The Dilemma of Multifetal Reduction

How to manage the complex emotions that arise while making a decision about your pregnancy with multiples

Dilemma of Multifetal ReductionTwin and triplet pregnancies are on the rise due to the increases in the use of fertility treatments.

Twin pregnancies can be a little bit risky, but pregnancies with triplets or quadruplets can present significant threats for both mom and her babies. If you are pregnant with triplets or quadruplets, you may be faced with a decision regarding multifetal reduction.

Multifetal pregnancy reduction is a medical procedure for reducing one or more fetuses in a pregnancy with multiple fetuses. This procedure is usually performed in the first trimester of pregnancy to protect the health of the mother and the baby(ies).

Benefits of multifetal reduction for both mother and the baby:

  • Reduces the risk of miscarriage and still birth
  • Reduces the risk of baby(ies) being born with a disability
  • Lowers the complications of the pregnancy (e.g. diabetes)

Risks inherent in multifetal pregnancy reduction:

Here are some of the risks that multiples pregnancies pose to the mother and her babies:

Risks for the mother:

  • Hypertension
  • Preeclampsia (high blood pressure during pregnancy)
  • Gestational diabetes
  • Higher medical costs
  • Increased maternal depression, anxiety, and burnout
  • Increased divorce rates in parents of multiples
  • Risk of losing the entire pregnancy

Risks for the baby(ies):

  • Increased risk of prematurity
  • Cerebral palsy
  • Learning disabilities and slow language development
  • Chronic lung disease
  • Developmental delays

All these risks are amplified with each additional fetus. For example, the chances of a spontaneous loss of the pregnancy is 25% for quadruplets, 15% for triplets, and 8% for twins.

Making a decision about fetal reduction is not easy. The following factors make this decision even more difficult:

Factors that make a decision about multifetal reduction difficult  

  • Short time-span to make a decision
    As a parent, you often have only a couple of weeks after learning about your pregnancy to make the decision of whether you want to undergo multifetal reduction. This time pressure adds a sense of urgency and overall anxiety to the process.
  • Ethical concerns
    There may be religious concerns for you as reduction is regarded as a form of abortion. In addition, you may struggle with the unnatural power you are given to “play God” in deciding which offspring should live. Guilty feelings often accompany this choice.
  • Intense or mixed emotions
    You may feel angry at your doctor for not informing you about the risks of a multiples pregnancy while you were undergoing your fertility treatment. You will likely feel attached to your babies shortly after conception, especially if you previously had numerous pregnancy loses, or struggled with infertility for a long period. Feelings of joy and relief from being pregnant can be accompanied by grief, guilt, ambivalence, and depression due to the impending loss. The decision to reduce may seem impossible if you have formed a strong bond with your babies.
  • Disagreeing with your partner about the decision
    You and your partner may have opposing views as to what you should do. Even if you were in agreement before you became pregnant, the pregnancy can affect your views. You may refuse reduction, while your partner may feel confused and irritated with you for changing your mind. On the other hand, your partner may support your choice, regardless, leaving you to carry the burden of the decision alone.
  • Societal pressure
    When you turn to your friends and family for support, you may encounter disapproval and lack of understanding. You may isolate yourself from your usual support network and any religious community you may be a part of in order to avoid criticism. If you do not seek support while making the important decision around multifetal reduction, you will have to make this difficult choice alone, which will likely be more stressful for you.

If you are faced with fetal reduction you may be stressed and confused. There is no simple answer as to what you should do. Either choice carries potential risks and also has potential benefits. While selective reduction might bring a sense of relief knowing you are more likely to have a healthy pregnancy, it may also bring sadness due to losing a fetus.

Making important decisions about your pregnancy while experiencing such intense and conflicting emotions is difficult. Here are some suggestions that may help you as you make your decision:

  1. Get informedTalk to your doctor, as well as the maternal-fetal specialist who does the procedure. Discuss the benefits and risks of multifetal reduction as well as those of continuing with the pregnancy, as is. You should seek out this advice in a timely fashion, in order to allow yourself plenty of time to make an informed decision.You should also gather information about the medical costs of having twins or triplets as well as the costs associated with raising them: meet families that have twins and triplets; consider going to one of the “Mothers of Multiples” meetings to seek advice.
  1. Meet with your religious leader, if you have oneClergy or rabbis may be able to offer information to help you make the best decision. Discuss the spiritual and ethical values that are affecting your decision to reduce fetuses or keep the pregnancy.
  1. Consider counselingCounseling will help you consider different options and evaluate the long-term impact of raising twins or triplets on you, your partner, and your family. If you and your partner disagree on what to do, counseling can help. A counselor can facilitate a dialogue where you and your partner explore how each of you thinks and feels about multiples reduction and help you make the best decision. If your partner leaves the decision up to you, and you feel burdened and alone, counseling can help both of you be involved in resolving this problem.Even if you are clear about your decision, it may be useful to meet with a counselor to reflect upon your options in order to avoid potential regrets.

Studies show that multifetal reduction can cause increased anxiety, depression, fear, sadness, and emotional conflict for up to a year after the birth. This is particularly true for younger women who are religious, those who wanted large families, and for those who had seen their fetuses on an ultrasound.

Although multifetal reduction is a planned loss, couples often go through a grieving process. Couples that openly recognize their loss and talk about it are likely to avoid deep sense of shame and failure.

The good news is that the research currently indicates that there are no long-term psychological effects for mothers once they have resolved their conflictual feelings about fetal reduction- further evidence that counseling can be helpful in the decision-making process.

If you are faced with multifetal pregnancy and are having a hard time making a decision, you may want to consider getting professional help. A psychologist that specializes in reproductive mental health can help you grieve the loss of your unborn baby(ies) and help you bond with the surviving baby(ies).

Call (281)267-1742 for a FREE 10-minute phone consultation.

Dr. Irena offers online therapy for women and couples in Texas and New York City. She uses research-proven method, known as Emotionally Focused Therapy (EFT) to help couples develop and maintain the emotional connection and support each other through stressful times. She has helped highly distressed couples be available and responsive to each other, access their resiliency, and strengthen their relationships.

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

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