This is possibly the most personal and emotional thing I have ever written. While it is long, I encourage you to read it all, as I hope you find it thought-provoking and possibly affecting. At the least, you will probably learn about something most people know very little about.
When you were a child you likely played a game with your friends at some point. In this game, you asked who you would sacrifice if you had to choose: mom or dad? your arm or your leg? your best friend or sibling? The question has no answer, which makes the game enjoyable for kids. However, there are situations in real life where you are forced to make just such a decision, and no manner of humor will make you feel better. When you look in the mirror afterwards, you will wonder forever if you made the right decision, because you can never know the answer.
Great Joy
At our first ultrasound at nine weeks my wife and I found out we were going to have triplets. It was completely spontaneous, meaning we did not use IVF (in-vitro fertilization) or other fertility treatments, the most common reason for the occurrence of triplets. Shock quickly gave way to joy as we called everyone we knew and sent pictures of the ultrasound out to every email address we had.
:o :shock: :P
You can read about how wonderful being pregnant is, how amazing the process of ultrasounds and breastfeeding is, and how you connect instantly to your child even before they are born. You can read about it all, but until it happens, until you know your life is irrevocably changed forever, those words are only words. The first time you see your child's heart beat, hand twitch, and feet stretch in the ultrasound you fall in love.
Having three babies wiggling around and waving at me from my wife's belly made my chest swell with pride and anticipation. My sperm were awesome, and possibly super-powered. I loved every one of my future children from the instant I saw them. I wanted to take them right there and hold them, but all I had was my wife's belly and a promise.
Shortly after the ultrasound my wife and I transferred from our selected obstetrician (a doctor specializing in pregnancy and birth) to a high-risk obstetric office. We had already purchased a fairly comprehensive book on multiple births, and had a list of questions ready concerning diet, their practice's views on multiple pregnancies, and other details.
Great Sadness
In five minutes the conversation had taken a dramatic and unforeseen turn. The statistics that scrolled in front of us like stock tickers were making a none-too-subtle argument:
* 20% of babies from triple pregnancies have a severe disability such as cystic fibrosis
* Approximately 90% of triplets are delivered by Cesarean (a surgical procedure in which the abdomen and uterus are cut open for childbirth)
* Over 90% of triplets are born premature, leaving them at higher risk for health problems and development issues throughout their entire lives (the average gestational age for triplets is 32 weeks compared to 40 for a singleton)
* The mother is at increased risk for any number of complications, such as anaemia and gestational diabetes
The doctor was proposing that we reduce our pregnancy to two fetuses to give them a better chance of not just surviving, but living longer and fuller lives. Doing so would also improve the pregnancy and health of my wife. Having expected the meeting to involve dietary planning and possibly rescheduling our career paths, I was left more shell-shocked by my meeting with the doctor than I had been by the discovery of the triplets themselves.
Going ahead with the reduction dramatically improves the chances of the remaining babies for prolonged gestation, improves the outlook for the mother, and any number of additional benefits. When I say improved statistics, the odds of a major disability drop from between 10% and 20% to between 1% and 3% (depending on your research reference. The differences in risk are jaw dropping; they would have to be or nobody would recommend the procedure. After all, we were being asked to decide whether one of our unborn children should live or die.
:| :( :question:
Do not mistake me as pro-life. Each person must decide for themselves when faced with these situations what they believe is best for themselves and for their families, and I would think no less of anyone electing the procedure. I do not know when a fetus becomes a baby, or even when we are c|assified as autonomous human beings. This is a personal decision.
How the Procedure is Performed
The procedure itself is described as "selective reduction;" the discontinuation of one or more fetuses of a multiple pregnancy to improve the health and chances of the remaining children. I was made to feel like it was not an abortion due to the change in nomenclature, but it is an abortion procedure. You are aborting a fetus. The procedure itself is not like a "regular" abortion, however.
The mother is taken to an ultrasound room to confirm the pregnancies (the father may be present for emotional support). The fetus to be reduced is selected based on the highest risk. The fetus most likely to incur health problems is selected to be terminated based on physical factors determined by a nucal translucency test on the ultrasound and/or position in the womb. The person that performs the procedure inserts a needle through the woman's abdomen, through the uterus, and into the amniotic sac of the selected fetus. The needle injects a solution that stops the fetus's heart from beating, which is confirmed on the ultrasound. The mother then waits fifteen minutes for the technician or doctor to return to confirm the termination via ultrasound.
An Emotional Wreck
The week that followed involved repeated rehashing of the statistics. I spent my time blasting holes in the numbers, spouting that their bias did not paint the full picture. My wife was drawn to the safer course. Swayed by the figures, she wanted to ensure a safe and healthy outcome for her babies, and I could not blame her. I do not know when I was irrevocably changed, possibly during the ultrasound, but I loved my babies. It was not my decision, my brain had surrendered completely and instantly to my heart.
I cannot remember having cried so frequently in one week's time in all my life. I do not consider myself a weak man, emotionally; I am typically the shoulder being cried on rather than the opposite. But whenever I thought about selecting one of the little fetuses grasping at life inside my wife and stopping its heartbeat - in person - I lost my breath, became dizzy, and had to sit down.
:( :cry: :?
The statistics do not go away either, painting a black and vivid image in your mind, as if you had stared at the sun too long. Even ignoring the increased risk of premature birth - the most common cause of problems with the babies themselves - the mother is almost guaranteed to have a Cesarean section. Cesareans have their own risks towards the health of mother and child, as well as more time in the hospital for mom and recovery time at home. With fewer children my wife might be able to avoid the Cesarean, spend less time in hospital, and the babies less time in the NICU (Neonatal Intensive Care Unit), if any time was spent there at all.
What made matters worse was the contention between my wife and I. I looked at the statistics and saw a biased sample set of numbers meant to bias our judgment. What was the sample set size? How many of the triplets in the sample were spontaneous as opposed to those from fertility treatments? Were the 10-20% odds towards a disability per pregnancy or per child? What was the level of severity? But my wife saw facts that might mean the loss or severe disability of one or more of our only children, and a difficult life she did not want for them or us.
There were additional factors that, though minor, in total favored reducing. Having fewer babies would mean an easier time financially; we would be able to provide a better life for two children than for three, in terms of financial support. With there, we would need to hire help with them, despite the help we would be getting from family, further cutting into our savings. Reducing, my wife would be able to return to work sooner with two babies than three, as well, potentially helping her career as a scientist and further improving our finances. Lastly, we would be able to retain the family car, a smaller hatchback rather than being forced to upgrade to a minivan or similar vehicle. It might seem like a small thing, but we already owned the car outright, it was already registered and insured, and was one less thing to deal with in what was fast becoming a short amount of time.
The little things, in combination, added up.
Visions of the Future
For me, my decision was already made. I had visions of family trips in a big, boisterous family group to national parks and museums. I saw the three of them picking on each other, and myself pitting them against one another to encourage them to potty train (Bobby peed in the potty twice, why can't you?). I could see them jumping onto our bed on Christmas morning, peeking over the level of our tall bed, three pairs of excited eyes.
:D :lol: :)
But the decision was not mine to make; not really. My wife had to carry them to term. She would spend more time than I raising them by necessity, as I would need to spend more of mine working. She needed to be ready for three more than I, and accepting of the risks to both herself and to them. Whatever she decided, I would support, regardless of my own desires.
Unfortunately, I could not help but bias her judgement. My excitement over the three of them was infectious, and my desired outcome oozed from my pores. How could she decide to reduce when she knew how much it would hurt me? Despite my reassurances to the contrary, she felt like the onus was on her, which was inadvertently and unavoidably true.
A Second Opinion
My wife and I scheduled an appointment with a different doctor at another hospital immediately; Boston has excellent care and we were lucky to be able to pick and choose after finding our first doctor cold, distant, and a bit reserved with her opinions for our liking. Indeed, the doctor we were going to see specialized in multiple pregnancies, and his and his hospital's reputation were excellent.
We immediately took a liking to him. He wanted to see an ultrasound before we even spoke with him, a detail the first doctor dismissed. The radiologist himself specialized in multiple pregnancies, and had a friendly relationship with the doctor. This obstetrician asked more personal questions in addition to our medical history. In short, he had all the medical expertise of our first doctor, but also more experience and compassion.
Our conversation was also quite different. His hospital had provided us with similar - but more detailed - information concerning a reduction by mail prior to our visit, a more professional touch we appreciated as we could prepare our questions. He was less biased towards the procedure, and discussed a new statistic: Life Fulfillment.
:? :? :?
Life fulfillment was the measure of the health of "multiples children" over the course of their lives. The statistics arguing in favor of a reduction pointed towards reduced risks associated with premature birth. But the vast majority of those children, even those that experienced problems, went on to lead normal, full, and healthy lives. In fact, about 90% of children born at 28 weeks went on to have 100% life fulfillment. Knowing that our children would be likely to go on and lead healthy and happy lives even if they had problems early on did wonders to assure us that things would more than likely turn out for the better.
The doctor did not encourage or discourage us in either direction. Though the medical statistics favored a reduction, he stated that there was no right or wrong answer medically or otherwise, and that this was a decision for us to make. In short, there was no reason we could not go on to have three normal healthy children, despite the increased risk.
A Decision is Made
Maybe it was because the second doctor told use what we wanted to hear. Maybe it was because we could not bear the thought of watching the reduction happen. Maybe it was because we could not live with knowing what might have been. But in the end, it was all these things and more. The prospect of three great kids; the possibility that maybe, just maybe, there was a reason for all this to be happening; the potential for any or all of them to do great things...we just had to keep them all and believe that everything would be okay.
Even if everything is not okay, at least we can say we took the chance.
:) :) :)
Abdominals - This was where I had been hoping for the greatest change. I worked my abdominal muscles inbetween sets of other muscles during every workout regimen. Unlike other muscle groups, you can work abdominals and obliques almost every day and see some benefit. I think every man longs for washboard abs, but they take a lot of time and commitment. I am not dissatisfied with the results, my abs are definitely tighter, but I am going to have to keep working at them to get to the level I would like to see them. 
Shoulders - Several years ago, before working out at all, my shoulders had blended into my arms in a tube-like structure. After a few months of working out in the beginning, the definition I had formed stayed with me to some degree. I am content with the appearance of my shoulders, which I did not work as hard as I would have liked (my shoulders routine typically fell on a Friday). Still, I would have liked more dramatic gains, as with the rest of my body. 
Arms - It might be tough to tell from the photos, but I am quite happy with the change in my arms. They definitely increased a bit, and are more defined, particularly when viewed relative to my shoulders. I saw an improvement in weight lifting capacity of 67% over the seven week period, which was a big confidence booster. Keep in mind that arm mass is mostly due to large triceps. There is a common misconception that big biceps equal big arms at the neglect of the triceps. 
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