Multiple births: let's not forget our ethics, please

November 26, 1997|By Mona Charen

THE FIRST thing that must be said about the birth of the McCaughey septuplets is that it is a miracle. The human female is not designed to carry multiple fetuses, which is why any pregnancy involving more than one child is considered high risk. That Bobbie McCaughey was able to reach 31 weeks with seven is amazing. Any woman who has carried one baby to term must stand in awe of her physical fortitude.

The human uterus is about the size and shape of a small pear. Yet, during pregnancy, it stretches to the size of a beach ball. The expansion of the uterus is wondrous, but it is not unlimited, which is why multiple pregnancies almost always result in premature delivery -- if not miscarriage.

Twins are usually born four weeks premature. Triplets are usually seven weeks premature. A triplet is 12 times more likely to die within the first year of life than a singleton, and the risks increase with each added fetus. Among the common perils for very premature infants are blindness, cerebral hemorrhage, bowel infarctions, lung disease and cerebral palsy.

The Luddites

There are some Luddites (Jeremy Rifkin comes to mind) who see episodes like this, or the far more common instances of multiple pregnancies yielding severely impaired babies, and denounce the technology that made it possible.

There are also people in the pro-life movement who decry the use of fertility treatments because so many clinics treat embryos as mere products.

Most Americans have only a fuzzy idea about how fertility treatments work and perhaps imagine that freakish pregnancies like Mrs. McCaughey's are unavoidable when fertility drugs are used. That is not true.

Patients on Metrodin, the drug Mrs. McCaughey took, are nearly always carefully monitored on a daily basis. Blood tests and ultrasound imaging give doctors a pretty good idea of how many follicles are forming on the surface of a woman's ovaries.

If a woman's ovaries have produced so many eggs in one cycle as to risk a multiple-birth pregnancy above twins, the fertility doctors are under an obligation to advise the patient of this. At a well-equipped clinic, the cycle will not go to waste (the drugs alone cost thousands of dollars each month) because the eggs can be harvested, fertilized and frozen for implantation at a later date. But if the clinic is not equipped to perform in-vitro fertilization, the only prudent course when a woman has responded with too many eggs is to cancel the cycle and try again the following month with a reduced dosage.

Again, the McCaughey case is unique. In almost every other pregnancy featuring five or more fetuses, severe complications and death are almost certain.

The foregoing assumes that ethical people will not engage in the vile practice of ''pregnancy reduction.'' Pregnancy reduction is the euphemism for selectively aborting some fetuses in a multiple pregnancy.

A godsend

Fertility treatments have been a true godsend to millions of people. But the technology must be handled like the precious gift it is. Each new embryo is a new person and should be treated with the reverence and care a person deserves. Couples should be sure that however many embryos they create, they will implant. If that sometimes results in a larger family than they planned, that is the price for the joy of being able to have children at all. And once a pregnancy has begun, its result should be in the hands only of God.

Mona Charen is a syndicated columnist.

Pub Date: 11/26/97

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