 182–183
ASD (Autism Spectrum Disorders), 319–320
ASRM (American Society of Reproductive Medicine) website, 185
assertiveness techniques. See responding to outside pressures
Autism Spectrum Disorders (ASD), 319–320
avoidance game, 133
awareness technique (response to outside pressure), 89
B
babies
childhood attitude toward, 35–36
current attitude toward, 39–44
monster dreams of, 42–44
nursing, 37–38
preparing for, 237–240
baby decision
advantages of making, 27
announcing, 232–236, 274–275
anxiety, coping with, 21, 27
changing mind on, 61–62, 80, 104–105
choosing therapist for, 218–219
conflicts in. See conflicting desires
counseling, seeking, 213–214
as couple decision, 18–20
couples counseling, 217–218
decision-maker bill of rights, 12
in divorce/widowhood, 48
in emergency circumstances, 22–24, 47–48
exercises. See exercises
global issues affecting, 15
growth decisions in, 9
happiness in. See happiness
importance of, 11–12, 14–15
individual therapy sessions, 216–217
making most of, 270–274
overcoming doubts about, 212–213
panic, avoiding, 20–22
poison vials. See poison vials
postponing, 9–10, 130, 141
pressure from others. See pressure from others
private dreams/goals, addressing, 31–32
reaffirming, 211–213
as rebellion, 68
resources for finding help, 219
safety decisions in, 9–10
for second child, 163–164
for third child, 164–165
time involved in decision-making, 24
timing of parenthood and, 49–54
workshop for, 215–216
wrong decision, effect of, 24–27
The Baby Matrix (Carroll), 228, 284
Baby Steps (Altman), 283
bad news exercise, 48
Barnett, Rosalind, 258
Baruch, Grace, 258
“Being a Grateful Wife Means Always Having to Ask” (Goodman), 258, 295
Berne, Eric, 79, 286
Beyond Sugar and Spice (Rivers, Barnett, Baruch), 258
bill of responsibilities to partner, 136–137
bill of rights
for decision-making, 12
for pressure victims, 86
for women pregnant after infertility, 191
biological father, choosing for single parenthood, 183–184
biological immortality, 113
birth control, sabotaging in couple conflicts, 134–135
body changes in pregnancy, attitude toward, 36–39
Bolick, Kate, 172, 303
The Book of Quotes (Rowes), 243
borrowing children, 101�
��104
Boston Single Mothers by Choice, 171
Boundaries: Psychological Man in Revolution (Lifton), 112, 286
Bowen, Murray, 68, 286
Buber, Martin, 113, 129, 286, 287
C
Callings: Finding and Following an Authentic Life (Levoy), 227, 286
career sacrifices
reactions to, 47
of working mothers. See working mothers
Carroll, Laura, 228, 284, 289
chair dialogue exercise, 32–35, 70, 196, 211, 212, 256
changing mind on baby decision
others’ reactions, 80
partner’s reaction, 61–62
as poison vial, 104–105
sterilization and, 229–230
checklists
gay parenting, 169–170
parenthood readiness, 64–65
single parenting considerations, 172, 178–180
childfree
as answer to doubts about baby decision, 213
future plans, 226–228
games parents play with, 79–83
games played by, 83–86
growth opportunities, 236
guidelines for enjoying choice, 224–226
after infertility, 17
as language choice, 16
poison vials about, 98–100
pressure from others, 78, 93
as second choice, 223–224
sharing decision with others, 232–236
spending time with other childfree people, 272
spending time with parents, 272–273
sterilization, 79, 228–233
“Childfree Decision-Making,” 17, 223
childhood
attitude toward babies in, 35–36
unhappy experiences in, 72–74
childless, as language choice, 16