A day in Wallerstein's office reflects the many concerns that bring people in. "I saw five patients today," Wallerstein says, and enumerates the varied but not uncommon reasons for their visits: "a family history of schizophrenia, amniocentesis that indicated Down syndrome, advanced maternal age, and multiple miscarriages."
What Services Does a Counselor Provide?
"Genetic counseling is a lot of teaching," says Wallerstein, who had found she loved teaching when she was a graduate student in molecular genetics. "Sometimes it's one on one, or working with one family. Some people do group counseling, or group teaching, and some do large group teaching." In general, a genetic counselor's services break down in three parts. He or she:
- Analyzes the couple's family history in detail.
- Researches the risks of exposure to medication or to teratogenic substances (those that might cause a defect if the woman were exposed to them during pregnancy).
- Offers clear, nonmedicalized information about the risks, benefits, and limitations of a variety of sophisticated testing options for numerous conditions. "Genetic counselors can both offer testing and provide interpretation of test results," says Wallerstein. "Many prenatal genetic counselors also specialize in grief and bereavement counseling and can offer support and crisis counseling."
What happens during an appointment with a counselor?
"A typical prenatal counseling session usually lasts about one hour and often begins with the counselor obtaining a detailed family history," says Wallerstein. "The counselor may then review information already obtained from the patient's physician, such as lab results or ultrasound reports. The counselor will review why the patient was referred and discuss available testing options. An experienced genetic counselor is usually able to make couples feel at ease quickly and will work with them through the session to determine which options, if any, are the best for them."
How should couples prepare to meet with a counselor?
"Couples may want to come with a written list of questions or concerns and may want to talk to their parents or other relatives ahead of time so that they can give an accurate family history," says Wallerstein. "If a woman regularly takes any medication or has taken anything during the pregnancy, it is helpful to let the counselor know the exact name of the medication, the dose and when it was taken and for how long. The counselor can then provide very specific information during the session."
Will insurance cover the consultation?
Maybe. Wallerstein advises checking with your insurance company ahead of time to make sure that genetic counseling is covered and at what level. "Some couples are surprised that their insurance won't pay for genetic counseling and are unprepared for the cost," she says. "Also, couples should obtain any necessary referrals or authorizations in advance and should let the counselor know if their insurance only pays for testing done through a specific laboratory."