Nadya Suleman's daunting future of raising octuplets into adulthood may best be understood by the exhausted but proud parents of other multiples and the researchers who study them.
And if there's anyone who could give Suleman some frank advice, it's a mom with five toddlers.
"There's a lot of hype for the first few months and everybody is interested in how you're doing, but the newness wears off after the first year," said Jenny Ferrill, 31, of Danville, Ill. She and her husband, Pete, 35, are raising 2-year-old quintuplets. Four of the five children have lifelong medical problems and the Ferrills are falling behind paying bills.
She and other parents of multiples say they would advise the California mother of 14 that donations that seem plentiful now will taper off after the first year. Somehow free formula and diapers never morph into free shoes or forgiven medical bills. Requests for TV interviews dwindle. Offers to baby-sit, if they ever existed, vanish.
Next can come financial stress, emotional strain and marital struggles — although Suleman is single.
One German study of 54 families of multiples found that most were severely fatigued with worry about money problems, their children's disabilities and chronic diseases. Nearly all the families relied on outsiders for help and financial support. Some felt guilty they had brought a burden on their families through fertility treatment.
A U.S. study of nearly 250 mothers found that for each additional multiple birth child — from twins to triplets, for example, or triplets to quadruplets — the odds of having trouble meeting basic material needs more than tripled. The odds of lower quality of life and increased social stigma more than doubled with each added child. And the risk of depression in the mothers also rose with each additional child.
"Parents really underestimate the enormity of the burden of providing care for multiple birth children, and this increases with the number of children," said study co-author Dr. Janet E. Hall, a professor of medicine at Harvard Medical School.
In focus groups conducted by the researchers, mothers who'd had fertility treatments described moral judgments from friends, and even strangers, telling them they had interfered with Mother Nature or God's will.
These studies, among only a few on the topic, have led some experts to call for mental health screening or counseling for parents seeking treatment for infertility.
But fertility clinics don't routinely counsel parents about the emotional and financial strains of multiple births, said Barbara Collura, executive director of Resolve, an infertility support group.
Suleman suffered intense depression after a 1999 injury during a riot at a state mental hospital where she worked, according to California documents. The 2001 birth of her first child "helped my spirits," Suleman said in a psychological evaluation detailed in the documents.
In an interview on NBC's "Dateline," she said she always dreamed of having "a huge family" to make up for "certain connections and attachments with another person that I really lacked, I believe, growing up."
Ferrill, the Illinois mother of quintuplets, said she's seen several Suleman TV interviews and is concerned about whether the California woman can get over her admitted desire to have children to make up for the isolation she felt as a child.
"That's a really heavy burden to put on children," Ferrill said. "It's your responsibility to give love to the children, not to have them give that to you, you know what I mean?"
The Ferrills received no counseling after fertility treatment — in their case, a type of artificial insemination and fertility drugs — resulted in more embryos than they expected.
"We went to a doctor specializing in selective reduction (reducing the number of embryos in a pregnancy), and he was one of the most cold-hearted men I have ever met," Jenny Ferrill said.
The couple decided to forge ahead with all the embryos, and while they don't regret their decision, Jenny Ferrill said it's important that couples get counseling on "not just the medical risks, but how your life changes."
The Ferrills have three boys and two girls. One of the girls had heart surgery as an infant and is healthy now. A boy has a chronic inflammatory throat condition that can make it difficult to swallow. Another boy needs physical therapy for abnormally low muscle tone. The other two children are highly sensitive to bright light.
Collura, of the Resolve support group, predicted the California octuplets may jar the industry to do more. Her nonprofit group will continue to educate families that a successful fertility treatment leads to a single baby, not twins, triplets or other multiples.
"We want a healthy outcome and that's a singleton birth," she said. The group began several years ago using stronger language emphasizing single babies. It's published a 10-page article outlining the medical, financial and emotional risks of multiple births.
There were only 68 births of five or more children in the United States in 2005, according to the National Center for Health Statistics. Most are not the result of in vitro fertilization, Collura said, but other types of fertility treatment.
Keith and Becki Dilley of Decatur, Ind., have sextuplets who will turn 16 in May. All six — four boys and two girls — are starting driver's education next week.
"They're going to have jobs," said Becki Dilley, 42. "That's when they can have their driver's license. They know they have to get good grades so they can get a lower rate on their (car) insurance."
The Dilleys wrote a book titled "Special Delivery" about their sextuplets, the first surviving set in North America, which brought in only enough money to buy some appliances. Becki Dilley and her husband both now work full time.
Their schedule is dizzying. The children, all high school sophomores, are involved collectively in choir, jazz band, football and soccer. They all are on the honor roll.
The Dilleys had some couples counseling early on. "In the exhaustion of focusing on the kids, you can forget to focus on each other," Becki Dilley said.
Her advice for Suleman? "Try to make time for yourself. Take it one day at a time," she said. "Put down the camera every once in a while. Your kids don't care if there's not a picture of them dressed up as a reindeer."