By Yolanda Heiberger
For Christine and Kevin Webb of Guin, Ala., the news that they were expecting another child was cause for celebration. Already parents of two girls, ages 12 and 10, the Webbs were thrilled at the idea of having a baby in the house again. “We all were ecstatic about having a third child, especially the girls, who couldn’t wait to help with a newborn,” Christine says.
But in the summer of 2003, Christine’s initial, routine nine-week sonogram took a dramatic turn. She recalls, “I remember the sonographer looking at the screen and saying she had never seen anything like this before. Then she told us there were four distinct heartbeats—and that I was carrying four babies.” It was at that moment, in a haze of shock and exhilaration, that the Webbs learned they would soon become parents of naturally conceived identical quadruplets—an event so rare that it occurs in only about one in 4 million births. “I had never taken fertility medication, so we were understandably stunned, but also excited. I think it took a couple of weeks for the news to really sink in,” Christine adds.
Her pregnancy was high-risk because of the potential complications involved in carrying multiples, so Christine was immediately referred to the High-Risk Pregnancy Clinic in UAB’s Maternal-Fetal Medicine (MFM) Division. There, she was placed under the primary care of maternal-fetal medicine specialists for the remainder of her pregnancy. “Christine had a remarkably good pregnancy free of major complications. Her excellent outcome was due in part to her commitment and willingness to cooperate with our team of specialists in managing her risks,” says UAB maternal-fetal medicine specialist John Hauth, M.D.
History was made at University Hospital on March 17, 2004, when Christine delivered four identical girls by C-section at nearly 30 weeks gestation. They are the only set of identical quadruplets ever born in Alabama. Emily, Lindsey, Sidney and Marley were born healthy and had no complications after delivery. “The occurrence of naturally conceived quadruplets is exceedingly rare. But what makes Christine’s case even more unique is that she is among the 10 percent of quadruplet mothers who carry all four babies to 30 weeks and deliver, as she did, with virtually no medical complications,” Dr. Hauth explains.
In this ehealth magazine interview, Dr. Hauth discusses the rarity of naturally conceived quadruplets and explains how UAB’s team of maternal-fetal medicine specialists collaborated in developing an individualized plan of care to successfully manage Christine’s high-risk pregnancy. Also, Christine gives insight into the range of emotions—from disbelief to elation—that she experienced during her uncommon pregnancy. She shares how her strong faith and the advanced prenatal care she received at UAB gave her peace of mind and reassurance every step of the way.
Dr. Hauth: “Christine came to us when she was about 11 weeks along. The nature of her pregnancy made her an especially unique patient. Naturally conceived quadruplets occur in only one out of a million births. But, the incidence of naturally conceived, identical quadruplets is even more unusual—occurring in one out of about 4 million deliveries. We have no clear explanation of why, in the case of identical quadruplets, one fertilized egg divides into four distinct embryos. But we do know that this phenomenon is not influenced by heredity, race or nationality.”
Christine: “When I was first seen in the High-Risk Pregnancy Clinic, I was still somewhat in shock and also a little afraid about what I was facing. But, Kevin and I have a very strong Christian faith and believed there was a reason why we had been given four babies. We chose to be optimistic that everything would turn out fine in the end. Dr. Hauth put me at ease and was very thorough in explaining the risks involved and what I could expect during the pregnancy, but he was also positive and enthusiastic.”
Dr. Hauth: “Initially, we discussed all the potential risks in a quadruplet pregnancy, and we developed a plan of care that involved monitoring Christine in the office on a weekly basis. We use a team approach to care, which means our patients benefit greatly from the collaboration of our 12 experienced maternal-fetal medicine (MFM) subspecialists who confer in developing an individualized plan of care. We continue to confer as the patient progresses in her pregnancy and, if complications arise, we discuss those as well.”
Christine: “I’m glad I wasn’t anywhere else in the world except UAB. I knew that the MFM subspecialists were discussing my case often, and it was reassuring to know that I was being monitored so closely.”
Dr. Hauth: “Christine had two primary risks during her pregnancy. First, the overwhelming risk that we were concerned about throughout her pregnancy was premature delivery. At UAB, we consider the lower limit of viability—the point at which a fetus is likely to survive outside the uterus—to be 24 weeks. Each day the babies remained in Christine’s uterus beyond this point significantly increased their chances of survival and lowered their risks for complications after delivery. On average, quadruplets deliver between 26 and 28 weeks. The odds of Christine making it to 28 weeks were 50-50.
“The other significant risk for Christine was preeclampsia. This is a condition in which the mother’s blood pressure becomes dangerously high, sometimes requiring the need for early delivery. Though Christine had a 50 percent chance of developing this complication, fortunately, that didn’t happen.”
Christine: “I’m 5’ 2” and weighed 95 pounds when I became pregnant, so there was some concern that my size could make it more difficult for me to carry four babies. But Dr. Hauth was always so encouraging and motivating; his attitude helped Kevin and me stay positive and keep believing that I could have a healthy pregnancy and a great outcome. Thankfully, I had no serious complications at all. I didn’t even have swelling. In fact, I didn’t remove any of my rings until I was asked to take them off prior to surgery the day I had the babies!”
Dr. Hauth: “Fortunately, Christine also had excellent support from her family, which is so important in keeping patients motivated to continue taking good care of themselves. I’ve told Christine that Kevin is probably the most supportive husband I’ve ever met.”
Christine: “Yes, my husband and daughters were an incredible help to me. They made sure I got enough rest and that I ate well—they were wonderful.”
Dr. Hauth: “When Christine reached 27 weeks, she had dilated 1 centimeter and was having contractions. We admitted her to the hospital at that point, three weeks before she delivered, because she needed close observation and treatment. While in the hospital, medications were continued to support the pregnancy, including weekly shots of progesterone. Also, she was given medicine to help the babies’ lungs mature in preparation for delivery. Christine began labor at 30 weeks’ gestation, and at that point we felt very comfortable preparing for delivery.”
Christine: “We felt so fortunate that all the babies were breathing on their own after delivery and were only in UAB’s Regional Neonatal Intensive Care Unit (RNICU) fewer than 24 hours. After that, they went to the continuous care nursery—an intermediate nursery where their nutrition was closely monitored. The nursing staff there was outstanding and gave the babies excellent care. Within eight weeks, all the babies were home with us. Just before we left the hospital to take them home, we painted one of each of their toenails with a different color nail polish so that we would be able to tell them apart.
“As you might imagine, having quadruplets has been a completely life-changing experience. It’s absolutely amazing and exhilarating, but also mentally and physically exhausting. When we feel too tired to keep going, one of the babies will do something that makes our hearts swell, and we’re reminded of how blessed we are. Many nights, when everyone is finally asleep and Kevin and I are exhausted, we look at the girls and feel so thankful that they’re completely healthy and happy. You never get over that sense of amazement and wonder at what a gift—what a miracle—you’ve been given.”