Decision making regarding multifetal reduction
Michelle Maifeld1, Sandra Hahn, Marita G Titler
1Center for Advanced Reproductive Care, Department of Nursing Services and Patient Care, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA. michelle-maifeld@uiowa.edu
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.
