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Termination for medical reasons -Twins- one healthy baby and one poorly baby.

" The day that will be etched in my heart forever. The day that I felt a type of pain that I would not wish on anyone. The day the floor gave way and my world fell apart. Lying in the hospital bed seeing and hearing her heartbeat alongside her brothers for the very last time was heartbreaking."

I am Kate, Mum to Oscar, our 3-year-old little boy, and Mum to our baby girl Rose, Oscar’s twin sister, who we lost at 31 weeks to Termination for medical reasons.

I had never heard of TFMR, it was never part of my vocabulary, and I didn't even know what it stood for until I had to. It never crossed my mind that this would ever be a discussion that I would be having with my husband. We already had our ‘getting pregnant’ issues and there was no way that we were going to be challenged with pregnancy complications as well.

Our journey to becoming a family was a long and complicated road of navigating many years of unexplained infertility resulting in numerous treatments and protocols across the globe – UAE, Ireland, UK, and the Czech Republic.

After over 5 years of an emotionally, financially, mentally, and physically draining roller coaster and nine rounds of varying IVF treatments, we found ourselves in the joyous position of being pregnant with twins in October 2019. The first trimester was draining with severe morning, afternoon, day, and night sickness but the fact that I was pregnant with twins was a miracle and nothing could take away from that. At the end of our 3rd trimester, we shared our wonderful news with our family and friends, we posted on social media, and we wanted to shout it from the rooftops and tell the world that we had finally done it!

But however difficult we thought the journey to getting pregnant was, it was not the end of our challenges and we headed into a very complicated pregnancy in the middle of a global pandemic.

In January 2020, during month 4 of the pregnancy, I had a severe complication and heavy bleeding, was hospitalised, and subsequently put on bed rest for the remainder of the pregnancy. The pregnancy was then monitored very carefully with weekly scans and tests. We had always been aware from previous scans that one of the twins was smaller, but it had not been flagged as anything to worry about and was quite common in twins. However, as the pregnancy developed and with the increased monitoring it became clear that one of the babies, our baby girl, was falling significantly behind in growth development. It became evident that there were severe brain, heart, and spine development issues. The babies were growing, one on track as a healthy thriving little boy and one little girl who was getting more and more poorly. Following days and nights of discussions, research, consultations, and internet searches we reached the unfortunate conclusion that termination was something that we would have to consider.

We had known nothing about TFMR, we didn't even know that it was a consideration with twins. We were very quickly thrown into a world we knew nothing about, but suddenly had to learn.

In March 2020 we traveled to the UK to meet with a fetal medicine specialist to evaluate the twins and discuss our options with the pregnancy. In that same week, the world went into pandemic lockdown. We found ourselves locked out of the country that we call home and stuck in the UK. Thankfully we had family there that took us in, and they became an integral part of this chapter in our journey.

When we met with the specialist, he carried out his detailed scans, and immediately confirmed what we already knew. We had held onto the hope that the outcome could change or that maybe there had been a mistake and that somehow miraculously he would see something different. However, in the end, it was exactly what we feared. We were faced with multiple scenarios: 1. continue the pregnancy and our baby girl may or may not survive, but by continuing the pregnancy we would be putting additional stress and risk on the life of the other twin and my life, 2. continue the pregnancy and she and the other twin may not survive the trauma of birth with a heightened risk of premature labor, 3. continue the pregnancy and have her rushed into multiple surgeries post birth which ultimately she may not survive. All scenarios had multiple risks and all lead us back to the fact that this little girl, if she survived at all, would be terminally ill and would not have any quality of life.

How do you make this decision? How do you make the choice? How do you tell people what you have chosen to do? How is the procedure conducted? Will she feel pain? How will the other baby be impacted? Questions going around and around and even when the answers were given it was so hard to comprehend and take in the reality of what was happening.

But a decision had to be made, an answer had to be given and ultimately, we had to choose what to do. So, after many lengthy discussions, consultations, tears, and heartbreak, we made the decision to proceed with the TFMR. The ‘decision/choice’ that no parent ever wants to have to make, but we knew that we were making the right decision for our family.

We had been advised that there was a risk of spontaneous labor following the TFMR procedure and so for the safest delivery and survival outcome of our healthy baby boy, it would be best to have the TFMR at the latest time possible in pregnancy. Our procedure was scheduled to take place at 31 weeks, the end of April. So, I carried both of my beautiful babies for another 6 weeks. They both continued to grow, they were both moving and kicking and very much alive. I felt their every movement and I felt their every breath and I knew that every day was a step closer to losing her.

On April 29th, the day of the procedure, at 31 weeks we said goodbye to baby Rose. The day that will be etched in my heart forever. The day that I felt a type of pain that I would not wish on anyone. The day the floor gave way and my world fell apart. Lying in the hospital bed seeing and hearing her heartbeat alongside her brothers for the very last time was heartbreaking.

The following 72 hours after the procedure were intense as there was a heightened risk of going into labor. Lying in bed holding on to my bump willing everything to be okay and for our little boy to hang on in there whilst also feeling an empty space. Feeling one movement instead of two and knowing that one heart had stopped.

Our little boy battled on and hung in there and I continued to carry them both until they were delivered on June 2nd, 2020 - a healthy baby boy and a sleeping angel baby girl. That day we met both our babies. We held baby Rose with her brother Oscar, cuddled them, and together as a family gave her our love and said our goodbyes.

We left the hospital 5 days later with a beautiful baby boy and a memory box. A birth certificate and a stillborn death certificate. A heart full of conflicting emotions.

Three years have now passed, and the pain and heartache has not gone away, but it is easier to manage, and it forms a part of us. We remember Rose always, we talk about her, we share her story, and she is part of the fabric of our family.

- Kate Joyce-Delapp


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