Dr. Katherine Hauser will never forget her first sight of Bobbi McCaughey's babies on the screen of the ultrasound machine. Hauser, a reproductive endocrinologist in Des Moines, Iowa, had been treating Bobbi for infertility, and the medication she'd prescribed had worked like a charm. Although it often takes repeated injections of ovulation-stimulating Metrodin to prime a woman's reluctant eggs for successful conception, Bobbi got pregnant on the first try. Hauser had warned Bobbi and her husband Kenny that a side effect of fertility drugs can be multiple births; in about 20% of cases, a woman who conceives on Metrodin has twins or triplets or, in rare cases, quads or quints.
But not even Hauser was prepared for what was happening in Bobbi's abdomen. There on the sonogram, taken six weeks into the pregnancy, were not two or three fetuses, not five or six, but seven budding human forms, each in its own tiny sac of amniotic fluid. Even now, half a year later, she can't fully describe how she felt. "The words shock and disbelief come to mind," she says. "For a good length of time, I couldn't wrap my mind around this."
Hauser's sense of wonder was tempered with serious concern. Multiple pregnancies frequently end in miscarriage or stillbirth, and the risk multiplies with the number of fetuses. While septuplets have been delivered a handful of times, in no case have they all lived more than a few days or weeks. So Hauser, along with the McCaugheys' perinatologists, Drs. Paula Mahone and Karen Drake, patiently explained to the McCaugheys the standard option in such a situation: they could, if they chose, undergo "selective reduction"a medical euphemism for the aborting of several fetuses so the others would stand a better chance of being born healthy.
For many couples, deciding whether to sacrifice some of their children to save the others would pose an agonizing moral dilemma. For Bobbi, 29, and Kenny, 27, it was a no-brainer. As deeply religious Baptists, they are utterly opposed to abortion. "That just wasn't an option," Kenny told reporters last week. "We were trusting in the Lord for the outcome." By conventional medical standards, the McCaugheys were taking a huge gamble; by their own, they were simply living their faith.
And as just about everyone on the planet now knows, their faith was rewarded. Not only did the septuplets emerge from Bobbi's womb intact last Wednesday, but they were healthier than anyone had dared hope. "I didn't think we'd have this kind of outcome," admitted an exhausted, exultant Mahone the day after she and Drake delivered the babies by caesarean section. "It just strikes me as a miracle." Kenny McCaughey's first public utterance, issued at a press conference at Missionary Baptist Church in Carlisle after a visit with his four new sons and three new daughters, was a simple but eloquent "Wow!"
The world clearly agreed. Within minutes after the birth, the Iowa Methodist Medical Center and Blank Memorial Hospital for Children in Des Moines and the McCaugheys' tiny nearby hometown of Carlisle had become the focus of intense international attention. President Clinton phoned to congratulate the new mother. "You know," he said, "when those kids all go off to school...you will be the best-organized manager in the U.S." (Her reply: "That, or I will be in a straitjacket somewhere.")
Millions of people watched as the extended McCaughey clan, members of the 40-person medical team who assisted in the meticulously planned delivery and, finally, Kenny and Bobbi trooped in front of the TV cameras to bear witness to their pride and joy. For some viewers, the repeated references to God and miraclesby doctors as well as relativesmay have seemed old-fashioned, even corny. But in the face of such passion and tenderness, it was hard for even the most cynical onlooker to remain unmoved.
In Carlisle, where Kenny works as a billing clerk at the local Chevrolet dealership and Bobbi worked at home as a seamstress, the reaction bespoke a neighborliness that seems to have vanished from too much of America. The incoming mayor vowed to find a plot of land for the McCaugheys, who live in a tiny two-bedroom ranch, and local businesses pledged to build a house and fill it with appliances. Chevrolet gave them a 15-seat van. Local banks opened accounts to hold the donations that are already pouring in. And a brigade of neighbors and friends has coordinated meal preparation, laundry, transportation, baby sitting and housecleaning. "They say it takes a village to raise children," says city administrator Neil Ruddy. "We just didn't know it would be our village."
Farther afield, Procter & Gamble, Mott's and Gerber offered the McCaugheys free diapers for life, free apple juice and baby food. Hannibal-LaGrange College in Hannibal, Mo., promised scholarships for all seven childrenpossibly eliminating at a stroke one of the greatest financial burdens of parenthood. "We were planning to raise our kids on what we earn," said Kenny at a Friday press conference, "but it looks as though help is pouring in."
Seven healthy babies born at once are clearly a testament to the marvelous workings of nature, or God, depending on your point of view. But they are also a powerful demonstration of human ingenuity. The septuplets graphically demonstrate both the promise of modern fertility treatments and their peril. Risky as it was, Bobbi's pregnancy was only the first of many serious hurdles the family might encounter. Because they're nearly always premature, multiple babies have 12 times as great a chance of dying in infancy. If they survive, they face all sorts of potential problems later in life, from cerebral palsy to kidney and bowel problems to blindness to mental retardation.
Even when multiple babies are relatively healthy, the joy they bring is accompanied by the terrible tollphysical, emotional and financialtheir care takes on the parents. Says Barbara Luke, a perinatal epidemiologist at the University of Michigan: "It is an injustice to children to be born in litters."
Nonetheless, multiple births are occurring more often now than at any other time in history. Infertility has been on the increase in recent decades, in large part because many women are delaying childbearing in order to pursue their education and careers. In response, doctors have developed a wide variety of treatmentsnot just infertility drugs but also high-tech methods, including in-vitro fertilization in its many variations. As a result, the number of multiple births has more than quadrupled in the past quarter-century.
None of that was on the McCaugheys' minds when they first went to see Hauser last spring. Their daughter Mikayla was 16 months old, and all they wanted was to give her a brother or sister. Bobbi had had trouble conceiving Mikayla; she had finally become pregnant after spending a fruitless year on one fertility drug and then switching to the more powerful Metrodin. Neither she nor Kenny wanted to wait a year this time, so she went on Metrodin right awaythough, on Hauser's advice, at a lower dose. But while doctors can carefully control the number of embryos they insert with in-vitro fertilization, fertility drugs are basically a roll of the dice.
Once the McCaugheys had decided that Bobbi would carry all the babies, the priority for her prenatal care was simple: if the septuplets were to have a chance, they had to be kept inside the womb as long as possible. The milestone her two perinatologists were shooting for was 28 weeks, the critical point at which a baby's organs and nervous system are sufficiently formed to offer a good chance of survival.