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reduction???

post #1 of 46
Thread Starter 
Forgive me if this is not discussed or if this is not the place, but . . .
My sister is pregnant following hormone injections and insemination and at the 6 week u/s 4 embryos were seen -- only 2 heartbeats but doc said that this wasn't unusual and they could easily be beating at the 8 wk u/s. Doc is really pushing for a reduction saying that 4 babies would be very difficult to successfully bring into this world. Sis is Pro-Life, but incredibly pragmatic and would hate to do nothing and hurt all of them. I am hoping that at the 8 wk there are only 2 heartbeats but I don't think that she can bring herself to hope against life after working so hard to create it. When the doc said initially that he suggested a reduction, she said NO way. But then he stated that that would put all 4 in jeopardy. Any info or experience regarding such a difficult topic would be greatly appreciated. I hate that she is facing such a difficult decision and can only offer my support.
Also does anyone know where I might be able to direct her for data and stats so that she can see what kind of battle she may be facing with quads and what the success rates are with reductions, etc.??
post #2 of 46
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post #3 of 46
It's a really, really difficult decision, complicated by the fact that even doctors aren't 100% sure that reduction helps with newborn outcomes such as preterm delivery. For instance here is one study that I have found about reducing from triplets:

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Quote:
We examined trichorionic triplet pregnancies with three live fetuses at 10-14 weeks of gestation that were managed expectantly [not reduced] or by embryo reduction. The two groups were compared for the rates of miscarriage, defined as pregnancy loss before 24 weeks, and preterm delivery prior to 32 weeks. ......CONCLUSIONS: In trichorionic triplets, ER to twins is associated with an increase in the risk of subsequent miscarriage and decrease in risk of early preterm birth.
I agree with the recommendations for her to start to read & follow the Barbara Luke program & diet ASAP, reductions or not. She does discuss the reductions issue in the book as well.

ETA if you want the full text of the above article PM me your email address & I will be happy to send.
post #4 of 46
A women here in the DFW area just gave birth to quads at 29 weeks and they are doing FANTASTIC! I would hedge a bet she wasn't following Dr. Luke's recommendations, either. All four babies are now in the step down NICU at 6 weeks old, all breathing room air, and 3 are on full bottle feeding. I think the heaviest babe is up to 5 pounds. It's a wonderful success story. Of course, there is no guarantee that your sister will have such a wonderful outcome, but it IS possible.

ETA: Oh, and she's at least partially breastfeeding them because she talks about pumping for them on her blog.
post #5 of 46
I got pregnant with triplets last fall and I was heavily heavily pushed to reduce to twins. The nurse at the infertility clinic, two peris, and my old OB all seemed to say reduce is better.

Statistically - the odds are better.

Emotionally - it wasn't worth it. It was NOT worth it.

Maybe. I really don't know. You can read my blog entry on it here - that was written during December's breakdown... I seem to have a serious breakdown every month or so because of it. It's like I'm pregnant now so I don't have menstrual cycles, but every 4 weeks or so I go off the deep end. (Last one was at 28 weeks so I'm due soon!) If you look in October 2007 archives there is some more stuff... It's just an impossible situation to explain, if you haven't been there. What you would or wouldn't do may seem so clear to you... I never thought I would do it but between my son and this pregnancy I had 3 miscarriages and I just couldn't convince myself then that *I* would be one of the ones to make it through a triplet pregnancy with all 3. I tried... I couldn't believe it. I didn't want to reduce... I was scared out of my mind not to reduce. I wanted to run away and not have to decide but I kept thinking of the Rush song that goes "If you choose not to decide you still have made a choice" and i thought I don't want to decide by not deciding...

Right now I am 31+ weeks with twin girls and everything is great - I am in a lot of discomfort from carrying two babies but they are both measuring on target, I have no signs of labor, nothing like that. They're fine - except baby A has turned breech and now I am worried over a c-section, the avoidance of which was one (stupid) reason for reducing. (I have never even had a tooth filled - my son was natural childbirth - I was so wigged out over being cut open and having the babies removed while I was awake... It doesn't bother me so much now but I needed time to get used to it and you don't have the luxury of time when you are in this position)

It is EXTREMELY f'ed up to spend your entire pregnancy wishing things would go wrong so you'd feel justified in your decision but that is how I feel. I wish my water would break. I wish my cervix would shorten. For a while I even wished these babies would die because I felt like I deserved to lose them all - another side of the same coin is during one of my breakdowns I thought I will give the girls up for adoption when they are born and give my son up for adoption, too, because I don't deserve to be a mother. My son is FOUR! He worships me! You can't just give away a four year old kid but that's how crazy I was. I don't feel that way now but I do feel scared to death something yet WILL go wrong, during labor, birth, whatever - because even with twins there are a lot of scarey stories out there. I bounce between fearing a c-section and demanding one because that is the fastest, safest way to get them out. (And, maybe I feel the c-section is punishment I deserve, who knows)

All I feel like is a murderer and I think my HMO pushed for reductions to keep their costs down and their stats good. (Fertility was covered through my HMO - infertility clinics don't like having higher order multiples on record and HMOs don't want to pay for 3 preemies in NICU) The whole experience has totally destroyed my faith in the medical profession. I trusted my doctors - I trusted if this was being presented as "best," even though it seemed horrible, there must be a damn good reason, you know? And I found a LOT of horror stories to back up my fears in going through with the pregnancy. And the doctors are really, really slick in pushing other little small things on you - the risk of the marriage breaking up is a big one. Think of your older child is another. Vague references to developmental problems that won't show up until later. I read/post to some selective reduction boards and I just want to cry, women coming on trying to decide and being giving the same crappy bogus vague lines I was given. It's just, why can't they say "These things will be hard, here are some resources for help..." instead of "these things will be hard, reduce."

To be totally honest though I am still very conflicted. I mean, it's a moot point, because I can't have my baby back - but since my reduction, quite a few women on different boards I read who got pregnant with trips around the same time as me have lost the entire pregnancy. Part of me feels I would rather have that - lose all 3 and be blameless - than have THIS - certain guilt that my actions (or inactions) resulted in the death of a child. But I don't know. How would it REALLY feel to lose them all? I don't know. I hope to hell I never find out. I read unhappy endings and I just feel like throwing up, I feel like I am right back in that indecision stage.

I also know that 3 would have been really hard to care for. Right now my son (4) is in such a tantrumy 4-year-old phase that I think of 3 newborns on top of that and ... I know I would have cracked up. But OTOH the guilt I have over losing that 3rd... I'm not exactly sane from that.

I am trying to focus on how much more of myself I will be able to give... breastfeeding, holding, comforting... but was it right to do this? Is it better to give more of myself to 2 and nothing of myself to 1 than to give less of myself than I'd like to 3? Why was breastfeeding so important to me that I was unwilling to risk needing any formula at all? I don't know. I will never know. I will never know how things would have gone and that's a lot harder to deal with than I thought it would be.

Even having been through all this... even feeling now 100% it's not worth it to reduce triplets... quads are another story. The risks are greater with quads. More total pregnancy loss with quads than trips. Maybe I would reduce with quads - but maybe I'd reduce to trips, not twins.

There are doctors who don't push reduction of trips - it kills me I didn't get just one more opinion. It kills me that by the luck of the draw I got doctors who do push reduction for trips - some women are never even told to consider it. But after 4 opinions... I guess I gave up. I think more docs are in favor of reduction of quads and I think it is more justified.

I can't say to reduce or not reduce ... but I can say tell your sis to act as if there are 4 NOW... start looking for information NOW... start looking into different doctors and opinions NOW. And be sure to look for emotional/psychological support NOW - I was not told to, and never thought I needed to because I thought I was making a "medical" decision. Turns out you don't have an abortion without counselling beforehand - this should be no different. This IS abortion. The ends may justify the means, it may be more complicated than an unwanted pregnancy - but you are giving up a child and there are emotional repurcussions to be dealt with.

My time frame was kind of short. We had two sacs, no heartbeats at 6 weeks... then 3 sacs with heartbeats at 7. It was 10 before my first peri consult and they booked my reduction for 12 weeks - it was really like I had 2 weeks of crunch time. That's another tip - don't let the peri book your reduction at the consult. Mine did - which I knew even at the time was a mistake. I didn't want it. They said I could cancel though and I preferred to be the good, docile patient rather than refuse to book - I figured I'd call and cancel. Only I never could. I'd pick up the phone and panic and couldn't dial.

I hope she doesn't have to decide - I hope she stays with twins. But 6 weeks is early - like I said I only had 2 sacs then. Anything can happen by 8 weeks. It's too bad they are making her wait 2 more weeks to see - that's 1 week less of knowing for sure.

Good luck to her.

eta - i hate to go against the grain but I think the barbara luke book is bunk. I have read of many women who followed the advice and lost all 3 or 4 babies. I myself have been so depressed since the reduction that my eating habits are absolute crap - yet my babies are doing great. It's a crapshoot... it comes down to luck... which is one thing that makes it so hard. You can have this, this, and that going for you... and still be met with disaster. If someone could have looked into a crystal ball and told me everything would be great in the end - I'd never have reduced. But after three miscarriages and with all the bleeding I had early in this pregnancy - none since the reduction - I just couldn't believe I would be one of the lucky ones, no matter what I did.

eta again - this is a good site IMO... http://www.multiplebirthsfamilies.co...s/ber_q11.html - had I read that before the reduction it would have made it more clear. And based on that I would say quads are dicey. Somehow I missed that in all my digging between weeks 7 and 10 - it's not that I did NO digging then, I just was too scared to be focused and thinking clear... instead I read things like this linked to my HMO's website which I am so skeptical of now... there is a lot of misinformation out there and it's so hard to know what to believe, what to do. ack - can't find the article - but I know it claimed the 25% total loss rate with trips and claimed half of all triplet families experience death or disability... which scared the pants off of me... somehow it escaped me that by having the reduction I was signing up for a 100% chance of death... the doctors gloss over THAT and I wasn't thinking clearly. But again, quads are different...
post #6 of 46
For me, the Luke recommendations were proven to accurate this week. I let myself go on protein and water for a week and my urine dip was complete crap on Monday. I won't let it slip again (and it was MINOR slippage).

Runnerduck, I just wanted to give you another I think you made the best choice you could at the time with the information you were given. I ache for your pain.
post #7 of 46
There's something goofy with the 4 embies/2 heartbeats situation. It's highly likely that two are living (heartbeats) and two are not (still visible, but not viable).

It's way to early to decide on reduction or not. We were warned that our twins could easily turn into a singleton in those early weeks. I'd just sit tight and see what happens.

But definitely she should eat right and take care of herself, no matter how many babies!
post #8 of 46
Quote:
Originally Posted by Leslie in Chicago View Post
It's way to early to decide on reduction or not. We were warned that our twins could easily turn into a singleton in those early weeks. I'd just sit tight and see what happens.
This is true - they may not all develop and/or if they do there is vanishing twin syndrome thought to affect a certain percentage of multiples - not all embryos make it through the first trimester. (This is why reduction is done at the end of the first trimester, to allow nature some time to take its course)

HOWEVER - any time spent thinking "they won't all develop" or "they won't all make it" is time NOT spent considering the seriousness of a quad pregnancy. Once you NEED to decide - time goes quickly - so the more time you spend giving it serious thought, the better.

Before I got pregnant, I thought triplets would be wonderful - but I didn't really look into risks and so forth. So once I got pregnancy with trips, I got overwhelmed with facts, statistics, scare tactics, etc. I wish I had had more time to process things.

Chantel - thank you. I know I probably DID make the best decision I did, at the time... it's weird but as sure as I am now that it could have worked, I was positive then that it couldn't. So really... I don't know, what else could I do? Even if I was wrong, I was so sure... And for all I know, in the long term, maybe it was the best choice. I'll never know the answer to that. I will just have to do the best I can with the kids I still have.
post #9 of 46
I've never had to make a decision on reduction but honestly, I couldnt do it. I would always wonder about the baby (or babies) I understand the doctors point, but there is a reason why 4 took, and if they all dont make it, then thats what would have to happen. But I couldnt look at my twins and wonder about the other 2 constantly....I would probably go mad thinking about it.

I wish her all the best in her decision. But she has think of how she will feel reducing the babies. Can she cope with that decision for her entire life?
post #10 of 46
I second the Dr. Luke book. Great suggestions on nutrition to improve the odds.

And RunnerDuck-- I can't imagine the position you're in. I wish there were more providers who were sensitive to and supportive of mothers facing unexpected pregnancy situations-- whether it's an unplanned pregnancy or surprise triplets (or quads), women need more support and less fearmongering.
post #11 of 46
Thread Starter 
Thank you so much for your words. This is a decision that has no easy answer and either answer can be second guessed forever, but that will not help anyone to be a better parent. Runnerduck you have made a difficult decision for your family but you made the best decision you could make at the time. I wish you and your family peace. Thank you again for your help. Good luck to all of you with your families.
post #12 of 46
My pregnacy started out as triplets. My RE did give us the option of reduction and I was against it from the beginning. He stated that our bodies are not meant to carry more than 1. I thought that since it took me 7 yrs to get pg in the first place, that we would deal with what God gave us.

At my 6 week u/s for viability, we showed 3 sacs (2 heartbeats could be seen), Baby C heartbeat could not been seen. We followed up at 7 weeks and all three had heartbeats, but Baby C's heartbeat was not as strong and A&B. I was told by my RE, to be prepared to lose Baby C, since the heartbeat was not as strong. That if I did lose Baby C, most likely my body would reabsorb it so I wouldn't have to go thru a miscarriage while being PG with the twins. Sometime between 10-12 weeks, I had a horrible bleeding episode and we think that it was Baby C.

I agree with what the other ladies say about the odds of the 2 out of the 4 not being viable. She will just have to wait and see what happens and make her decision from there.

I didn't see the Peri until I was 12 weeks and then I was with a high risk ob/gyn and the Peris. I delivered the twins at 31 weeks by emergency c-section since I had bad preeclampsia. They were born healthy and are now almost 4 yrs old.

I will keep your sister in my prayers and keep us posted.

Take care,
God Bless,
post #13 of 46
A friend of mine has quads. She's actually a single mom of quads, you may have seen her on Oprah. She was implanted with 3, and all of them took and one split. She thought about reduction but decided against it. They're 4.5yo now.
post #14 of 46
I am currently pregnant with twins, by way of a reduction from triplets that I underwent last week. It was a very difficult decision to make, but my partner and I did it mainly to reduce the morbidity associated with higher gestation pregnancies. Having two versus three lowered my risk for serious complications such as preeeclampsia and gestational diabetes, while decreasing the morbidity/complications often encountered with triplets and above. Mortality isn't as much of a concern now--we know that NICUs can keep babies alive, it's the morbidity that was a concern for us. Preterm labor, learning issues, plus a myriad of physical problems that can ensue from being a high order multiple. It was a very hard decision but we are glad we made it, to improve the odds of the other two (and me) of being healthy in the long term. It's a terrible decision to have to make, no doubt, but I believe we did the right thing. We never felt pressured by anyone, and I'd done a lot of reading of OB/peri journals before the decision was made. Good luck! Scd1978
post #15 of 46
SCD - meased to pleat you.
post #16 of 46
Quote:
Originally Posted by DoomaYula View Post
A friend of mine has quads. She's actually a single mom of quads, you may have seen her on Oprah. She was implanted with 3, and all of them took and one split. She thought about reduction but decided against it. They're 4.5yo now.
YES! I did see her. I thought she was amazing how she was able to take care of all 4 alone. She has to be super woman. How are her babies (not babies anymore ) doing now?
post #17 of 46
A friend of a friend was pg with quads (through fertility treatments) and she opted to select down to 3. She miscarried one and ended up with two healthy twins.
post #18 of 46
RunnerDuck, my heart and love go out to you.

I too was pressured to reduce because my donor twin (my boys had TTTS) looked like he was on the brink of death for much of the pregnancy. You are right, even if you choose to do "nothing", there is a lot of pain in that decision.

It's only after 4 years that I don't experience daily pain looking at my son who was the healthier of the two and know that I was willing to let him die too rather than make the decision to reduce. Even with a happy ending, that decision (or indecision, in my case) can be so haunting.

You are not an evil person. We all do the best we can. Having to make a decision like that while pregnant and all the high hormones and emotions that entails is something that I would not wish on my worst enemy. I'm so sorry you have to go through this. I hope that in time you will be able to find true peace with the decision you made, but until then please be gentle and loving with yourself, mama. You deserve it.
post #19 of 46
My heart goes out to all of you who have faced this decision. We had some question early on in my pregnancy about whether one twin might have a condition that would bring up the reduction question - luckily for us it turned out not to be so and the thought was never more than an outside possibility. Even with that experience behind me, I cannot say what I would do when faced with the situations you've described. There is so much involved and so many emotions, and I wish no one ever had to even think about all of this. Runnerduck, I wish you strength and healthy babies, and healing for yourself.
post #20 of 46
I'm glad people are being supportive here. I went through the horrible decision to reduce from triplets to twins. At the time I was so scared to have triplets and deal with all of the things that could go wrong with the pregnancy. My pregnancy was an IVF-icsi pregnancy and it took so much money to get pregnant. I was so afraid to lose all of my babies. I was also so afraid that I would not be able emotionally and mentally care for three babies at once. I also was afraid of the financial costs of a twin pregnancy (my husband and I got laid off from our jobs after I found out I was pregnant). For weeks I prayed that one baby would die so I would not have to make the decision and I also prayed that I would not go to hell if I did reduce. I made the extremely painful decision to reduce and it was very traumatic for me. I cried for weeks before the procedure. I never thought I was I was one to do that, but I was trying to do what was best for the family. I became extremely depressed after and had a difficult time carrying( a lot of intervention), but I made 34 weeks and 4 days with my twins.

It's been over a year since the reduction and I still mourn the loss of baby C. Almost everyday I think of the other baby, especially when we are having fun as I family.

If I had to do over again, would I? Probably yes. I really believe that it made a difference in the survival of my other two. They are so happy and healthy now. I made it to over 34 weeks. I almost lost them at 20 weeks and had to have a cerclage put in. I had an incompetent cervix, a very large fibroid, and preterm labor. I was told that if I had one more baby I possibly would have lost all of the them. I know I would have definitely lost my little Bella (she was baby A at the bottom).

I can't say to do it one way or the other. It is decision only she can make. You just make the best decision you can at the time. I'm so sorry she is in this situation. Very few people understand it unless they have been there.
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