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.