labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Tuesday, April 7, 2009

How Many Children is Enough?

I have purposely avoided discussion of Octo*mom, but there have been some ethical dilemmas rolling around in my head that I thought I'd throw out there. The main one being: whose decision is it, ultimately, when it comes to how many children a woman has? What factors are taken into account? Who controls such things?

Ultimately, I know that one question leads to another and arguments can be made in so many different directions. All sorts of "well, if this wasn't allowed, then the following wouldn't be an issue" points can be made. I think the biggest one for me is: had the reproductive endocrinologist only placed 2 or 3 embryos perhaps this wouldn't have been an issue. I don't even know how many embryos were placed in the Octo*mom case, but I do know that even if 2 embryos are placed during the IVF procedure, you can certainly end up with more than 2 fetuses.

What bothers me, I guess, is how this woman was vilified in the press for this. The raging feminist in me saw her being judged not just because she was on Medicaid and lived in a modest home with her 6 other children and her parents- it was because she decided to have these children without a husband. I think the underlying theme was how could this one woman dare to have these children as a single person? How dare she take charge of her fertility in such a way in the absence of a man!

Now, I understand people's anger that this woman is on Medicaid and how taxpayers' money is paying for all this. I get that. But this is where I have more questions. Can we, as a society or government or any other collective entity, tell individuals what they can and can not have for children based on their socioeconomic class and/or race? Thoughts of the ol' "prophylactic appendectomy" in the 1930s (and beyond!) in the South come to mind here. Is it just or ethical to put limits on these things for individuals? I would imagine many people would disagree with laws such as the China one child thing. So how is limiting the number of children for those who don't make 6 figure salaries or have a husband any different?

Nobody is vilifying the 18 & counting family....(sorry, don't know their names) and I presume because of the following: it's a married couple, all naturally conceived, and not on public assistance. Same with those other TLC shows that have large families, with the exception of the method of conception. I mean, these people are getting TV shows and lots of money for having large numbers of children- but I think the big difference is that they are married couples- and dare I say it??? Caucasian, too! Yes, I will pull out the race/ethnicity card on this one, because this is another thing I think is a factor here.

Perhaps what I am getting at is, who gets the rights to be the parent police? Where do they draw the line? I can come up with countless stories about women I have cared for during their pregnancy, birth, or otherwise that many would shake their heads at and ask, "Who let this one have a pregnancy/baby/be a parent?" And I guess my feeling is, no one should get that right except the woman who decides on having that baby (or babies, if you will). I'd be lying to say I've never thought, "Oh jeez! What was this woman thinking?" but as I've evolved as a provider in this crazy field of babies, women's health, and parenting, the more I realize it's just not my decision to make.

This brings me the hypothetical situation of counseling a woman who has come to me for preconceptual counseling (something women rarely do- a topic for another post another day) who is single, perhaps older, perhaps has a few medical issues that could potentially put her in the high risk category. What would I do? I'd be honest. I'd tell her what the risks are to a pregnancy with her given medical issues, what she can do preconceptually to minimize those risks, discuss how age would play a role in both ability to get pregnant and risks to fetus and pregnancy, and discuss her readiness for parenthood. I mean, what else can I do? Say, "Oh but you are 39, almost 40, have high blood pressure, and are single....I don't know if you should even be having children!" I do not feel its my place to tell a woman if she should have children or not. As a women's health care provider, I feel my role is to be upfront with how her specific factors can impact a pregnancy, how she can improve anything that poses a risk, and hope that she makes an educated decision on whether to proceed with a pregnancy.

I don't know...I guess my questions will remain as such. But I hope no one ever tells me that I am too old or shouldn't have children because they just didn't think it would be a good idea. I do know that it is unlikely I would be judged or hit up by the parent police, because I have all the "approved" factors that society deems necessary to have children the right way.


Mama K said...

Well said. "Parent Police"... yeah, really! Parents have the right to make these decisions for themselves.

Anonymous said...

Bravo, rebirth nurse! You show over and over again how much you respect women, and I always count on you to get to the heart of things.

I'm a social worker at a small non-profit that employs only six (progressive) women, and I was shocked by my coworkers' comments the day after the octomom story broke. The anger, the cruel and crude comments, the unabashed judgement... frightening.

The anger at this woman is so disproportionate to her "crime". The anger is clearly rooted in sexism, but no one wants to admit it. What about men who father but don't raise many, many children? Why aren't we attacking them? If it's about the public assistance, what about the corporations that take millions more from public welfare than she ever will?

It is disturbing how swiftly and harshly others attacked her, especially when so many reprehensible acts happen daily. I'm not saying I love octomom's choice, I'm saying I think the prospect of having society openly berate women for their reproductive choices is much scarier than the one out of a million women who chooses this kind of motherhood.

Ladies, give this woman a break. If we truly believe women should have freedom in their reproductive choices, we have to accept that a few of them will make choices we wouldn't.

Reality Rounds said...

I am a NICU nurse and have posted often about Nayda Suleman. I also have very feminist tendencies. What bothered me about her case was the total disregard for standard of care. Implanting 6 embryos in a mom under the age of 35 who already had 6 children is negligent malpractice. It puts the mom's life in danger, and of course, all the babies. The whole media coverage of this story rarely centered around the infants. They were collateral damage in a misguided decision on the mom's part, and malpractice on the doctors part. Nayda's backlash in my opinion, had nothing to do with what society thinks is best, but with the bastardization of science and medicine.

PE Mommy said...

She is not being judged because she is single. She is being judged because she chose to implant 6 embryos (knowing the full potential these could be 6 babies) when she already had 6 babies she can't take care of. Not too mention she had no visible means of support and was on medicaid and welfare. Yet she had the money for IVF and expects us the taxpayers to pay for it. This is infuriating to people that wait, plan their kids out, and scrape every penny to make it happen.

As far as counseling patients, I like that you don't tell them no or to stop. My ob is like that. Having another with my history (pe three times (twice severe) and delivery 3 times around 36 weeks) make me a very high risk patient. My peri has told me NO MORE. She even went as far as to say my ob should be tying my tubes. I know she means well and its because she cares. However, that decision is up to me and my dh. Ultimately, we are the ones that have to live with the decision and know what we are in for with a premature delivery, pe, and bedrest. If there were not people like me, she wouldn't have a job. :) My ob stays out of it, but gives me THAT look like I am nuts to want another.

geena said...

Personally I don't care what race or ethnicity she is. I don't care that she's single, nor do I care that she lives with her mom.

I don't even care that she now has 14 children.

I DO care about her ability to provide for them. I think she's irresponsible for making me (the taxes I pay) pay for her children.

Life isn't fair. If you don't have the means and the resources to care for 14 children on your own power, then you don't need to be having 14 children, no matter how badly you want them.

If life throws you a major curveball and you were once able to provide for all those children and now you can't... well, that's a different story. THAT is what public assistance is for.

But if you are ALREADY on public assistance and then you place even more of a demand on that system - on PURPOSE?

That's irresponsible.

Jill said...

I don't care that she's single or non-Caucasian or on Medicaid or used IVF. I do care that she is an utter loony toon. She recieved a$165,000 settlement because she "hurt her back" on the job, and used that money for 6 rounds of IVF and a lot of plastic surgery. Meanwhile she is unemployed and lives with her parents. Then, she chooses to add another litter of kids to this mess. Her parent's house gets foreclosed on because no one pays the mortgage. Hmmm, maybe that would have been a better use of money than a nosejob? She goes on TV and acts like a complete loon - decked out in a fresh dye job and French manicure, of course - while footage is shown of her kids running around a crowded, dirty house that has sheets for curtains. I do understand that it's a slippery slope when we try to decide how many kids someone should have, but seriously? When you'd rather get cheekbone implants than provide for the six kids you deliberately impregnated yourself with, and then you decide to throw in six - whoops, EIGHT more! - someone needs to draw the line.

Anonymous said...

I have met somebody by email who is one of those people who thinks that it is wrong to avoid conception by any means (even natural family planning), and this woman was always actively trying to get pregnant -- even after suffering several miscarriages in a row, she was trying again the following month! The problem I have with this particular case, though, is that this woman was frequently complaining about her money woes. One of the first email encounters was her saying that she was trying to get pregnant and already knew she would not have enough money to pay for a doula, or a home-birth midwife, much less for a hospital birth, so was wanting tips on how to barter, get the care providers to do it for a reduced rate, or for free, etc. She said at least one time that they were at the point of filing for bankruptcy if things didn't turn around soon, because they barely had enough money to pay their bills.

I don't know anything about this woman, except what I could glean from her letters, but I know she was married and assume she was white. Except for the financial thing, they were very similar to the Duggars (the 18 kids). I do not have a problem with the Duggars having as many children as they want; but I do have a problem with this couple having children, because they cannot afford the ones they have, and were considering bankruptcy due to their lack of funds.

There's a balance between idealism and realism. We might both say that ideally women should be able to have as many kids as they want and/or can take care of; but then we see cases like the ones mentioned here that give us pause.


Jack and Lexi's Mom said...

The difference is money! No one should have children that they can't afford to raise. No one should intentionally have multiple children and expect me to take money from my pocket, which could have been used to care for my own children, to feed, clothe, and medicate them! I don't care how many children anyone chooses to have. In fact, could I afford it, I would have two or three more. I can't afford it! The 18+ people are paying their own way. You can't have it both ways. You can't look to the government to paternalistically pay the way without imposing some rules. I pay my own way and expect the government to stay out of my business. Octo-mom expects the taxpayers of California to pay her way. Therefore, the taxpayers should get to make the rules for her!

Rebecca said...

I disagree that it has to do with her status as a single woman. Also, I wanted to point out that one such TLC family (Gosselin family) is not white.

Labor Nurse said...

Oh, I totally agree that money was a big factor for the continuous bashing. And being on public assistance does make this a difficult issue because taxpayer dollars are at work here. Not to mention implanting 6 embryos as a completely unethical, if not malpractice at work. But I guess the bottom line for me when I look at this situation is, who really gets to make the decision as to how many children one has?

SacredAngel said...

In an ideal world PARENTS would make these decisions for themselves. But it's obvious that the people around her, nor her for that matter were able to make the appropriate decision.

Implanting THAT many embryos is unethical. And if she was in the right place to make decisions she wouldn't have gone with that. Or the doctor wouldn't have made that choice in the first place.

You should be able to make the decision for yourself how many kids you can handle. And that's without assistance factored in. Because you shouldn't aim to live off of assistance. Yes use it if you need it but you should aspire to get off of it asap.

She obviously made the wrong choice and that's why everyone was up in arms. That and the poor ethics.

Anonymous said...

It's amazing how angry people get at "welfare moms" when the amount of taxpayer money they consume is so tiny compared to corporate welfare and money spent to keep wealthy people wealthy.

Again, I don't love her decisions, but I think people are ignoring some of the components of this situation in their haste to stone this woman. Her doctor implanted 6 embryos in each of her IVF treatments because her scarring was so bad it was unlikely any of them would stick. The first 5 times she had 0-2 children from the 6 embryos impanted. So, I agree it was irresponsible of her dr, but you can see that she believed she wouldn't have 8 babies. Also, she strongly believed that each embryo created had to be implanted and not destroyed (again, not a belief I hold, but not uncommon). So she felt she didn't have a choice in eventually implanting all 6.

As far as the taxpayer money, this is a one in a million situation. She is costing each of us 1/100th of a penny. I think we need to focus on the bigger issue of not bashing women for their choices or furthering the myth that women who rely on public assistance are a big financial drain on our country.

Ethel said...

Sigh, I know of moms who have series of children with FAS - one after the other after the other, each one taken away by the state for neglect, abuse, sexual abuse, etc... She has FAS, she continues to desire having her own child that stays with her perhaps THIS time, and refuses contraception.

We have no right to intercede except with removal, we have no right to limit her reproduction. This mom that I am speaking of is a HUGE burden on our society, probably far more then Ms. Suleman, her children will be burdens on us the rest of their lives and will probably continue their life as their birth mother did.

While we can not limit reproduction in good consciousness, we can make an impact for the living children, which is what our role is now. Keeping mom healthy as much as possible, enrolling her in her own care as well as the care of her offspring, and providing the support in raising those kids is what's needed. Those kids LOVE their mom, no matter what she puts them through, no matter how terrible it might be. They need her and will continue to need her.

I don't condone the massive reproduction on her part, but I have no choice in that matter - she has a right to reproduce. Now that fertility doc who jeopardized the mom's health, well that's something else and we have control over that.

Anonymous said...

So it really should be up to the woman as to how many children she should have. That being said, society should also be ready to penalize the mother and take away those children and place them in adoptive households if they can't be taken care of appropriately.

And that's really the issue here. She had 6 kids that she couldn't take care of and then willing went out to have more. Even one more in this situation is not okay. Eight more is ridiculous. Add to it her inability to hold a job, her lack of adequate housing, and a poor support structure. I don't care that she's single, but I do care that she doesn't have community support outside of her aging parents to take care of the children she already has. She doesn't need a husband, but any mother can tell you how tiring it is to be a good hands-on mom. Multiply that times seven and given the age range of the kids and lack of support, it would have been almost impossible. Multiply times 14 and honestly, it is impossible.

One quickly runs out of sympathy for this woman due to her poor decision-making, her frequent trips out of her home without her children, and her lack of insight on what has happened here. An ethical society can't force women not to have babies, but can make these women realize that there are consequences and penalities for their actions when they knowingly bring children into the world that they can not realistically support.

Anonymous said...

I'm with you labor nurse. No one should be telling anyone how many children they can have. Isn't that the beauty of America? Unfortunately it does mean that we, as a society, may have to fund someone else's poor choices. But I would rather my tax dollars go to help her raise her children, than to give up MY freedom to have as many children as I wish. (I have 4 so far and we are not on any assistance) It is a slippery slope to start dictating who can or cannot have children or to limit family size. I don't agree with octomom's actions. I think she is living in a dream world. But if we want to make rules for others we need to remember that those rules will also apply to us.

Labor Nurse said...

babybutterflies- the slippery slope is exactly why I feel we as a society can not dictate a woman's reproductive choices. As many of the commenters here have pointed out, there are things I disagree with. But its really not my decision. And whatever drain she is placing on "the system" is nothing compared to the corporate welfare our country provides. Or shall I say- we provide.

MomTFH said...

I don't have an argument with people of all socioeconomic classes and marital status being able to have children. I agree that people who make judgment calls on what women need to be sterilized makes me scared.

My problem with the octuplet story is the violation of reproductive standard of care of creating an octuplet pregnancy through an intervention. The mother and all eight embryos -> fetuses -> babies were endangered.

Patient autonomy, reproductive rights and informed consent does not mean the customer is always right and medicine is a smorgasborg regardless of risks of procedures.

She is no poster child for reproductive rights, anyway. She does not support selective reduction or destroying embryos, and provides an alternate fairy tale ending to these more practical alternatives to high order multiple pregnancies.

Labor Nurse said...

MomTFH- you bring up some good points as far as her being the poster child for reproductive rights if we look at the specifics.

SacredAngel said...

Anon 6/8 2:16pm and MomTFH you two are SO much better with words than I am. SO much better.

Basiorana said...

Had she had these children naturally, even with a man she had not married, I would have no problem. Because it's not just that she's on taxpayer money-- lots of moms are. And it's not that she had that many kids while on taxpayer money-- many people on welfare will have many, many children.

But she took taxpayer money and student loans and she intentionally impregnated herself with 6 fetusesat great cost. This was not accidental, nor was it due to innocent forgetfulness or even due to personal objections to birth control. She purposefully chose to have at least 6 children knowing that she could neither afford to care for them financially nor afford to give them the time and energy required. And she already had 6 children when she willingly chose to have 6 more (and then, had two extra surprises, which they knew was possible).

If you are on public assistance, you should not take fertility treatments. Period. They are expensive and if you have the money to spend on an elective procedure, you do not need to be on public assistance-- unless the money is from your assistance as it was in her case, in which case you are cheating the government.

It is sad when a woman is infertile, yes. Of course, Suleman was not infertile at all, she simply preferred this method, even though she could have had children by many, many safer ways even without a man, such as by artificial insemination. Or, since she already had the embryos frozen, she could have implanted them two at a time, and had 3 sets of twins-- much safer. She is perfectly fertile by her own admission and would not have had difficulty with implantation.

So I object to Ms. Suleman not because she is single, nor because she has many children, nor even because she is single with children on state assistance. I object because she CHOSE to have those children at that point in her life. Not an accident, not because she didn't use birth control, but because she spent thousands of dollars for them. And then she endangered her life and theirs by implanting them all at once.

If she wanted to have 14 children like Michelle Duggar did-- one or two at a time due to natural pregnancies-- I would not care even if she was on assistance and single. But this was an elective treatment. Unlike legislating children normally, I do think we should be able to legislate IVF. If there is a reason you would be unfit to adopt, you should not be permitted to have IVF. Ultimately it's the same idea-- a voluntary decision to have a child.

LaLa said...

My hubby and I were diagnosed infertile and have been trying to get pregnant for over 4 years. We tried the less invasive intrauterine insemination, and it never worked.

So as someone from the INfertile community, this woman makes a mockery of the available science, her doctor was absolutely guilty of medical malpractice for placing more than 4 blasts (since any one of those could have split and formed twins) and this event just increases the general belief that only nutjobs and selfish stupid people use artificial reproductive techniques. All of which pisses me off to no end.

She is obviously unbalanced, can't take care of the children she already had, and should have been ruled out of ART because her not NEEDING it to reproduce, already having multiple children and being MENTALLY UNBALANCED. Most (unfortunately not all) reproductive endocrinologists wouldn't have touched her with a 50 foot pole.

If you want to have 20 kids, fine with me, as long as you can take care of them, provide them a stable homelife and make sure they are loved and become halfway decent people. You can't fulfill that, you have no business having ANY kids, let alone a litter... but that is just my opinion.

Anonymous said...

Interesting comment; I just stumbled on this blog through another L & D nurse blog.

I don't agree at all with what Nadya Suleman did, but I think her fertility doctor is even crazier for implanting that many embryos.

That being said, I agree with you, that we should not use extreme cases such as this to limit reproductive rights.

I do disagree with you about Michelle Duggar (18 and counting). Even though she is married and does not get government assistance, I have heard people say HORRIBLE things about her, make remarks about how large families are ruining the planet and depopulating the ocean's fish, how her vagina must be the size of the Grand Canyon, how she is ruining the lives of the older children by homeschooling them and teaching them how to help care for their younger siblings, and on and on. I have five children myself and we are not on any kind of government assistance, in fact my husband is serving in the military, but you would not believe how many people think they have the right to openly chastise you for having more than two children (this includes family). My second child has special needs (autism) and I have been told MANY times that I had no business having more children once she was diagnosed, that I am ruining her life by giving her so many siblings and that the reason she still cannot talk at six is because I cranked out so many kids and cannot pay enough attention to her, yada yada.

Thanks for writing about this; I think I will write about it myself on my own blog.

Anonymous said...

I have to defend the Duggars, (18 and counting) because if you research them, they live totally debt free. They pay for their children, to birth, feed, cloth, and raise them. Totally. They buy everything up front. It took them years to do it because they did the work themselves, hiring only when they had to, with absolutely no medicaid/welfare dollars used.

Labor Nurse said...

I just want to make it clear that I was not inferring to the TV families on TLC that got the shows because of the number of children they have because I think they are morally corrupt or anything. I don't watch those shows at all so can't speak on that. My point was that on a whole, none of those families were villified in the press for the number of children they have.

Anonymous said...

Labor Nurse,

If it makes you feel any better, I took your comment in exactly the way you meant it. :-)


Jill said...

I have no problem with the Duggars either. I don't necessarily agree with a lot of their beliefs, but at least they are able to provide for their kids, and Mrs. Duggar looks like an amazing, capable woman. Their family of 20 looks more loving and responsible than families I've seen that are a tiny fraction of that size!

Housefairy said...

All I know is this: I heard about a woman who had eight living babies and I thiught Wow, here we go, she will be the media darling, she will be on Oprah, she will get gifts, the kids will be on the covers of the magazines, JUST LIKE THE SEPTUPLETS and the various high order multiples we have all grown up hearing about....
and then WHAM--she is all vilified. Her mom is ripping her to shreds, she has no husband, she is on public assiatance and I just sat back and thought WTF?

I was shocked. I watch ALL the shows. ALL of them, the quads and the quints and all the small towns who fricking RALLY behind some chick who got some embryos put in her. Churches, VFW halls, holding spaghetti dinners, and I was alwasy AMAZED by how much love-n-care you seem to get when you have an irresponsible fertility doctor. The mom is always on bed rest and cant work, the dad is either working some low paying job or he has to quit to do such and such--but thats just it--THERES A DAD SO ITS ALL SO PRECIOUS.

if you people think there isnt some "PUBLIC ASSISTANCE" going on, you are kidding yourselves. even if these familes have standard health insurance from good ole dad's jobby-wobby, the bills run in the MILLIONS of dollars for this stuff so yes WE ALL PAY FOR THIS.

but why the @#$#% this one chick is getting so tormented bugs me to no end.

But the Duggars (whom I really enjoy even tho their right wing crazies give me the willies--sometimes) are so GREAT because they have money? "Bless Mrs Duggars Heart" is all you ever hear...


She could be as koo-koo as they come, but if she had some random americana hunk standing around in the background she'd be completely in a different situation, REGARDLESS of where the money for this all came from.

and yes shame on the doctor for putting that many babies in, but again, 6 or 7 is a big blessing and miracle, eight is horror? Oh wait i forgot, no hubby.

Drew said...

Great post - you have some really valuable insights here. It's even more interesting to hear from a nurse's perspective.

I'm helping to conduct a huge nursing salary survey and I was wondering what you think best distinguishes one nurse from another?

Keep up the awesome posts :)

Joy said...

She had 6 embryos implanted. I think the major issue, that I've noticed, is that women who have fertility problems are allowed 2-3 embryos at most. Everyone is confused as to why she had 6 embryos implanted. Also, people were very concerned with how this endangered not only her life, but the lives of her unborn babies.

This woman only wanted 1 more but ended up with 8! It wasn't like she went in with the mindset of having half a dozen (or more) babies at once.

So kudos to you for standing up for this woman. It makes me sick to think how many people are attacking her when all she wants to be is a mom. It wasn't completely her fault. Her doctor shoulders most of the responsibility.

Babies are blessings and miracles- no matter how they enter the world. The part that makes me so angry is how much people attack these sweet, innocent babies... when they did nothing.