The Octuplet Question

FOR WEEKS, NKEM CHUKWU AND THE babies in her belly had defied gravity. In her Houston hospital bed, the 27-year-old lay tilted head down, feet in the air, as doctors tried desperately to withhold from the world--and medical history--a major delivery. The later the date, the better the babies' odds. Though one, a girl, had already pushed her way out of Chukwu's womb, seven were still inside. Fourteen arms, 14 legs, 7 umbilical cords, all jammed one against the other. But five days before Christmas, Chukwu went into labor--13 weeks early--delivering five more girls and two boys, the world's first live octuplets.

The littlest died one week later from heart and lung failure. The rest, their tiny heads the size of oranges, their hands not much bigger than thumbnails, were fighting to stay alive last week at Texas Children's Hospital. Blankets with blue and pink hearts helped keep them warm. Tubes snaked out of their noses, heads and feet. Monitors buzzed with vital signs. And a dozen nurses a day watched over them. ""None are out of the woods,'' said Dr. Leonard Weisman, chief of the hospital's neonatal unit, but ""we're hopeful.''

In 1997, when Bobbi McCaughey delivered septuplets, the world went baby gaga. Pictures of the can-do couple and their babies beamed out of Iowa and donations--diapers, a van, a house--poured in. The McCaugheys made the covers of magazines (including NEWSWEEK). The octuplets will also go down in the record books, but perhaps with a bit less fanfare. Doctors' warnings about the high costs--medical, financial and human--of multiples are growing louder. The number of triplets and other ""higher-order multiples'' has jumped in this country from 1,034 in 1971 to 4,973 in 1995--thanks in large part to fertility drugs, which McCaughey and Chukwu both took. Fertility is a booming, but imprecise, $2 billion industry. Dosages can be confusing, doctors less than vigilant and patients demanding. The result: more multiples.

In Iowa, the medical picture was brighter. The seven babies made it past 30 weeks and all weighed more than two pounds at birth--tiny, but viable. The Texas babies, on the other hand, are smaller, younger and sicker. All are well under two pounds (the littlest was just 10 ounces when she died) and underdeveloped--even for their ""gestational age'' of 27 weeks. One girl, Gorom, needed intestinal surgery. All have ""floppy airways'' and brains so soft they're ""almost akin to Jell-O,'' says Weisman. Like the McCaugheys, the babies' parents, natives of Nigeria, are religious Christians. But the father, Iyke Louis Udobi, 42, a respiratory therapist, is also defending himself against an assault charge for hitting his mother-in-law. (His lawyer said Louis is innocent; Louis himself told reporters that the ""problems . . . are past us.'')

Fertility treatments usually involve a series of two injections, the first a powerful hormonal surge that prompts the production of eggs, the second a follow-up drug that releases them for fertilization. Doctors say younger women, like Chukwu, are more likely to produce multiple follicles. But patient response can be unpredictable. ""If you don't give enough medicine, you wind up with nothing,'' says Dr. Mark I. Evans, chair of obstetrics at Wayne State University in Detroit, ""and if you sneeze twice, you wind up with six.'' It would have been possible to halt Chukwu's treatment halfway by withholding the second injection if doctors had observed through ultrasound that she'd spawned eight follicles. But many women, desperate to conceive and daunted by the high cost of treatment (drugs can cost $2,000 a cycle and are largely uninsured), pressure their doctors into letting them go ahead--even if their ovaries have been ""hyperstimulated.'' Patients can opt for selective reduction, in which some fetuses are given a lethal injection of potassium chloride. Some doctors consider it obligatory to increase the chances of a healthy outcome. But both McCaughey and Chukwu refused the procedure on religious grounds.

Multiple pregnancies are precarious from the start. The mother can suffer dangerous blood clotting and is far more likely to miscarry. The babies are at risk for everything from learning disabilities to blindness and chronic lung problems. Hospital costs can be prohibitive: the Louis babies will likely rack up a $2 million bill before they're released this spring.

There was some good news last week for the seven babies. Scans showed no internal bleeding in any of their brains--a major hurdle--and two of them tasted their first milliliters of breast milk. Donations began to stack up as well--$10,000 from the Nigerian Embassy, a lifetime supply of diapers, preschool scholarships. As Chukwu and her husband left the hospital last week, she thanked God. ""We are grateful for [his] wonders,'' she said. And, in the coming months and years, for his protection, too.