Should I Reduce to Twins?

You might have landed in this page either out of curiosity or you’re facing the most difficult moment in your life and trying to seek more real life opinions before making the decision. We’re not advocating or discouraging the option of selective reduction… we’re merely sharing what we have went through and hopefully will help you in making your decision.

For the benefits of those who don’t know what is selective reduction, (as quoted from Wikipedia), it is used to reduce a higher-order multiple pregnancy to a twin or singleton pregnancy, so as to avoid the medical issues generally related to multiple births…this procedure is done by injecting Potassium Chloride into the selected fetal heart…to stop the heart beat. Well… for those who don’t need to go through this torment, you may feel that “Reduction” sound hmmm… relatively medical or technical, but to those who had or are experiencing it now, this word is far too simplified to describe “ending the life of your selected baby”.

I feel that it’s like killing, my hubby feels that it’s like an abortion, and we both struggle emotionally for weeks and mths during the 1st trimester. It’s a test of our love and our faith in God, to make a decision that nobody can make for us, not even our doctors or our parents can decide for us.

SINGAPORE CONTEXT In the end we didn’t opt for it and I really have to thank the medical system in Singapore for making it so hard to get approval for this procedure in restructured hospitals. In KKH, a panel of doctors will evaluate each case and can take weeks to approve, while NUH’s approval time line is shorter, it still takes sometime before one can have it done. As it has to be completed in the first trimester, by the time we were suggested to reconsider this option after switching to KKH, I’m already at the end of 1st trimester and nothing can be done. We’re not sure about the practice in private hospital, you may like to consult with your private doctor.

This is the summarized version of our ups and downs with selective reduction:

Shortly after we realized it’s triplets, Roger (my hubby) suggested “selective reduction” which is vastly practiced oversea to increase the chance of survival for the other 2 fetus. Initially I was rational and practical, so I agreed. But after a few days, as the thoughts of “killing my own baby” became more and more realistic, I cried and scolded Roger for suggesting it in the first place. At that point, we didn’t know the gender yet or how “healthy” the babies were…what if we chose to kill the wrong baby? And so we decided to let God guide us. If any baby is to go, He (God) will be the one to decide, not us. And so all 3 babies were given a fair chance to survive.

When we switched to KKH, we chose to be followed up by an O&G Dr who specialize in fertility treatment…she suggested selective reduction. WHAT?! Just when both of us had quietly put this issue aside since 3 fetus were growing very well, this Dr suggest killing of 1 baby AGAIN? Then she said…”if you opt for selective reduction, it has to be done now (in that week or the following), if not will endanger the pregnancy…but KKH requires a panel of doctors and several weeks to approve, so the fastest is to switch to NUH (faster in approval).

Upon telling us all these, she then referred us to another Dr who specialize in multiples, who is very busy and we can only see her in the following week. OMG…the feeling of rejection and being kicked around and thinking of killing my baby, made me so sick and dishearten for the entire week. Fortunately, the Dr who was referred to take up our case is such a motherly and encouraging Dr and she didn’t mention “selective reduction”… She respected our decision to keep all 3 babies and assured us KKH has the resources and facilities to help us, not to worry.

Why didn’t we opt for it?

• Each fetus has it’s own sac so the risk of complication is much lower.

• One of the fetus showed signs of vanishing initially but survives ultimately, their survival spirit encourages us.

• All 3 of them grow equally well, so who are we to decide which one to go, when we can’t determine which one has problems or even know their gender during the 1st trimester? What if we choose the wrong baby?

• It’s not their fault that they landed in a crowded uterus, and have to fight for survival with other siblings. In fact, most of the multiples pregnancies are due to fertility treatment. So who are we to take away their chances to survive?

• There’s a risk that selective reduction may terminate the whole pregnancy, so we might end up with no babies.

• It’ll cast a shadow (especially the mother) for the rest of our lives. When we look at our surviving babies in the future, somehow there won’t be 100% happiness.

• It helps when both of us are Christians and we believe “God will not put us through more than we can withstand”. If He has planned the triplet pregnancy for us (1 out of 8000), He will surely pull us through.

• There’s still a greater chance of success for triplets. But if it’s quadruplets, than we might think otherwise.

We’re really fortunate and blessed that my pregnancy is comparatively better than other triplets cases in KKH. During the same period, 3 triplets cases end in pain, #1) 2 sharing the same sac didn’t make it during the 2nd trimester and the 3rd one in its own sac was endangered, whole pregnancy terminated. #2) Delivered at week 21, all 3 cannot make it. #3) Delivered at week 25, 1 may have some problems, the other 2 might survive. Of course, all 3 cases didn’t opt for selective reduction initially…

We also notice that the egg and sperm quality matters a lot too. I have heard of cases whereby the sperm or egg have quality issues, the pregnancies end in miscarriage even if it’s conceived naturally. Thus it’s better to solve the roots of the problems (by seeking treatment from gynae or male specialist) and have a much safer pregnancy than to rush into it and suffer from great disappointment when the pregnancies end prematurely.

So thank God, we didn’t opt for selective reduction in the first place.