Selective reduction from twins to singleton in UK

[ConfusedPigeon2026]

I really don't know how else to feel right now. I recently found out I'm pregnant with twins (6 weeks, already have a 2yr old toddler) and am really struggling with the overwhelming gravity of this. I am waking up depressed, spending the day avoiding anything about the pregnancy and withdrawn, going to sleep full of anxiety. I desperately wanted another child but did not anticipate having 2..

I wondered if anyone knew if selective reduction was still an option in the UK? Not due to medical reasons for the fetuses but for the mothers health. I really don't know if I can have 2 more children and am looking at options whilst we navigate this unknown territory. They are DCDA twins (separate sacs and placentas). I read that maybe Prof Kypros Nicolaides at the Fetal Medicine Centre in London might offer this.. does anyone have any experience or knowledge that could help?

Thank you so much for reading. I'm really hoping to hear informative replies, not judgement please as this is a really difficult time.

I used to be a midwife at King’s and never heard of it happening for twins to singleton. That doesn’t mean it doesn’t but it’s certainly not common and there will be risks to the remaining foetus. To be honest you might be better off aborting and trying again for a single pregnancy when you are in a better state of mind. Good luck.

No judgement- as a twin parent I remember feeling overwhelmed at the idea when newly pregnant, almost wishing it away. I'm sure having a toddler already makes the challenge harder. But it can be managed and there is help and support for parents of multiples.
I suppose you could argue that terminating an unwanted twin pregnancy is no different from ending a singleton. But I would worry that there will be a psychological and emotional cost involved with choosing to allow one to live and not the other. There was a heartbreaking thread on here a few weeks ago with twinless twins who posted about their ongoing sense of loss and incompleteness, which sometimes included difficult relationships with their Mothers, who would blame them for being the surviving twin.
I don't know if Prof Nicolaides would offer a selective reduction. I was part of his twin trial 18 years ago and I think more likely this is something he would perform in extreme cases of twin to twin transfusion syndrome, where one monochorionic twin is starving the other. I would probably have lost my twins but for the monitoring we had on that trial, for which I'm forever grateful. I was scared at the thought of having two but years later I know that having twins was the blessing of my life, and I am bound to urge you to stick with them and give them both the best chance of life. It is really tough at first, there's no question. But it gets easier and you grow stronger and more capable than you would believe possible today.
💐 💐 💐 💐

Can you lay out what concerns you so much about three children / twins?

Also No judgement. Went from 2-4, total shock and I still wonder but also my two girls are fabulous. Global pandemic so all possible help was off the table and we did it all with 4 under 5 ourselves. Not sure how to be honest but after the pandemic I had some help from the Homestart who are amazing (and not means tested, available to all multiples families). The Prof is amazing, had CVS testing with him and he honestly is the nicest kindest man. I would suggest chatting through all your options with a trained person so you are making an informed decision whatever. Honestly your feelings are completely normal and matched mine. There is help out there for twin mums if that is the route you decide. Big hugs.

No judgment - I’ve only got one (I used to long for twins so I’d be “one [pregnancy] and done”), but since having the one, my God, I don’t know how people can cope with two. It’s damn hard work as it is - and that’s before we get to breastfeeding and premature birth risk.

I agree with PP though: even if someone could get you to a singleton, there must be risk to the other. I would abort and try again if you really can’t cope (and your mental health and resources are a valid reason, to be clear)

@MauriceTheMussel of course everyone is different but I wondered how on earth you manage a second until just before my second (planned) arrived but you just do. I would say that for multiples, having a supportive hands on partner is very helpful but I also know mums who have done it on their own and they are ok.

OP maybe (in a supportive place) have a quiet think about how you would feel if you have a selection and lose both. Your own private answer might help with your thoughts about all this.

@ConfusedPigeon2026 as someone that has been through this too and knows the weight and depression that carries know there are options out there for you. You can ask your hospital / midwife to refer you Dr Nicolaides or Dr Basky for a consultation, not necessarily to do the procedure but to understand the procedure/ the risks / the recommendations and whether this is something they would perform in your circumstances. Advice we were given was it is possible to do the procedure, they recommend you speak with a psychologist / maternal mental health professional before you make any decision. Some info re the procedure we were given they will medically identify which twin would be reduced, we were told this would always be the twin furthest away from the cervix with a few exceptions. With non-identical twins risks are lower, but there is a slight increased risk of miscarriage to the remaining twin, but a slight reduced risk of premature birth. These are all things the dr could talk through with you so you understand everything it entails. I also agree with PP that you do in fact just make whatever work in terms of parenting more children, especially if you have a supportive partner, so it’s likely some of your concerns are just from shock and you’d actually cope just fine once you’ve come to terms with it but i also believe that maternal mental health can take many forms and feelings of not being able to cope whether thats physically / financially or mentally can be valid. And you can only do what is best for you and your family. I wanted to respond here publically so you know you’re not alone in having these feelings and that there are options should you wish to explore them zero judgement.

I really feel for you and no judgement. Perhaps allow yourself some time to process before making any choices. I would set a deadline for myself, like 1 or 2 weeks, where I’m just living it and gathering information before making any permanent decisions.

If you decide twins is not possible for you at all, I personally would probably opt for termination of this pregnancy. A very complex procedure which could lead to complications and the emotional complexity of knowing this is the surviving twin is a lot to manage. Unless it took me years and fertility support to conceive each time, I suppose.

Even if it could happen - what if the “surviving” twin ever found out… it could affect them for life …. I think the risk physically , emotionally is too high for selective.

Maybe abort both if you are feeling unready and wait till your toddler is older knowing the next pregnancy may risk in a twin

Having had a TfMR of one twin, it’s not a procedure to take lightly. High risk to other baby, injection through the stomach, the wall of the uterus and into the baby’s heart. Once the baby has died, still continues to be high risk for the other baby. Depends what stage you have the termination as to whether the remains of the baby are still there when you give birth.

obviously your situation is different to mine but could you live a lifetime looking at your child thinking there could have been another one? It’s not a nice feeling at all.

No judgement here. It’s your body and the rest of your life so it’s your choice. I had twins and a toddler and it was very hard. I remember when I found out it was twins reading that it was fairly common for one to not survive the pregnancy and feeling quite hopeful that would be the case.
Obviously now they’re here and young adults I adore every atom of them and can’t imagine life without them but it would have been so much easier with just two children.
I think possibly a termination of both would be more straightforward and lead to less distress overall.
Good to see you haven’t yet had responses from judgemental people. Whatever you do don’t tell anyone in real life.

Please don’t do this, twins who lose their sibling often speak of the ache they had for their sibling.

I am not a parent to multiples. But I have twins on all sides of the family (and actually gutted I didn’t have twins myself). And obviously couldn’t imagine life without the individual twins in my life. I think you may get some good advice speaking to TAMBA. From your post you sound in shock. Explore all your options, don’t only consider the termination route. This was a longed-for pregnancy, and other than the number of babies a wanted one? 💐

I would worry that you might lose both if you do this? Is it worth the risk?

I know someone who had a selective reduction of triplets to twins with prof Nikolaides. It all went well and the twins are thriving.

You need to do what is right for you.

You don't know how you might feel watching one from up, knowing they are at the exact age and stage of the other. It wouldn't be like a normal abortion, you'd have a reminder every single day. Plus the knowledge that one day the twin might find out and resent you. I would try to pinpoint exactly what it is that is the worry about 2 versus 1, and see if any of that could be resolved in some way (extra help from family, etc) and if you really can't see a way out I'd abort the pregnancy and try again.

I have twins, and totally understand the overwhelming feeling of “how will we cope?”

As a PP has mentioned you can get better advice from Twins Trust - that’s the new name for TAMBA. They are wonderful and can give you access to medical and emotional support.
www.twinstrust.org

When did you find out it was twins?

I had the exact same response as you. I was googling selective reduction before I even left the hospital. It was shock.

I spent the rest of the pregnancy thinking one wouldn’t survive. Not that I didn’t want it to but you get a lot of negative “what ifs” from all the appointments you’ll have going forward.

My beautiful girls turned 7 last week. Yes, it was hard but I couldn’t imagine them living without each other.

You need time to process it before making a decision.

Please speak to your midwife or GP and ask for a referral to the perinatal mental health service and tell them what you have told us.

I looked into this last year it’s available privately with a dr called professor Nicolaides. I had severe HG and wasnt allowed a certain medication till after 12 weeks then the one they did prescribe led to something called toxic psychosis. For the selective reduction you have to be around 12 weeks if I remember and I couldn’t get that far as was so unwell and had to just have a termination which I didn’t really want in the end .

Praying for you

I have named changed for this. I was in a similar position when I found out I was pregnant as I never expected twins and could t imagine three under three. I was so shocked and was worried I wouldn’t cope.

I had a 2.5year old when my twins were born. I also had very bad morning (all day) sickness. I was admitted to hospital with it a few times due to dehydration.

Although it’s a challenge I can honestly say it’s been worth it. They are all tweens now, very close. They argue, of course, but they are very supportive of one another. It’s a actually easier having two the same age as they play for hours together. Three meant lock down was so much fun. They came out completely unscathed emotionally and developmentally and I believe it was due to their relationship (this is irrelevant for your children but with two preschoolers and a slightly older child it’s an example of a time we could have really struggled).

They always have a friend at the park or anywhere really!

Finding twin parents in the early days is very helpful. You may find that there is a twin group near you - they are often not well advertised, many mums attended before the babies were born.

What is your biggest worry? Mine was coping with three small ones and the noise. What does your partner think?

I couldn’t imagine doing this, raising the surviving twin knowing they should have their sibling.

You need to either raise both or terminate both.

Can I ask, how come you've already had a scan at six weeks? Do you have a history of problems in pregnancy, or did you feel something was odd...?

I was told that having already got two children and carrying MODI twins, I would been advised to do this had I been carrying triplets. Definitely would have got the Prof to do it. Couldn’t do five plus the enormous risks of MODI and a singleton. Everyone has their limits and you alone know what yours are but I would wait until the initial shock wears off if you feel you can.