Nursing considerations in the case of multifetal pregnancy reduction.

This article concerns the issue of multifetal reduction performed in some cases of higher order multiple gestation in order to decrease the possibility of adverse pregnancy outcomes and increase the chances of survival in the remaining fetuses. If multifetal pregnancy reduction is considered as a treatment option, it is usually performed in the first or early second trimester. The decision to reduce one or more fetuses is extremely complicated, and numerous factors must be considered, since the procedure has risks, such as loss of the entire pregnancy or preterm labor and birth of the remaining fetuses. In addition, there are also psychological risks for the mother. Typically women faced with this decision have struggled for years with infertility and now they are asked to consider terminating one or more of the fetuses to prevent morbidity and/or mortality in others. Nurses who work with infertile women may be able to assist in minimizing the need for multifetal pregnancy reduction by educating women about the risks associated with assisted reproductive technologies and higher order multifetal pregnancy before decisions are made about multiple embryo transfers or intrauterine insemination after ovulation induction.

Lived experiences of Taiwanese women with multifetal pregnancies who receive fetal reduction.

This study explores lived experiences of Taiwanese women with multifetal pregnancies who receive fetal reduction. This qualitative study adopted a field method with observer-as-participant approach to collect data. Six subjects were recruited from a medical center using purposive sampling. Most of the subjects were contacted nine times. The total time of observation was 8-10 weeks. The collected data was analyzed by content analysis, and forming themes. The findings are as follows: (1) difficulty in accepting unexpected multiple pregnancies; (2) worry over danger/risk of multiple pregnancies and concern about fetal reduction; (3) decision to take fetal reduction for the safe delivery and health of two babies; (4) anxiety about the techniques of fetal reduction; (5) growing emotion of attachment to the fetus and guilty feeling; (6) unbearable physical/mental stress when facing the intrusion of fetal reduction; (7) being enmeshed in fear of unstable pregnancy and guilt; and (8) cloud of uncertainty diminished, return to normal pregnancy. The results indicated that the women with multifetal pregnancies, who received fetal reduction, encountered a difficult decision. They were exposed to tremendous emotional responses. The findings of this study can help nurses to gain a deeper understanding of those women's experiences. More sensitive, precise recognition, as well as suitable nursing intervention can be provided, in order to promote better acceptance of and adjustment to the fetal reduction.

"I couldn't think that far": infertile women's decision making about multifetal reduction.

In this phenomenological study women's experiences regarding their decisions to undergo or forgo multifetal reduction of their higher-order multiple pregnancies were explored. Seven women who had conceived higher-order multiple pregnancies as the result of in vitro fertilization were interviewed. Four participants accepted reduction, whereas three participants declined. Three themes were discerned: (a) the presence of infertility as a barrier to contemplating hyperfertility; (b) multiple-birth pregnancy as yet another form of loss for infertile women; and (c) the lasting effects of having made the decision.

Decision making regarding multifetal reduction.

OBJECTIVE: To identify salient variables that influence decision making regarding multifetal reduction (MFR) and describe their effect on individuals over time. DESIGN: Prospective, exploratory, descriptive design, using qualitative and quantitative methods. SETTING: Midwestern tertiary care center. PARTICIPANTS: A convenience sample of 11 consecutive consenting couples with triplet or higher-order pregnancies who elected to undergo MFR. METHODS: Semistructured audiotaped telephone interviews at three points: (a) 2 weeks postreduction, (b) 6 weeks postpartum, and (c) 6 months postpartum; a demographic and marital adjustment questionnaire. MAIN OUTCOME MEASURES: Themes identified by content analysis and compared via matrix analysis between males and females and at three points in time; trends in marital adjustment. RESULTS: Dominant variables influencing MFR decision making were risks associated with higher-order pregnancies and preservation of infants' and mothers' health. Most participants identified emotional issues, including moral and ethical dilemmas, as the most difficult aspect of reduction. Over time, participants reported feeling more positive about their decision; nonetheless, negative feelings emerged progressively. CONCLUSIONS: Risk aversion favored MFR decision making. Yet, both making and living with the decision were emotionally difficult for this sample. Interventions are needed to assist couples with this decision and its consequences.

Nursing students' right to refuse to treat patients and the relationship between year of study and altitude towards patient care.

Nursing students are taught the nursing code of ethics and how to deal with ethical questions and dilemmas. After graduation, they are expectedto adhere to this code, but as students do they? We examined student nurses' and their instructors' position regarding students' obligations in treating patients. In order to identify the students' perspectives towards these obligations, students and instructors were asked if a student has the right to refuse to treat a patient. A cross-sectional descriptive design was used in examining 162 academic nursing students and 16 faculty members' attitudes towards refusing to treat a patient. The results of this study indicate that significant relationships exist between clinical and ethical knowledge and the perception of obligations to ensure and protect patients' rights. Clinical and ethical knowledge are significantly related to the development of ethical conduct in nursing students.

Preparation for practice in the new millennium: a discussion of the moral implications of multifetal pregnancy reduction.

This article approaches the problem of multifetal pregnancy reduction from a moral perspective. It is one of many complex moral issues arising from reproductive technology and is one with which midwives and nurses are faced more frequently with advancing technology. The work is intended to be used as an educational tool for those who prepare tomorrow's nurses and midwives. The subject is discussed from three perspectives, the pregnant woman and her partner (clients), a midwife, and from a philosophical ethical perspective. In an attempt to introduce a degree of reality, the perspective of the clients is presented as a dialogue. The midwife's moral position and her professional difficulties are also discussed. The dialogue and discussion are supplemented with notes in which the issues raised by the characters are critically analysed and discussed. This article is designed to encourage reflection and critical thinking in tomorrow's health care professionals, and in those who have the responsibility of educating them for a future where reproductive technology is posed to generate more major moral quandaries.

Multifetal pregnancy reduction.

Higher-order multiple pregnancy is associated with significant maternal and fetal complications. Multifetal pregnancy reduction is one option for women with a higher-order multiple pregnancy. Various aspects of multifetal pregnancy reduction are discussed, including the background, options, risks, benefits, techniques, results, and appropriate physical and psychosocial support.