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ADVANCE Perspective: Nurses

Eight Is (More Than) Enough

Published February 4, 2009 4:33 PM by Adrianne O'Brien
As most of us know by now, Nadya Suleman, of Whittier, CA, gave birth to octuplets on Jan. 26. I don't think I'm alone, here, in having a moral and ethical problem with this.

Suleman, 33, is already a mother to six children, and is a single parent. The fact that she is a single mother isn't the issue. The issue is that she is now a single mother to 14 children, eight of whom are newborns. Angela Suleman, Nadya's mother, who has been taking care of the other six children while her daughter recovers, has issued a warning. She told her daughter that when she gets home from the hospital, "I'm going to be gone."

How well can one extraordinarily sleep-deprived parent tend to and care for eight newborns, let alone an additional six, all of whom are under the age of 7. Surely Suleman will have volunteers to help her, but still - the mind boggles.

Ethically, this is a dicey issue. Should a healthcare practitioner make a ruling that parents with children, even single parents with multiple children, cannot undergo in vitro fertilization, as Suleman did? No. But in this scenario, it is the physician's duty to understand a patient's emotional and financial - in addition to physical - health before implanting embryos.

Exactly how many embryos were implanted is not known; Suleman's fertility doctor has not been identified. That is, if she actually was implanted. Jacqueline Gutmann, MD, a fertility specialist with  Northern Fertility and Reproductive Associates, Philadelphia, called Suleman's story "thin" in a Feb. 4 radio interview. She noted insurance companies are more likely to pay for fertility injections, which often lead to greater numbers of higher multiple births, than vitro fertilization, and wondered if Suleman had actually used injections.

A good friend of mine, a nurse in the Philadelphia suburbs, underwent in vitro fertilization several years ago. She and her husband were asked very directly about the absolute maximum number of babies my friend would want to carry. (Their answer: four; three survived, and my friend delivered triplets in March 2003).

Any premature baby is at risk for lifelong problems, particularly higher multiple births, including blindness, deafness and cerebral palsy. For a person who has earned a degree in child development, as Suleman has, from Fullerton College, her decisions have been downright reckless.

82 comments

Abbey Scott wanted to know about nursing care required, in terms of number of nurses and shifts - I found this interesting clip, though it only applies to the delivery iteself, which requied 46 doctors, nurses and assistants for the C-section:

http://www.npr.org/templates/story/story.php?storyId=99919372

RN BSN April 3, 2009 3:21 AM
NJ

Kim,  the only thing that comes to my mind right now is something Dr. Linthicum taught us (I graduated with my BSN in 1982),  and although it was in preparation for working with pregnancy termination patients in our OB/GYN rotation, I think it applies here.  She said that, regardless of how you personally feel about the morality of the situation, your job is to support the woman and give her the best nursing care that you can.

RN BSN April 2, 2009 4:05 PM
NJ

Hi, it's the nursing student again.  I understand about confidentiality issues regarding nursing care and Nadya Suleman's case.  So maybe I should re-phrase the question:  

What are some ways that nursing care would show bias against a woman who about to give birth to mulitple babies via in vitro?  The only thing that come to mind right away would be failure to administer timed meds _on time_, or failing to assess for pain.

Kim Medina March 23, 2009 7:50 PM

Suleman will be getting at-home nursing care for free. She has accepted the invitation of Angels in Waiting, a nonprofit organization based in Blue Jay, CA, that will provide around-the-clock care once the infants are brought home over the next few weeks, according to Dr. Phil McGraw (yes, THAT Dr. Phil), who brokered the deal.

The neonatal intensive care nurses specialize in premature infant developmental care, said Linda West Conforti, RN, the CEO and founder of Angels in Waiting. The agency would have 14 nurses a day, four to five at a time. Normally, they say, that kind of care would cost about $135,000 a month.

West Conforti herself is compensated by the Family Foster Agency and bills the In-Home Operations Section of Medi-Cal as an independent nurse provider for up to 12 hours a day for her in-home nursing hours. Angels in Waiting is a 503(c) (3) organization; they accept donations on their Web site.

Angels in Waiting, according to their Web site, has a mission to "to move medically fragile foster care infants and young children into private residences under the care of Registered and Licensed Vocational Nurses as their foster parents." Whatever her issues -- and there certainly seem to be many -- Suleman has remained determined to care for her children herself. I'm not sure how the Angels in Waiting model fits with that, but the important thing is that Suleman's children will be receiving care.

This is apparently the second offer from Angels in Waiting. According to a Feb. 28 article in the Monterey County Herald, the group offered free, 24-hour care for the infants and six older children, plus a new home. West Conforti claimed that Suleman appeared to lose interest in the proposal when she was told that a reality show and a biweekly press conference on the babies' condition was not possible due to their fragile immune systems.

The new arrangement comes amid pressures at home. At least some of Suleman’s other children are angry over the impending arrival of the octuplets, Suleman has stated.

Dr. Phil’s syndicated TV show will address the issue on March 10 and 11, which will likely result in a nice ratings bump. Looks like that’s the Dr. Phil connection with this.

The drama continues!

Adrianne O'Brien, , Editor ADVANCE for Nurses March 10, 2009 10:13 AM
King of Prussia PA

This issue raised in some posts of "God will provide"  reminds me of how dangerous it is to teach our children that  "God" will provide or protect them is.  It is simply not true.  People, through their own understandable (narcissistic) relief, often comment that there was some sort of divine intervention when they or their loved ones narrowly escaped death or survived some harrowing experience.  The question then begs, What about those who DID lose their lives?  How do you think naive comments like that make THEIR loved ones feel?

RN BSN March 2, 2009 10:30 PM
NJ

To the student nurse who posted, I'm not quite sure of your question, but any RN's involved in Ms. S's or any of her children's care would not be able to comment on a public forum like this, since that would violate patient/client confidentiality.

RN BSN March 1, 2009 2:26 PM
NJ

Sorry, it was British Columbia, not England where that story about the 18 children took place.

RN BSN March 1, 2009 1:07 PM
NJ

Back in July of 2008, there was a news story about a Romanian couple in England who had just had their 18th child.  Several people who grew up in large families wrote in to the comment section.  For the sake of brevity, two comments that I saved are reprinted here:

"I am the youngest of 8 children. Believe me when I tell you that while I was growing up there was no individual attention from either of my parents. All my Dad did was work and my Mom did nothing but cook and clean. I don't think I had a moment alone with my parents until I was in my late 20's. There is no way these people can give any of those children the individual attention they deserve to grow up to be emotionally balanced adults."

"I come from a family of seven children, and based on my experiences, there is no possible way for parents to give all the children the emotional care they need. My mother was done raising children by the time I was 12, so while I was provided with a nice house, meals, clothing, etc......I had no one to talk to, no one to hug me or show interest in me. It's a terrible thing to do to a child. Those children will be raising each other and unless they are exceptional, there will be a lot of lonley little souls in that family."

RN BSN March 1, 2009 1:03 PM
NJ

Gee, I wonder if the deduction on my California paycheck will now read "Suleman" instead of "Medi-Cal".  Sounds like they are one and the same.  God IS providing, under MY name! (Yeah, it sounds harsh, but I'm really angry with this whole thing.)

The children (all of them, including her first six) are innocent victims of an ethical nightmare initiated by a narcissistic, un-employed leech on the "system" and perpetrated by a fertility doctor who should be held responsible for what he's aided and abetted.

Oh man...

Wait for it folks, when the money doesn't come in, Suleman will sue the fertility doctor who did not "evaluate her" appropriately and implanted all those embryos when he "knew" she was "disturbed".  I place my bet on this happening.

Kim McAllister, Emergency - RN March 1, 2009 1:45 AM
CA

As a nursing student, I want to know the opinions of RNs about how they feel their nursing care towards Nadya Suleman or any of her kids, as they grow older and move through the medical system, would be affected.

Kim Medina, student nurse February 26, 2009 11:02 AM
Tucson AZ

Soon we're going to be doing our taxes, I'm wondering if this woman can claim 14 deductions?!  If she's on welfare, does she even have to file a return?

RN BSN February 25, 2009 7:09 PM
NJ

If she did indeed have money to pay for invitro and plastic surgery, then that in itself means that she was using public assistance funds for herself, rather than for her children.  The state of California needs to investigate her.  I can just hear Judge Judy now (even before she underwent this pregancy), "Madam, you have enough children!"

Rn BSN February 25, 2009 6:06 PM
NJ

The issue here is how are all these children going to be cared for. Mom must think she is going to get all the free help with all the publicity.  This is really ridiculous She has money for invitro and plastic surgery but no job?

leslie pearson February 25, 2009 11:41 AM

The issue here is how are all these children going to be cared for. Mom must think she is going to get all the free help with all the publicity.  This is really ridiculous She has money for invitro and plastic surgery but no job?

leslie pearson February 25, 2009 11:41 AM

This is a perfect example of why the United States should incorporate a consumption tax - I live my life in a low consumption manner therefore I should not be required to pay for this woman's poor choice.

Maybe such a tax would make people think twice about repeating this, and consider refraining from making many other conspicuous consuming choices (huge homes, huge cars, generating mountains of trash, etc. etc. etc.)

Mimi February 17, 2009 10:20 AM
New Orleans

This case joins other cases that exemplify that medical technology advances far faster then medical ethics.  The medical profession needs to have  an ethical dialogue about what is possible with science and what is morally and ethically right regarding the use of fertility technology.  Yes the woman has a "free will" in America but at some point medical ethics needs to take a stand on what is best for the babies and for society.  We in the profession should do more than wring our hands over this and other situations which everyone agrees is outrageous and morally wrong.

Barbara Corey February 16, 2009 9:10 AM
Harpers Ferry WV

I know of no HIPPA violation involved for publishing the name of the physician responsible for this moral, ethical and medical debacle. Why is it that we do not know who it was? He/she has to know that a uterus is not a clown car, and that this was a dangerous undertaking for the mentally disturbed woman and the neonates, which would constitute malpractice, to say the least.

Anita, RN February 15, 2009 9:18 PM
PA

I too have run the gamut of emotions with this story and if I think too deeply about the issues it raises, it leaves me almost speechless.

These real children will struggle their entire lives to be healthy in mind and body as we all do in this complicated and complex world we live in.

The resources they "won't" have are overwhelming to consider.

The mother in this case own full responsibility for the predictable problems these kids will face, considering the nature of the choices she made.

We have children for different reasons and some reasons are selfish I'm sure.

In most emotionally healthy persons the selfish reasons are combined with a true sense of duty, responsibility and "other centeredness" that this woman surely seems to lack.

The whole thing makes me overwhelmingly sad.

Johnna February 15, 2009 11:12 AM

This has been a very interesting case.  Speaking as a nurse from Maine who has been a nurse for a number of years, we just don't see that sort of thing in this part of the US.  Only in California.......

Diane, Mental Health - RN-Nurse Consultant February 14, 2009 4:19 PM
Rumford ME

I agree with you all, except for one thing, in the United States of America, she has the right.

Mary, ICU - RN,C, Northwest Hospital February 13, 2009 11:24 AM
Randallstown MD

Humans simply aren't biologically designed to produce litters of offspring.  Whether one believes in a creator is irrelevant....high multiple births unaided by fertility technology are rare in humans, common in many other animals, a strategy which provides for survival of some offspring for species which experience high early mortality in nature.

Although even singlet births in a dysfunctional family can result in disrupted development for the child, in NS's situation this outcome is virtually assured.  I feel that everyone involved in this specific case, including the taxpayers of California, will suffer  negative effects, and hope that our legislators can use this as a stimulus to formulate legal standards for fertility technology.

Jessica Faye Harrison, Health Care - RN, DVM February 12, 2009 7:09 PM
Davis CA

Hopefully DCF will step in and maybe place these children with someone who can provide for them the love, attention and care that they will need.  As for the physician who implanted her, I feel he should be held responsible to financially provide for these children (medical bills, diapers, formula, etc.)  

Elaine, med/surg - RN, hospital February 12, 2009 6:49 PM
putnam CT

I just read the LA times article, and if she was on disabilty for a back injury stemming from her employment (as a psych tech?  wow, this really is a case of lunatics runnning the asylum!), then why on earth would she then carry through with a pregnancy (since pregnancy is murder on a woman's back)?!  

RN BSN February 12, 2009 7:22 AM
NJ

Here's an interesting post in the comment section from the NYT article, which I repeat here for the benefit of our readers:

This headline says it all "Taxpayers May Have to Cover Octuplet Mom's Costs".

8 very premature infants look to cost the taxpayers of California at least $1,000,000 for them to just to be able to leave the hospital.

The woman already had 6 children - 1/2 of whom are so severely disabled that they qualify for Social Security Supplemnetal Income based upon (a) their disabiliy and (b) low or no income in the household.

"Suleman was receiving $490 in monthly food stamps, and three of her children were receiving federal supplemental security income because they are disabled. Lowell Kepke, a spokesman for the San Francisco office of the Social Security Administration, said that a single parent with no income qualifies for up to $793 a month for each child with a physical or mental condition that results in "marked or severe functional limitations." That money is used for support and maintenance of the family, and Suleman would not be required to specifically account for how it is spent. If Suleman's disabled children received the maximum payment, she would get nearly $2,900 a month in state and federal assistance, including the food stamps."

http://www.latimes.com...

Keep in mind that the Food Stamp amount was based on 7 people and now she can claim 15 so take that amount and multiply it by 2.14 for a total in Food Stamps alone of $1050 every month. Now the grand total for the taxpayers will be over $3460 a month NOT including the fact that all will be on Medicaid and several of the octuplets will probably qualify for SSI plus qualifying foer housing assistance, cash welfare payments (TANF) etc.

Then there are the long-term and typically permanent health problems of premature multiple births. These are very serious including respiratory, cardiac and neurological (including impaired intelligence.)

Congratulations California you will get to pick up the medical bills for her progeny. The ones on SSI automatically qualify for Medicaid - and odds are at least 1/2 or more of the octuplets will be substantially disabled based upon (1) her track record and (2) being multiple birth premies. All the res of her excessive number of progeny will qualify based upon the fact that the only income is the children's SSI. (And probably she will too being the mother of children who are on Medicaid.)

She has no job, no income and owes $50,000 in student loans.

Now she IS BEGGING FOR MONEY! http://latimesblogs.latimes.com...

Her right to breed through articiicial means without restriction STOPS when the taxpayers have to foot the bill. And that applies not only to her but to anyone who thinks they have the right to produce children and live off the welfare system (Food Stamps, SSI for their disabled children, houseing assistance, Medicaid......)

Obviously the US 'voluntary' system on the matter of trying to limit multiple births from IVF or whatever it is called does NOT work. There are only 2 alternatives:

(1) Establish that implanting more than 2 embryos is malpractice per se and will cost a the doctor his medical license; and/or

(2) Require that any woman who insists on having more than 1 or 2 embryos implanted post a bond or sum of money sufficient to cover the possible medical costs and other lifetime expenses resulting from a multiple implantation. If that amount happens to be $2,000,000 or $3,000,000 or whatever, so be it. Their right to reproduce through technology stops when the taxpayers have to cover the costs of their choice to have a multiple birth.

— AnnS, MI

RN BSN February 12, 2009 5:53 AM
NJ

Amazing....if Ms. Suleman desired to keep repeating the pregnancy process, why wasn't she counseled about being a surrogate/host mother maintaining a pregnancy for couples unable to do so themselves? What really is disconcerting is her plans to pursue other activities instead of being home w/her children...forgetting the fact that special needs children require even more care! Unfortunately, all of her children are at risk. Sure, the funds (shamefully through exploitation) will come in now

Agnes Eytchison, Urgent Care - FNP, Mercy Regional Medical Center February 12, 2009 12:35 AM
Durango CO

It has become obvious that Ms. Suleman most likely has mental health issues.  However it is a moot point now.  I do hope this opens the door for laws governing bioethical issues such as this.  As long as practioners, as in this case, use judgement befitting an idiot, oversight is needed.  

"You know the difference between God and a doctor?  God knows he is not a doctor!"

Nancy, , RN Johns Hopkins Bayview February 12, 2009 12:20 AM
Baltimore MD

It has become obvious that Ms. Suleman most likely has mental health issues.  However it is a moot point now.  I do hope this opens the door for laws governing bioethical issues such as this.  As long as practioners, as in this case, use judgement befitting an idiot, oversight is needed.  

"You know the difference between God and a doctor?  God knows he is not a doctor!"

Nancy, , RN Johns Hopkins Bayview February 12, 2009 12:17 AM
Baltimore MD

Some people mentioned in comments that it is none of our business what happened before the babies were born.  However, that is precisely where the field of healthcare can and must take a hard look.  The availability of fertility treatments and various other current genetic treatments requires as much consideration for ethical principles as end-of-life decisions and certain tests without available treatments, e.g. cancer markers or full-body MRIs.  We have been irresponsible by letting science and personal interests rule with our decisions about fertility.  This case suggests that limited principles have been adopted for fertility treatments that can have significant consequences.  Healthcare practitioners are not well equipped for deciding how children are provided for after they are born, but we can work with ethicists before decisions are made that cannot be taken back.

Matthew Richardson, , RN Loma Linda University February 11, 2009 8:40 PM
Loma Linda CA

My husband just heard on the radio that the babies are still in the hospital, and that their bill will be about one million dollars, all paid for by the taxpayers!

RN BSN February 11, 2009 8:22 PM
NJ

She's got a website to beg off other people for money?  Gawd, that makes my blood boil!  Why should she (and the bio father - let's not let him off the hook) be rewarded for being irresponsible? She wants to go back to school?   Why?  I thought she already went to school.  If she's in class, who's going to take care of all her children?  If she already has some older kids that are developmentally delayed/disabled, who's going to take all the extra time required for them?  How will all this impact the children's emotional health down the line (it must occur to them at some point, "My mom created me, but then she was absent...she didn't want to BE with me.  Somebody else took care of me") OK, I've decided I've got to stop following this story for now, for the sake of my own sanity!

RN BSN February 11, 2009 6:59 PM
NJ

This women has now set up a website for people to send her money.And she wants to go back to school. How selfish can she be? These little children will need a lot more than money-they need love and attention. Who will be there to give it to them? What if she becomes ill? I became ill a few years ago with an illness that I have no control over. I had to leave work and guess what? God does not always provide. My husband and I have 2 children and try our best with a limited income to live from day to day. We depend on no one to help us. It is our job. She does need help in more ways than just taking care of those children. My thoughts and prayers are with the children.

marge, ICU - RN February 11, 2009 5:51 PM
shelton CT

I too have ethical issues with such an abomination.  I am a mother of 7 children and work full time and I have a husband who helps take care of them as well.  To say it's daunting to take care of that many singletons,  is an understatement.  I can't imagine what long term plan this mother has??  Clearly she wasn't thinking ahead, if she had, good common sense would have taken over and things may have turned out otherwise.  I feel having so many children with no financial security is irresponsible on her behalf and the physician involved in her fertility care (if there is one).  She must be waiting for the cash and gifts to start rolling in, like all of us other parents did right???  I hope people see the facade surrounding this woman and get her some help,  she needs it.  I also hope the good state of California sees the light and forces her to work,  without welfare benefits,  and/or places those children in homes where they will be taken care of properly.  We all know that will never happen but I can dream too can't I???

Deborah, NICU - RN, Brigham and Womens Hopsital February 11, 2009 4:03 PM
Boston MA

Although I think what was done to create this scenario is none of our business,I am concerned that this woman who professess to love being pregnant and who now has 14 children may be using the children to further her own agenda.As we all know health care is so expensive but here is this college educated person with no job,expecting ? who to pay for these kids and who to help with them.Surely she isn't capable of taking care of them all by herself ...who will save the children from this mess and who  or what will prevent her from doing this again?

Helen Hall, LTC - DON, The Boston Home February 11, 2009 3:10 PM
Boston MA

This story is astounding!  I have read many comments, and can concur with many of you!  What mother would want to ever put herself or her children in that type of situation!  I can undesrtnd, when unfortunate things happen in families, things don't work out and mom or dad leave.  And maybe this women had a significant other who was supposed to be around and then backed out of the deal.  But what women would conciously want to jump from 6 to14 children in one fail swoop, and do it on her own!  That's simply psychotic!  %0d%0a%0d%0aMy only conclusion to this whole scenario, it that she is crazy...and expected (and now getting) all this publicity for fame and fortune!  Because lets face it, they can/will pay big bucks for photos, interviews, and blogs for things like this!  Its like the Duggers...at least they are well meaning people, who are fairly self sustaining and have good reasoning behind their brewed of children!  But you know thye are getting paid a pretty penny every time their show airs on TV!!%0d%0a%0d%0aRN BSN

Faith Erdemir, ICU - RN BSN February 11, 2009 1:29 PM
Lowell MA

Some people focus on the babies, when there are other parties in this case.  Did it ever occur to anyone that the mother of the "octomom" might feel a bit exploited (in terms of her providing free childcare, for those numerous children foisted on her by her daughter) and may want to spend her life doing something else?  Maybe she would like some free time as she sees fit, or does not want to be in a media spotlight? How would something like this affect her marriage (I thinK I may have my answer in that the grandfather is talking about going off to serve in the military - i.e. he'll be gone, and a couple can't possibly have the same intimacy in their marriage with numerous children to raise)? Grandparents shouldn't be held responsible for the day-to-day childcare tasks of their grandchildren.  Here in NJ, there was even a legal case, in which the parents of a teenaged mother filed suit against the parents of the biological father (only 15) and asked for their help with the medical bills for their pregnant daughter, along with newborn/childcare costs (diapers, pediatrician bills, etc.) and the court ruled in favor of the defendants (the parents of the 15 year old father ), saying that grandparents cannot be held legally liable for the financial support of their grandchildren.  This means that parents of daughters share a greater burden of the financial responsibility, should their underaged child become pregnant.  Think about that, folks, when you teach your sons and daughters about sexual responsibility.  There was aslo a case here in NJ where an RN was disciplined by the Board of Nursing for leaving her child (only one - I've since forgotten what age) unattended ('latchkey") while she went to work.  

RN BSN February 11, 2009 7:24 AM
NJ

However ludicrous, irresponsible the choices made by Ms. Suleman and her fertility physician were to me, I still grieve for the children because they are who will inevitably suffer.  I love children, my husband and I have three of our own, would have loved to have more, but were concerned about being able to provide for them and so stopped with three.  And when I say provide I'm not talking about dance and piano lessons or sports, but the basics -- food, shelter, clothes, school, health and dental care.  Who will be picking up the tab for these children if they don't land a reality show?  My tax dollars (and yours) hard at work again!

Joann, Residency Program - Supervisor, TSC Family Health Center February 10, 2009 3:20 PM
Dixon IL

This isn't an issue of "God will provide" and "Don't judge". Yes, God is able to provide, but he also expects us to use wisdom and common sense.

Yes, it's too late now to change anything, the babies are here and we can only pray that they are provided for financially and emotionally. But to think that the "village" will step up to help raise these children is just as unrealistic thought that this mother had of having all these children in the first place. I'm married, work full-time, I have one son, one on the way, finishing school, have housework, homework, and attend extra classes/seminars for my career.  I don't have a whole lot left over to go help someone else raise their family, financially or emotionally and I know that my situation is not unique.

I think this family will be provided for financially because of all the media attention she is getting. I'm sure there will be reality shows, interviews, pictures, sponsors all willing to pay the price for the best story or best connection with the "Woman with 14 children". She has no other choice, but to exploit her situation, otherwise how will she support all these children? She is already talking about moving into a bigger house. Where is this money coming from?

Hopefully, this will bring enough attention to this issue so that laws and standards will be created and enforced and this won't happen again.

This woman isn't being criticized for deciding to be a single mother, she is being criticized for not considering the long term effects this will have on her children.

Veronica, ED, CLNC - RN February 10, 2009 11:41 AM
Riverside CA

Princess,  you're an RN like me right?  Educated in science, math, anatomy & physiology, psychology, etc. How the human body functions mentally and physically. I'm sure your training involved a psych rotation. How can you disregard the obvious?  ("God will provide" was never an answer on the NYCLEX/RN license exam). But I'm not debating the God issue at all. I'm debating if it is ethically sound to bring 8 children into the world at once via IVF treatment to a woman with blantant mental health issues, who already has 6 children-3 of whom are disabled, no job, no other source of income from a spouse/biological father, 2 overwrought parents and therefore a poor support system. Suleman's MD KNEW all this, how do you morally/ethically impregnate a woman with 6 embryos who has these issues? Medically she could have DIED! And left her other 6 children orphaned. (Even the military doesn't want both parents of a child to be facing military action so their child would not be orphaned)

I blame her MD for this possible evolving tragedy, he should be sued to help support the children, plus lose his license.  I only hope the best for these children, and yes maybe "God will provide" in the end, but why/how could anyone consciously place their children in harms way? No loving parent does so! I DON'T!!! Would you??? (Munchuasens Syndrome by proxy anyone?)

Everyone inside and outside the medical field knows that a woman carrying that many fetuses is taking a HUGE chance on her children's health.  Her MD implanted fewer embryos the other times, why so many now?  He KNEW better! If Suleman couldn't think for herself, then it was up to the medical professionals to do it for her and her children.  

If I had made a SELFISH medical decision like Suleman and her MD made that resulted in my child's disability, it would destroy me. Suleman has a happy, "everything-is-rosy" affect which scares me tremendously for her innocent children.  She is out of touch.

Lyn, RN February 10, 2009 10:14 AM

these are still beautiful little babies who need love and nuturing. I do hope that friends and the community will pool resources to help. Remember that in all this these poor little souls had no voice. we will watch them grow. I however cannot begin to wrap my arms around the effort and time it will take to raise them. I have twin 20 months old and I am so tired.

margaret February 10, 2009 10:00 AM
MA

The notion that God can and will provide is not ludicrous.

The individuals who understand what love and neighbour really means will eventuallly stand up and make a difference!  That is how God can and will provide.  He will provide inspiration to the hearts and minds of those who can afford to sow time, energy and resources to help this Mom raise these children successfully so they do not become a burden to the public!

As for her mother it is natural for her to experience burn out and she most likely will need a lot of psychological support.  her physical and emotional limitations are telling with the statements she has made regarding this issue with her daughter.  She still has 14 grand children and it is ok for her to say she is tired of taking care of the present six.

Thats understandable.  I am sure her church, neighbours and other volunteers will rally around these kids and their Mom and grandmother.

Yes it takes a village to raise a child.

We may be witnesses to the birth of someone who may be a Nobel Peace  Prize holder in the future

President of the United States  or Great Innovative Inventor

There are 14 beautiful opportunities to prove the enduring qualities of humanity still exists, and it still exists not as we expect or plan ,   but as God / Creation demonstrates!

Life is not a burden even in these hard economic times

LIFE is the ability to dwell in harmony with the world in all its circumstances.  We should live and show LOVE

Princess, RN February 10, 2009 9:04 AM
Miami FL

One last comment I'd like to make here:  This case brings to my mind those stories about the (usually) women who hoard/collect cats.  They have a mental health issue, usually with poor insight into their condition.  Only in this case, this woman hoards babies/children.

RN BSN February 10, 2009 5:25 AM
NJ

I watched the Today show this morning, and I have a few points/questions to make.

Suleman states that IVF procedures' odds are poor every time, but how come she has had at least 5 procedures (one ended up with twins) prior to this last one, all ending with a viable birth? How many embryos were implanted at EACH of those times? I highly doubt that it was 6! They were all, including the octuplets, implanted by the same doctor, didn't he/she know that Suleman's IVF treatments work well for her and it is ethically wrong to implant 6?  "Do no harm" is a doctor's credo, well doesn't include all the medical issues Suleman and her octuplets faced and will face in the future from such an extreme multiple pregnancy?

BTW, carrying a multiple pregnancy that large like Suleman's is a great risk to the mother, how can any MD take a chance that she might die and leave her 6 other children without a parent?????

IVF guidelines in the U.S. state that anyone under the age of 35 should have NO MORE than 2 embryos implanted at one time, Suleman is only 33 and had 6 implanted.  Why so many at once??? Suleman stated that she didn't want to destroy the other embryos so she had all 6 implanted, well why not do separate procedures? Didn't she realized that this pregnancy-"litter" can result in her own demise, and leave her 6 other children without her?  Is that LOVE??  No it is LUNACY!!!  On her part and the doctor's. She even stated on the Today show that she was "projecting" her own feelings of loneliness as a child onto her children. Even Suleman's mother pleaded with the doctor as to not do this last IVF on her daughter.  It is obvious to all that Suleman's mental capacity is diminished and it was up to her doctor to have evaluated her carefully before the last IVF! I think this is a malpractice suit, and Suleman's MD will ultimately lose everything--license and money, and deservedly so!

And please stop bringing "God will provide" thought into this!!! There are millions of children around this world who are abused, ill, starving or dying that need God to provide for them! Where is God for them? Come on, you know can't go willy-nilly and do what you want stating "God will provide!", especially in this economy too.  (And don't start with me!  I am a firm believer of GOD, but you can't deny all the suffering that is around us, why would any loving parent ever CHOOSE to have children brought into these circumstances??) She CHOSE to have 6 implanted knowing the risks she is inflicting on them (all 14) to satisfy for her own selfish childhood-issue needs. With those thoughts, she is NOT a sound individual. Her MD knew this and should be suspended and sued!

Lyn February 9, 2009 10:15 AM

And here I am reeling from yet another selfish human endeavor, one that greatly impacts an already suffering health-care system, another unwed mother (who ever said fathers are unnecessary?) without resources (monetary, emotional, psychological) to care for 16 children...let alone 14! It makes you wonder what was truly the incentive for doing this?? Worst of all, are the "professionals" who assist these women to develop litters of little souls who will never get the attention and love that they deserve. Shame on you. May God help us all.

Lesley , HBOT/Rehab - RN, CRRN February 9, 2009 9:43 AM
Reading PA

There is a good interview here, with Dr. Arthur Caplan, a professor of medical ethics from UPenn: http://airamerica.com/content/octomom

RN BSN February 9, 2009 7:55 AM
NJ

"Princess", you wrote that we don't have to "belittle her desions," when my suggestion  is that we are not "belittleing" (or if we are , then it is appropriate) we are merely making an accurate assessment/observation based on the information we have.  What woman in "her right mind," would want numerous newborns at the same time, when the reality is that just feeding and diapering ONE newborn takes all day?!

RN BSN February 8, 2009 10:26 PM
NJ

"Princess", you wrote that we don't have to "belittle her desions," when my suggestion  is that we are not "belittleing" (or if we are , then it is appropriate) we are merely making an accurate assessment/observation based on the information we have.  What woman in "her right mind," would want numerous newborns at the same time, when the reality is that just feeding and diapering ONE newborn takes all day?!

RN BSN February 8, 2009 10:26 PM
NJ

The notion that "God can and does provide" is ludicrous.  It is we humans who do the providing, whether it be financial assistance in the form of "free labor" from the volunteer childminders, or the distibution from the taxpayers who most likey were the ones who paid for the mother's and neonates' astounding (I'm sure) medical bills.  Have you ever had a child hospitalized?  I have.  Not only must you pay for the hospital bill itself (just for the use of their facilities and staff - and yes, that includes paying us nurses!), but you get billed seperately by all these different "speacialty" doctors.  We even got bills from doctors who examined our child -or her test results/radiology, that we never met, nor did they ever speak to us! My experience was that it was similar to when you buy/sell property, that is, all of the sudden everybody seems to come out of the woodwork to make money off of you.  I think that this story has sparked a bit of "counter- transference" in my reaction to it.

RN BSN February 8, 2009 8:18 PM
NJ

We all can have our say about this dilemna.  In today's society we are so ready to cast judgement based on our values. have we considered the values that this mother embraced when she made a decision to choose life.  Maybe, she thought she didnt have to depend on the public.(After all what does welfare provide to raise a child these days)

God can and does provide.  we as a nation have a difficult time rallying around LIFE.  we have GUTS for everything else, a new car, house, tv show but cant show up to the table to support Life.  There are issues here.  One of the major issues with MD-patient relationships is failure of physicians to communicate effectively with their patients.  Our healthcare system is so fragmented we have no real clues what is happening with our patients and often if we know we do nothing about them.  For example an 8yr old was discharged from a Florida Hospital after major surgery with a fixator in plae to a  single mother who had just been evicted and had lost her job. No support base here. There is UR so what other choices did the hospitals have after DC plan were already in effect.  

This mom will be supported by volunteers and by individuals who care to make a difference instead of judging, complaining and making nasty comments.  The Babies are here! They are Americans. Maybe as a nation we can start coming together to help each other in ways that are more positive than negative.

Of course this is an ethical issue.

We should discuss and debate these issues

We dont have to tear her down or belittle her decisions

Where were we when we allowed this healthcare system to exist.  We have all been talking for many years but we do nothing to effect changes to make the individuals and our society better.  We are a democracy.  Lets work it!

Princess, RN February 8, 2009 2:55 PM
Miami FL

Everyone is centantly entitled to their opinion but not entitled to dictate to others how many children to bear.  The obvious problem is with arrogant medical community that has imposed its knowledge without wisdom on the general public. Just because you can have children with medical interferience does that mean medicine should promote this? Don't we all know of times when medicine has imposed ITS "expertise" with very unpleasant outcomes.  I guess it was bound to happen when we as a people decided to push God out of the equation. The real $$ to be made here is in medicine...with all its "help," embyonic research/death, $ for organs, etc.

Kathleen, ICU - staff nurse, Fox Chase Cancer Center February 7, 2009 5:16 PM
Philadelphia PA

To my fellow RN ("Mark")who commented in favor of the Catholic Church's position on reproductive matters, as a woman and mother of two daughters, quite frankly I find the Church's contraceptive dogma/doctrine insulting and downright cruel to women (and their partners!), because if the woman does NOT want to be pregnant/lactating/running after a young child, then she must abstain from sex during the time in her cycle when she has the greatest libido (those few days around ovulation).  From what I read about Jesus in the New Testament,  I gather that he would ignore those "official" Church teachings/doctrines that treat women like crap, if He were to live in this day and age.  The day that the Pope has a uterus, is the day I will listen to him on female reproductive issues.

RN BSN February 7, 2009 1:12 AM
NJ

Regarding family dynamics, it just occured to me that those older 6 children will probably be parentified (that's NOT a good thing).

RN BSN February 6, 2009 9:40 PM
NJ

Does anyone have any insight on the nursing care this woman and the octuplets needed, in terms of number of nurses and hours/shifts? Just curious.

Abbey Scott February 6, 2009 2:59 PM

The more I read about these cases (this one, "Kate & 8," the Duggars, the couple in Romania), the more grateful I become that my husband was loving and responsible enough to have a vasectomy.  Why do some people insist that children are "a gift form god," when the truth is that they are the result of sexual behavior, or in this case, scientific technology.  I am reminded of a letter to Ann Landers many years ago.  A young woman wrote to complain that her mother was pregnant with her 9th child, and as the oldest she was expected to forgo college to be a "mother's helper."  When she complained to the nun at her school, she was admonished to cooperate with her family.  One woman wrote in to respond, "Tell that idiot woman with 9 kids that God does not "send" them, a few steps must be taken first!"  I don't think it's fair that this woman had all those kids, then dumped their care on her mother.  If the grandfather really is enlisting in the military, then that also means that he will be an absent grandparent, so he won't be able to help with the childcare.  And how is the biological father going to pay child support for all those kids??  

RN BSN February 6, 2009 2:46 PM
NJ

Rebecca sure hit it on the head too... get ready America and the media whores... there'll be MANY more people having LITTERS soon so they can become INFAMOUS.... oh, And Parents too....

kim yama February 6, 2009 12:37 PM

Are we not seeing yet that we live in a country that glorifies and REWARDS unexceptable and inappropriate behavior??? the only thing that is apparent to me and obviously NOT to many others is she wanted to be FAMOUS... are you getting that yet??? This has NOTHING to DO with the 8 babies she had bringing her total to 14 FATHERLESS children.... Why do you thin she's not showing her face??? Because she wants $$$$ for that and for her story! She'll have her hands out everywhere and WHY is it anyone's, any company's, any other human being's problem that this IDIOT wants to be a media whore??? I hope she gets NOTHING!

I hope those children are taken from her by DYFS or CPS!  They should NEVER have been GIVEN to her and it's obvious that whatever doctor did this cares about MONEY more than 14 SCREWED up children! living with a CRAZY mommy, NO daddy, mommy has NO job, she lives in a 3 BR home (HELLO, THAT IN AND OF ITSELF IS A DYFS VIOLATION)!

And I'm forgetting the biggest and most disgusting part of all of this.... this MORON will be "raising" these children so in 20 years, we'll have 14 stupider people with no moral fiber and an ITCH to make a name for themselves... even it is a BAD name!

kim, R.N. - Southampton Hospital February 6, 2009 12:35 PM
Southampton NY

Editor's note: This blog is a guest blog from our nursing publication, but we thought HIM professionals

February 6, 2009 12:12 PM

I know it is such a difficult issue to understand now, esp. that this octuplets Mom was already a single mom raising six kids! She already was experiencing a the joy/stress of having children, what in the world was she longing for in having children? surely she needs alot of psych support. But now the neonets are here. She needs alot of help!!!!!! Blaming her the more wont help the situation. God help her!!

Scovia Fitzhenry, RN February 6, 2009 12:12 PM
Philadelphia PA

Me too! I was shocked with that comment that Suleman made about the biological father.  Suleman is out of touch with reality. From what I can get from that interview was that at first she hid the fact that she was carrying that many fetuses from him. That he was only a donor, but now Suleman wants him to contribute.  If there is any truth to that, it would be a very sad situation for all.  No one likes to be manipulated, and unfortunately all 14 children are in the middle of this mess. She seems oblivious to all the stress she has placed on them and the rest of her family.

If that isn't a huge blinking neon sign of mental health issues, I don't know what is.

Lyn, RN February 6, 2009 11:26 AM

If if takes a village to raise a child, how many California taxpayers is it going to take to raise this village?  

It seems that there has been a complete bio-ethical failure here. God Bless these children.

Jane, Retired RN February 6, 2009 11:21 AM
Dallas TX

From the "Today" show article:

"Suleman told Curry that the father is a bit overwhelmed right now, but she is hoping that he will want to get to know his children when he is ready."

I'm speechless.

Abbey Scott February 6, 2009 10:55 AM

Did anyone see Suleman on the Today Show?  It looks like she had facial surgery to mimic Angelina Jolie!  Her lips look enhanced, with other possible facial surgery (nose, cheeks?), plus the rest of her styling- hair and demeanor mimics Jolie. Is that what Suleman wanted? To be like Jolie with all the children in tow?  I gasped when I saw the interview.  

Suleman wants to attend college in the fall to attain a masters degree in counseling.  She also discusses how much she loves the children, which I'm sure she does, but we all know as professionals that love alone doesn't solve everything-- it is a harsh truth. Suleman is definitely out of touch with reality.

We know we can't turn the clock back, the children are here, and need a tremendous amount of care.  It falls on the lap of taxpayers to help these poor children out, and think in their best interest where their mother could not or would not.  CPS will be highly involved as they should be.  New laws should also be enacted to limit the amount of embryos implanted at one time.  IVF treatments have improved greatly, and there is no need to implant a "litter".  The risk to mother and fetuses are all too real.  The doctor that took part in this procedure should has his/her license suspended.

Lyn, RN February 6, 2009 10:46 AM

I’m very disappointed this mom made a selfish decision on taking in 8 more children. Will these kids get the proper loving attention that all kids deserve? How can one parent give their undivided attention to so many, especially since she is a single parent, not saying that single parents can’t accomplish this, but 14! Are tax payer’s money going to pay for this fiasco or is she doing this to become one of the new freak show hits that seem to be cropping up on TV?

Mel, Nurse Recruiter February 6, 2009 8:57 AM
Orlando FL

Exactly how did an unemployed single mother of six other kids pay for the fertility treatments in the first place?

M. Olsen, Neonatology - RN February 6, 2009 8:36 AM
NJ

All I can say is this situation is unethical and we as tax payers will be paying for this family in years to come.

How unfortunate that Suleman was not counseled and evaluated from the first child she conceived.

As a psyc nurse I see patients with poor judgement and insight. Our staff attempts to educate and point them in the best direction for their self interest.  Not only is the patient involved, but their family is incorporated into the process.

 The children are a blessing, but the situation is very poor. The entire scenario could have been avoided.

 Why has the press become so involved in this? Who let them know what was going on?

This is personal and private, but now that some of the facts are out we feel compelled to comment.

  Medical Ethics needs to be addressed.  

Judy Hamrell, psychiatry - RNBC February 5, 2009 7:03 PM
Yorba Linda CA

Personally I think that this woman was being very selfish to have these children in the manner that she had. Not working and already having 6 children. What is going to happen to these kids? Will they be given the attention they so desparately need. I would hold the doctor(s) accountable for conducting this pregnancy. I feel for the grandmother for housing this large family. I also feel that the mother needs to undergo psyciatric evaluation. How does she intend to care for the 14 children when not working? I for one do not wish to pay for her to stay home and care for these children. She should work and pay for the childcare without any outside help. She chose this life. I also feel that she owes her mom an aweful lot for what she has and still is putting her through. To me she is just trying to outdo the family with the most kids to get a movie deal or a book deal or something like that to have loads of money. What was her reason for having these children. Has she ever been interviewed? I think they should be taken from her. Give them to someone who either cannot have children, or someone who can afford to have this many children. It's just not right.

Donna February 5, 2009 3:40 PM
Spokane WA

From personal and professional experience of fertility treatments and working with DD children, I can easily say that this family has selfishly hurt those of us that use these services.  Fertility treatments are not covered by insurance, so families are forced to overshoot their intentions by implanting many embryos in order to get the most bang for their buck.  There should be some serious investigation, but one person should not make the rest of us pay with more regulation and cost to our basic right of trying to conceive.  This educated mother should know better, and should be evaluated.

Colleen, pediatrics - PHN, self-employed February 5, 2009 2:12 PM
CA

THIS IS NOT A DIFFICULT PROBLEM TO SOLVE. I THINK MEDICAL ETHICS BOARDS SHUOLD MAKE IT MANDATORY THAT ALL POTENTIAL IVF OR FERTILITY PROCEDURES BE PRECEDED BY MENTAL HEALTH AND SOCIAL SERVICES EVALUATION.      

ELIZABETH, INTERNAL MEDICINE - NP, KAISER February 5, 2009 1:35 PM
LOS ANGELES CA

I agree eight is enough. We cannot rest that easy. The government will provide with everyone contributing. Miss Suleman clearly has some mental health issues which should have been addressed after the first six. I hope her mother doesn't leave as she has stated. Think of the six who have bonded with the grandmother. Lord help Miss Suleman bonding with the new eight.

Anne Morrison, Semi-retired - RN,BSN February 5, 2009 1:17 PM
Irvington NJ

The physician who implanted 8 embryo's needs to have his license revoked. What kind of a workup did he do on this mentally unstable [so says her mother] woman, not to know she already had 6 children. Even if she had 0 children, implanting 8 is not ethical.

Ann Tozer, Hospital - RN February 5, 2009 12:30 PM

I'm not in this field and I'm not judging, just my observation on the subject.This women has issues, but rest easy folks the goverment will provide!

Lee Dike, Aviation - pilot, ISP February 5, 2009 12:28 PM
St. James NY

Ms. Suleman is not the first person to have this happen and she is by far not the only person using IVF, wheater implacted or injections and having multiple births.  However, the negative statement and accusations are not given to others. Look at jon and Kate + 8 and the other group in which all six children are developmentally delayed, not one is critizing them.

You do not know what her intention is, so stop assuming it based on money and fame. I'm sure all of you have also done many things that would be morally questionable. May God bless her and her children.

Do not judge, RN February 5, 2009 11:24 AM
Bensalem PA

It is obvious that there are mental health issues, (personality disorder?) with Suleman, and  CPS is watching very closely since this case is a hot topic.  It is a revolting thought that Suleman might have chosen this path without a care assuming that she will receive money/attention for her story.  I wouldn't be surprised if the children end up with relatives/foster families.  My heart goes out for her children.

Lyn, RN February 5, 2009 10:28 AM

It is a very difficult situation.  As a CPNP, a woman who has undergone 5 fertility cycles and an adoptive mother, the situation is disturbing.  One does questions the ethics behind implanting a large quantity of embroys.  However, we must respect the individual who regards embryos as potential life and chose not to discard them.  Perhaps she could have donated them to another couple wishing to became pregnant.  But there is a saying he who is without sin, let him cast the first stone.  I am not: therefore, I will let God decide the necessary course of action.  But I am sure the medical ethics committee will as have their say.

Marie February 5, 2009 9:18 AM

I am the father of nine children with the first four being about one year apart. I can't imagine how one person can provide care for eight infants and six toddlers. She will definitely need physical, mental and financial support. Just wondering about the mind set of someone placing themselves in this situation.

Tom Anderson, self employed - RN LNC February 5, 2009 8:57 AM
Philadelphia PA

God bless the children in this situation...mothers are normally talented at multi-tasking, but come on!  Fourteen children!  Single mom! I personally feel that neglect will run rampant in that home as well as neglect in the budget....California will be paying the bills for this family for decades.  

Kmberly Couch, RN February 5, 2009 8:52 AM
IL

I think money is the underlying catch.  I don't think grandma will be gone when she gets home.  Not since we have already signed a publicist and haven't even left the hospital.  God bless the children, they are the ones that always get hurt by the actions of adults.  Children don't ask for this life of pain and possilble instability, it is forced upon them by people who "love them".  We truly have a world in deep moral conflict.

melanie ross, coag - rn February 5, 2009 8:38 AM
janesville WI

Human life is so precious....and always a gift! My concern is the whole idea of playing with nature. Why can't people allow themselves to get pregnant the natural way, as intended.

  I am very happy Nadya chose LIFE over death. The horror of abortion has become commonplace, why aren't people seeing how INSANE that is!

  God has a plan and will bless them, it is not our job to question that.

Dolores, School - RN, Village School February 5, 2009 4:34 AM
waldwick NJ

I question the judgment and ethical values of a physician who would participate in such a procedure.  Did he/she not know that this woman was already parenting six young children, enough to be a parenting challenge to most people, including myself?  How can a mother possibly care for eight babies, plus six others?  Common sense is absent here.  

Sharon, RN February 4, 2009 11:43 PM
IL

We will see more ethical dilemas if we continue to support in vitro fertilizations and manipulations with nature. It is these types of events that call to mind the document Humanae Vitae from back in the 1960's- there is a deep wisdom to the teachings of the Catholic church if only people would listen

Mark Davis, RN, CNS February 4, 2009 10:27 PM
Chicago IL

I also have issues with senerio as a mother, grandmother, and nurse. I know how stressful it can be parenting 4 children can be in a two parent household. I can't even get my mind around the thought of doing it as a single parent.  This story is further complicated by the fact that she has not been the primary care giver for the children that she already has, her mother has been been the primary caregiver  for them for the past 3-5 years  depending on which network you listen to. When my children were younger my husband was frequently out of town for anywhere from 2 weeks to 3 mos multiple times a year.  I only had 2 kids and occasional foster children on an emergency basis.  I had wonderful parents who would frequently drop over so I could decompress, take a nap or go for a walk.%0d%0a%0d%0aAll I can think of is how is she going to make this work. As a nurse we know that in the case of multiple births, these children often have health and development issues. %0d%0a%0d%0aI am teaching a ethics and legal issues class tomorrow with my nursing students in the morning

Sue Mason, University - Nursing Professor, APU February 4, 2009 9:56 PM
San Diego CA

Get Ready!  There will be others whom will follow her lead, specially if Suleman garnishes the publicty and the bucks that go with the noteriety of birthing octuplets! Now, it's a runaway train.    

Rebecca , self employed February 4, 2009 9:50 PM
Mckinney TX

There are ethical issues at so many levels.

I will grant that I am not expert at child development. But I will state that with 22 years of mental health practice, 15 years in Urology & 10 years on our Bio-ethics Committee as well as multiple credentials in quality & administration, there is plenty in this unveiling story that is cause for alarm.

Imagine 14 kids all under 7 years. The daily tasks of caring for the basic physical needs is already known to be exhaustive on this mother's support system. Even the Grand father is re-enlisting into the armed services to provide economic support.

Economic support brings to mind another conflict. I would presume that it is an essential parental responsibility to provide "adequate resources" (as noted in Section 5150) to be able to clothe & feed, not only one's self, but one's offspring. This matter is in light of the State of California's budget issues & the current debate of providing funding for school meals as a tool for educators to enhance learning.

I find that I have difficulty in getting my arms fully around this case.

Eric Winter RNc PHN CPHQ, , Case Manager VA W LA February 4, 2009 8:09 PM
Los Angeles CA

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