Saturday, January 31, 2009

Eight Too Many

 Updated 3/2017 -- all links removed as many no longer active and it was easier than checking each one.

I want to begin this post by basing it on “facts” reported in the news (ABCNews, Reuters, LA Times, Times Online):
  • single 33 yo mother, self described “professional student”
Nadya Suleman, who describes herself as a “professional student” who lives off education grants and parental money, broke up with her boyfriend before the birth of her first child seven years ago.
  • six children, ages 7 yo, 6 yo, 5 yo, 4 yo, 3 yo, and 2 yo twins
  • residing with her parents in a three bedroom home 
  • single mother’s own mother reports that her daughter used infertility treatments
  • recently gave birth to EIGHT babies, 
    The babies were born by Caesarean section nine weeks premature and ranged from 1 pound, 8 ounces to 3 pounds, 4 ounces. The woman was carrying 24 pounds of baby.
  • plans to breast feed (or more correctly use breast milk donated by other women to supplement her own)
  • source of income  (see above) – education grants and parental money though recently reported
THE single mother of octuplets born in California last week is seeking $2m (£1.37m) from media interviews and commercial sponsorship to help pay the cost of raising the children.
  • no mention of her insurance coverage, if there is any
I want to try to avoid the issue of fetal reduction and concentrate on some the other issues I find troubling.  
She seems (evidence is the six children she already has) to have had no need for infertility treatments.  So why did any fertility clinic take her own as a patient?  Were they more greed driven than patient driven?  That is my (outsider) view.
Human females were not made to have litters, and that is what eight babies to me is.  Sorry if I offend someone, but the risk of health issues related to such a pregnancy are multiple and serious: 
  • miscarriage, pregnancy-induced hypertension/stroke, preeclampsia, gestational diabetes, acute polyhydramnios, vaginal/uterine hemorrhaging, and preterm labor & delivery.
The preterm labor and delivery is a “given”.    The length of pregnancy is usually 39 weeks for singletons, 35 weeks for twins, 33 weeks for triplets, and 29 weeks for quadruplets.  Generally, once the pregnancy reaches about 32 weeks, the complications associated with premature delivery are significantly reduced. 
Risks of complications to mother from premature delivery (incomplete list)
  • Surgical and medical issues related to C-section
  • Emotional issues
  • Fatigue even if she has enough support

Risks of complication to each baby from premature delivery (incomplete list)
  • Inability to breathe or breathe regularly on their own because of underdeveloped lungs
  • Feeding and growth problems because of an immature digestive system
  • Intracranial hemorrhage (bleeding into the brain)
  • Hearing or vision problems related to immature nerves or treatment side effects
  • Developmental delay and learning disabilities from brain damage related to immaturity
  • Special problems for low birth weigh babies (less than 3.5 lbs)

Who pays for all of this and should we care?
Each one of these babies weighed less than 3.5 lbs.   Lets assume they all live (and I hope they do and that they beat the odds and don’t have any major long-term health issues). 
Median cost for NICU care (29 wk, 58 day stay in 1999) $61, 724 for each baby
The state of California is bankrupt.  The cost of each of these babies just for the first year of life is going to cost the California taxpayer more than I can imagine. 
I agree that the woman has the right to have more children, but I only agree to that IF she has the ability and resources to take care of them at the time she has them (I’m allowing for future unforeseen calamity).  I do not think she or anyone has the right to take money from my pocket that I could use to help my children (if I had any) or my nieces or nephews get their medical care or allow them to go to college.  Nor should I support her children instead of helping out my elderly parent.
Though it appears now from the Times Online that she is attempting to turn the birth of her eight babies into a source of income.  I hope she will remember to pay the hospital and doctors.  I hope she will put money into the continued health expenses these eight preemies will have. 
Although still confined to an LA hospital bed, she intends to talk to two influential television hosts this week - media mogul Oprah Winfrey, and Diane Sawyer, who presents Good Morning America.

Other Blog Posts on This Topic
Fat Doctor – Six and Eight
Medical Quack -- Obsessed with Having Babies?  Update on the Octuplets Story
Survive the Journey --Nadya Suleman's Octuplets -- How Many is too Many?
Dr Rob -- Don’t Forget the Kid(s)
NeoNurseChic – The Ethics of Octuplets
Moof -- Ooooopsie
Dr Cris – Making Babies or Saving Lives

Multiple Pregnancies, Maternal Risks – Womens Health Channel
Multiple Birth Pregnancy – University of Pennslyvania
Premature Babies – Medline Plus
Premature Births – March of Dimes


Anonymous said...

There are serious ethical concerns here with the IVF team who enabled this. Protocol would suggest the implantation of 2 embryos at most - and probably none in the case of a woman who is not infertile.

I wonder if the State of California will try to collect from the doctor(s) who helped? Yikes.

Jessica Gottlieb said...

Remember that here in Los Angeles all those costs will be at least double.

In 1998 when my first child was born and it was completely uneventful, the bill was in excess of $8,000. I was in the hospital with her for 2 days.

As a California taxpayer I'm calling for blood from the MD that did this.

Dreaming again said...

Given her penchant for living off grants, loans, 'other monies (welfare?) and now asking the media for money to interview long before she listens to the media saying "this never should have happened, protocol was breached" ...and she then in turns sues the doc and hospital involved?

Anonymous said...

One of the reports I read (sorry, can't remember which media outlet) offered the suggestion that so many drugs can be bought online, even infertility meds...and that the mother may have obtained the fertility meds online.

My ignorance abounds on the topic, so I don't know if simply popping a pill or taking an injection can increase fertility to the point of eight naturally fertilized eggs. If a medical professional was required to implant eight embryos, then I do hope they are not sued by the mother.

I feel terribly sorry for all 14 children of this woman. They will be growing up what I would consider a very unfit environment!

rlbates said...

Penny, Nadya's mother says she had invitro fertilization so doctors had to be involved. I think the doctor(s) should have said no to her and sent her to counseling. I agree with you about the "poor children". They are the innocents here.

purplesque said...

The most ridiculous thing about this story is the first thing you mentioned. Why was someone with seven children offered fertility treatment in the first place? Can't imagine any licensed physician with half a brain doing that knowingly.

Robin said...

Some articles are saying “doctors implanted far fewer than eight embryos but they multiplied. Experts said this could be possible since Nadya Suleman's system has likely been hyperstimulated for years with fertilization treatments and drugs.” [Tribune Link]

Also, I believe her first six children were by IVF, according to Nadya's mother.

I also read several blog sites with comments saying the Washington Post and other sites are saying she has insurance with Kaiser. I am still searching for verification of that.

I also read that California law will not allow someone who is already on welfare to get more money for children born after they are on it. This was put in place to decrease the "have a child to get another payment" syndrome. So, if she IS already on welfare, which does not so far seem to be the case, she won't benefit from these children with it.

Bongi said...

this woman can not be right in the head and now many children are going to suffer as a result.

but i wonder about both her mother who i see as an enabler by financing her lifestyle (a student needs an external source of income) and giving her a place to stay, thereby not making her earn her own way in life. the mother must have known about her intentions to go for more infertility treatment. i doubt she took a strong stance on that point either. she must bear at least some of the responsibility.

then the doctors. she had 7 children already for crying out loud. she did not need fertility treatment. just because you can do something doesn't mean you must do it. this is one time when i actually hope those doctors are sued, if not for questionable ethics, then for stupidity. surely you can sue for stupidity in america?

Anonymous said...

Thanks for this post.

This story was interesting from the get go, 8 babies? family files for bankruptcy? previous 6 other kids? no father? no job? alleged obsession with having children? living odd student loans? its complicated.

It difficult to assess someones motivation to give birth to a number of children at the far upper end of of the bell curve of normalcy without actually asking them....

Having said that, the reasons are many and certainly not limited to these:

-Economic/Poverty (to generate income)
-Psychiatric: delusions, poor judgment/insight, emotional needs

As this story unfolds and the details of the severe medical complications and astronomical costs associated with multiple births unfold, I think the ethics of birthing a litter (yes, I call it that as well) must be explored further.

If what I read is true, I would begin with a few questions which raised some flags:
-why pursue multiple IVF treatments for more than the avg amt of children?
-whats the pt's insight into her ability to care for multiple children on own (assuming parents help is limited and no father present)
-what are her reasons for continuing to live at home as an adult?
-what are her motivations for seeking economic support from inappropriate sources (student loans, immune from bankruptcy status btw...)

I imagine the State will not only get involved regarding the financial and ethical aspects of this case, but unfortunately child protective services may be right around the corner (due to neglect).

rlbates said...

Integrative Psychiatry, thanks for you insightful comment.

DrB said...

Apparently there is much question, as well, about whether she was truthful with the doc who was involved--for all of the reasons above, and many more, I would hope that the doc had no clue about her previous children.

This story makes me truly sick, and Ramona, you took the words out of my mouth: human females are not built to have litters.

Anonymous said...

Dr. Bates, you've covered the subject very thoroughly, and I learned quite a bit that I didn't know.

I also agree with the better part of those who've commented on your post. Although I'm really down on the idea of medmal lawsuits, I agree with Bongi that in this case, I would make an exception.

I've read in a few places that some people were saying it should be a time of "rejoicing" because everything went so well. I don't agree. It's a huge relief that everything went so well ..

... although it's nowhere near over yet.

Jabulani said...

Years ago we had a similar situation here in England where a woman underwent IVF and ended up with 8. The whole thing became an absolute circus and I tired of the story long before it came to conclusion, so I now can't remember if she actually birthed 8 or lost them or what. I just remember the whole media trip and being disgusted.

I'm trying very hard to consider both views here, given that my cousin had IVF and ended up with triplets. However, it does have to be added that this was her FIRST pregnancy, she paid handsomely for her treatment, and tragically - due to a very premature birth - she lost one.

Her husband, soon after the boys were born and before the death, wrote that he did not believe humans should have litters. It was too traumatic - for both parents. He is himself a twin and he said 2 was as many as women should have to cope with.

No matter how hard I try, I cannot see the other side. It's insane. I'm with you on this one RLB ... and pretty much everyone else it seems! Those poor poor children - ALL of them.

Cathy said...

Dr Bates, this is a very informative post and you hit on a lot of things I have not read any place else.

The stories keep changing surrounding this. As Robin states, I have read now on several sites that she may have very well had insurance to cover this. Supposedly through Kaiser.

It will be interesting to keep reading the updates and see where this all goes and to eventually find out all the truths. Like who the doctor is?

Return Of Saturn said...

I agree, Moof. It will be over when she has successfully raised 14 healthy, mentally stable children into adulthood.

As a California taxpayer, I'm extremely frustrated by the situation. Californians have been told that all tax refunds are on hold because there's no money. While no one has said that she is getting financial assistance from the state, I find myself wondering how in the hell a single woman is going to pay to raise 14 children.

I would love to be on my way in terms of my education, but I have to work and go to school, which slows the process. This has been the case since I was 16.

It pisses me off that all the talking heads are giving her so much attention and reinforcing her bad behavior.

Oh, and, no one has mentioned this yet... one of the 6 already at home has autism. She's already got her hands full!

Anonymous said...

What protection do doctors have if a patient lies to them? I'm sure her body could have told the doctor some truth about the children to which she had given birth. Doctors are in a vulnerable position if a patient is purposely manipulating them. I guess you develop a "sixth sense" about the truthfulness of patients. Are there any investigative resources for doctors? A clearinghouse of medical records? Any fingerprint and DNA databases for medical purposes? (OK, I watch too many CSI shows! LOL)