Multifetal Pregnancy Reduction: Psychodynamic Implications

Abstract

New reproductive technologies, such as advanced infertility treatments, may have significant implications for women's psychological experience of pregnancy and motherhood. This paper examines some of the psychodynamic implications of multifetal pregnancy reduction, a medical procedure in which some of the fetuses in a multiple pregnancy are aborted while other fetuses are carried to term. Forty-four women who had undergone pregnancy reductions were interviewed about their emotional experience of this medical intervention and their subsequent pregnancies. A qualitative analysis of their experience was conducted from five psychoanalytically-informed vantage points: drive theory, ego psychology, object relations theory, self psychology and a developmental perspective. Women experienced having to abort some of their fetuses as a stressful and distressing life event, and a fourth of the women experienced bereavement reactions which impaired their functioning for at least two weeks. Conscious and unconscious responses to the procedure included ambivalence, guilt, and a sense of narcissistic injury, increasing the complexity of their attachment to the remaining babies. However, the achievement of the developmental goal of parenting healthy birth children helped most women feel that they had made the right decision for themselves and their families. Further research is indicated, including interviews before the reduction and long-term follow-up of mothers and surviving children.

We Didn't Deserve This: Bereavement Associated with Multifetal Reduction

“…For those who chose to reduce, they grieved about the child or children who might have been while those who declined to reduce wondered about which one of their children would not be with them if they had undergone reduction. This was consistent with other studies of psychological reactions to multifetal reduction (McKinney et al, 1996;Schreiner Engel et al, 1995).…”

Psychological aspects of prenatal diagnosis and its implications in multiple pregnancies

“…For many couples, the psychological trauma of an MFPR will add to a long history of stress due to frustrated infertility treatment leading to low self esteem and a feeling of recurrent failure (McKinney et al, 1996). They may also be distressed by the seemingly (and often actual) arbitrary choice as to which fetus should live and which should die.…”

“…However, it appears that the great majority feel ultimately that they had made the right decision (Schreiner-Engel et al, 1995;Garel et al, 1997). There have been a number of followup studies reporting mothers' emotional state following an MFPR (Kanhai et al, 1994;Schreiner-Engel et al, 1995;McKinney et al, 1996;Garel et al, 1997).…”

Decision Making Regarding Multifetal Reduction

“…Rather, investigators have focused on the regret versus validation about having an MFR and the emotional impact associated with the decision (Bergh, Moller, Nilsson, & Wikland, 1999;Garel et al, 1997;Kanhyai et al, 1994;McKinney, Tuber, & Downey, 1996;Schreiner-Engel, Walther, Mindes, Lynch, & Berkowitz, 1995). Studies suggest that with time, most couples (94%) believe that they made the right decision to undergo MFR (Bergh et al, 1999;McKinney et al, 1996;Schreiner-Engel et al, 1995). In comparing 42 women who had MFR with 44 controls, investigators found that the developmental goal of parenting healthy birth children helped women in their belief that they had made the right decision for themselves and their families (McKinney et al, 1996).…”

“…Studies suggest that with time, most couples (94%) believe that they made the right decision to undergo MFR (Bergh et al, 1999;McKinney et al, 1996;Schreiner-Engel et al, 1995). In comparing 42 women who had MFR with 44 controls, investigators found that the developmental goal of parenting healthy birth children helped women in their belief that they had made the right decision for themselves and their families (McKinney et al, 1996).…”