America Has a Family Argument

Everyone has something to say about the babies. The eight babies born this month in Houston, where most of us don’t live, to Nkem Chukwu and Iyke Louis Udobi, whom most of us don’t know. Fifty years ago, before television turned the world into a small town, we wouldn’t have even heard of these births, or at least not moments after it occurred, as if we were all anxious relatives, deserving of an intimate, blow-by-blow account not only of the births, but of themechanics of conception. But then 50 years ago, before doctors had thought of tinkering with eggs, much less egg follicles, the births wouldn’t have happened. So here we are, hanging over the Continental Divide as if it were a back fence, having our say about the babies.

And as with any form of gossip, it reveals more about us than about those of whom we speak. The story of the octuplets--a word that, by the way, does not appear in many dictionaries--has two great American themes running through it. Fascination with whatever is first and biggest, and suspicion of those who made it possible.

The tale of the babies also offers bonus sidelight issues including fertility drugs--which allowed the eight eggs to mature; the abortion issue--the parents declined to selectively eliminate any of the fertilized eggs; and extraordinary measures--after the first baby was born vaginally at 25 weeks, Chukwu chose to spend the remaining few weeks almost upside down in an effort to keep the babies in utero.

The talk among the rubbernecking crowd is earnest, emotional, and comes in two varieties--the sacred and the apocalyptic. “A miracle,” say some. “Unnatural,” say the others.

The first group has the easier path. Reaction to the miraculous is pretty straightforward--prayers and thanks, perhaps a small donation. Chukwu and her family, the Nigerian community, and thousands of people across the country have responded so, praising her forbearance, sacrifice and inability to cull the brood within her.

Blessing or Disaster? Miracle or Misfire?

It’s the second group that’s having the harder time, spluttering among themselves, using words like “litter” and “unnatural.”

“It’s child abuse,” says Jirair Konealian, medical director of the Northridge Center for Reproductive Medicine. “It is not a miracle, it is stupidity. I place the blame partly on the family, partly on the physicians and partly on the media for making this out to be a blessing, not a disaster.”

Konealian is voicing, albeit vehemently, the general response of the medical community to the babies, the smallest of whom died days after birth. While they all wish the remaining seven well, most fertility specialists agree that their births were a medical misfire. A woman’s body is not, after all, an infinite resource; to sustain one or two developing fetuses is enough of a strain. More, and the fetuses are competing for oxygen, nutrients and space. An average, healthy newborn weighs about 7 pounds; none of Chukwu’s children broke even 2.

“Every medical procedure runs a certain risk of complications,” says Richard Paulsen, head of USC’s Reproductive, Endocrinology and Infertility Center. “This was a very serious complication of fertility treatment and should be treated as such. You wouldn’t celebrate a bad outcome during heart surgery.”

Of course not, but this particular complication resulted in babies, and that’s a little harder to categorize than, say, partial paralysis.

“Anything that has to do with human life and birth is fascinating to us, especially anything unusual,” says Dr. William Sears, a pediatrician and child-care author. “And in this case, there is the joy of seeing a previously infertile couple getting a bunch of babies. But the gut feeling is something is wrong with this picture, that humans are not capable of carrying and caring for a litter.”

That the remaining seven, if they survive, will face medical problems that could include cerebral palsy, blindness and learning disabilities is almost certain. And in talking of the babies, this is what seems to bother people the most. That the technology has gotten out of hand, that the doctors or the parents made mistakes, and that the babies will have to pay the price. And medical problems aside, how can any couple contend with so many infants? As stories documenting the McCaughey septuplets in Iowa illustrate, there is an assembly-line quality to family life that cannot be avoided.

“Babies need to be comforted, need to be held and nurtured,” says Sears, “preferably by their parents. When you have this many newborns, you’re not talking nurturing, you’re talking maintenance, you’re talking strictly survival.”

In America, most of us don’t like to curtail another’s pursuit of happiness, but we reserve the right to criticize how much it costs. How much the births will cost--in dollars, in time, in sacrificed health and quality of life, in fear that somehow birth and nurturance is not being taken seriously enough.

Trying to Set Reasonable Limits

We also don’t like a problem for which there is no immediate solution. Many are touting these births as a sign that there is a need for greater regulation of the fertility industry. In parts of Europe, for example, there are limits to the number of eggs that can be implanted during in vitro fertilization. But this would not have prevented the octuplets, who resulted from fertility drugs, not IVF. Some argue that couples should not be allowed to take the drugs unless they agree to selective elimination should multiple fetuses implant.

“Regulation is no good because there are always exceptions,” says Konealian. “And then they will suffer.”

And, says Paulsen, no amount of regulating, short of compulsory invasive procedures, is going to eliminate problems. “If I have a patient who is about to release eight eggs, I will tell her that unless she is willing to selectively eliminate, she should skip this cycle. And she may agree and then change her mind. Or I could suggest that we harvest the eggs and try in vitro. And she may say no. At that point, there is nothing I can do. It is her choice.”

While certainly monitoring within the profession should be encouraged, regulating baby making, even high-tech baby making, is not a great idea.

“I think many people’s first reaction is, ‘Oh, the poor babies,’ ” says Barbara Findlen, managing editor of Ms. magazine. “That was mine. And that’s genuine. But I think an important lens to examine this through is that everyone feels free to judge how people create families, feels free to judge mothers. And that’s dangerous.”

“You cannot think of regulations on who should become pregnant and how,” says Paulsen. “You cannot say, ‘If six eggs are fertilized, you must eliminate three.’ Society is not ready for that.”

“We have on the one hand the notion that children are wonderful, a gift from God and cause for celebration,” says David Blankenhorn of the Institute for American Values, a New York think tank. “Which is in conflict with the notion that technology is outstripping us. That there are trees of forbidden fruit of which we should not eat. That this may be one of them.”

The role of God is a large one in conversations about the babies and, is open to interpretation. The parents have been fairly vocal about their belief that the babies are gifts directly from God--this was the reason they could not intervene after fertilization. Others argue that the technology that helped create the babies was decidedly un-God-like.

“It seems to me such a contradiction,” says Findlen, “to use such invasive man-made methods and then at a certain point say, ‘No, we can’t alter this because it’s a miracle from God.’ Yes, the choices should be freely made, but to then take refuge in God seems a bit hypocritical.”

It would be nice, for those who believe in God, if he or she would send down a clearly worded ruling on this. But things have gotten a bit trickier since the Commandments.

And the conversation isn’t really about the babies.

It’s about whether we should do something just because, with a lot of help from a lot of people, we can. It’s about our desire to remain “natural” even while we race to become “new and improved.”

Is having eight babies unnatural? Is having a doctor remove a vein from your leg, cut it into pieces, then use those pieces to replace blocked arteries to your heart unnatural? Is sending a machine filled with people flying through the air from Los Angeles to London unnatural? People die or are damaged in those procedures too.

Yes, there is going to be a whopping medical bill, but there are many whopping medical bills in this country for illnesses and conditions caused by smoking, problem drinking and other lifestyle choices. How do we regulate those?

“When you start looking at the actual issues,” says Findlen, “at things like disability rights and economic rights and public policy, it does get very messy.”

If the choice Chukwu and Udobi made had resulted in one baby or two, as most successful fertility treatments do, we wouldn’t even be talking about the babies.

“I see all these beautiful children that have been born to infertile couples,” Sears says, “and they are miracles. Who would want to take that away?”

In the end, our opinions really don’t matter, at least not to the babies. To them, all that counts is that their parents believe they are miracles, and that enough people agree and are willing to help raise this particular miracle--or misfire--to adulthood.