Sarah Palin's choice

I greatly admire her decision to have a child with Down syndrome. But she would likely deny other women the right to choose for themselves.

Published September 5, 2008 10:07AM (EDT)

First, a little political mischief. Since being chosen as John's McCain's running mate, Sarah Palin has caused a hurricane in the media and blogosphere, where one rumor has it that her 4-month old son, Trig, born with Down syndrome, isn't hers, but belongs to her 17-year-old daughter, Bristol. The theory goes that Palin covered up her daughter's pregnancy for political reasons.

Yes, it's hard to believe (I surely don't). But at age 44, Gov. Palin would certainly be the right person to fly cover for her daughter. As most would-be parents know by now, having a baby over the age of 40 greatly increases the risk that the child will be born with Down syndrome. The estimated risk of having a child with Down syndrome is 1 in 1,300 for a 25-year-old woman. At age 35, the risk increases to 1 in 365. At age 45, the risk increases to 1 in 30.

Rumormongers could latch onto the fact that teens from the ages of 15 to 19 have given birth to Down syndrome babies at a higher rate than mothers in their early 20s. But it is not a substantial rate. No, what troubles me about Palin's fifth pregnancy is that she was given a choice whether to have Trig, a choice that, as a staunchly pro-life politician, she would deny other women. But let me back up for a moment.

As women age, the risk of bearing children with genetic problems goes up. Down syndrome is the most common of those problems. It is also known as trisomy 21. That's because the most common reason for Down syndrome is faulty cell division (meiosis), which causes an egg to get a second copy of chromosome 21. When a sperm fertilizes the egg, the result is an extra chromosome, giving the developing fetus 47 instead of the usual 46 chromosomes in its cells.

Children with Down syndrome have a variety of problems, starting with a different and distinct look, with eyes that slant upward, smaller ears, shorter stature and some differences in the shapes of their hands and feet. They are usually developmentally delayed as well. Other medical complications can include hearing and vision problems, heart defects and a risk of thyroid disease.

It's easy to detect Down syndrome prenatally, which is both a blessing and a curse for expectant mothers. Talk to any pregnant woman over 35 and she can tell you about getting the "Down syndrome talk." That is, her obstetrician would categorize her pregnancy as high risk and give her varying degrees of counseling about the risks of being an "older" mom. The obstetrician would also offer, and in most cases recommend, that the mom-to-be screen the fetus for Down syndrome or other defects. (These days, all women are supposed to be offered the option to have screening. But whether doctors uniformly and consistently follow that recommendation is not clear.)

What women do with that information is up to them. Some will take their doctor's advice and others will not, declining any counseling and testing for genetic problems. (Note to women: Be ready to sign at least one form to prove you said no. We doctors like to cover our butts.)

Tests to look for Down syndrome include ultrasounds at eight to 15 weeks into the pregnancy, looking for certain physical anomalies in the fetus, and amniocentesis, when a doctor takes a sample of amniotic fluid to look at the baby's genetic material. Women are then likely to be referred to a genetic counselor, so they can get another speech about the risks.

Gov. Palin apparently took a special blood test to detect that she was carrying a baby with Down syndrome. When he was born, she released a statement: "Trig is beautiful and already adored by us. We knew through early testing he would face special challenges, and we feel privileged that God would entrust us with this gift and allow us unspeakable joy as he entered our lives."

By knowingly giving birth to a Down syndrome child, Palin represents a minority of women. A 2002 study found that about 90 percent of pregnancies in the United States where the fetus was diagnosed with Down syndrome were terminated.

Rabid anti-choice activists have called that trend eugenics via medicine. But try telling that to a mother who is told early on in her pregnancy that she will be raising a child who will have a host of medical and developmental problems, requiring intense medical and social attention for the rest of his or her life. It can be tragic and nearly impossible news to bear.

Kids with special needs require and deserve intense therapies and attention to their needs. That's likely something Palin, with her political and social stature, can afford both financially and emotionally. But that may not be the case for other families, who have to struggle to balance work with home and family. They simply may not be up to the challenge of raising a child with Down syndrome. Sadly, kids with developmental problems like Down syndrome are at a higher risk for being abused by parents and other caregivers.

We could ask, given that Palin had no doubts about seeing her pregnancy through, why she bothered to take a genetic test. Why not, as you might expect a woman in her position and with her outspoken beliefs to do, decline any testing or counseling? Of course, it seems very reasonable to want to know about the health of your baby and to have time to prepare (emotionally and otherwise) for a baby that may have a genetic disorder. But that doesn't negate the fact that by having a blood test, Palin was given a choice about what to do.

And what she has chosen to do is fantastic. The love that she and her family have for Trig was clear in her speech at the Republican National Convention. It was inspirational to see a mother in a position of political power stand up for a child with special needs. But Palin was given a choice whether to have that child, something, if she had her way as a lawmaker, she wouldn't give others. According to legal experts, should Roe v. Wade be overturned, some states could outlaw abortion for Down syndrome or other birth defects, and women wouldn't have Palin's choice.

So while I respect Palin's decision to raise Trig, that's all the respect she will get from me. I don't see eye-to-eye with her on anything else: energy, guns, sex education and of course a woman's right to choose. Her supporters say that Trig signals that she practices what she preaches. Her decision to make her own choice but not grant it to others is a sign of her hypocrisy.

By Rahul K. Parikh

Rahul K. Parikh is a physician and writer in the San Francisco Bay Area. He wrote the Vital Signs column on Salon in 2008-2009. His pop culture-medical column, PopRx, runs on alternate Mondays.

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