30 May 2017
ByAppeared in BioNews 902
Channel 4, Wednesday 10 May 2017
'These kids will save my life. But I didn't do it for them to save my life, I did it for Aynur,' says Tony, talking about his newborn quadruplets and his partner.
This line captures the complex relationship issues at the heart of Quadruplets and Homeless, first broadcast on 10 May 2017.
This documentary is, as Channel 4 sells it, a modern love story. Despite the tabloid title, really it is about the relationship between Tony and Aynur, Tony's alcoholism, and the relationship between Tony and Aynur's parents, who cannot abide Tony but who agree to house the new family as Tony's bedsit is unsuitable.
We first meet Aynur and Tony waiting for the caesarean section where they will finally meet their four babies, after trying for a family for ten years.
Their back stories are moving. Aynur was sent to Cyprus by her family at 16 for an arranged marriage where she suffered domestic violence. Tony has had an alcohol problem since his youth and is on benefits because of a disability. They met when she cut his hair. They come across as a loving couple, despite arguments.
Events in the operating theatre are charmingly portrayed, with a succession of wriggly babies being raised above surgical drapes. We do not see what I, as an obstetrician, suspect must have been an extraordinary theatre environment: to safely deliver four premature babies there would have been a plethora of people and equipment including a team and resuscitation station for each baby.
Medical implications for the babies were barely touched upon and there was no hint that this IVF pregnancy would have been very high risk for Aynur. The only clinical information given is that the babies were born four weeks early, with three spending a month in hospital and the smallest staying in longer.
A public backlash followed the programme's broadcast in the UK, as viewers wrongly inferred the couple had had the quadruplets after fertility treatment on the NHS. A spokesperson from Channel 4 subsequently told The Sun Online that 'Tony and Aynur found out they were expecting quadruplets after having IVF abroad'.
It is unlikely that the couple would have had quadruplets if they had been able to access affordable fertility treatment in the UK. There are strict controls in the UK on the number of embryo transfers, and it is standard to discuss embryo reduction with patients who are pregnant with higher order multiples, to reduce the risks. There is now a recognised obstetric challenge in the UK caused by patients receiving IVF overseas and returning with higher order multiple pregnancies.
Quads are rare, with only four sets born in the UK each year, according to the programme. They are almost always born preterm. The World Health Organisation reports that preterm birth is the biggest cause of newborn mortality. It is a significant cause of disability and chronic health problems. The psychosocial and financial impact on families is substantial.
We see glimpses of the logistical problems involved in transporting and feeding four babies. We learn that there is a night shift, which Tony opts to do to avoid interacting with Aynur's parents during daylight hours.
The programme portrays the extended family as coping remarkably well with looking after the four babies. There is a hint at the pressures involved when we see Aynur shouting that she needs help the moment her parents leave the house, as she cannot look after four babies on her own.
Aynur comes across as dedicated and energetic, with substantial support from her own parents. Unfortunately, the relationship between her parents and Tony is so strained that he is forced to leave and return to his bedsit, being allowed back in the house only when they are out. Sadly, having abstained from alcohol when the babies were born, he starts drinking again when the living arrangements fall apart.
Several minutes of footage are dedicated to the couple's hunt for somewhere else to live. Despite having four children, there is nowhere for them to go – every time they mention DSS to prospective landlords, doors close.
Will everything improve if they move to Tony's native Ireland? He thinks so, but Aynur is not sure. She is torn between loyalty to her supportive parents, and Tony whom she loves. 'I wouldn't be able to do it without Tony,' she says.
While I was drawn in by the surprisingly sympathetic portrait of a couple in love against the odds, I was disappointed by the lack of focus on the quadruplets themselves, given the programme's title. I was concerned that higher order multiple pregnancy was portrayed so light-heartedly. No questions were asked of the circumstances that led to a quadruplet pregnancy, and this is a missed opportunity to explore ethical issues in IVF. On the subject of alcoholism, however, it is more honest The interviewer asks Tony: 'What did you want to be [when the babies were born]?'
He replies simply: 'Sober, of course.'