As the 3,500 townspeople here wait to see whether their population will grow by seven with the anticipated birth of septuplets, a group of doctors is weighing the optimal time for the mother to give birth.
But in a larger sense, to some other physicians, medical ethicists and lawyers the question is not when the septuplets will be born but the emotional, social, financial and health implications of a pregnancy that may put a small-town Iowa mother in the record books.
If Bobbi McCaughey, 29, who lies in a hospital in nearby Des Moines, successfully gives birth– and those children make it through their critical early months–the babies would be the world’s first set of surviving septuplets.
McCaughey has made it to about her 30th week of pregnancy, and each baby weighs more than two pounds. Those milestones enhance the babies’ odds of surviving outside the womb. Still, the infants will be premature and of low birthweight, increasing their risk of such problems as blindness, developmental delays and learning disabilities.
That prospect troubles some doctors, who contend that seven is too many for one woman at one time.
“It’s ridiculous,” Dr. Atef Moawad, section chief of maternal-fetal medicine at the University of Chicago. “The odds (of success) are so low. You get a nice case that everybody gets sensational about . . . but it’s putting too many people at risk. It’s just like driving down the Dan Ryan at 95 m.p.h. and finishing and saying, `I’m a good driver. I can do it.’ But why?”
Many questions about the long-term implications of high-technology reproduction have not been examined closely, doctors and other experts say. That is in part because the boom in multiple births is a relatively new phenomenon and partly because funding for such studies has been scarce.
In 1995, the most recent year for which figures are available, there were 4,973 births of triplets or more. That is up 272 percent since 1980, according to the National Center for Health Statistics.
In the case of the McCaugheys, questions include whether all seven babies will survive and be healthy as they mature; how the pregnancy and birth will affect the mother’s health and how Bobbi and Kenny McCaughey’s 22-month-old daughter, Mikayla, will adjust to her siblings.
Many people in Carlisle, some 20 miles from Des Moines, do not openly debate the ethics of the McCaugheys’ situation.
Rev. R.D. Streeter, the pastor at Carlisle United Methodist Church, where the McCaugheys worship, said the couple had trouble conceiving Mikayla. And he and others see Bobbi McCaughey’s current pregnancy as God’s response to her prayers.
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“They took the drugs and put it in God’s hand, and this is what evolved,” he said. “We think that they are doing what God wants them to do. And until someone else is put in their position, I suggest they keep their mouths shut.”
That is what most people are doing in Carlisle.
Until the babies are born, many people here are hesitant to speak about them. The news about the septuplets was kept secret until two weeks ago. Many say they want to protect the McCaugheys’ privacy. Others say they don’t want to celebrate too soon.
“This is a blessed event, but we won’t start dancing until the band plays,” said Streeter.
A local bank has opened a trust fund and the McCaugheys’ church is planning a meal service for the family and a communitywide baby shower. The car dealership where Kenny McCaughey works may help provide his burgeoning family with a new van.
The McCaugheys are not the first to conceive septuplets, but never have all seven babies survived for long, medical specialists say.
Though the long-term risks for both mother and babies are not clear, the short-term complications in such births are better known. A woman is built to have one baby at a time, specialists say, and multiple births increase her risks.
Short-term risks for the mother include kidney and heart problems, very high blood pressure and other complications.
Deciding when to deliver the babies is a balancing act between the needs of the mother and those of the babies, each of whom may be at a slightly different stage of development. That is because the first fertilized egg to implant itself in the womb took up the best spot–the one optimal for development.
“At seven, you’re going to have somebody at the bottom of the barrel, in terms of spots to attach to,” said Dr. Roberta Karlman, an expert in maternal-fetal medicine at Loyola University Medical Center in Maywood. “There’s an unequal distribution of nutrients that can result in severe stunting of one or two or more of the babies.”
Multiple pregnancies are among the most closely monitored of all pregnancies.
Although the details of Bobbi McCaughey’s care have not been released, doctors who have experience with multiple pregnancies say she likely is very uncomfortable.
The presence of seven babies taxes her heart. Her uterus may be the size of two to three beach balls, squeezing her other organs and making it difficult to do everything from eating to breathing.
“There is serious maternal discomfort,” said Karlman, who has overseen the care of women with as many as four babies.
A woman carrying multiple fetuses at McCaughey’s stage of pregnancy may be given a weekly ultrasound.
“Some of these women, you can see their abdomen rolling and undulating because there are more arms and legs going,” said Karlman. “It’s like there’s an earthquake going on in the abdomen.”
In that exam, doctors usually check a number of factors for each fetus, including muscle tone, flexibility, breathing, heart rate and the amount of amniotic fluid.
If there are no signs of fetal distress and the woman can handle it, the pregnancy continues. But at 30 weeks, if either mother or babies get in trouble, the delivery begins.
In McCaughey’s case, about 40 doctors are standing by.
What allowed McCaughey to make it 30 weeks into this pregnancy?
“Luck,” said Karlman. “She is the exceptional woman.”