Making Peace with Selective Reduction

Amber Leventry | Longreads | June 2018 | 11 minutes (2,805 words)

December, 2012. I shifted my gaze to my partner and away from the snow hitting the windshield of our SUV, coming at us fast and dizzying like those moving star screen savers we used on our desktops in college.

My partner was asleep in the passenger’s seat. Hours earlier, her pregnant belly had been home to three living fetuses. It now held two beating hearts and one that had stopped after being pierced with a needle full of potassium chloride.

My knuckles were white from gripping the steering wheel. I took a sip of my Diet Coke and ate a cheddar-filled pretzel Combo. Even with a snowstorm hitting the East Coast, we left right after the procedure. We didn’t want to stay another night in Boston, three hours from home and too far away from our 20-month-old daughter, who was in the care of friends. We knew we were driving right into the heart of the storm, but our journey had never been easy, and it seemed fitting to be pursuing comfort in difficult conditions.

***

November, 2012. “Are you religious?” the doctor asked as we stared at the flat-screen television mounted to the wall.

Two weeks after undergoing intrauterine insemination (IUI), Amy took a home pregnancy test and it was positive. At seven weeks we went back to the fertility clinic to have our first ultrasound.

The black-and-white picture on the screen was a projected image of my partner’s uterus. Joined by two nurses, the OB-GYN checked that there wasn’t a fourth fetus in my partner’s belly. He maneuvered the ultrasound wand with one hand and labeled the image with the other. I watched him manipulate the machine, looking for life as if he were playing hide-and-seek. He found three. My partner was pregnant with triplets.

I grew up in a Christian church, under the eyes of God and in a congregation full of hypocrites. My partner went to Hebrew school and was raised on Jewish traditions and family poker games.

“No,” we both answered. He seemed strangely relieved.

Before I could ask why he cared, he wanted to know if we knew the term selective reduction. We didn’t. He suggested we make an appointment to return and talk with him about our options. Unless religious reasons prohibited us from considering it, he wanted to provide the pros and cons of aborting one or two of the healthy fetuses.

While we don’t practice religion, it has hugely impacted our life together. Religion was the reason my mother chose not to come to our 2001 civil union ceremony in Vermont. When we were still just girlfriends, college students living together illegally in an off-campus condo, my partner and I used to tell each other, “I’m going to marry you someday.”

In 1999, we were still in college and knew the post-graduation ceremony we wanted to have would only be valid in the eyes of friends and some family. We knew the only ones who would consider our love sacred would be us. Homosexuality was against my mother’s beliefs. She loved me but wouldn’t support my “mockery” of marriage.

Religion was what slowed the momentum behind states beginning to recognize gay unions, and religion was why marriage still hadn’t been recognized by the federal government.

Religion was something used to limit us and our ability to be respected and considered equal as queer individuals and as a same-sex couple. Religion was not a sounding board my partner and I used to make decisions.

When the doctor seemed happy that faith did not prevent us from thinking about the next steps, religion was no longer a limiting factor in our lives. Our lack of religion was suddenly opening up our options as a couple.

***

December, 2012. “All three fetuses are equally healthy, so we are going to insert the needle into the heart of fetus C,” the doctor performing the procedure told us. “It is farthest away from the cervix and eliminating it will be the least disruptive to the pregnancy.”

“Do you want to see them one more time?”

My partner was lying on a medical table, her stomach exposed and ready. I squeezed her hand, and we looked away from the ultrasound screen.

“No,” she said.

“OK. Are you ready?” the doctor asked.

***

August, 2009. When my partner and I were ready to have kids, we decided to buy frozen sperm from a cryobank. We evaluated the desirability of anonymous donors based on physical features, family medical histories, and characteristics gleaned by reading essay answers they had written in response to the sperm bank’s questions. Because I was the nonbiological mother, my partner and I tried to find a donor who resembled me in looks and personality. I could not share their genes, but maybe I could share their eye color. Maybe they could share my sense of self. We chose a donor with blue eyes, blond hair, and the ability to know his strengths while accepting his flaws.

When we found the perfect guy, we had to figure out the perfect amount of his sperm to buy. We performed fertility math equations to determine the supply needed to meet the demands of a growing family; time, siblings, and potential miscarriages were variables. We hoped 12 vials of frozen sperm would yield at least two children. With any luck, 12 pregnancy attempts would be enough to create the little family we had always wanted.

***

February, 2011. “She’s here, she’s here!” I had screamed when my daughter, my first child, finally entered the world.

After nearly 24 hours of watching my partner struggle to give birth, she finally pushed our posterior, sunny-side-up baby girl into the early light of day. But it came at a cost. The damage our daughter did to my partner during her vaginal birth resulted in an immediate trip to the operating room. The top of our daughter’s head kept emerging, but after the pushing and the contractions, her head would retract. Our baby wasn’t yet in danger, but she was causing my partner to tear and bleed. There was a moment I was prepared to have the doctor’s perform an emergency Cesarean section, but with one final push my daughter was born. The top of her head was black and blue from having pushed against her mother’s pelvis for hours.

The doctor suggested we make an appointment to return and talk with him about our options. Unless religious reasons prohibited us from considering it, he wanted to provide the pros and cons of aborting one or two of the healthy fetuses.

Before they wheeled my partner out of the room, she held our baby and cried through red eyes; the whites of them had been replaced with the fiery presence of broken blood vessels.

I placed my daughter on my chest and didn’t know if I should feel relief, elation, or worry.

***

November, 2012. Triplets. Triplets. Triplets. As we left the hospital’s fertility wing, I said the word three times, once for each fetus.

I said it to determine if hearing it would make me know what to do with the knowledge. I said it while looking at the ultrasound picture that had the letters A, B, and C printed over three grainy sacs. I said it again and again to try to grasp the reality of the decisions we would have to make regarding the three lives now housed in my partner’s belly.

It had taken six tries and six vials of sperm to conceive our first child in 2010. After she was born, the months ticked away and her milestones were reminders of just how lucky we were. We had a perfect little girl; it almost seemed like testing fate to ask for just one more, but at 15 months, she was no longer just our daughter but also the potential sibling to at least one other child we hoped to have.

We wondered if we could do it with only the six remaining vials. We had made our peace with the possibility that we couldn’t, but we knew how blessed we would be if we could. Our second pregnancy was achieved after one doctor assisted intrauterine insemination. This time around, we were blessed times three.

***

The obstetricians who had delivered our daughter had told us the average gestation period for triplets is 32 weeks. They explained how their low birth weight could cause complications and the long-term health problems that could ensue. They told us that a triplet pregnancy also increases health risks for the person carrying the babies. Some of those risks would be amplified for my partner because of her difficult labor and delivery the first time. Carrying a second child, just one baby, was worth worrying about; carrying three babies would likely be too much for an already weakened cervix.

The doctors provided the science and our odds of having what was considered to be a successful pregnancy in terms of carrying three babies as opposed to two or one. They told us stories of patients who had faced the same choices. They told us stories of hope and faith, fear and longing. But they always provided the facts, the actuality of all predicted and desired outcomes. But how do you define success in this situation?

What was our definition of success when it came to this pregnancy? Would we only consider ourselves successful if we declined reduction despite the risks and found ourselves the parents of healthy triplets? In doing so, we would be accepting the reality of a complicated, if not dangerous, pregnancy. We would be expecting and planning to spend weeks in the NICU upon the babies’ birth. We would be accepting the possibility of the loss of one or more babies after delivery.

Would success for us mean the reduction of risks via the reduction of life? Would this also reduce our prospects for love, health, and boundless potential? As a gay couple, we had worked so hard to make a family. How could we be OK with eliminating even a small part of our dream? We knew the risks of not going through with the reduction, but there was risk in going through with it, too. Would success mean we sacrificed a life to enhance the possibility of health and happiness for two others?

Ultimately, we accepted the loss of one baby.

Nothing about this pregnancy felt like success.

***

October, 2015. “Let’s play Who’s Missing!” my daughter and oldest child screamed upon entering the house after a day at preschool. She kicked off her rain boots and was eager to show me and her two siblings how to play a game she had learned that day.

My daughter ordered one of us to go to another room while she hid one of her siblings under a blanket. When given the cue, I or her other mama was allowed to come into the room to guess who was missing. But her toddler siblings refused to stay hidden, or the dog wouldn’t get off of the blanket, or both of her siblings would try to hide. The appeal of playing a game she’d enjoyed with 15 like-minded 4-year-old classmates was lost on our family of five.

After my daughter threw a tantrum and ended the game, I thought of Fetus C.

Fetus C will always be missing. We don’t know the gender, but I think C was a girl, and I can feel the weight of her missing on my lap. I can hear echoes of her laughter mixed with that of the others. I can see the tears she will never cry in the tears my living children cry in abundance.

***

When my partner was four months pregnant the first time, we sat around our friend’s dinner table and signed paperwork that added a state marriage certificate to our collection of other documents that proved the legality of our relationship. We already had a civil union certificate, living will, and directives for me to become the guardian of our unborn child should something happen to my partner during childbirth. Our soon-to-be family of three would be protected, if not by default under federal law, then within the boundaries of our home state after much money spent on lawyer’s fees.

That sense of security was elusive the second time around. No amount of paperwork can protect three babies from the risks of a triplet pregnancy — with an average gestation period two months shorter than the nine months associated with a single birth — and delivery. We weren’t the types to find that security in the bible or in prayer. We were more the types to find our guidance in scientific journals. We read them and realized that the risks of keeping all three fetuses  outweighed the benefits.

***

June, 2013. “Of all the times, you don’t have your phone on you?” I listened to my partner’s exasperated words on my voicemail after coming inside to check my phone, which had been charging on the kitchen counter. While I had been cleaning windows, she had been sitting in a puddle of amniotic fluid. Her water broke right before she walked into work on a Monday morning. It was time. The babies were coming.

My partner had started to dilate at 29 weeks and our babies were born at 36 weeks. They were ready to come home three days later. We had introduced two healthy babies to their big sister, knowing the potential for three healthy babies or no babies at all had always been there. We reduced the pregnancy from three to two when my partner was 13 weeks along. The only thing that was guaranteed was an aborted baby. There was risk that the reduction would disrupt the entire pregnancy. Reducing one could mean reducing all three.

By the time my partner was at 24 weeks, the doctors relaxed a little. But her prenatal care was more involved than with our first pregnancy. There were more appointments, more ultrasounds, more things to be cautious of as time hopefully gave our babies the chance to develop and grow strong. While we had never wanted to be in the position to decide for or against a selective reduction, we were thankful we had the choice. We let each scenario play in our hearts and minds, we tried to predict the future, and we wanted our desires to prevail over medical truths. We could fight the odds and possibly be one of the families to have healthy triplets. Even more than science, though, mother’s intuition told my partner she could not carry triplets. She knew three would be too heavy. I didn’t disagree, but it had taken me longer to accept our decision.

Science cannot talk its way through or out of a broken heart though. Not regretting our decision doesn’t mean my heart doesn’t hurt each time I think about the injection that stopped the beating heart of Fetus C.

Science cannot talk its way through or out of a broken heart though. Not regretting our decision doesn’t mean my heart doesn’t hurt each time I think about the injection that stopped the beating heart of Fetus C. But the loss of life doesn’t equal the loss of love.

***

December, 2012. “I would advise my wife to do the same thing,” the doctor who performed the reduction had said as he talked us through the procedure before we went into the exam room. We sat across his desk from him, and I believed him.

My partner was 13 weeks pregnant. We had learned about the triplet pregnancy six weeks prior. There had been a chance one of the babies would stop thriving. There had been a chance we wouldn’t have to consider the reduction — nature would take care of it for us.

But we had to redefine success and what it meant to thrive. Our constant was always this: We wanted to keep my partner safe. We wanted to give our babies the best chance at starting life without medical issues we could potentially avoid. We accepted people’s prayers, but our decision was not based on religion. Our faith was in medicine when we decided to reduce a triplet pregnancy to a twin pregnancy. Our hope was based in love.

***

October, 2016. Three are running through the field. I can see them as I drive home. I take my hand off of the steering wheel and wave to them, but they don’t see me. Their golden hair shines like wheat in the setting sun. Their arms are outstretched as they run in circles, not to or from anything. They are just kids running in the warmth of a summer evening, placing all their trust in our hands, the hands we wring over and over again while doing our best to keep our babies safe.

When I come into the house, I drop my bag and go out the back door. I see my partner watching them. And I watch too. I can see their rosy cheeks. I can hear their giggles. I can feel the weight of their need and love without ever having to hold them.

We no longer have triplets, but we still have three.

* * *

Amber Leventry is a writer, partner, and parent. Her writing appears on Ravishly, The Next Family, Parent.co, Scary Mommy, Babble, Huffington Post, and The Washington Post.

Editor: Sari Botton