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