The baby machine: science gone crazy

New drugs mean women can carry six or seven babies. CATHERIN MARSTERS on the problems multiple births pose for families, doctors and society.

The future of the latest family of multiple babies - seven born in a Washington hospital just over a week ago - is anyone's guess.

Babies born in such numbers have a history of dying or suffering sometimes dire health problems.

But although it is early days, fate seems to have dealt these latest arrivals a kind hand. Each weighed around 1kg (2.2 pounds), compared with an average full-term baby of around 3.6kg, and they were only 11 weeks premature.

Neither statistic is too bad. Premature babies here with the same statistics would be given good odds for survival.

So far the American septuplets, known as Babies A to G, are one of only three sets of septuplets (seven babies) in the world to survive. One of those sets, however, was originally made up of octuplets, but the eighth one died.

With survival comes a range of possible dangers. Apart from health problems, the parents of multiple-birth babies are more likely to split up. The probability goes up with the number of babies.

Parents encounter enormous stress, personal and financial. And the whole big instant family must cope with celebrity status - Babies A to G, some still struggling for breath on ventilators, are said to be already the subject of full-scale media madness, their births trumpeted as a miracle of modern medicine.

Faced with the risks of multiple births, fertility experts are rethinking treatments, and new American guidelines attempt to limit the number of embryos that can be implanted after in vitro fertilisation.

Are Babies A to G a modern miracle - or are doctors who allow such large multiple births dicing with danger?

A New Zealand fertility expert says the healthy birth of these babies is down to one thing: luck.

In this country, septuplets are unheard of. But in line with the rest of the world, the numbers of twins and triplets born here has risen markedly with the use of fertility techniques.

The big multiple births happen when a doctor uses drugs to stimulate a woman's ovaries so more than one egg is produced at a time, with the idea of increasing the chance of getting one that can be used.

Often more than one is implanted to make sure that at least one is successful, but sometimes more than one takes. A process known by various terms, including "reduction," is then sometimes used to reduce the number of foetuses.

Dr Richard Fisher, from Fertility Associates, a private facility run out of Ascot Hospital in Auckland, says producing seven or eight babies at a time is bad medicine.

Technology, of course, played a hand in the birth of the Washington babies. The mother was on fertility drugs which enabled her to produce extra eggs, and although she was reportedly startled at the number of babies she was found to be carrying, she refused a reduction.

Dr Fisher says putting a woman on the kind of fertility drugs which would result in this sort of multiple pregnancy is not on.

" ... you should be able to avoid septuplets by monitoring the response to drugs."

If a woman is given a drug which stimulates the ovaries, the doctor can see what her response is and what the risk of multiple births is.

"And if you identify that, then your advice should be that the person should not have intercourse and should not try to get pregnant."

Most doctors would tell patients clearly that they must not do this - it is too risky. If the patient went ahead regardless, only then could the doctor be excused.

Most New Zealanders do not need stern lectures, says Dr Fisher: "We have a relatively educated population who are motivated by trying to have healthy babies - not babies at any price."

What is reduction, or selective termination, and is it done in New Zealand?

Reduction is basically abortion of some of the foetuses. With too many babies, a woman is sometimes advised, for her own safety and to give some of the babies a better chance, to get rid of some of them.

It is apparently commonplace in parts of America, but not all women agree to it.

The mother of the newborn septuplets refused. She is a Muslim and it went against her religion.

In 1996, British woman Mandy Allwood shot the seamier side of fertility treatment into the headlines partly by refusing to abort any of the eight babies growing inside her. She also entered into an agreement with the tabloid News of the World which would see her reportedly make a lot of money, depending on how many of her babies were actually born.

She turned down her gynaecologist's offer to selectively terminate six of the babies ("the uterus cannot expand beyond certain limits," said Dr Kypros Nicolaides at the time), claiming her big concern was not the money but that all her babies were delivered healthy.

In the end, not a single one made it. She miscarried three after 18 weeks and the rest a week later.

Dr Fisher says this type of multiple pregnancy would not have been allowed to happen here and reduction in this country is a rare thing.

"Unfortunately, it's part of the American culture that if you just have too many, well you just get rid of a couple, and I don't think that has ever been considered a sensible alternative in New Zealand.

"We would rather people didn't have too many so we didn't have to make that choice."

Deciding to kill a couple of embryos was an "awful choice" for any parent to have to make.

Fertility Associates' policy was not to be involved in selective reduction "because we do not think it is appropriate to be creating pregnancies and to be destroying them at the same time."

But if by chance or mistake a woman found herself carrying seven or eight babies, she was likely to be offered reduction.

What are the health problems of multiple premature babies?

Getting septuplets to 29 weeks in the first place is extremely rare, says Dr Fisher. Usually, the Allwood outcome is common and babies are miscarried.

The ones who survive are likely to have health burdens and possibly developmental difficulties.

They can spend their first weeks or even months on machines, which can save their lives but can also damage their fragile, under-developed bodies.

They must be watched for complications such as bleeding in the brain, which can cause brain damage, cerebral palsy and deafness.

Says Dr Fisher: "The more you have, the higher the likelihood that some of them will have significant handicaps. And for any of them to have a significant handicap is a big enough problem without having another four or five siblings."

In 1997, a set of septuplets were born to Bobbi and Kenny McCaughey in Iowa.

The American public was elated, but some of the children, who all survived, have been diagnosed with serious problems.

Bobbi McCaughey writes a weekly column on the internet at American Baby.

Alexis, "the second tiny body to be pulled from my body" developed feeding problems, she writes, and it was discovered that she and sister Natalie had severe reflux, when the muscle at the end of the oesophagus could not hold back the stomach contents and there was severe vomiting.

When the septuplets were a year old, Alexis and her brother Nathan were behind in their physical development and both were found to have forms of cerebral palsy.

"Alexis was diagnosed with hypotonic quadriplegia, which causes muscular weakness in her arms and legs, and Nathan was diagnosed with spastic diplegia, a condition that causes severe muscle spasms in the legs."

Alexis still has to be fed three times a day by tube with formula injected into the tube at each feeding and is progressing slowly, says her mother.

The tube she has to wear under her clothes does not bother the child generally: "She only gets upset if it leaks - as it occasionally does."

It is heartbreaking for their mother, who clearly adores all her children.

She writes: "It's hard for Kenny and me, knowing that our precious children struggle so and will have to work harder than other people."

What about other famous multiple birth families?

New Zealand has its own set of famous multiple babies - the Lawson quins - but their lives have been touched by tragedy.

Born in July 1965, they were immediately caught in the glare of publicity after becoming the first multiples in this country conceived with fertility drugs.

The Queen even sent a message of congratulations.

But the toll was tough and the Lawson parents, Samuel and Ann, separated when the quins were aged six.

Ann remarried a couple of years later - a marriage which ended when second husband Gary Eyton shot her in the head then turned the gun on himself.

Samuel Lawson died from cancer in 1997 at the age of 61.

Possibly the most famous multiples in the world, however, were the Dionne quintuplets - five identical girls whose births in Canada in 1934 were so unusual for their day that they became a virtual human zoo.

The Ontario provincial government decided that their impoverished, depression-era parents could not take care of them and the girls were made wards of the state, living in a hospital known as Quintland, a bigger tourist attraction than the Niagara Falls.

One claims she knew the word "doctor" before the word "mother."

Only two remain alive. Two died as young women, one from a stroke and the other from a seizure, and a third died last month, aged 67.

In a moving letter written to the McCaugheys and printed in Time magazine, the three sisters who then survived urged that the septuplets not be exploited.

"Multiple births should not be confused with entertainment, nor should they be an opportunity to sell products ... "