Octuplet Birth Raises Ethical Questions and Public Outrage

Sunday, February 1, 2009 12:48

Posted in category Infertility, Preemies, Pregnancy

On January 26th, 2009, a 33-year-old woman named Nadya Suleman gave birth to octuplets, 9 weeks premature. The fact that this pregnancy was carried all the way to 30+ weeks is a miracle, but beyond that it looks like more of a nightmare.

According to statements made by Suleman’s mother, Angela Suleman, the woman chose to have these frozen embryos implanted rather than have the embryos destroyed. The embryos were created during an earlier IVF procedure, and according to reports, all of her previous 6 babies were conceived via in vitro fertilization.

That’s right, not only did Suleman just give birth to 8 babies, but she already has 6 kids between the ages of 2 and 7 at home. Two of these children are twins, and one of the children reportedly has autism. On top of that, Suleman is single and lives with her parents.

Like many of the fertility doctors interviewed about this story, I’m not in the business of telling people what size their family should be. HOWEVER, I do think it is the responsibility of fertility doctors to tell someone how many babies they will help them make at one time! Considering the risks that high order multiples carry to both mom and babies, willfully setting out to implant enough embryos in a woman to create the possibility of an octuplet pregnancy is irresponsible on the part of her fertility doctor.

So far, no one is saying exactly how many embryos were implanted, but had her doctor followed 2006 American Society for Reproductive Medicine (ASRM) guidelines, they would have used no more than 2 embryos. According to these published guidelines, the suggested maximum number of embryos is based on maternal age, embryo quality, and the result of previous IVF attempts. They suggest a maximum of one or 2 embryos for transfer in women under 35 years old (Suleman is 33), 2-3 at 35-37, 2-4 at 38-40, and 3-5 embryos maximum at an age over 40.

My biggest beef with this whole story is the fact that this mom and doctor worked together to create a pregnancy that had no chance of being carried to term and also risked the life of a mother of 6. Now of course, no one expects to have that many embryos actually implant, but the doctor had to know that what they were doing was risky at best. It isn’t their job to say how many children a woman can have, but it is their job to say how many children they will help a woman create at one time. If Suleman didn’t want the embryos destroyed, she could have gone through multiple separate IVF cycles, using 2 embryos each time. IVF is expensive, but all those cycles can’t hold a candle to the combined medical expenses of even the healthiest octuplets born 9 weeks premature.

Prematurity carries high costs to both the babies and society. Premature babies are at risk for life long developmental and medical complications, including death. They are subjected to painful medical procedures in an effort to keep them alive, and they often require therapy and medications for years after their birth. Preemies often have problems with sensory processing, social development and subtle learning issues that can cause them significant trouble in school and beyond. Despite popular belief, preemies are not just small babies, and they don’t always catch up by age two or three. The lost time in utero, and subsequent medical interventions have longterm consequences we’re only beginning to understand. This doesn’t even begin to address the enormous medical expenses these babies will incur over the next year and beyond.

As miraculous as it is that all 8 of these babies were carried to 30 weeks and survived, this pregnancy is a huge failure for modern assisted reproductive technology. It calls to question the morals and ethics of the fertility clinic involved and the mental health and motivations of the mother, who is now reportedly seeking $2 million from the media in return for interviews, and is hoping to be on Oprah. As for Suleman’s parents, one wonders if there wasn’t something they could have done to intervene here as well, like seeking some sort of psychiatric help for their daughter if they really felt she was “obsessed” with having babies.

What do you think?

36 Responses to “Octuplet Birth Raises Ethical Questions and Public Outrage”

Kim says:

February 1st, 2009 at 1:04 pm

I totally agree. But something tells me we’ve yet to finally hear the whole story. I think it could get crazier yet.
Kristie says:

February 1st, 2009 at 1:09 pm

Oh, I agree. The story gets more interesting, in a sad sort of way, every single day. I really want to hear something direct from whoever put these embryos inside this woman. I even read that she worked for a fertility clinic at some point. If true, that is probably connected to this in some way, and it shouldn’t be too hard for someone to figure out who this fertility clinic employer was . . .
ExtraordinaryMommy says:

February 1st, 2009 at 1:09 pm

I have to tell you….I feel exactly as I do and appreciate that your post was well thought out and gently worded. I think this is a sensitive issue, but you have to wonder about a woman who is seeking $2 million dollars and time on Oprah within a week of the delivery.
Jessica (aka @kikarose) says:

February 1st, 2009 at 1:12 pm

This whole situation makes me see red. You have to wonder at what point you could accuse the mother, and even the medical team, of child endangerment. Considering the risks involved with high order multiples and the fact that this woman had already undergone successful IVF treatments the sheer recklessness of transferring 8 embryos, even frozen embryos, the medical team HAD to know they were endangering the lives of any possible fetuses. I can’t help but feel pity for those poor kids, the 6 already at home, and the 8 who will have to live with the rash decisions made by the mother and her doctors.

Just to correct you on one thing though, I heard that the mom wasn’t technically single, her husband is a contractor who works in Iraq, which is why she lives with her parents. Not that that makes a huge difference in the long run!
Kristie says:

February 1st, 2009 at 2:11 pm

Jessica-

I’ll check into that. I’d heard that the mom’s father had been a contractor in Iraq (a translator), not the octuplets’ father. There are so many stories going around though, so either one could be correct. Thanks for the heads up!
Kristie says:

February 1st, 2009 at 2:12 pm

ExtraordinaryMommy-
Thank you.
Kristie says:

February 1st, 2009 at 2:22 pm

To follow up, this is what I read about the mom being single:

“She’s [already] got six children and no husband. I was brought up the traditional way. I firmly believe in marriage. But she didn’t want to get married.” (this is the octuplet grandma speaking)

Quote comes from the following article:
http://www.nydailynews.com/news/us_world/2009/01/31/2009-01-31_octuplet_grandmas_shame_daughter_has_14_.html
Laura says:

February 1st, 2009 at 2:54 pm

This event is triggering outrage on so many levels. The cherished miracle of birth is now tainted. On a personal level, people are troubled by this story of reckless self-indulgence completely absolved of any responsibility. The state of California has officially began sending IOU’s as income tax returns. This is the income we earned honestly and completely trusted would be returned. Not a mere entitlement! The responsible citizen despairingly wonders where their money went. After scrutinizing budgets and self-sacrificing to meet the demands of our own lives, this is extremely troubling.
Here is a woman living her fantasy at the painful expense of everyone, untouched by reason or reality. There are no shortage of enablers. Somebody or something should have prevented this. Without the cooperation of a physician, it wouldn’t have happened.
I am very impressed that the medical profession is actively addressing this perversion. Ethics are now truly valued. Maybe it’s a cliche, but “first do no harm” is returning alive and well. Thanks for your blog!
We are all deeply concerned how much of this is going on and what we can do to end it in the future.
Kristie says:

February 1st, 2009 at 3:47 pm

Laura-

Very good points. California is having major financial woes, and I would be livid if I was sitting around waiting on my tax return while the state paid out on this hospital bill.
Jessica Gottlieb says:

February 1st, 2009 at 9:54 pm

“this pregnancy is a huge failure for modern assisted reproductive technology”

I love you for having the chutzpah to say it like it is.
Kristie says:

February 1st, 2009 at 10:05 pm

Jessica-

Thank you
Cindy C. says:

February 1st, 2009 at 10:05 pm

I wondered how long it would be before she started asking for money for appearances. I haven’t paid close attention to this story, but I have to ask myself how culpable society as a whole is for this. We have made celebrities of multiple birth families and given them money and homes and t.v. shows. I’m not saying no one should consider IVF, when necessary. (I have struggled with fertility issues myself and understand the heartache of not being able to carry a baby to term) While I admire someone’s “choosing life”, I am concerned about the long term impact of decisions such as this. I agree that it could have been (probably should have been) safely spread out. But then, where’s the payout for a twin birth? Am I too cynical?
William says:

February 1st, 2009 at 10:12 pm

This fertility doctor was sicker than it’s patent. The PR stupidity of Kaiser attaching their name to this ‘Frankenstein”I wanta be on Oprah’ stunt is beyond dumb.
jaded says:

February 1st, 2009 at 10:14 pm

Well, although I think this is super ridiculous, because 14 kids under 7 is crazy. I can say I was born 3 mos early @ 2.5lbs. And turned out fine and healthy. Through the younger years, up to age 5 or so, I was sick a lot and had fevers. But after that I’ve been healthy with no major issues. And no developmental challenges. (Age 30 now). So I have high hooes that these kids can turn out fine. B/c I did. After that 3 mo hospital when I was born, I was a healthy kid.
Kristie says:

February 1st, 2009 at 10:40 pm

Cindy-

I think you are dead on. There is no “payout” for a twin birth. Aside for some free diapers, I don’t think there is much payout for anything less than 6 babies these days. The only way to stand a chance of being able to afford that many babies as a single mom in the US today was to make a media circus out of the kids by doing something like this.
Kristie says:

February 1st, 2009 at 10:43 pm

Jaded-

I am so glad that you are healthy and well. That gives hope to a lot of preemie parents out there. Unfortunately, whether it is because of something we’re doing in the NICU, or preterm birth itself, most very premature babies aren’t as lucky.
Colleen says:

February 1st, 2009 at 10:49 pm

I would not watch Oprah if this idiot got on. What intelligent or worthwhile thing could she possibly have to say? But most people would, out of morbid curiosity. Scandal sells.
Bonnie Sayers says:

February 1st, 2009 at 10:52 pm

I read in a story that the grandparents bought her a house and then last yr they ran into financial problems, file bankruotcy, than changed mind and paid it off, but sold house to do it so moved into the house they bought for the daughter.

I am concerned about the son with autism and surprised to read earlier today that there is a set of twins. It was freaky the way they showed grandpa with three kids leaving house with sheets over their heads to get to car, seems very familiar like Michael Jackson with his kids.

We are in Los Angeles so this is local and my neigbors brother lives in Whittier, which is where the home is, hospital is in Bellflower. Mom for a few more days there and the kids for one month at least. She is trying to get sponsors and talking to Oprah and Diane Sawyer.
Brenda says:

February 2nd, 2009 at 3:58 am

I am the mother of a 28 weeker who is now 10 months old adjusted. As you can imagine, this story touched a nerve with me. Our baby is only doing so well because of all the time and effort we have put into him. He may still have some long term effects, but I can’t even begin to tell you how sad I feel for those babies who will never have the same kind of nurturing we give our baby every day.

Those babies are not fine as the media reported; they are not healthy. One was born at 1lb 8 oz. They are fighting for their lives now. When I look at the pictures of our baby when he was less than two pounds (1lb 12oz), you can tell that he was anything but healthy. Seeing how the media glosses over this part just confirms to me how most people have no clue what goes on in a NICU.

It’s not a happy place and all the things that babies go through there are horrid. I am having a really hard time coming to terms with the idea that she (the mother) intentionally did this to them. It’s hard for twins to go full term, let alone what she and her doctor did.

I don’t know what the solution is, but I won’t get into the debate about how many children a family should have. The experiment in China has failed completely so government regulation is not the answer, but it does seem that there is a standard in fertility medicine and the doctor/clinic broke that. I hope that some sort of repercussion will come for them so other doctors/clinics do not follow suit.

In the meantime, I can only hope that those babies and the children already at home will benefit from every source that becomes available to them through either social programs or whatever means of charity they can receive. Whether or not you agree with what has occurred, those children need help. I hope people do not lose site of this detail in all the hype.
steve says:

February 2nd, 2009 at 6:04 am

great post!!! this is very very useful thanks….
Kristie says:

February 2nd, 2009 at 9:46 am

Brenda-

You’re right. My own daughter was born 9 weeks early, just like these octuplets, and weighed in several ounces heavier than the largest of the 8. There was nothing about her that I would have called healthy, especially in her first week of life. Feeding tubes, oxygen, ventilators. People have no idea how risky it is when a preemie starts being fed. My own daughter got necrotizing enterocolitis (NEC), and spent 2 weeks in pain, unable to take any food. For some of that time we couldn’t even pick her up to comfort her.

Once they get home, these babies face a very high risk of getting RSV or some other respiratory infection from their 6 siblings. RSV could put a preemie straight back on a ventilator, or kill them. Can you imagine trying to keep these 8 babies from getting sick with that many other kids in the house?

For anyone who is wondering, our singleton daughter (girls do statistically do better than boys) spent 46 days in the NICU, and spent a total of 51 days in the hospital in her first year. Coping with this with 8 babies is going to be exceptionally difficult, especially when some of the babies start coming home, and others are still struggling in the NICU.
executive gifts expert says:

February 2nd, 2009 at 10:36 pm

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FUMI says:

February 3rd, 2009 at 3:57 am

Any funds this woman obtains from any publicity, should first of all be used to pay for the medical costs of looking after 8 pre mature babies until they leave hospital safely.
The woman should then be assessed as to her reliability to actually be a good mother, to all 14 of the children.
I think it is clear that she is a good candidate for one of the most irresponsible individuals possible, when it comes to parenting qualifications.
As in all cases, the authorities should look into the welfare of the children, first and foremost.
Anonymous says:

February 3rd, 2009 at 3:17 pm

1. The doctors responsible should be investigated, and if found responsible for wrongdoing, they should lose their licenses.

2. This woman put herself, her children, and her doctors at risk. She exploits her children, reproductive system, and the medical establishment for fame and fortune. While the law doesn’t view this as child abuse, I certainly hope this changes. If she receives any support, it will only reinforce this sort of behavior.

3. I think the media should take a united stand in ostracizing this woman for her irresponsible and abominable behavior. She should not be granted interview money. She is currently bankrupt, YET HAS A PUBLICIST. This makes me want to VOMIT.

4. Unfortunately, the media frenzy will play into her hands. I am 100% sure of this. Her doctors and debts should be paid off before she sees one cent. I seriously hope the public outrage seriously discourages any endorsements or sponsorship of any kind.

You should not have any more kids than you can care for. This is child abuse, plain and simple. This woman is sick, and any company that sponsors her is just creating more of her kind.
CaraM - TheHouseholdHelper says:

February 4th, 2009 at 8:09 pm

As another preemie mom, Kristie you know this makes me sick! Knowingly straining the resources of the NICU and the state is despicable. On top of the quality of life she will be giving her children – seriously!?!?! I feel so bad for those poor babies, and their 6 siblings.
I can’t get pregnant and have decided NOT to go through fertility treatments (drugs) because of the risks, and wont consider IVF because of the chances of having multiples (I’m over 35 and there is a history of twins in my family). As much as I would love to have another baby, my son is here – now – and is my priority.
She and her doctors need to re-set their priorities.
Kristie says:

February 5th, 2009 at 1:36 pm

Cara-

Well put. There is a lot to be said for making responsible decsions about growing (or not growing) your family. These poor kids have so much going against them now.
Karen in Indianapolis says:

February 5th, 2009 at 5:22 pm

Everything about this story is just disgusting. Both the mother and doctor should be punished somehow. I just feel sorry for all of her children. And if any one pays her money for interviews, I hope they are smart enough to put the money in a trust fund for the children.
Bob Lewis says:

February 5th, 2009 at 6:39 pm

This is a great forum, I look forward to taking part in your conversations! It’s rare to find a blog or anything else with this many people engaged. You have a lot to say, and a great following. I look forward to taking part in this Intelligent conversation, and I’ll tell others about you.
Thanks, Bob Lewis
Jim Lee says:

February 8th, 2009 at 12:35 pm

You folks haven’t seen anything yet.

I guarantee you this mother of many will collect a minimum of 20 million bucks over the next 1-5 years from endorsements, book deals, speaking engagements, and appearances.
Managed first aid services says:

February 9th, 2009 at 2:03 am

Great blog post….Very good information. California is having major financial woes, Thank you
berkey water filters says:

February 9th, 2009 at 7:52 am

I agree this brings up a lot, and I mean a lot of issues. There are tons of ethical questions. Should those frozen embryos be destroyed? Who gets to regulate what is good for another person? Is she mentally unstable and therefore unable to care for these now 14 kids? I seriously doubt that she and her doctor went into this planning on having eight viable births, but the question is brought up, should they have done it at all? Who is ultimately in control?- Nate
Maddy says:

February 9th, 2009 at 6:32 pm

I heard just the tiniest snip about it the radio initially, just enough to make me praise the wonders of modern medical technology and what a story of hope it would be for so many couples struggling with fertility.

Then I heard more and more as the days followed.

I’m still trying to hang on my initial reaction now that it’s been so tainted.
Best wishes
Lisa says:

February 11th, 2009 at 3:21 pm

As you know, I have had the preemie experience. My 28 weeker is now 21 and healthy. No one would ever guess that he was born so early. The media really does gloss over the reality of the NICU. Even though the babies seem relatively healthy, there are no guarantees that there won’t be any problems.

From what I have read, the mom had 6 embryos implanted and 2 split. Most parents that have had a preemie understand the importance of a full-term pregnancy. I can’t figure out how this woman could possibly care for 14 kids, 8 of which are newborns.

I have also read that the California med. board is investigating. I think the doctor that made such decision will face some serious consequences. It’s just outrageous.
Jaci Struwe says:

February 11th, 2009 at 8:01 pm

The ethics of this woman’s decision are not up for grabs. It’s crazy on a multitude of levels. No Man! No integrated family unit to aspire to. This is bizarre and sadly, just media fodder.
Lisa @underthelaundryheap says:

February 12th, 2009 at 1:12 pm

This situation makes me so angry. I can’t believe this woman and her doctor would willfully put babies at risk for the problems associated with prematurity.
maureenM says:

February 25th, 2009 at 5:46 pm

It breaks my heart to hear what this woman has done. It is so reminiscent of the Dione babies its scary. They were raised in a zoo. Looks like this will be the same. I saw a video clip of her arguing with her mother. Does she realize how petty, manipulative and ignorant she sounds? Obviously not nor does she care. If Oprah has any ethics she won’t put her on the show.