At the age of 28, I was admitted to the antepartum unit at Mount Sinai Hospital, where I lay in Trendelenburg position day and night, flat on my back, my head 15 degrees below my feet. It was hoped that with the benefit of gravity, my twin girls could remain inside me, so that they might make it to 27 weeks. I had just seven more weeks to go.
In this discomforting position, I spent endless hours on my iPhone researching premature births. Yes, girls born prematurely fared better than boys. Yes, 26 to 27 weeks were much more viable than babies born at 24 to 25 weeks. Even at 24 weeks, they’d remain in the newborn ICU for several more months, a frightening and stressful time filled with ups and downs, but I could still emerge with two healthy girls who might have some developmental delays, muscular weaknesses and/or some learning disabilities, but certainly their lives would be worth living.
Still I prayed, though I had never been religious. I prayed that my babies would make it and that I would stay calm, because I knew anxiety would put me into labor. And anxiety had been my baseline for as long as I could remember. Now I had to focus on my babies, no matter the stress. Anxiety had no place here.
I’d battled stress and anxiety at every step of this pregnancy, having tried for years to conceive. Finally, my husband and I went to an infertility specialist and began the agonizing (and costly!) journey of IVF. After daily injections of hormones and finally intrauterine insemination, where my husband’s sperm were injected directly into my uterus, we were joyfully stunned to discover I’d become pregnant on the first round.
We were even more stunned by what came next.
“Um, I think that you should sit down,” my physician said, turning to my husband, Ben, while I was undergoing an ultrasound.
Ben sat down, as the doctor pointed to the screen.
“One, two, three, four, five … there are five heartbeats and five sacs.” He paused to let that information sink in. Then he said, “Get dressed and my nurse will help you to my office. We’ll discuss our options.”
He spoke matter-of-factly, but the quaver in his voice and the look on his face made it clear that he was also in shock.
Five heartbeats, though I knew, having been trained as a physician myself, that “heartbeats” is just a warm and fuzzy term medical professionals use to describe the sounds of fluttering cells of embryos too undeveloped to yet have hearts.
The odds of a quintuplet pregnancy are 1 in over 50 million. Even with IUI, the odds of quintuplets are still exceedingly rare, since five mature follicles would (in theory) have been seen prior to the insemination. But multiple pregnancies do happen, and when they happen, whether naturally or through IUI or other infertility treatments, the health and lives of all babies and the mother carrying them are at heightened risk.
In my case, at 5’3” and weighing less than 100 pounds, five babies could have killed me. They certainly would put the lives of their wombmates in jeopardy, because the average gestation period for quints is just 29 weeks — that’s the average, which means many are born earlier than that. I couldn’t carry five babies.
After the shock had passed — to the extent the shock would ever pass — we met with our doctor, who told us our only option was selective reduction. Selective reduction is another way of saying that some of my babies would have to be aborted. While I support a woman’s right to choose for both medical and personal reasons, I never imagined I’d have to choose to have an abortion. I had wanted to have a family — I had endured immense pain and discomfort to get pregnant — yet now I’d have to “choose” to abort some of my own babies!
“While I support a woman’s right to choose for both medical and personal reasons, I never imagined I’d have to choose to have an abortion. I had wanted to have a family — I had endured immense pain and discomfort to get pregnant — yet now I’d have to ‘choose’ to abort some of my own babies!”
I asked if triplets could be an option, but at my size, triplets were still too great a risk to the health and my life and the lives of my babies. I could only carry twins.
Selective reduction does not mean selecting which embryos will live and which will die based on their sex but on their chances of viability. In order to assess that viability, a CVS — chorionic villus sampling — of the placental sacs was necessary. However, that procedure — itself a risk to the fetus as five long needles would pierce my abdomen and each placental sac and hopefully not pierce the moving fetus — could not be performed until 13 weeks. (In cases of singular pregnancies, 10 weeks is often sufficient, but with five crowded into the same womb, those extra three weeks were crucial.) I was only at nine weeks, so I had another month to go. Another month for my babies to grow inside me and for me to fall all the more in love with them, all the while knowing that three of them would be “reduced.”
Words do not describe how sick, anemic and pathetic I was during those months that I remained pregnant with the five developing babies until we could get a CVS and then schedule the reduction. I became numb to the multiple ER visits, appointments and fascination of the medical staff who treated me. I had become a medical anomaly created by science who had to face a tortuous “decision” to sacrifice three of my babies, so that two of them, and me, their mother, might live.
The choice of which of those three would be aborted was not mine to make. It was a medical decision my OB/GYN would make, one she could only make after waiting another 10 days for the test results to be returned. By that point, the quints had developed to nearly 15 weeks — nearly four months of maternal bonding. Or maternal grieving. But as any mother knows, you will do whatever you can to save your babies, and I knew, both as a physician and a mother, that “selective reduction” was not about killing three babies but about saving two.
Five weeks after the selective reduction, even having twins proved a risk to their own survival, so I was admitted to Mount Sinai, where I found myself hanging nearly upside down, praying my babies would make it to at least 24 weeks. At 23 weeks, my labor began. Then mass chaos, pushing, pain, joy and grief. And finally, pathetic, tiny little cries. I was a mother.
My babies, Peaceful and Beautiful, were born on Oct. 1, 2012, around 10:30 p.m., and died early the next morning. I did not cry those hours while I held my babies, knowing that they would pass. There were no measures that could save my two little 1-pound, underdeveloped babies. They felt no pain. They were warm and cozy in their hand-knit sweaters donated by volunteers who knit such clothes for extremely preterm babies. They were kissed. They were loved. They were held. I cherished every moment of being a mother to them.
And as I held them, my own body was failing. I’d developed a serious postpartum hemorrhage that required immediate surgery. As the doctors urged me to let my babies go to save my life, I refused. I would not leave them while they were living. I owed them my love and mothering for their short time here.
“This one has passed,” a physician said, after checking their heartbeats. No longer fluttering cells, their hearts had developed, but one of those tiny hearts beat no longer.
Still, I wouldn’t let them take her. Not yet. Her sister was alive and warm. We would stay together.
When the physician returned to the room, she looked at me with soft, compassionate eyes. “She’s passed.”
The physician left the room, crying. Her humanity comforted me.
I had failed all five of my babies.
Whisked into surgery without even a moment to cry or process the loss of my babies, I began to fade. I was sick — so sick. I saw lights above me — not the lights of the hospital but golden, iridescent lights that drew me to them. I was dying. In the distance, I heard voices.
“Epinephrine, STAT!!!! Her pressure is tanking. She’s lost a lot of blood.”
My heart felt as if it had exploded as the IV epinephrine flew into my system, but then I calmed.
Lying in the same bed I had for the last three weeks and listening to healthy babies’ heartbeats on the antepartum unit, I was no longer nearly upside down, no longer pregnant, no longer a mother. I had lost the battle for my children, but I was alive. And I would not have been alive if I had tried to carry those five. Had I died, I would not have the three beautiful children that I have today. Aborting those fetuses saved my life and my life led to more life.
Go Ad-Free — And Protect The Free Press
Already contributed? Log in to hide these messages.
“Selective reduction” is a decision no woman should have to make, and it’s a decision no woman wants to make. But it’s a decision a mother may have to make. And for that reason, along with so many other reasons, only a mother and her physician should be empowered to make that difficult choice. The choice to live or die.
Amy Sosne, M.D., M.Ed. is the author of the forthcoming memoir “A World Turned Upside Down: A Memoir of Healing.” A graduate of Mount Sinai medical school, Amy was a psychiatric resident when she suffered a breakdown that led to her own journey with mental health treatment related to sexual abuse she suffered as a child. She is now the mother of three thriving children and works in higher education and elementary outreach while teaching yoga and mindfulness, and pioneering interactive educational programs with college students and local elementary schools.
Do you have a compelling personal story you’d like to see published on HuffPost? Find out what we’re looking for here and send us a pitch at [email protected].