Reassurance and Routines in Prenatal Genetic Counseling

Hello again, bloggie doggies! 🐶 I’ve had a wonderful and long week of being a wanna-be genetic counselor, and I’m excited to share all of those fun updates.

Before I forget, I wanted to make sure I share that next week my blog will be published on Friday afternoon instead of sometime Thursday! That’s because next week is my post-Match interview in Wisconsin. Typically I’ve done my interviews on Fridays, like this one, and then shared my thoughts the following Thursday. However, I suspect that Wisconsin will give us the results of our post-Match interview within just a few days of the interview. And I want to be able to appreciate the interview I had without the complicated feelings of “I got it” or “I didn’t”. Thus, next week I’ll be coming at you live from Wisconsin!

If for some reason they don’t give us the results by 2 weeks from now, well, I guess I’ll just have to make a post called “I’ve Been an Applicant for 632 days and NO REALLY TODAY MIGHT ACTUALLY BE THE LAST THIS TIME.” 😂

Speaking of Wisconsin, it’ll be fun, but like don’t expect too much because I’m pretty sure there’s like 6-8 of us going out for one spot! I’ll do my best and they’ll pick the best fit for them. 💜

Ok, now to talk about prenatal genetic counseling!

Hello, stock photo! It sure would be nice to be able to take pics of patients for the purpose of this blog but HIPAA said no.

I shadowed with two genetic counselors at Intermountain Healthcare Maternal Fetal Med. I’ve never had the chance to shadow prenatal before and I was very fortunate to catch 2 young grads, eager to share their love of the profession, and also having a pretty routine day in clinic!

I’ll be honest, up until Monday, I thought of prenatal counseling as a lot of telling pregnant women that their baby won’t survive long after birth. And there certainly is some of that. There’s also some carrier screening, some reassurance, and some low-risk pregnant women getting routine screening. That’s more in the vein of what I saw on Monday.

And as much as that seems like it could be boring… I really liked it! I could really see the counseling aspect of genetic counseling shine through. Because the women we saw were all low-risk for fetal complications, they had a lot of freedom as to what type of genetic testing to pursue, if any. Of course, any patient has the right to set their own limits as to what type of testing they undergo. For a low-risk woman pregnancy though, it seems like the choice to not pursue any testing or only pursue limited testing, comes up more often. And when a woman or family needs to make those kinds of decisions, a genetic counselor plays a huge role in helping them elucidate their own feelings about each testing option.

For example, one patient on Monday came in by herself. She wanted serum screening for Down Syndrome, despite being low-risk. That’s pretty typical. However, her husband had voiced that he didn’t want her to have any screenings like that, since abortion wasn’t going to be on the table for them.

At first, this patient was unsure if she wanted to go through with the serum screening or heed her husband’s wishes. Upon talking with the genetic counselor though, she realized she truly did want all of the information she could have about her baby. She even decided to go ahead and self-pay for cell-free DNA screening so that she could also find out her baby’s sex, as well as get a clearer picture of the baby’s risk for Down Syndrome and Trisomies 13 & 18.

Cell free DNA screening examines fragments of fetal DNA in the mother’s bloodstream to look for abnormally high levels of DNA from certain chromosomes. It also examines sex chromosomes, thus revealing the sex of the baby. Image from http://www.downsyndromeprenataltesting.com

This appointment reminded me a lot of crisis counseling. It’s not that the patient was in crisis per se, but she needed someone to talk through her thoughts with so that she could understand what she really wanted out of her pregnancy care. She needed someone to share that they support her either way and to encourage her to decide for herself and not to please someone else. Crisis counseling employs a lot of the same techniques. We don’t decide what our texter or caller needs, we help them share what they need and then we work together to get them just that. Genetic counselors advocate for their patients to understand what they want out of their care, and get it.

Switching gears a bit, I’m also very happy that I got to be slightly helpful in the prenatal clinic. Funny story. So I volunteer at Intermountain, but at Primary Children’s rather than Intermountain Murray, which is where I was shadowing. Since everyone in the building needs to be wearing identification, I generally wear my Intermountain Volunteer badge while shadowing at any Intermountain Hospital. Since I’m taking a medical Spanish course, I picked up a “Hablo Espanol” button for my badge lanyard a few weeks ago at Primary’s. But I took that off for shadowing because I was like “I won’t need to hablo espanol today”

Me goofin with my Hablo Espanol button

Literally walked into the first appointment of shadowing and the patient was like “Hi, this is my mom, she only speaks Spanish.” And while I obviously wasn’t allowed to provide official medical translation, I did muster up the courage to greet Mom and eventually chat with her as we walked to the lab with the genetic counselor after the appointment. It really does mean a lot to people just to have someone speak to them in their language, even imperfectly.

I’d definitely love to shadow in prenatal again in the future, and hopefully see more of the range of appointment types. Overall, I loved to see genetic counseling play a role even in healthy pregnancies. Genetic counselors can be great sources of information, and approachable providers if patients have questions about anything! You don’t have to have a genetic disease or a genetic disease in your family to benefit from having someone like that on your care team. Prenatal genetic counseling can apply to so many people–anyone who wants kids or is having a kid. That group equates to about 92% of people, according to a recent Gallup poll.

Plus, if you don’t want kids and thus prenatal and peds are irrelevant, maybe cancer, cardio, or general adult genetics will be relevant to you and your family. Point is, with all of the different applications of genetic counseling, it can truly be for anyone. It can be a great source of reassurance, information, and empowerment for any type of patient.

This week I also interviewed for 2 GCA positions, and kept on prepping for Wisconsin interview. The party doesn’t stop just cuz Match Day happened!

Lol, RIP. 🙂

-Laura Cooper-Hastings

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s