Thursday, September 06, 2007

Peri Appointment

I had my perinatologist appointment today. I thought I would come away from the appointment with more information and a clear idea of what I wanted to do next. I was so wrong. I did get more information, but I am even more confused now. I know that he has to be impartial and not try to sway you one way or the other - I'm sure they do that for legal reasons - but it would be nice to hear their opinion.
I did get a long list of different things like preterm labor and NICU admission and it compares rates of singleton pregnancies to twins to triplets and up.

This is just so unfair that I have to make this decision. I think I am still leaning toward reduction, but I really don't want to lose the whole pregnancy. But it's not like I have a crystal ball that will tell me the future if I did decide to keep all 3. Because who knows, I could lose all or some of them, they could be born with cerebal palsy, or they could be born completely healthy. There is no way of knowing and I think that is what is driving me crazy!

So, I really have to consider not only health consequences, but also financial ones. We are planning on moving back to the midwest next summer, but if we can't sell our condo, we aren't moving. I'm not sure we could afford to live in San Diego with our mortgage and take care of 3 babies. As it is, we both have to work to pay the mortgage. Add to that the cost of daycare, and we would have no money left over.

I also do not want my babies to have to be in the NICU. They most likely will be if I continue with three. I also do not want any of them to have any disabilites like cerebal palsy. It would be heartbreaking.

I just really hate this. It's so unfair.

17 comments:

Natalie said...

It really is unfair hon. :( I'm sorry you have to make such a tough decision.

Taina said...

Just remember, there is no right answer.

bleu said...

I am so sorry you are going through this. The only advice I can offer is what helps me and what I tell dear friends when they are faced with a hard decision. That is to find a quiet place, take 10 or 15 minutes and find some quiet and center yourself and then when you are quiet and still and centered..... listen. I truly believe the answer will be there, in that space, where you will know what is the right choice for you.

I wish you peace with whatever your decision.

Bleu

Fertilize Me said...

No words, just prayers. You are having to deal with an unfair amount of the universe right now

Sara said...

Heather- I wish I had some words of wisdom for you, but I don't. All I can say is that I am thinking about you and your little ones everyday...I know that this decision is not easy for you, I really wish you didn't have to make it- I wish there was an easy answer. I had hoped that after your appointment today that you would have had more answers than questions. You have been through so much already just getting to this part of your journey- no one should have to be thinking about this, especially you- you have such a kind heart- I wish that I could take your pain away. Please know that if you just need to talk or need to vent or just need someone to listen- I am here. Hang in there- sending you love and hugs my friend.

nola said...

You're right, it isn't fair. Nobody should have to face this kind of decision, especially without knowing what the outcomes may be. Whatever you decide to do, I know you will think long & hard and weigh the facts that you do have, and trust your gut instinct as a woman and now, a mother. I, too, wish you peace in this. And whenever you need us, we'll be there to support you without judgement on lp.

Donna said...

Such a hard place to be. My prayers are with you. I have no idea what I would do in such a situation. I pray that you will have peace no matter what you decide. Life is so complicated in this age of technology.

Egged Out said...

yes as everyone says, this is an unfair dilemma to be placed in. I wish you peace of mind as your come to a decision. my thoughts are with you.

Shelby said...

Such a difficult decision. It sucks that you have to make this choice. I will be thinking about you as you work this out.

Karen said...

My first perinatology appointment didn't make anything any more clear either. Okay, so here are some thoughts though...

1. You said you're still leaning toward reduction but you really don't want to lose the whole pregnancy. I'm assuming that your concern there is the risk of total fetal loss that is present with a reduction procedure? I asked my perinatologist about this way back in the dark ages at the beginning of this pregnancy. He follows about 15 sets of triplets per year, and for every triplet patient he cares for, he reduces two, so he's doing about 30 reductions per year. When I said that I was concerned that the studies I was reading about reduction suggested an increased risk of total fetal loss with triplet-to-twin reductions, he said you have to be careful in reviewing those studies because they tend to be very long-term studies (he's quite correct... I had 8 studies printed out in my file with me that day and nearly every one of them was a compilation of data collected over the course of 20-25 years... medicine has changed a LOT over that span of time, so it's fair to imagine that skills with reduction procedures have improved as well. He also said the other thing those studies don't account for was what kind of care those women received after the reduction... were they seen by MFMs, OBs, Family Practitioners, Midwives, or No One? This piece of information could make a huge difference in the significance of the statistics presented in the study. So my husband asked him outright: How many total fetal losses had MY doctor's practice experienced after reduction? The answer was zero. But then he corrected himself and remembered a woman who had come to him 17 weeks pregnant with sextuplets (really late for a reduction as they typically do a reduction by 15 weeks) and they were reduced to twins. She then moved out of state, went to a regular OB, and complained of contractions at 23 (I think) weeks and the OB told her not to worry about it. Her water broke and she delivered the next day and neither baby survived. I think it's safe to say that particular loss was not really related to the reduction, though. Lesson learned? Talk to your MFM about how many reductions they do per year, how many total losses they've experienced after reduction, and what the circumstances were. It's likely that you'll find the chances of total loss aren't any higher than they would be if you carry all three or if you had a normal singleton pregnancy.

2. I also asked my perinatologist whether it was significant that I wasn't comparing a normal triplet pregnancy and its risks to a normal twin pregnancy and its risks. Rather, I was trying to compare a triplet pregnancy to a triplet-reduced-to-twin pregnancy, which isn't quite the same thing. He agreed that it does carry a SLIGHTLY higher risk than a normal twin pregnancy, but that the risks still much more closely approached the risks of a normal twin pregnancy than the risks of the triplet pregnancy.

3. Those two things being said... your other fears may or may not be justified. You say you don't want your babies to be in the NICU. But I know plenty of singleton and twin babies who spent time in the NICU. You are quite correct that the babies could be born with CP or completely healthy; however, this is also true with a normal singleton pregnancy. In fact, when we looked at the risks of long-term disabilities for triplets, the increase in risk really wasn't all that significant. We looked at these statistics pretty closely because it was the ONE fear that my husband voiced... he otherwise said this decision really was mine since I had to bear the physical burden either way. If you had a singleton with CP, would you blame yourself? Probably not. So why should you blame yourself if you had triplets with CP?

4. Re: financial considerations... I can't really help you there. The financial ramifications of triplets terrified me. They still do. I don't know HOW we're going to do it, and my husband and I both make very good salaries, even accounting for the fact that we live in a very expensive area (Washington DC Metro Area). When we pile on the mortgage, student loans, our new car payment (hello, Minivan!), preschool tuition for our 4 year old foster son, and now potential daycare/nanny for triplets... it's TERRIFYING. (never mind food, clothing, etc.) We, however, very specifically did not consider financial issues when deciding on the reduction issue. I'm not saying you shouldn't consider financial ramifications, I'm just saying we purposely pulled it out of the equation. I wanted to make a purely medical decision, not a financial or emotional one, but I also know that our approach is not a practical approach for everyone, and I don't believe there's one set formula for making this decision, so I'm not saying you should follow our model necessarily.

5. You are right that there is NO way of knowing the outcome either way. And either way, you will always wonder "What if I'd made the other decision?" It's a completely unfair decision to have to make, because there IS no good decision. Just remember that whatever decision you DO make, you've made the RIGHT decision, because it is YOUR decision and no one can take that away from you. You don't ever have to tell anyone you struggled with this decision if you don't want to, or you can tell everyone about the struggle if you want to. Either way, whatever you decide, it is the absolute right thing for you and your husband.


Sorry this is so long!!!

Stacy said...

New to your blog. I am so sorry for what youa re going through. If you ahven't already found it I know IVF Connections has a board for fetal reducations that provides stories and advice from both sides. Here is the link:

http://www.ivfconnections.net/board/forumdisplay.php?f=176

Anonymous said...

I think you need to put all of the science and assvice aside and go with what you think is right. I could not make this decision...I feel for you.

The Oneliner (Christina) said...

ohhowscary.
i wrote out a response and realized that everyone else already said the few things i had to offer.
i do think the chances of total loss with a reduction is very, very slim. i know. still.scary.
GL with the decision.

Anonymous said...

I'm really sorry that you have to make this decision. If you're concerned about finances, you could talk to a pregnancy crisis center (like Life Choices) and I know they would be willing to help you get the supplies you need.

Kami said...

That would be a very tough decision. I spoke about it briefly with my RE when we put back 6 embryos and he said that he wouldn't know what he would do if he had 3 - that he would need to be in that position before he could decide. The risks and the benefits so closely balance.

I understand not wanting your children to start out their lives in the NICU too.

I will be thinking about you.

Amanda said...

*first time reader of your blog*

I am so sorry that you are having to make this decision. I cannot imagine how hard this must be for you.

I will pray for you. And like taina said, there is no right answer.

Anonymous said...

" Anonymous said...
I'm really sorry that you have to make this decision. If you're concerned about finances, you could talk to a pregnancy crisis center (like Life Choices) and I know they would be willing to help you get the supplies you need."

Just know that they will talk/bully you out of SR on moral grounds.

I support you an any choice you make.