The XX Factor

Bridget Jones Needs a Better OB-GYN

The whole plot hinges on Jones’ decision not to get an amniocentesis.

Bridget Jones’s Baby

The basic plot of Bridget Jones’s Baby, which opened last weekend to a disappointing third-place finish at the U.S. box office, seems simple enough. Bridget (Renée Zellweger) has sex with two men (Colin Firth and Patrick Dempsey) in the span of a week, gets pregnant, and doesn’t know which of her lovers is the father. Her obstetrician (Emma Thompson) recommends an amniocentesis because, at age 43, Jones runs a higher risk of having a fetus with chromosomal abnormalities. Amniocentesis, a test in which a long needle penetrates a pregnant woman’s abdomen and uterus to draw fluid from the fetus’s amniotic sac, can also determine a DNA match with a potential father.

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But when Bridget sees the needle (and hears from her doctor about the attendant risk of miscarriage), she panics and flees—and so her life becomes ripe material for a Dear Prudence column. Both guys accompany Bridget to prenatal classes and obstetrician appointments. Hilarity, as much as can be expected from a three-quel two decades past the golden age of rom-coms, ensues.

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Is a relatively risky procedure involving an enormous needle really the only way to determine a fetus’s father? It might have been back when the first Bridget Jones film came out in 2001, but there’s been a safer and much less invasive way to figure it out for years. Around 2011, a new test that could confirm a DNA match arrived on the U.S. and U.K. markets. The Non-Invasive Prenatal Paternity Test, one of a series of screening tests under the non-invasive prenatal testing (NIPT) umbrella, requires only a sample of the pregnant woman’s blood and a DNA sample from the suspected father. It works as early as 12 weeks into pregnancy, while amnios are usually performed between 14 and 20 weeks’ gestation.

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It’s true that amnios come with a slight chance of miscarriage, but women often get mixed information about just how risky it is. Some doctors say it’s 1 in 200; the American Pregnancy Association puts it at around 1 in 400; a much-publicized study in 2006 said the risk was much lower, around 1 in 1,600. Bridget’s doctor warns her about the chance of miscarriage without giving her any specific numbers to help her weigh the risks.

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Women have been able to pay out of pocket for NIPT tests since they first became available; they’ve cost between several hundred and a few thousand dollars. Now, more U.S. insurance companies are beginning to cover them, though some only do so under particular circumstances of risk and provider. Earlier this year, Britain’s National Health Service (NHS) approved NIPT, meaning low-income women will also have access to amnio alternatives. So Bridget almost certainly would have been able to figure out her baby’s paternal identity without taking her chances with an amnio, if only her doctor had thought to tell her.

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That’s not the only thing Bridget Jones’s Baby fudges for the sake of making Firth and Dempsey bounce through a birthing class on yoga balls. Under the NHS, pregnant women meet with midwives, not obstetricians, for the most of their pregnancies. Liz Humphreys, a writer who moved to London from the U.S. soon after becoming pregnant, told me she got a different midwife at each visit. Under the NHS, amnio is only offered if initial scans show high risks of genetic or chromosomal abnormalities. At 42, Humphreys was a “geriatric mother” like Jones, but she says that neither her midwives nor her GP even mentioned the need for an amnio. This was partially because she paid to get the NIPT Harmony blood screening test not covered by NHS, which showed that her fetus was at low risk for Down syndrome and other chromosomal disorders.

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In real life, Bridget’s midwife probably wouldn’t have pushed the amnio option without other indicators of risk beyond age. “Here in England, and in Europe in large I would say, since the medicine is public, you are not encouraged to get multitudes of tests, scans, procedures unless there is a genuine need,” Alona Cherkassky, a London-based mother, told me over email. Her 12-week scan indicated that her baby had about a 1 in 11,000 chance of having Down syndrome, far too low for doctors to recommend an amnio. She opted to pay out of pocket for a less invasive, less risky MaterniT21 test, in the NIPT category of blood tests, instead.

Not everyone weighs the respective risks of miscarriage and genetic disorders the same way. One friend of mine got pregnant by accident when she was 38; she and her husband weren’t sure they wanted to be parents at all. “We both agreed 100 percent that if there were anything wrong with the fetus we would be terminating,” she told me. She got the Materniti21 blood test, which showed low risk for fetal abnormalities, but she wanted the “gold standard” of an amnio to be sure. Her doctor fought hard to discourage her; my friend says the doctor’s words are seared in her memory: “If I had 20,000 women in a room, your age with your Materniti21 results, there would probably be one woman who had a problem with the baby. There is a 1 in 300 chance you will miscarry from an amnio. I can’t really sleep well at night with those odds. Can you?” She could, and she did. Her fetus was fine.

In other words, an entire short film could be made about one woman’s internal and external deliberations around amniocentesis. But it would have been no fun if a simple blood test had returned the answer Bridget was looking for—that would have meant no love triangle drawing out the mystery for another 90 minutes and certainly no slapstick too-many-cooks-in-the-delivery-room labor scene. Fortunately for the rest of us, there’s a better way.

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