Sunday, August 14, 2011

The two to one pregnancy

We interrupt this series on Freud with a news flash:  Multifetal pregnancy reduction has made it into the popular press in the USA.  There is an article in the New York times about it. " The two minus one pregnancy."    Lots about how much better it is to carry, deliver and care for one baby than two, but not a whisper about the survivors. The level of ignorance about this side of things is breathtaking.  Its all about Mum, not the remaining baby.

One multiple birth  web site did attempt to address this:
How do we tell the survivors? Do we tell the survivors? When is the best time?
A very difficult series of questions. If the reduction was discussed with other family members or friends, there is a chance that at some time in the future, even inadvertently, your children will hear the news from someone else. In order to control the situation as best you can, it is helpful to let them know their beginnings. Parents know their children best and can assess when is the best time for them to hear the news. Use age-appropriate language for whatever age you feel is right. Beginning as early as possible may be an easier because if you don’t choose the right words at age 2 years, say, the results will be less damaging than if you didn’t choose the right words at 14 years old. Another point to keep in mind is that when a secret is made public, it loses impact and can no longer cause as much harm as it would when sprung upon someone at a later stage. The news later in life can rock their world and change who they are.
Be prepared for some very difficult rebuttal questions such as why wasn’t I killed? Did you kill my sister/brother? Was it a boy or girl who was killed? Will you kill me (and/or my sisters/brothers)? All of these and more are possible.

" The news later in life can rock their world and change who they are.'

That is a though worth holding in mind as we debate the morals of this version of  therapeutic abortion. 

In my latest book "Womb twin survivors - the lost twin in the Dream of the Womb" I wrote this:
Multi-foetal pregnancy reduction (MFPR)

Foeticide can be carried out on healthy foetuses in the second trimester of a multiple pregnancy if there are too many foetuses developing. In that case there is a risk that they will all be lost if the numbers are not somehow reduced. There is usually some natural loss of one or more foetuses in the very early stages of a multiple pregnancy. If this does not occur, by the second trimester there may still be too many foetuses, so a multi-foetal pregnancy reduction may be made.
Through the 1980s and 1990s, various forms of selective foeticide  were developed. These were based on an earlier system developed in the 1970s, of puncturing the heart of the selected foetus and injecting air into the circulation.  The selection of foetuses for MFPR is usually made in the first trimester, but where possible it is considered helpful to wait until the second trimester, when the foetuses are a little more developed and any abnormalities can be more easily diagnosed.  The method of choice today for selective foeticide is potassium chloride injected directly into the heart of one or more of the selected foetuses. This is a well-known method of causing cardiac arrest.
The policy now adopted by some assisted reproduction clinics is to transfer only one or two embryos during IVF. Also, some steps are being taken to limit the irresponsible use of fertility drugs. As a result the number of pregnancies with triplets and more is gradually reducing.
However, the focus now is on twins. Because the reduction procedure is now available, some parents are asking for twins to be “reduced” to a single baby in order to guarantee delivery of one healthy baby. One study in Denmark of 44 multiple pregnancies reduced to two foetuses included 16 pregnancies reduced from twins to a singleton. In this study the good effects of reduction from twins to one were clear in terms of the size of the babies and the length of the pregnancy.  In the light of positive reports such as this, the practice of selective foeticide is likely to continue despite the misgivings of some professionals. An article entitled “Do reduced multiples do better?” published in 2005 stated clearly that they do.  The same article reports that women over 40 carrying twins benefited from a relative lack of pregnancy problems when their twin pregnancy was reduced to a single womb twin survivor.
The emotional problems experienced by the parents, who have the option of watching while a selected few of their multiples are destroyed, are only now being addressed. It is known that the parents find MFPR very difficult, in particular the arbitrary nature of the selection.
Some professionals have been voicing their concern about the emotional difficulties associated with MFPR, because no details are available about the possible effect on the survivors or how the parents should tell them.

The survivors of MFPR

In published articles about MFPR there is little mention of any health and disability problems caused to the surviving babies. We know that dichorionic DZ and MZ twins suffer fewer problems when their co-twin dies, so it is to be assumed that most successful pregnancy reductions take place among foetuses who are developing in their own a separate chorion. Held safe in their own private life-support system, dichorionic twins presumably suffer no physical ill-effects as a result of the sudden heart failure of one or more of their fellow womb-mates. MFPR is a recent development, so the survivors are still young at the time of writing. It seems to suits the interests of both parents and professionals not to emphasize the physical effects on the survivor when a co-twin dies, let alone a larger number of fellow foetuses. This is understandable, as no one would want to cause unnecessary anxiety to a pregnant woman.
However, more and more large-scale studies are being carried out and it is becoming clear that there are definite physical effects on the survivors, particularly if their MZ co-twin dies.
As the practices and morals of this are debated it would be entirely wrong to leave the psychological effects on the survivors. My research has clearly shown a profound psychological effect on the sole survivors (And there is some evidence that triplet sets reduced to twins by the natural loss of one of them affects both survivors. At the very least, they are acutely aware of being triplets, not twins.)

The psychological effects are real and profound and often include suicidal feelings, self harm and self sabotage. Without appropriate help, these difficulties can be life-long.

Please dear reader, do what you can to pass this message on to the people who matter in this debate. 

This little blog, the books and Womb Twin can do little more than make a start.  We need an international outcry to get the world to wake up to this - can you help?


  1. someone once said: I don´t understand why
    it is called "murder" after birth and
    before birth it is called "the mother´s decision"...

  2. I just don't understand how the parents could be so selfish and take away their child's life, and then to make it worse, they're taking away the surviving baby's twin or multiple. It makes me sick to say the least. I wish they'd consider how it's going to affect their surviving child along with how it will affect them, before a decision is made.

  3. This work is SO important! Experts are discussing the fact that sole survivors of IVF (where fetuses are reduced by what is called " natural wastage") leave the survivors at risk of physical disability, but they don't seem to care about the psychological effects.

    This is because they simply DONT KNOW that the loss of a twin or more before birth leaves a psychological effect on the survivor. We womb twin survivors now have a voice. There are millions of us throughout the world. We have to tell our story where we can - so spread the word! Tell everyone you can, face to face, on blogs, forums, Facebook and everywhere, that this is real.

    Maybe soon, if we work hard, the doctors and other experts will start to listen. We must speak out NOW - our time has come!