The surviving Frustaci septuplets struggled to stay alive in an Orange, Calif. hospital last week. The infants, if they live, will not go home for several more months because they weigh less than two pounds each and suffer from a variety of complications. Dr. Michael Katz, 39, who has developed a monitoring device to help detect and treat pre-term labor, is an Israeli-born assistant professor of obstetrics and gynecology at the University of California, San Francisco and associate chief of perinatal services at Children's Hospital of San Francisco. He talked to correspondent Giovanna Breu about multiple births and their impact on parents.
What problems do multiple birth babies face after they are born?
Often much smaller than a single baby born prematurely, they have problems regulating their respiration and heart rates, and they are unable to maintain body temperature. That's why they are in incubators. They have problems suckling and absorbing food into their stomachs because their intestines are not ready for it. A tube must be put down into the stomach, and sometimes if they are very premature, they are fed nutrients straight into the vein.
What is the greatest danger to the babies' survival?
Mainly respiratory problems. Premature babies often lack a substance called surfactant that they develop in late pregnancy, and without it the air sacs in their lungs collapse. The baby must be put on a ventilator and air pushed into its lungs under continuous pressure. A high concentration of oxygen is pumped into that air, which can become toxic if used for prolonged periods. That can cause blindness. So the pressure and concentration of oxygen is lowered as soon as possible.
What other problems are common?
Up to half of the babies under two pounds have brain hemorrhages. The blood usually goes into the normal spaces everyone has in the brain. However it can sometimes result In brain damage, causing cerebral palsy or mental retardation.
Do premature babies feel stress?
Yes. Remember that a baby at 28 weeks is used to swimming in warm water and not breathing on its own, and you take this baby out and stick a tube in its throat and start to pump air and oxygen into the lungs. It's necessary for survival, but it is still a tremendous trauma to the baby.
What are their movements like?
They are less purposeful, more like the movements that they would perform in the womb. Premature babies are kept on waterbeds in the nursery to give them the feeling that they are still in the uterus. Some nurseries have tapes playing the sounds of heartbeats and blood flow, which the baby would have heard in the womb.
How do you help parents handle a baby's death?
We encourage the parents to be there at the time of death, and we try to have the nurse who has cared for the baby with them. We counsel them about the causes of death and urge them to share their feelings.
Will babies who survive have mental or physical problems as adults?
The long-term outlook is still unknown because only very recently have we been able to save such babies. Most specialists feel that the chances for normal survival are better than 80 percent. In the rest, there are significant handicaps, such as learning disabilities and hearing problems.
What problems does the mother face?
Instead of taking the baby home and breast-feeding it, the mother has to go to the nursery where the baby is attached to many tubes. That interferes with her ability to touch and cuddle the baby and, of course, to breast-feed it. However, these mothers can pump their milk and store it in the hospital's milk bank. Then it is given to the babies when they are more mature.
Can the mother touch her babies?
They are very delicate. Touching is not prohibited because it is important to bonding, but handling the infant is not always possible. Even changing a diaper may disturb the baby's heart rate and blood pressure.
What are the psychological effects on the mother?
She may worry: Did I do anything wrong that the baby was born prematurely? Will the baby be normal? At home she needs to give extra attention to her older children and also to her husband, who may feel left out. But she herself may feel that everyone gives attention to the babies and not to her. She is completely exhausted, and I think that postpartum depression may be aggravated by multiple births.
Are multiple births frequent with Pergonal, the fertility drug that Mrs. Frustaci took?
At least 80 percent are single births. Most of the rest are twins, and fewer than 5 percent are triplets or more. Pergonal is a hormone that directly stimulates ovulation in women who don't ovulate regularly or at all. It is safe when properly used.
What are its disadvantages?
Hormones like Pergonal are unpredictable with respect to how many eggs will ripen each time a woman uses them. Patients must be monitored.
How time-consuming is caring for all these babies when they come home?
It takes 15 or 20 minutes to feed one baby. By the time a mother changes it and pays attention to it, half an hour has passed. They have to be fed at least every four hours. That's three hours a day per child. If the mother has no help, she simply has no time for anything else. Mothers with one child tell me that they are exhausted and have no time. Imagine multiplying it.
It does sound exhausting.
Yes. But for some the strain of being infertile among so many couples with kids is much worse than the work and stress of having four, five or six.