Selective Reduction: Two Women, Two Views

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In the world of infertility, while everyone is focused on shots and ultrasounds and the two-week-wait, there are some decisions that no one likes to talk about. What if I end up with multiples? What if the fetus/baby is sick? What if…

Selective reduction. Two women pregnant with 3 babies chose differently, and neither would have it any other way.A multitude of things cross the minds of women once they see the positive pregnancy test, but this one – this one is probably the most controversial of all. Selective reduction isn’t something society likes to talk about, but it’s a real thing. It’s a real conversation that happens in pretty much every high-risk OB’s office or with the mother carrying multiple babies.

So, in all fairness, and since multiples are a ‘risk-factor’ when undergoing fertility treatments, the HDYDI team decided that if it came up this week, we’d cover it. We’d share with you in a nonjudgmental way. We’d share so that others going down this path know that it IS something you’ll be asked about. That it IS something you need to think about – no matter what your decision ends up being. And that no one – NO ONE – can make that choice but you, and whatever your choice ends up being, that as fellow women, infertiles, moms, etc. – you will find someone that supports you.

In the Grey: Shelby’s Perspective

Shelby pf A Mother to OneShelby is a public health consultant, author, and founder of A Mother to One, a website dedicated to support and information for women choosing selective reduction. She is the mother of a five-year-old, a military wife, and spends her free time traveling the world.

In the summer of 2008, I decided to terminate 2 of 3 fetuses in my womb. No, I didn’t walk into Starbucks and decide to walk into an abortion clinic following. It doesn’t work like that.

Here’s the how: During the spring of 2008, we opted to give IUI a try while my husband was deployed. Voilà, a positive pregnancy test! We were overjoyed beyond belief.

And then, two weeks later, this overwhelming joy was followed by one of the most terrifying moments of my life: a hysteria-inducing ultrasound that revealed three fetuses and caused my 6’4” RE’s face to turn a shade of white I’ve never seen. There’s nothing pretty about vomiting during a vaginal ultrasound, and the sheer terror that plagued me that day is not something easily forgotten.

I knew within moments of hearing, “There are three. We need to talk,” what I would do; my mind had been made up nearly two years prior in a what-if discussion with my husband. The risks were just too much for me to fathom: 40% rate of loss, average gestational age of 32 weeks and a 36% impairment rate.

I was one of the fortunate ones who knew what selective reduction (SR) was even was prior to beginning my fertility treatments. I called it “fertility’s ugly stepbrother;” it existed to clean up the messes fertility drugs caused. My end goal in fertility treatments was always one healthy child, and although the decision to move forward with SR didn’t come easily to me, I reduced from triplets to a singleton at 12 weeks gestation.

I’ve always been open and honest about discussing my SR in public. However, in discussing this choice, I have begun to notice I don’t fit in. The choice advocates aren’t sure how to respond; the pro-life advocates call it abortion; and women who have terminated for medical reasons fume that I would associate my choice with theirs, as I have a child and they do not.

The multiples community looks down on me as cowardly or selfish. From time to time I receive emails confirming this is true.

We, the selective reduction community, don’t fit in anywhere. I’ve had friends who worked at abortion clinics call the procedure “half an abortion” or a “partial abortion”. I’ve had family members suggest I could have adopted the other two fetuses to friends. There’s the always deeply loved “baby killer” moniker that won’t seem to cease, no matter how many times I explain fetal development and the statistics on triplet pregnancies.

Hence, the weird-grey-area of reproductive choice is where I’m comfortable, nearly six years post-procedure. I don’t feel the need to fit into a certain place or space in the world. The grey gives me comfort, knowing I’m inadvertently bridging the gap between the pro-choice and pro-life worlds. Selective reduction doesn’t fit anyone’s expectation on what choice means. When you fall into the grey, it causes this wormhole of stereotypes to occur: where does she belong, where does she fit, this choice makes me uncomfortable… My response: I am where I was meant to be.

Let me push the envelope on what you believe choice means, let me be the one who informs you that choice is not simply a means to an end. Choice can mean a means to a beginning. Choice led me to a very healthy, vivacious, beautiful child.

Confounded? You aren’t alone. These days women’s reproductive health issues are fodder for water cooler discussions at the office. Words like vagina, afterbirth and choice give way to fanaticism in ways that confound me.

I never thought discussing my pregnancy or my vagina would lead to a place wherein I find myself today: the creator of a community, the only life preserver women feel they have when faced with such a complex situation, and the only person willing to use their name and put a face to what selective reduction really is. But, here’s where I sit: a happy mom, who provides support and doesn’t apologize for our decision to terminate two fetuses.

My life is one that will never get uncomplicated. I am a strong-willed woman, born by a strong-willed woman, and I have my own strong-willed daughter. I come from a long line of women who choose to push envelopes. These days, I’m not trying to push them; I want to burn their very existence. I may make you uncomfortable, as the very idea of opting to terminate two of three fetuses in a pregnancy can be disquieting. The grey is that last puzzle piece that can’t be forced to fit into the slot you want it to. We are the puzzle piece left over, and we’re comfortable with that.

You might be reading this asking yourself a lot of questions. Why did she terminate two of three and not one of three? Does she feel bad? Does she question her choice? The answers to those questions are complex and not exactly easy to answer. I made a choice, just as you make choices: how many embryos to put in, whether or not to continue multiples, choosing a donor for sperm/eggs. They’re all choices.

I am a mother, just as you are or will be. And I want the best for my child and for my family at any cost. My question back to you is this: are we really so different, then? We’re just parents or future parents, making the best decisions for our families. Perhaps there’s no line delineating us after all.

 The Aftermath of NOT Reducing: Angela’s Perspective

Angela Bickford headshotAngela Bickford is the mother of triplets, one of whom passed away after 49 days. After three years of infertility, and her subsequent loss, Angela has made it her mission to help other moms going through similar struggles. She works for the non-profit, Hand to Hold, which supports the preemie/NICU/loss parent, and writes about surviving after loss on her personal blog.

When it came time to have ‘that’ conversation with our doctor, I knew what was coming. I’m a type-A, worry-about-it-all, see-the-missing-tile type person who’s already experienced three years of trying and several miscarriages. Part of me felt it would be the ‘smart’ choice, and part of me just wanted the miracle of three, healthy babies.

Deep down, I wasn’t really that conflicted. I knew that I could never reduce – not because of my faith or whether or not it was acceptable – but because I’ve always wanted to be a mom and with it taking so long to get to this point, I wasn’t letting any of them go.

So my husband and I said a quick ‘no’ and moved on. We didn’t need to hear the risks, we wanted all three.

At 14 weeks, a cerclage was placed to help ensure they’d stay cooking longer. At 21.5 weeks along, I was placed on home bed rest with the beginnings of incompetent cervix and told that Baby A was at the most risk. This is when my self-doubt started to creep in.

The second-guessing. The what-ifs. And, of course, it was too late to revisit that conversation… (side note: it wouldn’t have changed anything, but it’s important to note that even after making my decision, my mind still wondered.)

At 23.5 weeks, I landed in the hospital and continued my bed rest there. Eventually, Baby A’s water broke (11 days in), but the babies didn’t make their entrance for another 19 days. All sick. All needing resuscitation. All near death.

It was day-by-day and minute-by-minute. It was a lot of what-ifs and second-guessing. Wondering how we could have done things differently or if the outcome would have been different if we had.

Because, in the end, we lost Baby A – Carter – because that risk – that real risk they talk about in that conversation no one wants to have – it won.

I guess I share all this to say that even though I didn’t personally choose to reduce, I still didn’t get my happy ending. Could reducing have made for an easier pregnancy? Could it have helped my other two stay cooking longer and ultimately be free of the lasting effects of prematurity they have today?

I’ll never know. But what I do know… is that I made a decision. It may not have been a decision someone else would have made, but I own it, and I’m okay with the way it ended up.

Two women, two views. Different outcomes, same question.

We’d like to end by saying that every situation is different – every pregnancy, every woman, every uterus. In life, in the hardest of situations, you have to step up and do what you feel led to do. And we challenge you to put yourself out there and see the other side… to have compassion for someone you may not know for the decisions they make that are not yours to make, whether you agree with them or not. To love and support your friend through their struggle to make this decision and make sure they know you’ll be there on the other side. Because everyone deserves support. Everyone deserves at least that.

Infertility TalesThis post is part of Infertility Tales 2014, How Do You Do It?‘s series to raise awareness about infertility and its impact on families. Please take a moment to read through some of the personal stories of loss, pain, fertility treatments, and success.

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Angela is a stay-at-home mom raising surviving triplets. She lost her first-born triplet, Carter, after 49 days, and her survivors, B & T, keep her pretty busy with their ongoing needs as a result of their prematurity. She manages to find time for her business and personal blog ( Her tagline ‘Mom of Triplets. Lost One. Survived & Sharing’ is her goal in blogging and she aims to share with others that it’s possible to survive after loss. She and her husband live in the Houston, TX suburb of Cypress. She also blogs at Thirty-One:10.

6 thoughts on “Selective Reduction: Two Women, Two Views”

  1. Thank you Shelby. It is very important that Selective Reduction is discussed openly and women know about their options and choices in order to make the most informative decision which is best for their families. I found myself in a quad pregnancy as a result of IVF, given the stats I knew that there is no way I would be able to carry 4 or even 3 to full term. My goal was to have a healthy pregnancy and a healthy child at the end of this infertility battle. I was prepared to do whatever it takes to achieve that. I asked myself a few questions, would I be OK with the possibility of pre-term labor? The answer was no. Would I be OK taking the risk of having the babies so early that 1 or more either wouldn’t make it and would suffer, or be disabled for the rest of their lives? Was it fair to them, myself, my family? Women who choose to reduce don’t just wake up one morning saying, “O hey, let’s just go and reduce!” it’s a very difficult decision that takes many factors into consideration. It’s a brave choice that not everyone is strong enough to make. Like Shelby and many other women I made that choice. I chose to give my hard earned, long deserved pregnancy and my future child the best possible outcome. Being healthy. I reduced to a singleton. I have my son who is perfect!!! Being a parent means taking responsibility for making the best choice possible for your child, as tough and unfair as those may be. THANK YOU SHELBY FOR OPENLY SPEAKING ABOUT THIS!!!! Thank you for the support you offer women, you helped save many many lives. You are just amazing.

  2. Thank you for providing both points of view. For me it clarifies that there is no one, right choice. It is such an individual and personal decision and one that is best made when fully considering all the choices and possibilities.

    I also underwent 3 years of IVF, negatives and miscarriages before conceiving my singleton son. We decided to try again for “1 more”. As I was waiting to go into the surgical suite for the procedure my doctor approached my husband and I about the embryos that had been thawed. He recommended placing two in my uterus. I told him we wanted to place three to maximize our chances of success. The conversation went back and forth over many minutes with each of us insisting on our position. As the patient, I believe I had the ultimate say however, he made us stop and think when he asked what we would do if it resulted in a triplet pregnancy. Without hesitation we responded that we would not do a selective reduction. Primarily, for me, due to the risk of miscarrying all. But it crystallized for us the situation and we ultimately decided to go ahead with two embryos. That IVF attempt resulted in a twin pregnancy.

    I’ve many times reflected back on that day and have said a very grateful Thank You to my RE for sticking to his guns. We were blessed with two healthy, strong, full term babies and I thank God that we didn’t have to weigh those concerns and make that choice. Blessings to those of you who do.

  3. Shelby and Angela, your stories perfectly capture the reason why I am an advocate for reproductive rights for all women. I am not a mother and never will be, but I know hundreds of mothers. I know women who ended unexpected pregnancies and women who carried their babies to term and kept their babies or placed them up for adoption. I know many couples who have adopted children. I know women who did IVF to become single parents. I know women who ended medically unviable pregnancies and women who continued them, giving birth to children with major medical problems. Each woman, each pregnancy, each potential child, each complication is unique, and I believe all women should be able to make their own decisions when it comes to fertility/pregnancy. Thank you for sharing your stories so honestly. You will never know how many women you will help.

  4. At 40, I found myself pregnant with triplets as a result of IVF. This was my second round; the first had resulted in an early miscarriage. Testing showed that one of the fetuses had serious genetic abnormalities and was not growing well. This fetus had a strong potential to miscarry and therefore jeopardize the entire pregnancy. Therefore, we made the very difficult decision to selectively reduce, and I later gave birth to healthy full-term twins, both over 6 lbs and not in need of any NICU services. As others have said, selective reduction is a very personal decision, and although I feel I made the right decision with my pregnancy, this might not be the right decision for another parent.

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