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The Octuplets – What Should Have Been Done and What We Can Do Now February 8, 2009

Posted by Nalini Padmanabhan in Healthcare.
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On January 26, California mother Nadya Suleman gave birth to octuplets. When it first broke, the story was hailed as an exciting success of modern medicine, as all eight babies were born alive and in stable condition. According to the Washington Examiner, these children were just the second live-born set of octuplets in history, and the first in ten years. USC fertility program director Dr. Richard Paulson, who was not involved in the delivery, commented on the rarity of the event, “it’s a risky decision to try to have all eight babies. I would not recommend it under any circumstances, but I respect a parent’s decision.”

His words foreshadowed the controversy that was to erupt over the next several days as more information was revealed about Suleman’s family and history and the conception process itself. The pregnancy was found to be the result of in vitro fertilization, in which Suleman’s doctor implanted eight embryos with the hope that at least one would take. The American Society for Reproductive Medicine recommends that fertility doctors implant no more than two because of the increased risk – to both mother and babies – associated with the higher-order multiple births that often result. However, according to Duke University’s Dr. Geeta Swamy in an interview with the LA Times, “Doctors should be making efforts to curb these higher-order multiple gestations, but it really is still up to the individual physician. There aren’t any laws or legal ramifications to it.”

Further news reports found that Suleman, a single mom, already had six other children and was living with her parents, bringing up additional concerns about the children’s psychosocial well-being and financial stability. A classmate of mine described a lunchroom debate one day at work, saying that, “one woman said she should be sterilized. Someone else said she should be institutionalized.” Although the details of Suleman’s psychological profile remain publicly unexamined, it is clear that she is not equipped to be a mother of 14, and that she will need help financially – if not in other ways as well – to give her children a stable childhood.

What is less clear is where the responsibility lies, and what can be done in the future. As the quality of fertility treatments and their frequency of use continue to increase, situations like these will become only more common. With six children already, many would argue that Suleman should not have been seeking fertility treatment in the first place. Legislating against it, however, is more controversial; it smacks of “one child per family” laws, and proposing or supporting such a measure would be political suicide.

Moving to the medical side, most would agree that Suleman’s doctor should not have implanted eight embryos. While he cannot be legally held liable for the riskiness of the pregnancy and delivery, both because there is no legislation on the matter and because all eight children ended up in stable condition, creating such legislation would be a much more viable avenue for preventing future events. As mentioned earlier, the medical risk of higher-order multiple births is well established. Political arguments against implanting more embryos than a mother is able to safely give birth to would be flimsy at best. A possible compromise for women who want the higher chance of getting pregnant provided by implanting more embryos would be to include multiple cycles of IVF in the treatment program, rather than implanting many embryos at once.

Another selling point of legally limiting embryo implantation during a single cycle of IVF is the societal and familial cost of raising large families, particularly with the added strain of birth defects and other medical problems more common in multiple births. Doubling – or more – the size of one’s family all at once is already a significant emotional and financial challenge for those who do it without treatment; it just doesn’t make sense to allow it to happen intentionally as well.

Fortunately, the current controversy has provided just the window of opportunity for such a policy. The question has been put on the national agenda, and public opinion, while divided on what can be done in Suleman’s situation, supports some kind of action to prevent it from happening again.

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Comments»

1. Kayla Yost - February 9, 2009

Thank you for shedding light on this issue. The media (in TV show Jon and Kate plus Eight) glorify parents that give birth to large sets of multiples. However, few understand the risks that both parents and doctors take when implanting more embryos than a mother is able to safely give birth to. I agree that IVF should be further regulated in this regard.

2. medhead - February 10, 2009

This instance smacks a bit of the movie “Idiocracy.”

Still, I don’t agree regulation is in order (I’m for getting Congress as far away from my ovaries as possible); though I do agree that this was shameful. Regulation would be a knee jerk reaction to a symptom, ignoring a systemic problem. On Nanny 911 recently, there was a family of 10 — the wife wanted 12 total, even knowing that her truck driver husband was battling a drinking problem and had already ‘put their family through a lot.’ People make inexcusable choices about how they raise their families all the time. While well-publicized (and higher-tech), there isn’t anything new about what this woman did.

Communicating what’s healthy and offering help for those that want it is the only viable recourse.

3. Nalini Padmanabhan - February 11, 2009

Thanks for your thoughts. I agree that communicating about the health issues relating to higher-order multiple births is important, especially with the recent interview with Suleman where she mentioned she wasn’t expecting more than twins (http://www.google.com/hostednews/ap/article/ALeqM5ilIx-PXnXPpwF1a_nlRYF00fzBIQD968875G0).

However, I see policy regulation as a potential systemic solution to the systemic problem that, as you said, exists. Of course it would have to have provisions ensuring that we don’t start down a slippery slope of overregulating women’s bodies – I don’t want Congress particularly close to my ovaries, either! A silver lining to the octuplets story is that it brings attention to this problem and gives us the opportunity to act on it.


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