Octuplets' Mom Not The Problem - Clinic Should Share The Blame

A drive to perpetuate the species through the act of reproduction is something that is hardwired into just about every life form on this planet. Humans alone, for the most part, among all those different life forms, make a conscious decision to reproduce or not to reproduce. We go to great lengths to control the number of offspring we produce: medications, surgeries, torturous calendar-keeping, condoms, abstinence - all in the name of attempting to control the number of children this biological drive may cause us to spring upon the world.

But those efforts pale by comparison to the lengths to which individuals and couples facing fertility problems will go, not to try to control the number of children they produce, but simply to be able to have a child in the first place. The longing for a child of one’s own, combined with the inability, for whatever reason, to have one, is a source of great pain and heartache for many. It is almost impossible, particularly for those not "reproductively challenged", to understand the grief that people in those situations feel.

I recall an essay by the English writer, Charles Lamb, "Dream Children: A Reverie". In it, Lamb is sharing family stories with his two children, telling them all about their great-grandmother. He paints a serene and lovely image of a moment of sweet family life, his children at his feet, listening to his story. It is, as it turns out, truly just a dream, for Lamb never married or had children, devoting his life, instead, to the care of his sister. But his longing for children of his own comes pouring out in this essay: "…and while I stood gazing, both the children gradually grew fainter to my view, receding, and still receding till nothing at last but two mournful features were seen in the uttermost distance, which, without speech, strangely impressed upon me the effects of speech: ‘We are not of Alice, nor of thee, nor are we children at all…We are nothing, less than nothing, and dreams. We are only what might have been…'"

For me, those lines, so poignant and wrenching, represent what the passing years of hoping and dreaming in vain of having a child must be like: slowly watching those dream children fade into the distance must be torture. In the light of such pain, it is easy to understand and accept just how far some are willing to go to bring those dream children to true life: hormone injections, sperm donations, egg harvesting and freezing, surgeries, bedrest, premature deliveries, the risk of multiple births, not to mention the incredible financial cost attendant to all of these procedures. Yes, people will go to incredible lengths to bring those dream children to life, and it is their choice to do so. But what about when something in that dream is terribly wrong?

Like most other people watching, I imagine, when news of Nadya Suleman’s octuplets’ successful arrival first broke, I was rooting for them and for her. The niggling voice in the back of my head that couldn’t figure out why on earth anyone would let a woman carry that many children at once was shouted down by the boisterous hope that all eight babies would actually survive.

But as more details were provided, that persistent voice in the back of my head became louder, more persistent, even angry. Every new detail raised questions for me: Why would she do this when she already had six children at home? Who would help her with these babies? How would she survive financially? What kind of irresponsible, unethical clinic would have implanted that many embryos in a woman in her situation—in any woman for that matter? Was there a breakdown of the pre-treatment evaluation and counseling process? Had there even been one in place?

And yet, as quotes from Ms. Suleman began trickling out, about how her biggest dream, all her life, was to have the large family she felt she’d been denied herself as a child, I kept coming back to Lamb’s essay on the pain of wanting those dream children so desperately. I wanted to hear Ms. Suleman, in her own words, explain to me in a way I could understand, why her situation was a dream come true and not an unnecessary disaster-in-waiting. I watched her interview carefully, hoping that she might say something that would so explain it to me that I could say "Aha! Now I get it!"

Sadly, her interview has only increased for me the number of questions and has greatly fueled the anger I feel for the physicians who allowed this poor, dreamy woman to put herself in this situation in the first place, this clinic which appears to me to have taken advantage of her crazy dream. She spoke of wanting many children, and indeed, it’s not our place to dictate how many children a family decides to have; but if an alcoholic speaks dreamily of wanting just one more beer, is it right for his doctor to buy it for him?

In her interview, Ms. Suleman spoke with great confidence about being able to support her family once she completes her master’s degree. How on earth will she find time to study? Where will she get the money to pay for her classes? If she does, by some great miracle, find the money and complete her coursework, who will take all fourteen of her children all day long while she works? This is not a slam on working mothers; this is a reality check. Call any childcare center right now and ask them if they would be able to take fourteen additional children all under the age of eight.

She spoke of her great and enduring love for her children, something I do not doubt in the least, but as she defended the quality mothering time she would give to each (she holds each baby for 45 minutes a day), I couldn’t help but do the math. What does she think the other seven babies will be doing for the other 23 hours and 15 minutes each day? And what will her other six children be doing? For many large families, the older children pitch in and help take care of the younger ones, helping with feeding, care and dressing, homework, and so on; none of her other children are old enough yet to be able to take on those roles.

She spoke only briefly of the donor, saying that he was, understandably, overwhelmed, and expressing a hope that he would one day perhaps want to get to know his children, which begs the question for me, were these his dream children as well? Is "hoping" that he will be involved enough for them?

I watched her make her rounds from bassinet to bassinet in the hospital nursery, as she kissed and touched each baby lovingly. At one point, she apologized to one of the babies for not being able to stay for long, and it was a poignant moment. Their whole lives, and the lives of their brothers and sisters at home, will now be made up of "I can’t stay for long because another one of you needs me now." Anyone who has more than one child is familiar with that juggling act; sometimes one of your children needs you more at a given moment and you have to ask another child to wait. It’s hard enough in a family of average size; how long will each of those children be made to wait now for her precious love and attention because of the decision she has made to have so many of them?.

The longer I watched Ms. Suleman, the more dreamy and out-of-touch with reality she began to seem. The anger I’d felt for her, and that I had hoped she would be able to explain away, had not lessened, but her apparent inability to connect with reality shifted the focus of my anger from her to the fertility clinic which performed all of her in vitro procedures.

I am not a health professional, but even I could see that there were some red flags in Ms. Suleman’s background that should have suggested to them that she should not be implanted with more embryos. She had had trouble with depression in the past; she had no job, having been seriously injured enough that she couldn’t work; she already had six children at home under the age of seven; she did not have a partner who could help provide any kind of support, financial or parental. Why on earth would the clinic have gone ahead with this?

Because Ms. Suleman wanted them to; those embryos were "her children", she said, and besides, she never really thought that it [the fertilization] would work. After so many previous successes, why would she ever have banked on that this time around? But the biggest question of all remains, and that is why six embryos were implanted, rather than the standard two or three? It doesn’t matter that it was unlikely that all six would take, and even less likely that one would split, let alone two. That clinic was negligent in its responsibilities to do no harm to this woman and to her children. Every embryo implanted in that procedure should have been considered a viable, potential pregnancy, not a "let’s throw another one in there, just in case" add-on. Clearly, the clinic did not consider the consequences. And to illustrate that, just for a moment, let’s consider what the public’s reaction would be right now if Ms. Suleman’s uterus had ruptured under the stress of this pregnancy, and not only she, but all eight babies had perished as a result. I cannot even imagine the outrage if the outcome had not instead been so miraculous.

Ms. Suleman was incredibly fortunate not to have had critical health issues develop from the stress of this outrageous pregnancy on her body, but will anyone be able to say the same for sure of her children? The risks for these babies have been well-documented, ranging from seizures and heart and lung problems to physical and mental challenges. Just the bill from their care to date is already between 1 to 3 million dollars. How on earth will this dreamy, unrealistically optimistic young mother ever manage to come out from under this financial burden?

The point is, she should never have had to. I’m not talking about selective abortion here; some have questioned why she didn’t choose to selectively terminate several embryos, but that opens up an entirely different, and uglier, debate. The question remains and must be answered why the clinic didn’t spot Ms. Suleman’s disconnect from reality and address it, and why the clinic would implant that number of embryos at once. In my opinion, Ms. Suleman, misguided and deluded though she might have been, and continues to be, is not the real problem here.

Thousands of people just like her flock to fertility clinics for in vitro procedures every year, thousands of them, starry-eyed and filled with a desperate hope that the doctors will be able to help them bring their dream children to life. Thousands of them have embryos implanted, and many are successful. But when those clinics start ignoring warning signs in those desperate people’s lives - possible histories of mental illness, financial instability, lack of stable living arrangements - then they have crossed the line of the sacred oath they take to "first do no harm".

To be sure, this is the land of the free, and people in this country get really irritated when anyone starts to try to legislate that ferocious biological drive to perpetuate our species, and laws telling people what they can and can’t do with their own bodies and their own embryos would certainly put us on a slippery slope to ending reproductive freedom. However, where laws end, ethics should pick up, and that is where the clinic in Ms. Suleman’s case utterly and irresponsibly failed.

Ms. Suleman has her dream children now, and I imagine that help will come out of the woodwork for her and her children - at least, I hope that it does, or else for these dream children, their future will come to resemble more of a nightmare, and so unnecessarily. Perhaps other clinics, and the dreamers who visit them, will learn from Ms. Suleman’s experience that, to paraphrase Jurassic Park, they should spend less time being so preoccupied with whether or not they can achieve these "mega-litters", and start thinking about whether or not they should in the first place, because you can’t always rely on a miracle.