Selective Reduction: The most heartbreaking decision a pregnant couple could have to make

Congratulations, you’re pregnant—with multiples! These words can be both exhilarating and terrifying. Especially if the safety of one or more of the fetuses is at stake. You and your partner have to choose whether selective reduction is right for you, the pregnancy, and your family—but the decision is heartbreaking.

Thankfully, although it’s a stressful decision, studies show it can be satisfactory at the end. In fact, the research shows that most women who choose selective reduction would make the same decision again (Schreiner-Engel et al., 1995).

Before You’re Faced with Selective Reduction

Pregnancy was supposed to be a joyous time.

You really wanted to have a baby. And if you went through fertility treatment, you went to great lengths to get where you are.

At first, you and your partner relished going to your appointments. There was nothing more exciting than waiting to hear your baby’s heartbeat for the first time or to see them on the ultrasound.

But your joy quickly turned into worry when you found out you were pregnant with triplets (or higher order multiples).

Faced With the Decision – You Didn’t Even Know Selective Reduction Was a Thing

After learning just how many babies you were expecting, intense emotions set in. How would you parent so many at the same time? Would you be able to carry them to term? Would they all be healthy?

Stress, anxiety, excitement, you felt all of it.

Then your doctor sat you down for the “talk.” There were risks involved in carrying so many babies. It was likely to result in complications for your health and theirs. They would be small, and maybe weak. They might have physical or mental challenges.

While pregnancy brings about intense emotions under normal circumstances, complicated pregnancies make those emotions even more stark.

And that’s when you learned about selective reduction. Maybe you’d never even heard of it before. But your doctor said it could improve the chances of a healthy pregnancy and the delivery of healthy, thriving newborns.

On top of all this new information, the stress, and the intense emotions, now you’re under a time crunch. Your doctor is pressuring you to decide before the pregnancy progresses much farther.

You and your partner have to make one of the biggest decisions of your life, and you have to make it fast.

The Hardest Time Is Now

As you’re considering this heartbreaking decision, you may feel overwhelmed with fear, uncertainty, and self-doubt. It’s hard to make any decisions when you’re dealing with intense and contradictory emotions. And it feels impossible when you have to do it under time pressure.

You’re Not Alone in the Decision

Although it feels isolating and agonizing, it can be helpful to know that you’re not alone in making a decision about selective reduction for a multiple pregnancy.

Many women have had to terminate pregnancies for medical reasons, and many have had to choose whether to selectively reduce multiple pregnancies.

Researchers have surveyed women in situations just like yours to gauge their emotional responses. Turns out, those emotions can range from anxiety and depression to guilt and even thankfulness (Gonzalez-Ramos et al., 2021).  

You’ve seen your babies growing inside you. They’re yours, and you love them. There are also medical risks, and those feel scary. You’re grateful there’s an option that could help keep you and your babies safe and healthy. But you feel guilty for even considering it.

It’s not just you. So many other women have felt these emotions, too.

As you ride the waves of emotion and struggle with your decision, there’s another important source of support you shouldn’t forget:

Your partner.

Strong connection with your partner can soothe the worst of your anxieties and help hold you up when you feel depressed.

Psychologist and researcher Dr. Sue Johnson explains that your partner can be a source of hope and a reminder that things will get better (Johnson, 2014). They can listen and help you process your conflicting thoughts.

Most of all, your partner is a physical and emotional reminder that you are not alone.

Selective Reduction Hurts, But It Gets Better

It may feel like this period of dread will last forever. Or you’re sure that the procedure itself, if you choose selective reduction, will be horrible. But many couples report feeling a sense of relief after the procedure. They’ve made a decision, and then they can move on to grieve.

Women who’ve had a selective reduction procedure say they felt emotional pain and fear during the procedure and mourned the lost fetuses. However, several months after the procedure, their thoughts about the lost fetuses were less frequent and much less painful, and most of the women grieved for only around one month (Schreiner-Engel et al., 1995).

Research has also found that women who chose selective reduction did not experience higher rates of depression than those who didn’t (Leithner et al., 2020)

How Couples Can Heal Together After Selective Reduction

  • Immerse yourself in your experience (allow yourself to feel)

Allow space for your feelings after the reduction procedure. All your feelings.

The only way “out” of this emotional turmoil is through it. The more you allow yourself to feel sadness, grief, anger…the faster you can heal. Additionally, it can be helpful to identify the emotions as you feel them and put a name to them. Studies have found when you can name your emotions, you can tolerate them better (Lieberman et al., 2007).

  • Listen to each other

Be empathic, and curious when listening to your partner. You don’t have to have an answer, you can have empathy for your partner’s pain.

Similar to the way a partner can support a woman feeling trauma after miscarriage, your partner can support you through their presence and listening ear.

In fact, your relationship can get stronger through this adversity. Coming together and connecting through the challenges builds resilience in the relationship, and even intimacy (Tronick & Gold, 2020).

You can come out of this experience together and individually with a renewed sense of strength. And you can do it together as a couple.

Together, you will be able to get through uncertainty, fear, and struggle, and you can work together to make meaning out of loss.

About Dr. Irena

Dr. Irena has helped numerous couples navigate these heartbreaking decisions. She offers online therapy for women and couples in Houston, the Woodlands, and New York City. She uses research-proven method, known as Emotionally Focused Therapy (EFT) to help couples connect during the difficult decision-making process and heal after loss.

If you would like to schedule a session, email Dr. Irena for a free 10-minute video consultation: or call (281)-267-1742.


Gonzalez-Ramos, Z., Zuriguel-Perez, E., Albacar-Rioboo, N., & CAsado-Marin, L. (2021). The emotional responses of women when terminating a pregnancy for medical reasons: A scoping review. Midwifery, 103, 103095.

Johnson, S. (2014). Love Sense: The Revolutionary New Science of Romantic Relationships. Little, Brown Spark.

Leithner, K., Stammler-Safar, M., Springer, S., Kirchheiner, K., & Hilger, E. (2020). Three or less? Decision making for or against selective reduction and psychological outcome in forty women with a triplet pregnancy. Journal of Psychosomatic Obstetrics & Gynecology.

Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting Feelings Into Words: Affect Labeling Disrupts Amygdala Activity in Response to Affective Stimuli. . Psychological Science, 18(5), 421-428.

Schreiner-Engel, P., Walther, V. N., Mindex, J., Lynch, L., & Berkowitz, R. L. (1995). First-trimester multifetal pregnancy reduction: Acute and persistent psychologic reactions. American Journal of Obstetrics & Gynecology, 172(2), 541-547.

Tronick, E., & Gold, C. M. (2020). The Power of Discord: Why the Ups and Downs of Relationships Are the Secret to Building Intimacy, Resilience, and Trust. Little, Brown Spark.

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