Confronting the Taboo of Multifetal Pregnancy Reduction: A Qualitative Study of Maternal Decision-Making in Triplet Pregnancies

P M van Baar; R Arnoldussen; E Pajkrt; M A de Boer; C J M de Groot; B F P Broekman; M G van Pampus

doi:10.1002/pd.6724

Confronting the Taboo of Multifetal Pregnancy Reduction: A Qualitative Study of Maternal Decision-Making in Triplet Pregnancies

Prenat Diagn. 2024 Dec 10. doi: 10.1002/pd.6724. Online ahead of print.

Authors

P M van Baar^{1

2}, R Arnoldussen³, E Pajkrt^{2

4}, M A de Boer^{1

2}, C J M de Groot^{1

2

4}, B F P Broekman^{5

6

7}, M G van Pampus⁸

Affiliations

¹ Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
² Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
³ Vrije Universiteit, Amsterdam, The Netherlands.
⁴ Department of Obstetrics and Gynecology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands.
⁵ Department of Psychiatry, OLVG, Amsterdam, The Netherlands.
⁶ Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
⁷ Mental Health Program, Amsterdam Public Health Institute, Amsterdam, The Netherlands.
⁸ Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands.

PMID: 39658834
DOI: 10.1002/pd.6724

Abstract

Objective: To explore the personal experiences of women faced with the decision to continue a triplet pregnancy or undergo multifetal pregnancy reduction.

Methods: A qualitative study with semi-structured interviews was conducted between October 2021 and April 2023. Participants included women who continued a triplet pregnancy, and those who underwent multifetal pregnancy reduction from triplet to twins or singletons, 1-6 years post-decision. Interviews focused on: (1) the decision-making process, and (2) the emotional aspects and psychological impact of the decision. Thematic analysis was used to identify patterns, involving familiarization, defining themes, and producing the final report.

Results: Data saturation was achieved after 16 interviews, revealing two main themes: (1) maternal intuition as a guiding force, and (2) navigating the crossroads: coping and reflection on the decision. These themes illustrate an interplay between maternal intuition and intrinsic feelings in the decision whether to perform multifetal pregnancy reduction, seemingly less influenced by external factors. Mothers who adhere to their intuition (15/16) have a low likelihood of experiencing regret. Despite the inclination to share and seek support, a persistent taboo surrounds the topic of multifetal pregnancy reduction. The findings also emphasize a considerable gap in aftercare for women, regardless of their decision.

Conclusion: There is a need for improved care and support for parents facing the decision of continuing a triplet pregnancy or deciding on multifetal pregnancy reduction. Efforts should focus on fostering open societal dialog about this taboo subject, and addressing the gap in aftercare to provide comprehensive support to women post-decision and post-birth, thereby establishing a more supportive and compassionate framework.

Keywords: counseling; decision‐making; maternal; multifetal pregnancy; multifetal pregnancy reduction; psychological impact; psychology; triplet pregnancy.