What is a perfect baby and who defines it? In this month’s issue of the American Journal of Obstetrics & Gynecology, (aka “Gray Journal”), Drs. Chervenak, Laurence, McCullough, and Brent wrote a very thought provoking article with a complicated title: The perils of the imperfect expectation of the perfect baby.  

The authors allege that pregnant women are in error to assume they will have a perfect baby and often request diagnostic tests and birth plans in the hopes of fulfilling this goal. Because there is a 3% risk of birth defects for all pregnant women, a 15% risk of miscarriages in addition to other potential problems such as premature births, the authors believe it is dangerous and inappropriate to make the assumption of having a “perfect” baby. They propose that physicians should make patients sign an “informed consent” documenting that it is quite possible that their baby might not, indeed be “perfect.”

One of my favorite quotes regarding obstetrics comes from Dr. George Macones who says “The risks of pregnancy and childbirth are often under appreciated.”  As physicians, we need to do a better job advising our patients that there ARE risks involved in having a baby and it was for that reason that I decided to write The Smart Mothers’ Guide to a Better Pregnancy. However I think the authors are misinformed if they think pregnant women want a perfect baby. My years of clinical experience have proven otherwise. Most pregnant women do not want a “perfect” baby. They want a healthy baby.

In my clinical practice, I offer screening tests for Down syndrome, a condition that involves an abnormal number of chromosomes resulting in a child with mild to moderate mental retardation that is sometimes associated with heart conditions. For many years, none of my patients had a positive result and then suddenly there were two in the same year. Both mothers delivered babies with Down syndrome but in their eyes, their babies were perfect. And who would disagree?

Should patients be made aware of the risks involving pregnancy? Absolutely. Should they sign an “informed consent” stating that their babies will not be “perfect,” or does that cross the line? I’d love to know your opinion.