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Octuplets -- why?

The birth of octuplets in a Bellflower hospital this week was greeted by celebratory headlines around the world. "Miracle Mum Gives Birth to Eight Babies," announced the Belfast Telegraph. But, in truth, it's hard to celebrate a situation in which eight lives -- nine counting the mother -- have been placed at enormous risk.

My concern stems from personal experience. In 1997, my wife gave birth to twins who were, like these eight babies, premature. Our babies, both girls, were born at 24 weeks; a full-term birth is about 40 weeks. Each weighed less than 1 1/2 pounds. The smaller of the two, Nina, died after a 49-hour struggle. Her sister, Josie, spent four torturous months in the newborn intensive care unit, or NICU, before coming home. She is now 11 years old. Apart from a very mild case of cerebral palsy, Josie is doing beautifully. We are very fortunate.

If I learned anything from the experience, it is that extremely premature births place an enormous burden on infants, their families and society. The burden begins immediately after birth, when the children are whisked away to the NICU for what can easily become weeks or months of intensive care costing thousands of dollars a day.

Delivered by caesarean section at roughly 30 weeks gestation, the Bellflower babies ranged in birth weight from 1 pound, 8 ounces to 3 pounds, 4 ounces. It surely will be a matter of weeks, if not months -- and millions of dollars -- before they are allowed to go home.

But this is about much more than money. It is about survival and, for those who make it, quality of life. While all eight of the Bellflower infants were listed in "stable" condition, two were placed on ventilators because of breathing problems. And a "stable" diagnosis guarantees next to nothing in terms of how they will be faring tomorrow, or five or 10 years hence. Premature babies account for more than half of all infants who do not survive the first year of life. Those who do survive often encounter problems ranging from blindness and feedingproblems to cerebral palsy and long-term developmental disabilities.

And it is not just the babies who pay the price. From higher insurance premiums to the rising costs of special education, all of us are affected in one way or another.

Whether it is in society's interest to continue spending enormous sums of money to save babies who otherwise would have died -- and to do so with no guarantee that they will develop into fully functioning human beings -- is one of those enormously difficult questions that have emerged as we have applied our rapidly developing technology and know-how to issues of life and death. A much less difficult question to answer is whether we should be doing more to reduce the number of extremely premature births in this country. The answer, of course, should be a resounding yes.

It is no coincidence that premature births in this country have risen at the same time that more women are undergoing fertility treatments. According to the National Center for Health Statistics, the rate of preterm births in the United States -- defined as birth at less than 37 completed weeks of gestation -- has risen by 36% since the early 1980s. Nearly 536,000 babies were born too soon in 2006.

One of the main reasons for the growing number of preterm births is a high number of births of twins and "higher-order multiples," all of which are more likely to come into the world too soon. Triplet-and-higher births increased nearly fivefold from 1980 to 1998 before leveling off over the last decade, and experts attribute the bulk of the rise to "assisted reproduction."

In the case of the Bellflower octuplets, the hospital wouldn't say whether the mother had been using fertility drugs -- but most experts consulted by the media say there is little doubt that she had. The octuplets' births are just the latest in a series of high-profile births of octuplets, septuplets and sextuplets presumably made possible by fertility treatments. Many of these babies did not survive.

Among the lucky ones are those heralded by a Des Moines Register headline as "Iowa's Seven Wonders." Born to Bobbi and Kenneth McCaughey of Carlisle, Iowa, in November 1997, these babies were the product of fertility treatments that, in the estimation of the Des Moines Register, "obviously worked better than [the parents] could have imagined." The McCaugheys' fertility doctor came in for a fair amount of criticism -- reportedly, for allowing fertilization to occur after Bobbi's fertility treatment had led to the maturation of about three times the expected number of eggs. Still, by characterizing one doctor's actions as an amateurish mistake, representatives of the fertility industry were able to deflect criticism from their field as a whole.

The presence of three to eight fetuses, of course, does not have to result in the birth of three to seven children. Thanks to a procedure called multifetal reduction, parents have the ability to reduce the number of fetuses and therefore limit the risks to the mother and the remaining babies. It is obviously a difficult and painful decision for prospective parents, but the bottom line is that multifetal reduction can vastly reduce the chances of an extremely premature birth and other complications.

But multifetal reduction, which involves the elimination of one or more fetuses by injection during the first trimester, is no different from an abortion in the minds of many. Indeed, the McCaugheys and other parents of higher-order multiples have, in many cases, strongly resisted (on the basis of their religious beliefs) any suggestion that they reduce the number of fetuses involved.

Multifetal reduction, of course, confuses the abortion issue because it introduces a situation in which abortion might, in fact, be necessary in order to save the lives of the mother and the remaining fetuses. But the pro-life lobby prefers to avoid such nuances, and insists that there is no difference between multifetal reduction and a random abortion of an unwanted child.

As the parent of an NICU survivor, I have no problem with the lengths to which doctors go to save some extremely premature infants. Once a baby is born, we need to do all we can to give it life, provided the parents consent. But we also need to take steps to ensure that better decisions are made earlier in the process, before these babies are born.

One such step is obvious: We need to get a better handle on the administration of fertility treatments in this country. Fertility doctors must be held more accountable for their actions. The medically assisted birth of triplets or higher should be viewed as the equivalent of malpractice.

In addition, when fertility treatments yield triplets or more, we need to promote responsible decision-making on the part of parents -- chiefly, by encouraging or even somehow requiring them to engage in multifetal reduction.

Babies are a miracle -- whether they arrive in a group of eight or an army of one. And, because they are a miracle, we need to do everything we can to ensure that they survive and live a rewarding life. The octuplets born in Bellflower are doing OK for now. But we must remember that they are a very lucky eight. And we must do all we can to make sure their experience is not repeated any time soon.

William H. Woodwell Jr. is the author of "Coming to Term: A Father's Story of Birth, Loss and Survival."

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