Thursday, April 12, 2007

Deflated

I give up. I was very firm in my no-reduction position. I was clear, I had thought it out, I had researched it and researched it and researched it. I wasn't going to be pushed around.

And then I saw my OB this morning. I love him. I respect him. I trust him. These are all important things with an OB. He asked what I'd decided after talking to the perinatologist, and I told him I just really didn't think I could consider reduction. I didn't hear anything compelling enough to convince me otherwise, and I know I'm taking on a huge risk, but I think that the risks with reduction are almost as scary, nevermind the moral dilemma. I told him it isn't fair. I told him there was NO good option here... both options are rotten, and there's no way around it. I don't love the triplet idea. I want a big family and I'm all for welcoming three children into my life, but I'd be lying if I didn't say I'd much prefer to welcome them individually.

And my OB, who I trust more than just about any doctor I've ever had, looked at me with a look of such genuine concern and told me very calmly that he is very worried about my ability to carry all three. He's worried that if I try, I'll lose them all. I'm worried that if I reduce, I'll lose them all. See? No good options. I told him that the perinatologist had sort of brushed off the concern about my height affecting fetal weight, but he strongly disagrees, and I've got a study sitting in my bag that supports his position on this. Women under 165 cm are at a much greater risk of severely low birthweight triplets than women over 165cm. I'm 152 cm. He reiterated that he was still troubled by the 12 week loss I had in my last pregnancy, since there was no apparent cause for it (and they couldn't do genetics on the fetus, because it was mishandled by the ER). He agreed with me that there is absolutely no good choice in this matter and that there are risks on either side of the coin. He understood my concern of total fetal loss resulting from a reduction. He told me he would absolutely support me no matter what my decision, but he asked me not to make up my mind until after the nuchal fold scan and/or CVS (if we do the CVS). I think that's a fair and reasonable request.

And now... I just feel so defeated. So conflicted. So uneasy. I haven't really stopped sniffling since this morning because I just don't know what to do. No matter what I do, I'm going to second-guess myself. No matter what I do, I'm going to blame myself if it all goes South. No matter what I do, I don't know how I'll deal with the consequences. I am utterly, completely, miserably confused right now. And there is no one who can make this decision for me. Even my husband's opinion seems to be that he'll support whatever I decide, and he sees both sides of the argument, and he feels like it's my body that's going to have to deal with the consequences either way, so it's ultimately up to me. In some ways, that is the bottom line. While yes, it should be a joint decision... I'm the one who has to carry three if that's what we do, and I'll be the one physically carrying the burden of that decision. While it may seem like a cop-out... he's really right. Certainly I wouldn't allow him to FORCE me to have a reduction, so ultimately... it's true. It's my body, my call. Like it or not. Still, it would be nice if he would have a strong, specific opinion on the matter, so that I could either rebel against it or embrace it and blame him when it all goes wrong. ;)

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Oh yeah... I should mention... The OB couldn't hear the heartbeats with the doppler, maybe just a tad bit too early. I thought I heard it at some point, but it was brief and fleeting and he couldn't get a lock on it. So he took a quick look with an ultrasound, though I didn't get any pictures. He just wanted to get a quick peek to see if the heartbeats were all still there. They are indeed. Three of them. Three viable fetuses. The sacs have grown a bit and they're all squished up together. Anywhozit, I got my quick peek. Nuchal Fold scan at the perinatologist's office next Friday (the 20th).

20 comments:

decemberbaby said...

What utter suckage... I have no idea how I'd go about making that kind of decision. I guess not thinking about it until the nuchal scan makes sense... I really hope that you can make it through this decision as easily as possible. I hope that somehow it'll be clear to you... but infertility seems to mean a constant muddying of the waters.

Big hugs to you. I'm pretty sure that's all I have to offer.

Erin said...

*sigh*

That's about all I can offer. There are so many risks either way you turn. I'm just hoping for the best outcome, whatever that may be.

carrie said...

So very, very tough. I'm so sorry you're in this situation. Did he talk about the risks of reduction with you? I know you've been concerned that no one has been talking about those risks.

Dr. Grumbles said...

It is all so confusing and difficult. I have no idea what I would do. I hope all 3 do well if you decide against reduction. If you do opt for reduction, I hope the remaining fetuses thrive. I just want the best for you, whatever form it make take.

Jody said...

I'm sorry. The indecision and the uncertainty and the ultimate unknowability all just SUCK.

You might try the old, somewhat tired trick of imaginging yourself at 14 weeks, and you've made each decision. Which imagined future feels better? (This totally elides the question of what actually happens once the pregnancy gets challenging, of course. I'm so useless.....)

Jody said...

One last, admittedly biased question: you say the MFM practice you're going to use has strong HOM statistics. What do they say about the height question? What are their outcomes? I'm becoming more and more convinced that a lot of the statitical findings are very locality-dependent, and you might feel more strongly (in EITHER direction) once you hear from the MFM on the height issue, particularly with regards to their particular protocols and outcomes.

I know we got one set of stats on outcomes (birth weight, etc.) from a resident fellow, and when the attending came into the room, she crossed them all out and revised upward for their patient outcomes. And then explained why his stats, based on the outcomes at his med-school teaching hospital, weren't as good as theirs.

The height thing has been shown to correlate with better outcomes, is the problem. Do I know moms of your height who did great? Yes. But the stats are there.

Sigh.

Thalia said...

Unbelievably difficult, Karen, I don't know what to say. As you say, there are pretty much no good answers here.

Thinking of you, (has the bleeding stopped?)

Susan said...

Oh, ugh. What a difficult place you are in. Such incredibly, inconceivably difficult choices. I'm sorry that you are feeling so burdened and I wish I knew what to say to ease some of this for you. Will be thinking of you.

Anns said...

I don't think this decision can be easy either way so I'm glad that you've made up your mind and are sticking to your guns. Regardless of what happens you'll know that you did the right thing for YOU and that's all that matters.

We're here for you hun. Be proud of your decision not to reduce, you are giving all 3 of your babies the best possible shot they can have. Your decision is selfless and strong.

Anns xo

Anonymous said...

I think deflated sounds about right.

I just wish there was an easy answer.

Thinking of you. Lots.

Marie-Baguette said...

I am going to tell you something that might complicate things even more, but our nuchal was abnormal (thickness of 3.8mm instead of 3). We cried non stop for 24 hours until we got the results that the baby was fine. So the nuchal will not give you a clear answer. Only a CVS will. I am thinking of you

Unknown said...

I can't imagine how difficult this is for you. All I can offer: go with your heart.

Anonymous said...

You might not have a decision to make anyway, if the halakhah says you are forbidden to reduce. Only if you are permitted but not obligated to reduce will you have a decision to make. Right?

It does seem that since you will be doing the testing you will indeed need to wait until you have results that are conclusive, no?

twirl said...

I wish it was simpler for you, I really do.

It seems like there are valid stats on both sides of this issue, and I wonder if all the continued info is muddying things up for you. You already know there are good and bad outcomes possible for both choices. It seems like there isn't going to be a clear scientific answer in this case.

I think for definitive answers about fetal health, you'd want to do the cvs, as the NT can be inconclusive. You don't need more inconclusive.

Anonymous said...

I really feel for you.

Chris said...

I don't envy you this decision at all. Fortunately you'll have the support of the important people in your life regardless of what you decide.

Kellie with an "ie" said...

I wanted to tell you about a blog I ran across a few days ago. The writer is currently pregnant with one child after having a reduction from quads. I didn't know if this would be of interest to you at all, but thought I'd forward it along.

http://canwemake3.blogspot.com/

Sending you every good wish for a healthy pregnancy.

Lollipop Goldstein said...

Sweetie, I wish someone could make the decision for you. Or, at least, that the decision would be clear-cut. Easy to make. Settled. I'm sorry. I'm hear to listen if you need a sounding board to bounce ideas.

Leah Goodman said...

*hugs* from Israel.

Unfortunately, without prophecy, there's no way to know what the right decision is. It really sucks.

Feel good. Sorry about the nausea...

I had a throwing-up-in-the-middle-of-the-street adventure during my nausea phase.

Wishing you all the best,
t.c.

bloggeresse said...

Don't know the details of your pregnancy history as I just found your blog.. But I'll say that the doctors told us too, that carrying quads isn't quite what a body's made for... And they mentioned that it was possible to have some removed (although it was merely mentioned, not really suggested!), but that it would often happen that - if we removed two, the other two'd fall out. Well, we'd always wanted a whole bunch of kids (although not really at the same time..), so there really was no option. Now, I'm 170, and not thin (which the doctor pointed out was excellent in this case. And I only put on 3 kilos during my pregnancy, came out thinner than ever...), but my body was fine with the whole thing.

Hmm. I thought I'd just mention that it was doable, but I seem to have gotten lost rambling, as usual...