Selective reduction - is it available in the UK?

[Unexpected2020]

I’m so sorry to ask this here, and it’s breaking my heart that I even have to consider it. I’ve just found out that I am pregnant with twins, it is a massive shock. For a significant number of reasons - physical (I’m extremely petite), mental health, financial, and for the preservation of our family, we just do not feel we can go ahead with it. I am struggling to find any info about my options - I have read about selective reduction, is this something that is available on the NHS? Please be kind and don’t judge me.

I’m sorry you’re going through this. Is selective reduction continuing the pregnancy with only one baby?

@BeingATwatItsABingThing thank you for your kindness. Yes, it’s basically terminating one pregnancy to continue with just one.

A relative of mine caught via IVF and would have had 5. For various medical reasons it was recommended that she only keep three. This was some years ago as all three babies are now adults.
But it was definitely a thing in the UK once.

Unexpected2020

I thought it was but didn’t want to make assumptions. I have no words of advice as I haven’t been in your situation but I can only imagine how tough this must be for you. I hope you are able to make the right decision for you and your family.

I believe that it is only available for medical reasons potentially mental health of the mother could be considered but usually in higher order multiples.

Don’t feel you need to apologise for asking the question you dont have to at all x

Yes it is available and may come under the mental health reasons for you.
A coupe of things I will say though to ‘reassure’ you if that’s the right phrase is in terms of you being petite - most of the time women will have babies to suit their bodies so even if you are petite and your husband is 7ft babies are more likely to be petite during pregnancy. In cases where they are identified as being big you would be advised accordingly and perhaps have a c section.

Obviously I can’t really comment on finances and mental health as I do not know exact circumstances
. There is support available though if needed.
And sorry if this is the wrong thing to say it’s in no way meant in the wrong way but it may help to clarify - if the preservation of your family depends on only having 1 baby why is that ? Usually if someone is unexpectedly pregnant it’s that they want to continue totally or not at all I’m just wondering why it would make the difference to continue a pregnancy with just 1 and not both sorry I’m probably staying it wrong I don’t want to upset or offend
You don’t say if the pregnancy itself was planned or not ? So I was unsure if it was the shock that you were pregnant and it’s twins or shocked just that it’s twins ?

Sorry again if I’ve worded anything badly x

@XylophoneSymphony no you haven’t worded anything badly, I know what you mean. We already have one child, and this was an accidental conception (condom broke, but my cycles are so irregular I thought we’d be fine), which we decided to go ahead with because we thought we’d be ok. But two is a whole different ballgame, the massive shift in dynamic would be huge, on top of everything else.

Do you know if they are identical or non identical ? I’m wondering if that may have an impact on the decision it would be worth it trying to get an appt (if that’s possible atm) to discuss is there an early pregnancy unit or do you have a midwife yet ?
I don’t know much of the procedure but I would guess it’s easier if they are not in the same place/sac

I really feel for you it must be such a difficult time and such a hard decision to make. There should be counselling available your gp may be able to do a phone consultation then an urgent referral to speak to someone who would know exactly how it works to help you make a decision

It's such a difficult thing to come to terms with. How far along are you? I sadly lost one of my twins at 10 weeks and apparently 1 in 3 twin pregnancies end that way (vanishing twin) so it may be that nature takes its course.

I've only ever heard of selective reduction being offered when there the was a medical issue that would severely compromise one of more of the babies' growth and affect the healthy outcome of the pregnancy (more often in the case of triplets or more). You'll need to discuss the way forward with your doctor. Good luck with what is decided, but petiteness of the mother is not normally an issue in twin pregnancies.

A friend had selective reduction of triplets to twins. All 3 appeared healthy but there are higher risks with more babies and she didn’t think she could cope with 3. It was done by Prof Nicolaides at Kings a couple of years ago (NHS) and all went well.

Hi Unexpected2020, we hope you don't mind but we're going to move your thread over to our Pregnancy Choices topic.

Sorry you're going through such a difficult decision.

From what I've read, it's only available very early on and for more than two babies. Someone else asked this question on here a while back and that's basically what came out. You either abort both or neither I'm afraid.

FWIW, petite women can have twins safely.

community.whattoexpect.com/forums/multiples-and-twins/topic/high-risk-because-of-petite-frame.html

I'd search out some Facebook groups for parents of twins and multiples and ask them how they managed/what tips or tricks you could use. There's also TAMBA- the twins and multiple births association. Really make sure you know the nitty gritty of both your options as far as possible before you commit to one. Let logic rather than fear be the deciding factor. Apologies if you've already done this, but thought it worth a mention in case you hadn't.

Good luck.

Hi OP,

I explored this for many of the same reasons as you. I could not physically, psychologically or financially deal with two babies at once.

A lot depends on the type of twin pregnancy. Do you know if the twins share a sac or a placenta? In the case of DCDA twins (separate sacs and placentas) reduction is relatively more straightforward. In the case of MCMA twins (share a sac and placenta) it's an extremely high risk pregnancy and there is an ethical case for a reduction if the mother desires it, but it is a complex and difficult technique involving lasers IIRC. If it's a MCDA pregnancy (same placenta but separate sacs), sadly no doctor will do a reduction as there is a significant risk to the other foetus. I went directly to a head of foetal medicine who had written one of the relevant research papers and he saw me.

Bottom line, if your twins are DCDA I think you may be able to achieve a reduction but it would require expert input. Please feel free to PM me if you want.

@ChainsawBear thank you so much, I have PM’d you. They are DCDA.

Selective reduction is definitely available in the UK but I've only heard of it in the case of large multiple pregnancies where there are significant health issues for the mother and babies e.g. 4 babies being reduced down to 2 or 3.

No advice but so sorry you’re going through this. I’m currently trying to make a decision over an unplanned no 3, having got a young baby. It’s so tough, sending lots of love.

No advice but would it help to contact your local clinic to discuss options and speak with a counsellor?

@anikam for some reason I can't respond to your PM at all. I'll try again later.

No problem. Thank you

If they are already known to be identical that suggests that they share a placenta and possibly a sac too. That does make reduction more complex as the standard method in the most common type of twin pregnancy (DCDA) can't be done with twins that share a placenta. On the other hand, MCMA pregnancies are so high risk that there is a case for reduction purely on that basis and it can be done with a laser method. The man I spoke with about laser reduction in MCMA was Mr Christoph Lees, he is head of foetal medicine at Queen Charlotte's. I emailed him directly, he booked me in at his clinic and was very honest and kind.

Best to you.

Hi @ChainsawBear i am in the same situation as you unfortunately. How did you get on with Christopher Lee? Did it work out for you in the end? Many thanks