Septuplets' birth stirs debate
ALEXANDRIA, Egypt — By contrast, the world's first surviving septuplets, born to the McCaughey family in Iowa in 1997, came at 31 weeks and the biggest baby weighed about the same as Khamis' smallest. There are two other sets of surviving septuplets, both born to Saudi women.
Khamis' doctors waited so long to deliver the babies because Egypt has only a few respirators for newborns, and none were available. So for weeks, doctors kept Khamis in Alexandria's Shatby Maternity University Hospital, letting the fetuses develop enough that their lungs could function on their own after birth. But the wait also increased the risk to the mother.
"We were simply blessed by God that no complication happened ... If there had been a complication, Ghazala would have died," Dr. Mahmoud Meleis, who performed the Caesarean section, told The Associated Press.
After their birth, images on television showed the boys — Mohammad, Kareem, Bilal and Yassin — and girls — Israa, Habiba and Do'a — lying side-by-side in two makeshift incubators, oxygen hoods covering their heads. Four were then whisked by ambulance to two other hospitals because there were not enough incubators at Shatby.
Except for the television images, Khamis has not yet seen all her babies; she has been able to hold and breast-feed only the three at Shatby. Though she was ready to leave days after the birth, she remains hospitalized because she has nowhere to stay in Alexandria, a four-hour drive from her farming village of Ezbat Emara.
Last week, baby girl Habiba and boys Yassin and Mohammed were resting in incubators at Shatby, tiny caps on their heads — red for the boys and lime green for the girl. All were breathing on their own, though Habiba and Yassin wore protective eye patches.
Some Western medical ethicists have questioned the use of fertility drugs by a young woman who already has three children, considering the risk of multiple births."This is a medical failure," said Guido Pennings, a professor of fertility ethics at the University of Ghent in Belgium. "You cannot take this risk because of the complications to the mother and the babies."Pennings, who was not involved in the case, said Khamis' doctors should have been more careful in prescribing fertility drugs to a woman who had already demonstrated she was capable of conceiving."Twenty-seven with three children: That woman is fertile," he said. "Even if she had a period of infertility, that's an indication that you should be careful when you stimulate" ovulation.Some Egyptian doctors are worried that the mix of cheap fertility treatments and Egyptians' eagerness to have many children could lead to more risky multiple pregnancies — which the country's health system cannot handle. Locally made versions of the drugs are government-subsidized and only cost about $7.50 a shot.There is also pressure on women to produce a son as a point of pride and for financial reasons. Boys help families by working and earning incomes — often at a young age — and they ensure inheritance, since daughters and wives can only inherit a portion of their father's money, and if there are no male children, the bulk goes to the fathers' brothers."The important question to ask is why did she want to become pregnant after already having three children," said Hassan Sallam, head of Obstetrics and Gynecology at the University of Alexandria."It's because she had three daughters and didn't have a boy. In many parts of Egypt, if she doesn't have a boy, it's as if she didn't have children at all."Khamis sought fertility treatment five years after her youngest daughter, 5-year-old Rahma, was born because she was having trouble conceiving and wanted a boy, said her doctor, Abdel-Rahim Moussa.He said he prescribed fertility drugs to stimulate egg production. After five injections, he recommended Khamis and her husband have intercourse.The doctor said he was stunned when he later found nine heartbeats; he said he couldn't remember whether he did a sonogram to see how many eggs had developed before recommending the couple try to conceive."It's just so rare that all the eggs would get fertilized with regular intercourse," he said.The doctor said he strongly advised Khamis to undergo fetal reduction, in which some fetuses are terminated to ensure the safety of the others and the mother. But he also told her there was the possibility of losing all the fetuses, and Khamis refused. Later, two of the fetuses were lost during the course of the pregnancy.Emad Darwish, the hospital director, said Khamis should have received more counseling about fetal reduction. "I have performed several reductions and have never had a case where I lost all the fetuses. She needed to know that," he said.
