Sunday, February 08, 2009
This is not going to be a column that dumps on the misguided and clearly troubled Nadya Suleman -- the 33-year-old unemployed single Whittier mother of six who gave birth to octuplets last month. Of course, a single mother of six has absolutely no business having more children.
But the real issue here is that we live in a country with so few regulations on the human fertility business that clinics can engage in practices that can lead to premature births -- producing low-birth-weight babies doomed to chronic illnesses and even infant mortality. The outrage isn't that Suleman is unemployed. (She would have had to quit her job anyway to care for her children.) The outrage is that the medical profession enabled her to give birth to eight premature babies, who each weighed between 1.5 and 3.3 pounds, which can be very hazardous to their development.
Doctors' understandable desire to help infertile couples conceive children has led to medical advances that are not necessarily healthy for children. The new order is great for adults, who now can have children without a partner and in defiance of age limits, but it is not necessarily in the best interests of the children they bear. We have created a society that dictates that all reproductive wishes should be answered. Then we criticize an over-her-head mom -- whose own mother fretted that she was "obsessed" with having kids -- when the inevitable horrors happen.
According to the Los Angeles Times, Suleman's mother, Angela, says that the other six children were in vitro babies from the same sperm donor; two are twins, one child is autistic. The octuplets, Suleman's mother said, were the result of her daughter's wish to try for "just one more girl." (She got six more boys and two more girls.)
You can say her fertility doctors -- whoever they are -- should have refused to impregnate an overburdened single mother. They should have.
However, in August, the California Supreme Court ruled unanimously that a San Diego fertility clinic had no right to refuse to inseminate a lesbian in a partnership on religious grounds. What happens if doctors refuse a single mom, who can sue based on state law banning discrimination based on marital status?
This story has created a public stir, in part because of the enormous resources at play. It costs about $10,000 to $15,000 for a single cycle of IVF treatment. Yet now, the mother could end up on welfare if she cannot support herself and her 14 children. It's not fair, critics complain, that she can choose to have kids she can't care for, but taxpayers can't choose not to pay for her welfare.
Then again, these innocent children had no say in choosing their mother. Kaiser Permanente Bellflower Medical Center employed a 52-member medical team -- including 12 doctors, two anesthesiologists, seven physicians just for the babies, seven respiratory therapists and 24 nurses -- to deliver the seven expected babies, who remain in the hospital, but are doing "remarkably well," Kaiser spokesman Jim Anderson told me on Thursday, the day Suleman was released. (In case you are wondering, Suleman authorized Anderson to say that she did not use Kaiser for her IVF. In fact, IVF is not a Kaiser-covered benefit.)
Stanford professor William Hurlbut, who sits on the President's Council on Bioethics, has seen IVF bring joy to infertile families. But he also noted that, "Multiple births are the bad thing about IVF." The more children per birth, the worse the medical problems are for the mother and the babies -- who are more likely to die, and are often born prematurely, underweight and more likely to suffer from cerebral palsy or respiratory problems.
American Society for Reproductive Medicine spokesman Sean Tipton noted that his group sees this story as "a failure" of reproductive medicine because, "Multiple births can and should be avoided." His group has worked to reduce multiple births from IVF.
Doctors can abort some of the babies -- they call it "selective reduction" -- to reduce the health risks to mother and children. I'll overlook the considerable ethical issues in the interests of limited space. Be it noted that doctors cannot make a mother agree to the procedure. According to reports, Suleman refused "selective reduction" -- and thankfully, Kaiser says the babies are healthy.
California could limit the number of embryos implanted in a mother -- or set up some protocols to reduce life-threatening multiple births. But there is no easy answer.
Hurlbut noted that each IVF embryo is more likely to create twins than in vivo fertilization. Doctors implanted six embryos in Suleman at her request, which resulted in octuplets.
It amazes me that a state that bans more than one parts per thousands of a certain chemical in children's toys because it might cause cancer or reproductive problems has no laws and no regulations to limit IVF multiple births, which we know raise the mortality rates and serious health problems for mothers and children.
So please, don't just bash the unemployed mother. If Suleman were married and rich, this still would not have a happy ending. It's time for America to wake up to the fact that IVF is not simply a benign reproductive choice.
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