The Baby Keeper

Elliott can come off as a cowboy—he occasionally wears a gold chain under his scrubs, and he says there's something to the idea of Phoenix as the academic "Wild West," where doctors take risks and "think out of the box." Still, with patients, he is gentle, thorough and not in the least intimidating. He uses very few technical terms; he refers to a "baby" instead of a "fetus." "A lot of OBs are very busy, and they don't spend much time explaining things," he says. "It's amazing how a patient responds to that."

Few of Elliott's out-of-state patients are referred by other OBs. He does not advertise, either. Instead, nearly half the patients find him through enthusiastic postings from other moms on Web sites such as Mothers of Supertwins and The Triplet Connection. At least one patient saw him on a Discovery Channel show and came all the way from St. Maarten. 

Despite his high profile, Elliott did not set out in medicine with a plan to become the go-to OB for the highly multiparous. During his fellowship in Phoenix, from 1978 to '80, he says, "there was only an occasional triplet. You never saw quads." But as numbers of multiple pregnancies started increasing in the '80s, Elliott began to experiment with magnesium sulfate, a drug that was used to treat pre-eclampsia. The drug had extremely unpleasant side effects, including severe fatigue, muscle weakness, low blood pressure, and difficulty breathing; while on it, Elliott's patients told him, only half-jokingly, that for his own safety he'd better hide his surgical knives. But Elliott thought "mag" might be useful in extremely high doses for prolonging large pregnancies. In 1992, he published data showing that 10 local women on his protocol had carried quadruplets on average for 32 weeks and a day—a paper he describes as "saying to the world, 'it's not as bad as you think it is'."

For quadruplets, 32 weeks and a day is indeed impressive. Most quads, if they're lucky, are born at 31. (As a rule of thumb, every extra baby in a pregnancy subtracts three weeks off the standard 40. Twins are born at 37 weeks, triplets at 34 and so on.) Each extra day in the womb is precious, allowing the babies to develop their lungs and pack on the ounces, potentially avoiding long-term neurological problems such as cerebral palsy, which are linked to low birth weight. For women carrying multiples, then, every day that they manage to stay pregnant is a good one—no matter how painful and weak that day may make them feel.

With multiples, there's also a higher risk of going into labor before the babies are viable at all. In 1996, Elliott got a call from a woman's husband in Peoria, Ill. She was pregnant with quads and had started having contractions at 23 weeks—so early that all four babies would surely die if they were born immediately. "Her doctors basically told her and her husband that she would be delivering and that there was nothing that they could do," says Elliott. "They weren't giving her enough [magnesium sulfate], and they were afraid to go any higher than they had." Elliott wasn't so reluctant. After trying, and failing, to convince the Illinois doctors to up the woman's dosage of magnesium sulfate, he said he'd take over her care himself. She managed to get to Phoenix, where he put her on bed rest and a high dose of "mag," and the babies stayed put until an astonishing 34 weeks. Word spread and suddenly, other women from outside Arizona started flocking to Banner Good Samaritan.

Delivering triplets, quads and quintuplets is a regular part of Elliott's practice now. His quints, he says, generally stay in utero even longer than his quads, for 32 weeks and four days. (He is writing up the data for publication.) In 2007, Elliott delivered a set of quints that broke the world record for total weight. He also delivered the Masche sextuplets, that entered the world relatively healthy in the same week that another set of six, under the care of doctors in Minnesota, was born too early to survive. But of course other examples of large sets of surviving multiples abound—just watch the Discovery Health Channel or TLC for a few hours and you'll hear their stories.

Elliott is puzzled as to why other doctors do not use very high doses of mag, as he does, to prolong pregnancy. They prefer lower doses of mag, bed rest or other drugs, including antibiotics, beta-mimetics, calcium channel blockers and nonsteroidal anti-inflammatory drugs (NSAIDs)—none of which is guaranteed to stop early labor. "Many places today don't think you can be successful [with large multiple births]," Elliott says. "We're just more willing to do the best we can."

If using magnesium sulfate in extremely large doses makes Elliott "radical"—and he himself says that it does—he is doing so in a fairly radical country. Magnesium sulfate is widely used in the U.S. and Canada to forestall labor, albeit at much lower doses than Elliott's. No other country in the world uses it so widely for that purpose. A Cochrane Review—a scholarly survey that many doctors look to for guidance—recently found that mag doesn't actually work as a tocolytic (a type of drug that prevents labor). "There was never any scientific foundation for using it to stop labor in the first place. It was based on theory, and on several flawed, uncontrolled studies," says Dr. David Grimes, an obstetrician-gynecologist with the Durham, N.C. nonprofit Family Health International, who wrote an opinion piece in "Obstetrics and Gynecology" based on the Cochrane data. "Anyone who's using it to prevent labor at this point is out on a limb."