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Selective Reduction: A Painful Choice

The Most Difficult Choice

Patrice Sullivan said she never felt as though she had an option. “It was a horrible choice,” said the Boston area mother of six-year-old twin girls. After undergoing an intrauterine insemination—where the ovaries are stimulated to produce eggs, and semen is introduced directly into the uterus—Sullivan was shocked to learn she was pregnant with quadruplets. Soon after the ultrasound revealed four beating hearts, Sullivan’s doctor told her, “This won’t work.” She was urged, for the sake of her own life and to attempt to have healthy babies with good birth weights, to reduce her pregnancy at least to triplets. “I trusted them,” Sullivan said of the doctors.

Sullivan, who had been trying for years to get pregnant, was now faced with a procedure which she described as “like an abortion.” After a great deal of agonizing—without emotional support from her doctor or the medical staff—she and her husband decided, at 11 weeks into the pregnancy, to reduce it to triplets. “It was very emotional,” she recalled, saying that she was awake during the “horrible process.” Five weeks later, Sullivan lost one of the remaining three fetuses in a miscarriage.

Losing one of the triplets was “such a shock and overwhelming loss” on top of the grief over the reduction, she said. Sullivan didn’t tell people she’d initially been carrying quadruplets but did share the triplet news with them. To her surprise, friends provided no comfort. “Many people, including the doctors, told us that it was probably better that the baby died before ‘it’ was born because it probably wouldn’t have been healthy anyway,” Sullivan said. “The usual response was, ‘Well, at least you still have twins.’ We really were not allowed to publicly grieve. People just didn’t want to hear it.”

People in Sullivan’s position are often urged to reduce not just to triplets, but to twins because of the risks involved. Whatever choice they make, they often find themselves alone, without support and afraid to talk about it because people don’t understand the complexity of their decision.

As the number of triplet and higher order births has increased dramatically, more and more physicians are urging parents to avoid them. Between 1980 and 1997, the number of births for a triplet or more pregnancy spiked by over 400 percent from 1,377 to 6,737, according to a 1999 federal Centers for Disease Control (CDC) report. The average gestational age for triplets is almost 34 weeks (40 weeks is considered normal for a singleton), according to Mothers of Supertwins (MOST). Quads average about 31 weeks while quintuplets are usually born at 28.5 weeks, the group said. “Among triplet pregnancies, the rate of premature labor before 37 weeks is 68 percent,” MOST reported, adding that premature births for more than three babies is a near certainty.

However, these babies are almost all premature and have low birth weights. “Rates of low birth weight, very low birth weight, and infant mortality were four to 33 times higher for twins and triplets and higher births” than for singleton births, said the CDC report. According to MOST statistics, 88 percent of triplet births involve babies weighing less than 5.5 pounds while 100 percent of quads and quints are smaller than 5.5 pounds.

The selective reduction procedure recommended for many women who find themselves pregnant with higher order multiples involves the doctor inserting a needle into a fetus’ heart and injecting air into the umbilical vein, according to the book, Having Twins. An ultrasound is then performed to make sure that that particular fetus’ heart has stopped beating. The reduction is typically done as early as possible in the pregnancy.

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