Friday, January 30, 2009
Octuplets--Why?
A recent editorial in the LA Times, Octuplets--why?, explores the issues of high-order multiple births and extreme prematurity. The author is himself familiar with multiples, prematurity, disability, and death: one of his 24-week twins died shortly after birth, and the other has mild cerebral palsy. I thought this editorial was interesting in light of last month's discussion about extreme prematurity.
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I'm just baffled at the whole octuplets story. The latest news is that the mom is a single mom, living with her parents, in a 3 bedroom house...and she has SIX OTHER KIDS. Two of which are twins! This just sounds too soap-opera to be true, though, so I'm trying to reserve judgement until I know for sure!
ReplyDeleteOne question I had on your earlier post on extreme prematurity was -- at what gestational age would you intervene, rescusitate, etc. You said you'd have a hospital birth if before 36-37 weeks, so I wondered if it's up to the mother to decide on interventions. I assumed, I guess, that doctors do all they can to keep these very-premature babies alive, but can you sign DNRs pre-delivery?
ReplyDeleteI'm with Jill on this particular case. I can't fathom why she would seek fertility treatments if she had six children already.
ReplyDeleteIf I found myself in a the situation of having multiple embryos implant I believe I would selectively abort. I'd rather increase the odds of having two healthy babies and not risk my life to carry more than that.
I don't believe this was a situation where she had embryos implanted, my impression is that she used ovulation stimulating hormones. (there has been much discussion with Multiple Births Canada regarding this situation)
ReplyDeletefamilies of higher order multiples are then faced with the extremely difficult and gut wrenching decision of selective reduction.
When a mom gets pregnant, in any manner, we definately have a social responsibility to ensure that a healthy number of embryos is implanted, but the lines are much fuzzier when using drugs to stimulate ovulation.
There are just no guarantees in life, with any baby/ies. Regardless of her situation, it is important that she/and all moms of multiples receive appropriate resources and supports and that the general public does not make her into a freak show -
unfortunately something I highly doubt, simply because with 'only' 4 kids including twins, people I meet on the street treat me like I am some bizarre freak of nature.
Erin
The thing is, for those of us who believe a human has a soul from the instant of conception, the thought of selective reduction, however noble the reasoning, is just too heartbreaking to fathom. It's like the Nazi who would line up a mother's children and say, "shoot one of them or I'll shoot them all". It feels like playing God. Personally, I just couldn't choose to abort some of my babies to save others, I couldn't live with that. I think this lady is wonderful for continuing with what will no doubt be an extremely difficult pregnancy, in effort to protect the sanctity of her little lives growing within.
ReplyDeleteJane--I just don't know enough about that to give you a reliable answer. I know that generally they won't do anything before 24 weeks. I don't know if you can give DNRs in that window between 24 and __ weeks.
ReplyDeleteYes, it is highly unlikely that octuplets were a result of IVF. High-order multiples are almost always from ovulation drugs, not IVF. There's pretty much an ethical agreement among IVF clinics not to implant more than 2 embryos at once except in really unusual circumstances. And they're even moving more and more towards doing 1 at a time: first one fresh and subsequent ones frozen if the first one doesn't take.
I posted on another forum about what does and doesn't trouble me about this:
ReplyDelete1. We don't know her situation, or her, or her family; judging whether she "should" have x number of kids is drive-by parenting, and it's really none of our business. That sort of thing makes me see red.
2. I also hate the "x group is costing us all lots of insurance money!" argument that the author of this article makes. Every time I see it, it comes across as an excuse to beat up on a group (moms of multiples, the obese, whoever) that the author disapproves of. And there are lots of groups that never get called out in this way; sport injuries cost millions of dollars too, but nobody comes out to suggest we outlaw sports.
3. If we want to discourage high-multiple births, the simplest way is to approach it from a position of concern for the mother; make the case that it's bad practice and unethical for a doctor to put a patient's body through such a dangerous process in this way, even if she consents to doing it.
The story just gets weirder and weirder: http://www.cbsnews.com/stories/2009/01/30/earlyshow/health/main4764432.shtml
ReplyDeletewhat i don't get about the argument that says no selective abortion is that, um, it started with saying yes to more than god in the first place.
ReplyDelete?
a little hypocritical there? i mean, either it's god's will or it's not.
same thing goes for doctor interventions prior to ___ weeks gestation. if it's god's will for the baby/ies to live...
it's not about judgement against anyone - her body, her babies, no skin off my nose - but those decisions definitely impact other women/babies and their decisions NOT to intervene.
AND i'm all for consistency, especially from women, as it's women whose bodies are up for grabs during pregnancy and birth.
Dittoes to Niecey. Although I must say, if she purposefully sought assistance to conceive with six children at home... It at least makes me very curious to hear what her reasoning were.
ReplyDeleteI think the whole realm of assisted fertility is a Pandora's box that humanity is ill-equipped to figure out. And I speak as one who has benefited from it...
Absolutely cannot fathom going through with an octuplet pregnancy after knowing how risky it really is. The number of women who end up with preemies that also used ART is tremendous. I know a LOT of women that used IVF that ended up with a preemie.
ReplyDeleteAt to the gestational age of resuscitation there is a LOT at play. The "old" generally accepted rule was treat at 24 weeks plus and do comfort care under 24 weeks.
That has shifted in many institutions. Some of the considerations are: 1. gender of the baby (female infants lungs are generally mature earlier than male infants) 2. race of the baby (african american babies achieve lung maturity earlier than caucasian babies) 3. Whether or not the mother has received a round of neonatal steroids for lung maturity 4. Estimated fetal weight of the baby
Some of these factors will lead a doctor to resus earlier than 24 weeks. I know of MANY 23 weekers on the preemie list I am part of and a handful of 22ish weekers. Almost all are girls.
As to the rights of parents. I think that is likely handled on a case by case basis taking into consideration all of the above factors, the hospital's policies, and also (sadly) the Born Alive Infant Protection act. My understanding is that DNRs are most often only honored at delivery if the baby is pre 24 weeks. Of course I have also known people whose doctor has allowed them to choose comfort care at a later gestation and know of a couple cases where gestation was "fudged".
Hope this helps answer your questions Jane.
My preemie was a 28 weeker and I had neonatal steroids on board so we were definitely going to resus. We didn't need to because he was breathing at birth. He did need surfactant and was on a vent for a bit, but if you are curious he is a normal rambunctious 3 y/o boy now.
I will say that when my pre-e first surfaced at about 23-24 weeks my husband and I did have discussions about not resuscitating.
I recently had IVF and my doctor was *very* strict about the number of embryos I was allowed to have implanted. I had tried clomid before and did get 7 embryos once. Had they all become fertilized, I would have been in her situation, so part of me really empathizes with her.
ReplyDeleteHowever, I do think it is unethical to implant 8 embryos and the latest thing I read was her mother saying that she had IVF. I still doubt it. There is more to this story. If she chose to implant 8 embryos, she took a really big risk. Glad she has a happy ending.
Loved emjaybee's point about sports injuries costing tons and not commented on.
Personally, I don't have a problem with the fact that she has 6 kids at home. (Could be because I have 6 under 6 and 2 sets of multiples... I don't know?) What I have a problem with is the fact that either she or her doctor (or both of them) allowed her to end up with 8 babies growing inside of her. The risks to her are so many and she has 6 kids at home that could have lost their mother. And then what about the after part? When those 8 babies comes? She'll have 14 kids under age 7 and all competing for her limited attention, love, etc. It's not fair to them. It's hard enough to meet the needs of one child, but 8 at once? That's just insane.
ReplyDeleteMy biggest problem was when the author of the article said that selective reduction should possibly be mandated. That is just ludicrous! I think that the doctors need to be more vigilant in making sure that not too many eggs are released...I'm sure this is easier said than done. I can understand the "it's not God's will for you to have children" argument...and I've seen God open the barren womb with no medical intervention first hand. At the same time, I can't imagine the pain of not being able to bear children.
ReplyDelete"Playing God" begins with IVF and Clomid. One has no moral standing to toss out the "playing god" card about selective reduction once you've anted up in the assisted fertility game.
ReplyDeleteCould it be God's will for you is to be childless?