Dr. Manny: The unforeseen danger of letting lawyers decide the fate of a mother and her unborn child

If you’ve been reading the news, you’ve probably heard the story of a Georgia man demanding his surrogate mother, California woman Melissa Cook, terminate one of the three triplets she became impregnated with via an in vitro fertilization (IVF) procedure. The man, who has not been named, only wanted two babies, so he and his lawyer want Cook to terminate one of the fetuses.

While most reports center around the legal and monetary ramifications of the dispute, what isn’t being discussed is the health implications to both this surrogate mother and the unborn children she is carrying. And this is why I am so disgusted by this story. It is a tragedy— and almost everyone is to blame. The only real victims in this situation are these poor, little, unborn children.

Surrogacy as a concept can provide the miracle of life to a couple who, due to medical reasons, are unable to carry a child of their own. And the honorable effort of a surrogate mother is that she would lend her body freely, knowing the steps to bring new life into this world. But this case is different— it’s like this father wants to custom-make his family, as if by a la carte.

The first problem with this, from a clinical standpoint, is this surrogate mom underwent an IVF procedure, during which she had three embryos implanted. I don’t understand why an IVF center would not counsel all the parties involved that perhaps three embryos could result in three births. In the world of INVF, there are many technical ways of determining that the embryo that you are implanting may have a higher chance of evolving since nowadays we have technologies like pre-implantation genetics that can minimize the possibility of a spontaneous miscarriage due to a chromosomal abnormality.

Now, as a result of an extra pregnancy, the father — who doesn’t want more than two children to be born— wants the surrogate mother to undergo a selective reduction.

A selective reduction is a technique that was developed in the early ’90s whereby doctors reduce a multiple pregnancy to a less-risky number of fetuses to minimize maternal complications. Usually, doctors reduce pregnancies down to two fetuses. The technique is executed with ultrasound guidance. A small needle is inserted into the fetal sac and the fetus is injected with a chemical substance, usually potassium chloride or digoxin. The fetus dies instantly, and the two remaining fetuses remain in the uterus.

However, a selective reduction carries a high complication rate, which may include ruptured membranes and infection. Some of these complications may even force the doctors to recommend that the pregnancy be totally terminated because it may jeopardize the life of the mother— especially in cases of infection. So, you see, selective reduction is not as easy and simple as everybody, and seemingly this man’s legal team, talks about.

Now, what about triplets? How dangerous are triplets? There’s no doubt that a triple pregnancy is a high-risk pregnancy, but I have delivered dozens of triplets over the course of my career, and, I have to say, I think that under the right circumstances with the right sets of triplets and a mother who is otherwise healthy, triplet pregnancies do achieve good outcomes.

What are the risk factors of having triplets? Those potential outcomes include premature labor, and the incidence of high blood pressure and diabetes in the mother. But, as I said, with proper screening, some of these complications can be minimized.

Of course, triplets do have to be delivered earlier than would twins and a single child. You have to remember the womb was made to hold only one child. So by having three, you do run out of room after a while. These babies typically are delivered between 34 and 35 weeks, give or take, and if they happen to be growing properly, their birth weight usually is 4 pounds and change. Again, they might need a little monitoring in the hospital, but they usually go home after a few days.

All that said, I’m not saying that selective reduction should not be part of the discussion of a triplet pregnancy management— but all of these things should be fully explained to all parties involved early on in the pregnancy. Right now, Cook, the surrogate mother, is reportedly 17 weeks pregnant, and if that is the case, then this is not going to be a selective reduction— this is going to be a selective termination. And a selective termination, again, is an involved procedure that, as explained before, carries a risk.

Ultimately, I think the ethics of a surrogacy pregnancy should not be mandated by lawyers, where a pregnancy is looked at as nothing more than a product under a contractual agreement. We’re talking about life and ethics. I know that New York State is looking at lifting its ban on so-called commercial surrogacy, but, even though I support surrogacy, in this context I do not support the word “commercial” with regards to determining the outcome of births and existing life.