Thursday, June 6, 2013

Selective Reduction Risks and Decisions

I had my doctor's appointment on monday with Dr. Adashek. He was awesome. The staff was amazing.

We were shown into an ultrasound room, where another very experienced technician did my scan. She was serious. She had "ultrasound elbow" and wore a splint. Like tennis elbow, but from excessive diagnostic imaging. She confirmed (again) that baby C had anencephaly and looked at my cervix length (which is amazingly long, go me).

Dr. Adashek came in and this is a play by play of the highlights of the conversation:

He gives me a big hug. I love hugs. He sits on a rolling stool 2 feet in front of me.

Dr: So, you've been quite the topic of conversation. I've been talking a lot about you behind your back. I've talked to several of the doctors at Nellis as well as Dr. Bolnick. You understand what's going on. We don't need to repeat that. I understand you've already talked to Olivia (the genetic anomaly counselor) and Dr. Bolnick about the procedure for having a selective reduction and I want to answer any questions you have and talk about risks of all scenarios. Where are you currently in your decision to have a selective reduction?

Me: I'm leaning towards having the reduction but I want to know what the risk of carrying all 3 babies to term (as far as my body allows) vs. the risks of the reduction are. Basically, is the risk of losing all the babies by doing the reduction MORE than the risks to myself and the babies if I carry them?

Dr: Carrying HEALTHY triplets, the risk is way more. Carrying triplets and one of them having anencephaly, the risk is even higher to you and the other 2 babies.

Me: What? Why?

Dr: Your body knows that something is wrong with that baby. It is going to pour more nutrients and amniotic fluid into that baby's sack to try and heal it. Which of course, won't work. Ultimately, that baby will get bigger and occupy more than it's fair share of the limited space in there. It will force preterm labor, possibly earlier than 28 weeks. We are happy when someone carrying healthy triplets gets to 32 weeks, and you are still looking at 2 months in a NICU as well as all of the additional health issues associated with preterm babies. At 28 weeks or earlier, you will definitely lose baby C, and the risk of baby A and B being blind, deaf or both as well as having lung problems or a brain hemorrhage is astronomically high. In addition to that, YOU are at risk for preeclampsia, uterine hemorrhage and whatever emotional distress you have because you lose a baby and may deal with 2 other children with severe lifelong health issues.

Me: Ok. What are the risks with the reduction? What are the odds that I could lose all the babies? Troy and I have already decided that there is no way I can go through fertility treatments again, so if this pregnancy doesn't work out, we're done.

Dr: The risks of losing the whole pregnancy are between 1/100 and 1/300. I have the most experience in the whole practice with reductions, thus the highest success rate. Most people lose the whole pregnancy because of an infection as a result of the procedure within 24 to 48 hours. What are your biggest hesitations about the procedure?

Me: Religious mostly. God blessed us with these children and I don't want to feel like I killed one of them. I'm worried about being judged by my friends or family who feel the same way. I know that this is a personal decision, but I still feel like I want the support and approval of everyone.

Dr: Screw them. You tell them to carry triplets and go through the emotional trauma of losing a child. And then watching 2 of them fight for their lives with underdeveloped brains and lungs while you stand helplessly by, knowing that you could have done something to help them 4 months before. Ultimately, you might feel regret and sadness and guilt now, but it's better to feel it now and give your healthy babies the BEST CHANCE at a healthy life than risk their lives and deal with the emotional trauma of burying a child at the same time and feel guilt for the rest of your life. This is your decision. Don't let the other people in your life GUILT you into making a decision that could effect the health of your other babies for the rest of all of your lives.

Me: Troy...are you ok? You haven't said anything.

Troy: I've been on board with the reduction the whole time. I'll support you either way. This is probably going to be harder on you than me. If you decide to carry the babies, you're the one who has to do it and I'll wait on you, hand and foot.. If you decide to have the reduction, I'll be there praying with you and holding your hand.

Me: Ok, well isn't it too late? I'm 15 weeks today.

Dr: It's actually the exactly right time. People choose to have reductions of healthy babies between 12 and 15 weeks. You actually have cause for health reasons of you and your babies.

Me: Ok, well when can we do this?

Dr: I'll schedule you for tomorrow afternoon as my last patient. I don't want to feel rushed because I have other people waiting and I don't want you to feel like I ran out when the procedure was done and didn't answer your questions or hold your hand after.

Me: Ok, let's do it.

He also gave us his personal cell phone number. He told me to never ever go to the ER, never go to Nellis, and to never call the emergency after hours number. He wants me to deal with him personally through the rest of my pregnancy and ensured that I would remain under his care for the remainder of my prenatal care.

I had the reduction on Tuesday afternoon. The staff was amazing. They held my hands, rubbed my hair, and gave us cell numbers to call with questions. My sister flew in this morning to keep me company. I'm doing well. I'm feeling the other 2 babies move, which is comforting to me. I have been relaxing on the couch and drinking lots of water. As of now, I am on the fence about blogging about the actual reduction. I'm not sure who wants to read about it and who would just rather not know. Based on feedback and levels of curiosity about the procedure, what happens to the baby, etc I will blog/not blog.

Some of our friends brought us meals the day of the procedure and the next day. You guys are awesome. I love you. Troy wants those recipes...you guys know who you are.

Update: And I finally wrote about the procedure...about a year later...

http://barnesdailycircus.blogspot.com/2014/05/selective-reduction-procedure-in-detail.html

16 comments:

  1. Thank you so much for sharing your story Natalie. You and Troy are such amazing parents and those babies are so lucky to have you. I can't imagine how difficult this has been and continues to be for you. I hope that you know that you made an informed decision and I think it was absolutely your best choice. Heaven gained a baby just a little early but I'm glad it was just one and the other two will hopefully live long and happy lives. I am thinking of you.

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    1. Thanks Ellen - hopefully the road will be easier from here on out.

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  2. Wow. You are such a strong woman! And I am so very glad you have such an amazing doctor. You deserve the best care and the peace of mind that hopefully accompanies it. It may have been a hard decision to make now, but I can't imagine how much more painful the outcome could have been for the two healthy babies otherwise. I'm praying you have nothing but a smooth and easy pregnancy from here on out!
    If you want to talk about the reduction, I'd read it. Just title the blog accordingly and those that are scared to read it can pass it by. This blog has to be at least somewhat therapeutic for you, not to mention that it is easier to write it once than repeat it to 50 people separately. If it helps you through it, blog it. If it hurts too much, it can wait. I'm certainly just glad you are doing well after all of this.
    I hope and pray you recovery quickly, and look forward to reading more/seeing more ultrasound pictures!

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    1. Thanks Amanda - I am ready to be excited now, instead of just worried all the time. Sleeping less than 5 hours a night can NOT be good. Or maybe just preparing me for what is to come? Either way, hoping things are better from here on out right?

      I'm excited about our next ultrasound. They gave us a pretty good idea of what we were having, but we wanted to wait 1 more ultrasound to confirm :)

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  3. I second everything that everone has said to you! I am in awe of everything you've endured thus far (and will continue to, with twins). You are an amazing woman!! And Troy, he's cool, too. I also LOVED the doctor's 'screw them' comment. I'm so happy you have a wonderful team of doctors there for you. I totally agree with Amanda said, I would read about it, but please don't feel any pressure to write. I am fascinated with the human body, as I know you are. Stories like yours are much more real since I know you, and let us get a front row seat to how precious life really is. I can't wait to follow this journey further with you guys.

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    1. Thanks Aimee- God really puts people in your life at the right time, and Dr. Adashek certainly made things a little more black and white for me when I felt like I was stuck in a "gray spot." I've gotten a pretty strong response about the reduction in terms of the "curiosity." How do they get the baby out? Does the baby stay in? Did you bleed? Are the other babies going to know? Are you on bed rest? And et...I have ignored them for now because I think I'll go ahead and blog about it. Talking about/writing the same thing would be emotionally draining. Miss you guys and your little Mini is such a daredevil!

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  4. Natalie - What a roller coaster of a journey you have been on! I really had no idea until I clicked on your blog today. I'm so sorry you and Troy have to go through this but we are keeping you and the babies in our thoughts and prayers. Thanks for the blog ... can't wait to see pictures of the new babies!

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    1. Thanks Jamie. It's been a roller coaster for sure I know you guys have been on one of your own with your little guy...who is seriously adorable. He looks so happy!

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  5. Your strength and honesty is so admirable. That must have been the most difficult decision to ever have to make and it's not one of those black and white choices in life. I can understand how your faith and also fear of judgement plays into the choices you make, but you are a mom and you are a believer in God and you made the choice that you believe is right and what will give your two babies the best chance to have a healthy life and/or life at all. I pray that God gives you peace and that you have a healthy and enjoyable rest of your pregnancy.

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    1. Thank you so much. I felt so blessed to have a doctor who spoke so plainly to me and reminded me that this is my life and I need to make choices that are the best for my family because no one needs to live with them except for me. It was feeling so "gray" until I spoke to him about the actual risks to all of us. Thank you so much for your prayers, we really have felt them all :)

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  6. Hi Natalie, not sure if you remember me from First Southern but Everett and I want to tell you how sorry we are about your baby and how happy we are that the other 2 are doing well. we are no strangers to theloss of a child we lost 3 one at 9 weeks 1 at 17 weeks and 1 at 24 weeks. if you ever, ever need anyone to talk to someone that has been through loss, please feel free to e mail me and vent or anything you need.. i know how hard it is..... dena317@aol.com
    Debbie and Everett De Morier

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    1. Thanks Debbie - Of course I remember you guys....we love your kiddos from youth group! How's Nick? He joined the army right? Marines?

      I'm so sorry for your losses. I had no idea :( You have 3 angels up in heaven watching over your boys.

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    2. Nick is actually just graduating from high school and going to del tech Alex is in the young marines a youth program that goes until 12th grade.My boys were named Eric and Samuel and Eric actually lived for 15days before we had to make the decision to take him off the vent. Very hard thing to do. do you get to hold your baby or get any pictures? We did have pictures which I didn't want at the time but am happy to have now. our little Samuel was so tiny like a barbie doll and we did get to hold him a little. I really mean it about e mailing me anytime I know what you are going through... Everett and I pray for you and Troy and Avery always

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    3. It's funny that you asked that, because that's not how a reduction works. The baby didn't come out. Which a lot of people have been asking me about. I'm not sure I could emotionally handle seeing a 15 week baby...eek. Thanks so much for your thoughts and prayer. They mean more to us that you know. Love love

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  7. Sis. No one in ur family is going to question ur decisions. The good thing about family, most of the time, is that they trust us to do the right thing because we always do the right thing. It wasn't a hasty decision. It was well thought out with risks and benefits. I personally knew you would do the right thing bc I cant ever remmember you making a bad decision. I told Mer that. She is super worried for you btdubs. I said "Shit please, if anyone would know what to do its my Sis and troy."

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    1. And you typed btdubs. I seriously could not stop laughing. Love you. Hugs and kisses to Mer.

      xo
      Natalie

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Thanks for reading!