An ethical, financial debate over having quintuplets
Parents want Kaiser to send them to specialist out of the network
MOUNTAIN HOUSE » The fertility doctor warned Chad and Amy Kempel they could end up with multiple babies, even triplets, as the couple set out this year to have a third and final child.
A month into their pregnancy, as the ultrasound technician counted out — Baby A, Baby B, Baby C, Baby D and Baby E — Amy burst into tears. She is carrying quintuplets, an extremely rare and high-risk pregnancy with grim chances that all five babies will survive. Just 24 sets of quintuplets were born in the United States in 2015.
Now, nearly 21 weeks pregnant, instead of decorating a nursery, the couple is battling with Kaiser Permanente to send them to an out-of-network Arizona doctor who specializes in high-risk multiple pregnancies, setting off an ethical and financial debate over how far a healthcare provider should go to accommodate families facing extraordinary medical circumstances.
“Every minute of the day feels like a fight,” Amy, 34, said during an interview at the family’s house in this small community of Mountain House, a few miles northwest of Tracy.
Having already lost premature twins in their first pregnancy, the Kempels are desperate to keep their five babies from being born too early.
Kaiser insists it “has the necessary experience and resources to provide high quality care” for the Kempels — before and after birth.
“We understand that this is both a joyful and a stressful time
for Ms. Kempel and her family,” said Colleen McKeown, senior vice president and area manager at Kaiser Walnut Creek, one of the neonatal intensive care units where the Kempels would deliver their babies. “Our priority is the health and well-being of Ms. Kempel and her babies, and we are committed to continuing to work closely with her to provide the care and support they need.”
Their situation is not entirely unprecedented. The doctor of the famous Octomom Nadya Suleman, another Kaiser patient, also requested to see the same Arizona doctor, John Elliott, he said during a phone interview. But Suleman was denied, too. She was 31 weeks pregnant when she successfully delivered her eight babies in 2009 at Kaiser’s Bellflower hospital in Southern California.
But the Kempels say they are still worried the Walnut Creek hospital doesn’t have the experience to deliver quintuplets.
The couple has appealed to California’s Department of Managed Health Care. They’ve written to Gov. Jerry Brown. They’ve reached out to local lawmakers and even President Donald Trump. Sometimes they get a canned response, sometimes no response at all.
Now, the Kempels are terrified that their worst nightmare is about to come true all over again.
In 2013, Amy’s first pregnancy ended tragically when the couple lost beloved twins Marshall and Spencer, who died hours after birth. She was 22 weeks along — nearly what she is today. They had already been buying clothes and toys and Chad had built the cribs. Amy’s mom had sent out baby shower invitations, and gifts had begun flowing in. Then, the crushing loss.
But the Kempels were relieved and overjoyed in the years to come. Their daughters Savannah, 3, and Avery, 17 months, were born fullterm and healthy using the same fertility treatment they tried during their first pregnancy: intrauterine insemination, where sperm are inserted into a woman’s uterus near her eggs.
Amy has what’s known as an incompetent cervix, which means it’s likely to open too soon and lead to premature labor. That’s what happened with the twins, with devastating consequences.
That’s why Amy can’t shake the thought: “We’re destined for another funeral.”
While a typical pregnancy lasts about 40 weeks, the average gestation for quintuplets is only 27 weeks, according to Elliott, the Phoenix-area perinatal specialist— and that’s for women without complications like Amy’s.
Babies born before about 23 weeks generally don’t survive. And even babies born at 27 weeks have significantly higher risks of cerebral palsy and other potentially debilitating issues than babies born full term.
When the Kempels learned Amy was carrying quintuplets, their Kaiser doctors advised themto selectively reduce, which involves eliminating some of the fetuses to increase the odds of delivering one or two healthy babies. Amy and Chad, who are Catholic, prayed over the idea. They consulted a priest who told them he didn’t think God would criticize them for reducing in such a situation. They made the appointment.
“In the end,” said Chad, a 36-year- old systems engineer for San Mateo County, “we just said we can’t go through with that. So here we are.”
The couple began searching Google for “how to save quintuplets.” Elliott’s name kept popping up, with accounts from happy parents of multiples calling him a miracle worker.
“Most people have this idea there’s nothing they can do and there are things he’s doing that are stopping labor,” said Chad, who has been consulting with Elliott.
For decades, Elliott and his team have used medications, such as magnesium sulfate, in high doses for lengthy periods in order to stop pre-term labor. He said his method has been successful, but he acknowledged that it is not widely practiced; studies show there are “small risks,” he said, including creating fractures in unborn babies.
Most perinatal doctors, he said, use these intravenous medications — but for only days, not weeks, and then stop them to let nature take its course, something Elliott calls “a disaster when you are trying to keep five babies in the womb.’’
At least one Bay Area perinatal specialist is dubious.
Dr. Patricia Robertson, a UCSF professor in maternal-fetal medicine who co-founded the UC/Kaiser undergraduate research internship program, cautioned against relying on magnesium sulfate too heavily.
“We use it carefully, as needed, for early contractions, or to protect the brain of a premature baby before they are born, or to protect against seizures in high-risk mothers,’’ Robertson said.
She said she believes the Kempels would receive excellent care from Kaiser’s specialists.
“Everybody does their very best to prolong a pregnancy to term,’’ Robertson said. “I don’t want to be disrespectful to Dr. Elliott. But there are other alternatives to intravenous management for 10 weeks that could be used to continue’’ pregnancies.
The Kempels understand that it could cost Kaiser hundreds of thousands of dollars to send them to Arizona, but Elliott argues it can bemore expensive if babies are born too premature and suffer lifelong complications.
Elliott, 71, said he has successfully delivered more than 700 triplets, 109 quadruplets and 23 sets of quintuplets, most recently last year. Elliott said three other sets of quintuplets who were 23 weeks old or less did not survive after complications developed with their mothers’ pregnancies. Kaiser has offered to send the Kempels to Stanford for a second opinion about whether Kaiser is qualified to provide the care they need.
But the couple still wants to go to Arizona, and Amy is running out of time. Ideally, Elliott wanted her there around 18 weeks, and on bed rest around 24 weeks.
So the Kempels have been walking a fine line between holding out hope and mentally preparing for the worst.
They’ve allowed themselves to pick out names — Lincoln, Grayson, Preston, Noelle and Gabriella — but not furniture or toys this time.
“That’s a place we don’t want to go,” said Chad, who remembers disassembling the crib after the twins died.
Amy hasn’t allowed herself to imagine what life would be like with seven children. But on good days, Chad has pictured raucous Christmas mornings with pajama- clad toddlers and the family’s two cats, all running around their threebedroom home.
“It is going to be chaos,” he said, smiling. “We just hope we can get there.”