Though posts to the “AITA” section of Reddit often make us cringe at selfish human nature, every once in awhile we come across a really serious dilemma we can’t ignore. This week was a doozy, when a pregnant woman took to the online forum to get advice on a disagreement she’s having with her husband over whether to reduce her fetuses from three to one.
“My husband is opposed to it because he feels it is wrong to ‘pick and choose,’ even though we wouldn’t be doing it by gender (too early to tell anyway and even if it wasn’t, the doctor would just do the reduction the way he feels is the best way to do it) and he is excited about the idea of having a large family,” the woman wrote.
They already have a 5-year-old daughter, and while she wanted to have only one child, she compromised with her husband to have two. The triplets were conceived naturally.
“But I feel like it is easy for him to be excited about it when he is not the one who will have to be pregnant with three babies,” she continued. “He is not the one who will have to stop working for five years until they are in full-time school, he is not the one who will be doing the vast majority of childcare duties and day-to-day wrangling of the babies, not the one who will have to breastfeed three babies, etc. etc. etc.”
She also cited her doctors’ advice that triplets face a number of health risks. Taking all that into consideration, she asked the subreddit, would she be “the asshole” for getting the fetal reduction, then lying to her husband and saying she’d miscarried two of the fetuses?
Redditors’ responses were so quick and fervent that the post is already closed to comments. But SheKnows turned to OB/GYN Dr. Katherine Hicks for a more professional assessment of this difficult decision.
“If a woman is trying to convince her partner that reduction is the right course, I think the conversation she has to have is, ‘You might lose me as a result of this,'” Hicks told us. “First and foremost, it’s her decision. She’s carrying the fetus, and she’s the patient.”
Multiples pregnancy has a number of risks to the mother, including high blood pressure, diabetes, stroke, hemorrhage and even death. These risks are significantly higher for women carrying three or more fetuses than they are for twin and singleton pregnancies.
Then, as the Reddit poster said, there are the risks to the fetuses.
“The chance of triplets going to term going the full nine months is extraordinarily rare, so you’re looking at the likelihood of having three premature infants,” Hicks explained. “The chance of all three premature infants surviving without any deficit at all, with no learning deficit or anything like that is also quite low. Usually one or more of the triplets suffers as a result of being either premature or having some other problems in utero. … I know people who have had triplets and all three triplets did well, but that’s the minority.”
One person commenting on the post had some heartbreaking personal experience with that outcome.
“For what it’s worth, I’m an IVF baby who is a triplet,” lithiumfleur wrote. “My parents chose not to reduce, and one of my siblings is severely disabled due to a lack of oxygen, and will never be able to live on their own. My siblings and I were all born extremely early and were almost blind in both eyes if not for some surgery. I had cataracts in my twenties because of this, and have no peripheral vision. They’re not kidding about the health risks.”
From a strictly medical standpoint, Hicks said having a fetal reduction would be the best route.
Multifetal reduction became a relatively common procedure when IVF involved transferring multiple embryos to improve the chances of successful pregnancies. IVF has since improved so that doctors don’t have to implant as many embryos, but if a woman has been taking medication to stimulate ovulation and then conceives without IVF, she still has an increased chance of having a multiple pregnancy.
The procedure usually happens at around 12 weeks, and can be done in a doctor’s office. Using an ultrasound, the doctor injects a chemical (through the patient’s abdomen or vagina) into the sac containing the fetus, stopping its heart. There is also the option of radiofrequency ablation, in which the doctor can use electric currents to cut off blood flow to the fetus. In some cases the doctor can use genetic testing to determine which fetus is the healthiest, but they may instead base their decision on the ultrasound alone. Once the fetus is no longer viable, it slowly gets reabsorbed into the uterus but does not disappear completely.
There is some risk that fetal reduction can cause miscarriage of the remaining fetuses. That risk is four out of 100 triplet-to-twin procedures and seven out of 100 quadruplet-to-twin procedures. But remember, there is also the risk of miscarriage if she doesn’t undergo the procedure.
One woman who had reduced from quadruplets to twins wrote to the original poster about her experience.
“It’s some of the most heart-wrenching stuff a human can go through, and I feel for you and your husband as you step into this unknown,” ardentmuse wrote. “I’m by no means saying you shouldn’t reduce. (That you as a couple will have to decide.) I would have no children right now if I hadn’t reduced myself. But what I’m saying is it’s a big decision and a medical procedure that will impact this pregnancy and any you may have after.”
After urging the pregnant woman to “do the math” on the various risks and outcomes with her doctor, ardentmuse went on to describe the tragedy she went through after giving birth to those twins at 25 weeks. She eventually lost one of them.
“I can say personally that losing a baby outside the womb is so much worse that the pain that was my reduction,” she wrote. “Holding him as he took his final breaths will likely always be the darkest moment of my life, and close to it the moment I had to set that baby down, walk back into the room with the incubators, and somehow be present for my even smaller child still fighting.”
But beyond the medical outcome of this woman’s decision, many on Reddit wanted to discuss the moral dilemma of possibly lying to her husband. Most agreed that even though the decision is hers, nothing good would come of trying to cover it up. Hicks too thought that openness would be a better option.
“Ideally a couple would come to a joint decision, and he has every right to have an opinion on the matter,” she said. “However, if they absolutely cannot agree I believe it is her decision and hers alone, ultimately.”