When Shontae Minor and boyfriend Khristian Rohena learned she was pregnant with quadruplets, they followed their San Antonio doctor’s advice and sought a selective fetal reduction.
The procedure would have eliminated two of the fetuses while they still were in her womb, raising the chances that the remaining two would survive and be healthy, according to medical experts. The doctor also advised Minor, 22, that her own health could be in jeopardy if she attempted to carry all four to term.
But a state worker told the couple – after they had already traveled to Houston for the procedure – that Medicaid wouldn’t pay the $4,000 bill for the fetal reduction.
Fetal reduction for Medicaid patients like Minor, who qualifies because she is low-income, is caught up in the politics of abortion in Texas. Since the procedure is classified as abortion, federal rules apply: Medicaid will only pay in cases of rape or incest or if it’s necessary to save the mother’s life.
Now, the state-federal tax-funded health plan could end up paying $1 million or more to provide Minor’s complicated prenatal care, which included six weeks of hospitalization, and care for babies. In Texas, Medicaid spending for births, including prenatal services and care for a baby’s first year, amounts to $2.2 billion a year.
The possibility of appealing the denial of the fetal reduction was never presented to the couple, but, if they had asked, the state Medicaid agency well might have reversed its initial decision, a spokeswoman later said.
“While the policy on abortion doesn’t include (risk to the fetuses), it also doesn’t preclude us from looking at all the factors involved in this unique case,” Stephanie Goodman, spokeswoman for the Texas Department of Health and Human Services Commission, wrote in an email. “Doctors and patients can and should question a decision they don’t think is in the patient’s best interest. … I’m sorry that didn’t happen in this case.”
Two sets of twins
Minor gave birth to two sets of identical twin boys on Jan. 15 – 10 weeks early. The boys ranged in weight from 1 pound 15 ounces to 2 pounds 7 ounces.
On Jan. 25, one quad died of a staph infection at St. Luke’s Baptist Hospital. A second one died Feb. 7 of a bacterial infection and meningitis.
The two remaining babies, Yariel Raphael and Orion Rico, remain in a neonatal intensive care unit at a cost of about $3,500 a day for each, according to a national average, and might not go home until March.
Minor and Rohena, a 34-year-old unemployed Iraq war veteran, were stunned to learn just three months after the birth of their first son that Minor had become pregnant with quadruplets without fertility assistance – a one in 700,000 chance. “We couldn’t believe it,” she marveled.
But after hearing of the risks to the fetuses and to her, the couple drove to Houston, praying all the way: Should they go through with the reduction or not?
“We wanted daughters. What if we destroyed the girls?” Rohena said.
A woman with a multiple pregnancy is five to 10 times more likely to die than a woman carrying a single fetus from such complications as hemorrhage and heart failure.
Quadruplets have a significant chance of dying before birth, right after birth or before their first birthday. The possibility of lifelong problems, such as cerebral palsy, blindness, deafness and mental retardation, is greater, too.
For a reason
Reduction lessens the danger to the woman and reduces risk of loss or serious impairment of the fetuses by prematurity by as much as 80 percent, Evans said.
But when Medicaid turned them down, they took it as a sign. “God gave (the quads) to me for a reason,” Minor said.
At a funeral Thursday – Valentine’s Day – an overwhelming sense of sadness prevailed as the couple buried their second baby, Ryan Nico, next to his brother, Yandel.
“I feel I’m missing a big piece of me,” Minor said, weeping in the moments before the small wooden casket was lowered into the ground.
The couple clutched hands, surrounded by some family members, church friends of Rohena’s mother and a few others. Tears rolled down Minor’s face.
The road ahead is long: Rohena’s car was repossessed. The $2,500 a month he gets from the military and $800 in disability payments won’t stretch far, he said. With his health issues, he can’t do the hard labor he used to, so job prospects look bleak. Minor receives food stamps and that helps, he said.
Despite the agony he and Minor have experienced, despite whatever pain his two sons may have endured in their short lives, Rohena said he still doesn’t regret not appealing the reduction.
“What’s happened has happened,” he said. “I’m not angry.”