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An Expert's Perspective

Program: Breaking News: An Expert View on the Risk of Multiple Births

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  1. An Expert's Perspective

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Andrew Schorr:

Hello this is Andrew Schorr from Patient Power as we have one of our breaking news discussions. If you’ve been following the news you saw that a woman in the Los Angeles area gave birth to eight babies, and while the initial reports are the babies are doing okay and the mother is doing okay, there’s been concern in the medical community whether the idea of multiple births to this extent whether the public is aware of the dangers that can go with it both for the babies and for the mom.

Joining us to help us understand and give us expert perspective on this issue is Dr. Thomas Benedetti. Dr. Benedetti is Vice-Chairman of the Department of Obstetrics and Gynecology at the University of Washington in Seattle.

Dr. Benedetti, so I know you’re not the doctor nor was your team for the woman in Los Angeles, and I heard there were maybe over forty medical personnel involved in this delivery and the care of the babies, but what would you want the public to understand about the high risk, if you will, of a multiple birth pregnancy and particularly to this extent?

Dr. Benedetti:

Just let me start off by saying I’m thrilled from what I know of this case, and what I only know is what I’ve read in the newspaper or heard in the news media that the mother and the children appear to be doing well, in fact much better than one would have anticipated because the issue of what we call higher order multiple gestations, that is more than twins; triplets, quadruplets, quintuplets, and in this case I guess octuplets; presents tremendous challenges for the parents, for the medical profession, and for the children themselves.

I often liken this to multiple people trying to inhabit a one-bedroom apartment. It’s made for one person, and the more times you have more people, all the people crowded in get in trouble, and then the apartment at some point in time breaks, and that’s exactly what happens with this. So we know that multiple gestations pose significant problems for the mother. The two biggest problems are the development of a syndrome called preeclampsia or high blood pressure in pregnancy, which can in itself be quite life threatening, and the risk of that goes up the more babies are in the uterus.

The second thing is the uterus is a muscle. The more you stretch it the less likely it is to perform normally after you un-stretch it. So when you pack eight babies in a uterus the risk for hemorrhage, sometimes life-threatening hemorrhage goes up quite a lot. So those are the issues for the mother.

I don’t know about this pregnancy whether it was conceived with artificial reproductive technologies, but there is a very high likelihood that it was, and the medical profession views the result of a pregnancy where you get eight babies as a mistake, that is there was some medical error made in the monitoring or is oftentimes made in the monitoring or the accomplishment of the stimulation that results in this many babies because nobody wants to have eight babies.

One of the main reasons that you don’t want to have eight babies is that the likelihood of them going to viability as it was in this case is actually quite small, and as a result the first thing the patients are faced with, the parents, are the decision about how many babies do they want to have. So they’re oftentimes faced with an issue of doing what we call selective reduction, which is basically a pregnancy termination of a number of the babies to reduce the number of fetuses to a number that is more consistent with a better outcome for both the babies and the mother. So you put the parents in a very difficult situation. They’ve been trying like crazy and spending a lot of money trying to get pregnant, and then all of a sudden now they’re pregnant and the first thing you say to them is well, would you like to think about aborting a few of these babies, and obviously some patients don’t want to do that and so they’re left incurring incredible risks to themselves and their babies because of those issues.

Then once you get past that then you’ve got the problem of what happens to the babies. The more babies you pack in a uterus the more likely they are to deliver early and the more babies the earlier they deliver. Octuplets are so rare that we really don’t have very good figures about those, certainly no modern figures, but we do know that in the case of quadruplets, that is half as many babies as she had, that there is at least a twenty-five to thirty percent chance that one of the babies would be expected to have cerebral palsy, that at least one of the babies would be expected to have some major disability such as impaired hearing or deafness, impaired sight or blindness, and babies born very early as these often are oftentimes have lifelong issues with the inability to concentrate, schooling problems, behavioral problems, and so these very premature, extremely premature multiple gestations of four, five, six, seven, and eight, just present tremendous challenges for both the parents and the medical profession and the society in general.

Andrew Schorr:

Dr. Benedetti, I know we’ll have more discussions in our nation about this as we go forward as we have people who are having kids later and maybe having more difficulty having children and turning to fertility approaches and so working with medical professionals to do something that’s safe for the mom and safe for what babies that may result. So it’s exciting when fertility approaches work, but I think you’ve given us a sobering side of it when there can be so many babies, and there’s all this risk that’s introduced to the mom and to the children whether they survive and what life they can go forward to.

Thank you so much for explaining this sir. Dr. Thomas Benedetti who is Vice-Chairman of Obstetrics and Gynecology and an expert on this subject at the University of Washington. Thanks for joining us sir.

Dr. Benedetti:

Thank you.

Andrew Schorr:

I’m Andrew Schorr. Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of UW Medicine, their staff, or Patient Power sponsors, Patient Power partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you’re your own doctor, that’s how you’ll get care that’s most appropriate for you.

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