The Magnificent Seven

LATE LAST TUESDAY NIGHT DR. Paula Mahone sat staring at a telephone. A team of doctors and nurses at Iowa Methodist Medical Center in Des Moines had been waiting for this moment since the day in early October when 29-year-old Bobbi McCaughey entered the hospital with seven fetuses in her womb. If they survived, the babies would make medical history as the first living septuplets. That night perinatologist Mahone's first task was to book the operating room for a Caesarean the next day. But she was afraid. Not about the delivery, or the fate of the mother and the babies. Like her patient, she is deeply religious and had long ago concluded that ""God is in the center of this.'' What she feared was the planetary circus she was certain would follow the births.

Minutes earlier Mahone and her colleague, Dr. Karen Drake, had decided to heed McCaughey's pleas to end the increasingly difficult pregnancy. The previous week, doctors had administered drugs to stop contractions. The side effects were nasty: headaches, hot flashes, a general feeling of lousiness. When contractions started again, McCaughey told her doctors that after more than 30 weeks of pregnancy, she had had enough. ""I sat by the telephone for three to five minutes,'' Mahone recalls. ""I really did not relish all that was going to happen.'' Then she dialed.

The next morning pagers alerted the pre-selected 66-member medical team sardonically dubbed Operation Snow White by some hospital staffers. At high noon Mahone, Drake and anesthesiologist Dirk Brom assembled in the operating room. A faint antiseptic scent, the light odor of a doctor's office, greeted McCaughey as she arrived in a wheelchair. The medical team had expected to help her onto the operating table, but she showed the mettle that had brought her this far by standing up and walking over on her own. At 12:30, Brom administered an epidural. Then McCaughey lay down and looked at her 52-inch girth for the last time. Mahone and Drake's mood was more serious than in most deliveries; Mahone had even forsaken the jazz she often pipes into the OR, because she did not want any distractions. Brom, too, caught the tone. ""I kid around with my patients,'' he says. ""But there wasn't any kidding around this time.''

The team had assembled in three locations. Mahone, Drake and Brom were in the delivery room along with another anesthesiologist, an obstetrics resident and several specialized nurses. Moments after delivery, each baby was to be carried by a neonatal-transport nurse to an adjacent operating room, where three neonatologists would direct stabilization teams for each infant. After preliminary examinations, the babies would be placed in high-tech carriages humming with heart, oxygen and respiration monitors. Then they'd make the four-minute trip through hospital corridors to the Neonatal Intensive Care Unit (NICU) at Blank Children's Hospital, a partner medical center attached to Iowa Methodist.

At 12:45, the three clusters of doctors and nurses fell largely silent; the only sounds were the crackle of the walkie-talkies and cellular phones that networked the whole team. McCaughey's abdomen had been cleansed and draped with sterile cloths. Mahone made her incision. It was not the horizontal cut typical of most Caesareans. Mahone needed room to work. ""We didn't want to be in there wrestling to free an infant,'' she says. She made a 15-inch vertical incision from McCaughey's pelvis to the point on her belly above the top of her uterus. She cut down to the uterus, moving abdominal muscles and the bladder off to the side, and entered the womb.

The McCaugheys had already named their babies, but the perinatologists wanted no confusion in the heat of delivery. Through sonograms, they had come to know them as Babies A through G. They were arranged in an inverted pyramid with Baby A (nicknamed ""Hercules'' because of all the weight on top of him) at the bottom.

At 12:48, Mahone announced, ""Vertex,'' meaning the infant was coming out head-first. ""It's a boy. Baby A.'' Kenneth Robert McCaughey emerged with his mouth open, a grimace on his little face, his arms moving gently as he felt his new world. The little infant, just 3 pounds 4 ounces, sucked in his first few breaths and let out a fledgling war cry that echoed in the cheers of NICU doctors and nurses when word zipped there by walkie-talkie that Baby A was up and running.

The transport nurse carried Kenneth through the door to the second OR, holding him level with his head extended away from her body as she wiped him clean with a blanket and declared: ""We have a nice, pink, baby boy.'' That simple sentence was a medical signal that there was no apparent emergency. With each arrival in the OR, the doctors and nurses kept up a running dialogue. ""Talk to me. Are you pink?'' ""Yes, I'm pink.''

After each infant was removed, Bobbi McCaughey's uterus contracted to fill the void and forced another infant into position for delivery. They bobbed up, one after another at one-minute intervals, reminding the doctors of apples in a barrel of water. As Mahone lifted each one, Drake clamped and cut the umbilical cord. Baby C (Alexis May) was second, then Baby B (Natalie Sue). After that, the McCaughey septuplets stuck to the alphabet: D (Kelsey Ann), then E (Brandon James), F (Nathan Roy) and finally G (Joel Steven), born exactly six minutes after Kenneth. Their mother was awake, listening to Brom give a play-by-play. Their father, Kenny, 27, stood by the doctors. Brom later recalled that Bobbi was calm, but ""I saw some tears in her eyes.''

Within hours of the births the news flashed around the world, and the frenzy of publicity was on--just as Mahone had feared. In his hometown of Carlisle, just outside of Des Moines, Kenny, a billing clerk at a car dealership, was treated like a rock star. Corporations plied the family with gifts (a new house, a 12-seat van, diapers, car seats, strollers, groceries, even seven years of free cable). Tabloids waved big checks for an exclusive (one $250,000 offer was turned down). President Clinton called. Even Jay Leno and David Letterman got into the act. Leno: ""Seven babies at once. You know what Mia Farrow calls that? Thursday.'' Letterman joked that the public hadn't seen that many people come out since the last episode of ""Ellen.''

But the births also touched off an intense debate over high-tech reproduction, waged on talk shows and op-ed pages. The controversy centered on the fact that McCaughey had taken fertility drugs, which often result in multiple births, just as she had with her daughter, Mikayla, now 22 months old. Multiple-birth babies are much more likely than singletons to be born too soon and therefore experience a range of health problems (sidebar). While admiring the skill of the Iowa delivery team, many fertility experts worried that their success would cause other parents to underplay those risks, or even to try for an instant mega-family. ""This may give false hope,'' says John P. Elliott, director of maternal-fetal medicine at Phoenix's Good Samaritan Medical Center, who delivered quintuplets last October. ""When you look at the statistical chances that she would be successful, you're literally talking about winning the lottery.''

Doctors usually advise women pregnant with more than three to undergo ""selective reductions'' that kill some in the womb. ""There's no doubt that if a couple's primary goal is to maximize the chance of taking home healthy children, they're better off reducing to twins,'' says Mark I. Evans, a geneticist and ob-gyn at Detroit's Wayne State University, who pioneered the procedure. The McCaugheys, both devout Christians, refused to consider reduction. Choosing to kill a wanted baby is agonizing. Six years ago, Darcie and Bob Jones of Keizer, Ore., spent two weeks trying to decide whether to abort one of the four fetuses Darcie had conceived on fertility drugs. They targeted the baby farthest from the cervix but ultimately decided to do nothing. ""We were well prepared for the fact that we might lose some of them or all of them,'' says Darcie. ""But we felt it was not up to us; it was up to God.'' Today, says Darcie, that baby is ""our Ian,'' who, along with his brother and two sisters, entered kindergarten this fall.

Some experts questioned how McCaughey became pregnant with so many fetuses. Her physician, Dr. Katherine Hauser, prescribed the drug Metrodin, which stimulates egg production. Doctors usually use vaginal ultrasound to see how many eggs a woman has produced and generally recommend that she abstain from sex if she has too many. ""If you see seven follicles about to erupt, you don't have to inseminate, you don't have to have intercourse,'' says Dr. Louis Keith, president of the Center for the Study of Multiple Birth and a professor of obstetrics and gynecology at Northwestern University. ""The appropriate means to stop this is by canceling the entire cycle.'' In a press conference a day after the septuplets were born, Hauser did not provide any details of the advice she gave the McCaugheys at that point and bristled at the suggestion that seven fetuses might be too many: ""Should we as a society dictate to individuals the size of their families or their choices of reproductive care?''

But in a time of limited health-care dollars, multiple births--which have increased dramatically with the use of advanced infertility techniques--can seem a questionable use of resources. ""They're all on respirators,'' says Dr. Peter Heyl, a maternal-fetal specialist at Eastern Virginia Medical School in Norfolk. ""Our NICU costs $1,000 a day just to lie in a bassinet.'' He estimates that it costs a few thousand more a day for the septuplets' ventilators, blood work and physician fees. ""My hunch is we're into six-figure fees getting the seven kids out of the hospital,'' Heyl says. So far, McCaughey's insurance has picked up most of the bills.

The debate didn't seem to hamper the McCaugheys' joy. ""We were trusting in the Lord for the outcome,'' Kenny McCaughey told reporters. Kenny made his first public appearance on Thursday at the Missionary Baptist Church in Carlisle, where he and his wife worship. (The couple also has a large extended family, many of whom live nearby.) His first word: ""Wow!''

Their pastor, Robert Brown, calls the McCaugheys ""one of the most faithful young couples'' in his congregation. The church has been at the center of plans to care for the family. Eight church members formed The McCaughey Committee to raise money and provide other help (chart). As word spread through Carlisle that Bobbi was carrying septuplets, just about everyone guarded the family's privacy and kept them out of the papers for months.

Kenny's co-workers at Wright Chevrolet remember the summer day when he first showed them the ultrasound picture of the seven babies. He was, says sales manager Dane Wright, ""a little stunned.'' After Bobbi was put on bed rest, church members arranged to deliver family dinners. Others baby-sat for Mikayla. Bobbi McCaughey was trying to gain weight to help the pregnancy, and church members made it a mission to bring her favorite foods--Mexican takeout, meatloaf--to the hospital (ultimately, she gained only 25 pounds, including about 20 pounds of babies).

Late last week doctors said the babies were doing well; Bobbi and Kenny were able to briefly hold Kenneth on Friday. The septuplets will probably stay in the hospital until sometime in January, but Bobbi is expected to be home by Thanksgiving, which the couple plans to celebrate with their families. Friday night, as he posed for a NEWSWEEK photographer, Kenny McCaughey pondered whether he would do it again. Then he smiled and shook his head. Next time, he said, ""it's someone else's turn.''


The money and resources necessary to raise septuplets are staggering--even excluding the medical bills. Here are the approximate first-year needs and expenses of seven healthy babies:

ESTIMATED FIRST-YEAR NEEDS FOR SEPTUPLETS: Diapers 15,400 Infant wipes 22,400 8 oz. cans of formula* 3,600-5,000 Loads of laundry 1,460 Volunteer helpers 35-49 FIRST-YEAR ESTIMATED EXPENDITURES FOR SEPTUPLETS, FOR A U.S. FAMILY EARNING $34,000-$58,300: Housing $15,790 Child care and education 5,820 Transportation 5,820 Food 5,175 Miscellaneous[t] 4,635 Clothing 2,370 Total $39,610