Multifetal Pregnancy Reduction
As with most topics not clearly addressed within the Qur'an, abortion is a subject strongly diverse in conclusions. While some may wonder why abortion should be discussed here at all, a quick reflection on the recent birth of 9 babies at one time (Indonesia all babies died) should bring an answer. The clear abuse of infertility procedures brings forth several questions for muslims such as regulations, proper procedures, as well as multifetal pregnancy reduction. What will be discussed below are the islamic view of abortion in general, dangers of multifetal pregnancies, and the process of multifetal pregnancy reduction.
There are two main views of abortion, one view holds that abortion is prohibited at any point of gestation. Unless it is due to the threat of the mothers life. This threat is established by the testimony of three experts regarding abortion as the only means to protect the life of the mother.
The second main view holds that abortion is permissible before the soul is given to the fetus. The question of when the soul is given is broken down to three main views A) 120 days B) 40 days C) when there is voluntary movement from the fetus. This voluntary movement usually occurs during the 12th week of gestation, but many women may not notice the movement until much latter, sometimes 20 weeks.
The allowance of abortion before ensoulment vary greatly between scholars. Such reasons can include, but are not limited to, rape, threat of life to the mother, threat of life to an existing child, and serious malformations of the fetus are legitimate means to terminate the pregnancy.
According to Imam Hanafi if the pregnancy of a woman harms the life of an already existing child by way of milk production, than the pregnancy can be terminated. Hanafi happens to be more open in matters of abortion than the other three madhabhib. This thought can also be taken a step further such as the threat of one fetus to another, as exhibited in a question posed to Jamaat e Islami Pakistan.
While I have yet to find a learned muslim who directly takes on the issue of multifetal pregnancy reduction. I do have hope that one day this, as well as other issues of infertility, will be fully addressed. All we have to go on at this point is the indirect rulings and how they are applicable in our situations.
While pro-life and pro-choice are "hot" debates today, they should not be a dividing factor within our ummah. We, no matter what madhahib we choose to follow, or not follow, have a common basis of agreement. And this is the protection of the mothers life, versus that of the fetus. Islam is not a hard religion, but one that is justly balanced, to force a woman to die for the chance birth of her child, out of some "religious" duty is something foreign to Islamic principles. For the sanctity of life, how strong indeed, is laid forth in saving the life already established is to supersede the one that can not exist without the life of the former. If the fetus has the ability to live on its own than it is given such a chance, if not, the option of abortion is given to the mother. This is very different then many current rulings in other religions today.
There is always a probability of harm to a mother with any pregnancy. But as the number of fetuses increase, so does the probability of harm, not only to the mother herself but also to that of fetuses. Some of which include: miscarriage, congenital anomalies, hyperemesis gravidarum, anemia, pregnancy induced hypertension, polyhydramnios, preterm labor and delivery, which would effect the fetuses with possible abnormalities in lung, heart and kidney development, bleeding in the brain, low birth weight, intrauterine growth restriction, hemorrhage (postpartum), cerebral palsy and other neurologic disorders, malpresentation, dysfunctional labor, and fetal distress.
One has to consider with such a high number of fetuses that a woman's body is just not made to withstand such a process on a wide scale. While yes, admittedly there have been several successful births with such high numbers of 6, or now even 8 fetuses. The question is, what about the non publicized many who do not have success stories? While we are no longer fascinated with numbers such as four and five, they do happen relatively, often, considering it was not long ago such things did not take place on such a level. We do not hear of the horror stories of women losing all of their babies, or not only withstanding the loss of one or two, but now having to deal with the on going damage that the surviving child/ren have to live with day in and day out. While it may be great if we all had success stories, it would be wrong of us to glorify having so many children with out understanding the true nature of this ordeal.
Multifetal Pregnancy Reduction
Multifetal reduction is generally suggested with four or more fetuses present. The procedure is done between nine and twelve weeks gestation, and is most successful early in pregnancy. Many times the reduction is made to two fetuses remaining, but reduction to triplets can also be taken into consideration, for recent research has suggested no sign of improvement in perinate morbidity and mortality in triplet pregnancies.
The process of the reduction is done on an outpatient basis. A needle is inserted, either through the abdomen or vagina, guided by an ultrasound, and an injection of potassium chloride is given to the selected fetus(es). Usually the smallest fetus or the one lowest lying is chosen for the procedure. There are risks, 75% of pregnancies are subject to premature labor, the incidence of miscarriage occurs with 4 to 5%. However, there is data to support longer gestations, higher birth rates, reduced hospital stays, as well as health benefits for both mother and children.
Having gone through infertility treatment, as well as having multiple fetuses (twins) I do hold some strong opinions on the medical procedures that should decrease the possibility of multifetal pregnancies. I do question the doctors procedures when such large numbers of fetuses occur in a single pregnancy. And than suggest reduction as an option, after the fact, as if this is a "clinical trial". Infertility treatments have been successful enough for doctors to know and follow simple suggested guidelines. But between a combination of couple emotions, doctors inability to look beyond statistics, realizing that things can actually go the way they don't expect them to, and the bottom line of "how much does it cost". If the procedure to monitor egg production is followed, than a doctor should never make the mistake of giving HCG to a patient who has four, six, and even eight eggs developing. If doctors did not give patients higher dosages of drugs in order to increase egg production just because a woman has not conceived, ignoring, or not taking the time to find out if she is indeed ovulats. And if doctors, as well as patients did not insist that so many embryos be used for implantation, than the possibility of such "miracle events" would surely decrease.
As Muslims we have a greater responsibility, we must take precautions to lesson the likelihood that such things will happen.It is up to the patient to become educated and make the doctor follow guidelines that you feel secure with. It is the patients choice of how many embryos are placed in her uterus. The doctors can not make the mistakes by themselves, we as patients bear a burden of responsibility also. While many may become overwhelmed between emotions of wanting a child, the financial hardships of infertility treatments, as well as the spiritual struggles infertile couples endure, we as muslims have a strong foundation in which we should seek proper guidance in all matters that we undertake. We should not let our emotions, wallets, or any other thing lead us in a matter for this will be our downfall. It is very important that we do all that is possible to prevent such incidents. This I can not stress enough, muslims must seek guidance with Allah even though such treatments are halal. We must remember to put our duties as muslims first, rather than our desire to have children..
I would love to ensure all couples that this situation will never happen to them while undergoing infertility treatment. Even with all the precautions we take, this may still happen to any couple facing a high number of fetuses. However, like all things that we face it is important to go into a situation fully educated with ones options. While I would never suggest that one undergo this procedure nor deter one in their decision to do so, for this is not my place, I do pray for all muslim couples facing this matter today and in the future (inshallah).
On no soul doth Allah Place a burden greater than it can bear. It gets every good that it earns, and it suffers every ill that it earns. (Pray:) "Our Lord! Condemn us not if we forget or fall into error; our Lord! Lay not on us a burden Like that which Thou didst lay on those before us; Our Lord! Lay not on us a burden greater than we have strength to bear. Blot out our sins, and grant us forgiveness. Have mercy on us. Thou art our Protector; Help us against those who stand against faith." (2:286)
But those who believe and work righteousness,- no burden do We place on any soul, but that which it can bear,- they will be Companions of the Garden, therein to dwell (for ever). And We shall remove from their hearts any lurking sense of injury;- beneath them will be rivers flowing;- and they shall say: "Praise be to Allah, who hath guided us to this (felicity): never could we have found guidance, had it not been for the guidance of Allah: indeed it was the truth, that the messengers of our Lord brought unto us." And they shall hear the cry: "Behold! the garden before you! Ye have been made its inheritors, for your deeds (of righteousness)."
Abortion, Birth Control, and Surrogate Parenting An Islamic Perspective: by Abul Fadl Mohsin Ebrahim
Contemporary Topics In Islamic Medicine: by Dr. Isam Ghanem
Human Development As Revealed in the Holy Quran and Hadith: by Dr. Mohammed Ali Albar
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