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What on earth was the woman thinking? And what, pray tell, was the doctor at the fertility clinic thinking?

I'm referring to the case of Nadya Suleman, the California woman who gave birth last week to octuplets -- six boys and two girls.

Her feat was initially proclaimed "a medical miracle," but then the gritty facts surfaced. The "miracle" soon morphed into a raging ethical debate about medical science that had gone off the rails and a woman who may have gone off, too.

In case you've missed a chapter in the story, here's a quick review: Suleman is 33, unmarried, a graduate of California State University, has no job. She already had six children, ranging in age from 2 to 7.

All six were reportedly conceived with the help of a sperm donor and in-vitro fertilization, a process whereby a fertilized egg, or embryo, is implanted in a woman's womb.

Six children weren't enough for Suleman. Despite her mother's angry protestations, she returned to the unnamed fertility clinic where eight of her embryos had been frozen. Were all eight implanted or just one embryo that multiplied? The story is murky.

In any event, it took 46 medical staffers at Kaiser Permanente Bellflower Medical Center to help deliver the eight babies (the unnamed fertility center is not related to the hospital). Doctors expected seven babies but the eighth was discovered during delivery.

There is no law restricting the number of embryos that can be implanted. Medical guidelines, however, recommend that many factors be weighed before embryos are implanted. Factors such as the mother's mental and physical health and her home life.

Which makes you wonder why the doctor, whose name has not been revealed, would proceed with more implants given Suleman's other six children and no job. And did he bother to ask who would be caring for Nadya's children while her daughter was giving birth to octuplets? Answer: Her angry mother.

The California medical board should call the fertility doctor on the carpet and force him to explain himself. Rules need to be tightened. David C. Magnus, director of the Stanford University Center for Biomedical Ethics, told The Washington Post that the Suleman case reveals that the infertility and reproduction field of medicine is poorly regulated. Medical guidelines, he said, are full of "you should" rather than ironclad rules.

As a friend pointed out to me: No social service department or adoption agency would have likely permitted Suleman to be a foster or adoptive parent, given her other six children and no job. So why would a fertility doctor have helped her have more children?

Meanwhile, what motivated Suleman? Had she read too many issues of People magazine, glamorizing Angelina Jolie and her boyfriend, Brad Pitt, who've been baby-making machines themselves? Did Suleman want a piece of the spotlight?

She's already hired a publicist who appeared on "Good Morning America" and described Suleman as "a wonderful woman." The publicist claims that TV, book and other lucrative offers are pouring in from around the world. Diaper and baby food companies are dodging Suleman because of medical ethics, but her story is perfect for People magazine, which buys photo rights.

Maybe her motives had nothing to do with money but everything to do with her psyche. Some psychologists say women, especially single women, are often motivated to have children because they're lonely and love-deprived. Suleman's mother said her daughter, an only child, had been "obsessed" with having children ever since she was a teenager.

Now for hard questions: Who will care for the 14 children? Who paid for the fertility treatment? Who will pay for the family's future expenses? Maybe we taxpayers will be bailing them out.

Suleman's mother, meanwhile, has been so distressed about her daughter's obsession to have more babies that she sought help from a psychologist. He advised her to move out of the modest, three-bedroom house she shares with her daughter and brood.

But it's her daughter who desperately needs psychiatric help. And the fertility-clinic doctor has got some answering to do, too.

Rosemary Roberts writes a column for the News & Record on alternate Fridays. E-mail: rmroberts@triad.rr.com.