Wow. Today was a rough sort of day.
I’d like to warn everyone that the nature of this blog is of a very sensitive subject, and some readers might find it difficult to deal with. Please understand that it is not my purpose to incite argument or bring about judgement – only to offer the facts as I have them.
I’m going to skip right over the fatigue and nausea. I imagine if I write about those things every day they occur, my blog would become more like a broken record. Let’s just go ahead and assume they will eventually go away, and things get better.
Today, I experience my first “multifetal reduction.”
Let me give a little background on what this procedure means. Medically speaking, and pregnancy that has more than one fetus, or a singleton, is considered high risk. The higher order the multiple (triplets, quadruplets and so on) the higher the risk to the pregnancy and to the mother. We’re not talking about small risk increases here, however. It is not correct to say that having twins is twice as dangerous as having a single baby, or that having triplets is three-times riskier than having twins. The level of risk involved in carrying multiple fetuses is a ten fold to a hundred fold higher, or more. For example, statistically 60% of all twins will deliver pre-term (before 37 weeks gestation), but 90% of all triplets will deliver early.
It becomes quite obvious that from the medical standpoint, having more babies inside is a scary prospect. Without getting ridiculously technical or boring, doctors now have the option of offering parents a ‘multifetal reduction’, which literally means lowering the number of fetuses within the womb to allow for the possibility of a normal, full-term pregnancy. In the case of triplets, a couple may choose to reduce to twins and drastically increase their chances of delivering two healthy babies, rather than losing all three. The procedure is not without risk, but doctors always counsel their patients that the risk of complications from a reduction is much lower than the risk of carrying multiples instead.
There is, however, a drastically different reason parents can choose to undergo reduction. A couple came in today with a twin pregnancy – a viable, healthy baby growing along side a baby with a neural-tube defect known as “anencephaly” or “acrania”. Acrania is a developmental mistake where the ‘neural tube’ fails to close during the growth of the embryo. Instead of having a normal skull, or cranium, these babies have no neural tissue and no bone. There is usually little more than a face and a primitive ‘hind brain’ that is unable to sustain function. Babies with this anomaly are called non-compatible with life. They have a 100% mortality rate after birth, and usually don’t survive a matter of minutes, let alone hours.
When faced with the prospect of an already daunting twin pregnancy, and then offered the information on their anencephalic twin, the couple were given the option of doing a medically recommended reduction. The procedure would increase the chances of carrying the ‘normal’ baby to full term, thereby increasing the chances of having a normal singleton pregnancy.
This couple chose to proceed with the reduction. I will not share any details, or any of the procedure. However, I will share that it was one of the hardest things I have ever done, both in my life and in my career.
One never knows how they will handle a given situation until they are faced with it. I wish I didn’t have to face things like these.
It is not my place to judge or disagree with a choice that any parent has made. Each person makes their own choices based upon what is best for them. Dr. S points out that we do things from a medical standpoint to best increase the health of the mother and the baby, and it helps to think of it that way. If it were MY pregnancy… well… like I said, I don’t know how I would handle that situation unless I were faced with it. I hope I never, ever am.
