Decision making regarding multifetal reduction.

OBJECTIVE

To identify salient variables that influence decision making regarding multifetal reduction (MFR) and describe their effect on individuals over time.

DESIGN

Prospective, exploratory, descriptive design, using qualitative and quantitative methods.

SETTING

Midwestern tertiary care center.

PARTICIPANTS

A convenience sample of 11 consecutive consenting couples with triplet or higher-order pregnancies who elected to undergo MFR.

METHODS

Semistructured audiotaped telephone interviews at three points: (a) 2 weeks postreduction, (b) 6 weeks postpartum, and (c) 6 months postpartum; a demographic and marital adjustment questionnaire.

MAIN OUTCOME MEASURES

Themes identified by content analysis and compared via matrix analysis between males and females and at three points in time; trends in marital adjustment.

RESULTS

Dominant variables influencing MFR decision making were risks associated with higher-order pregnancies and preservation of infants' and mothers' health. Most participants identified emotional issues, including moral and ethical dilemmas, as the most difficult aspect of reduction. Over time, participants reported feeling more positive about their decision; nonetheless, negative feelings emerged progressively.

CONCLUSIONS

Risk aversion favored MFR decision making. Yet, both making and living with the decision were emotionally difficult for this sample. Interventions are needed to assist couples with this decision and its consequences.