"IT'S A MIRACLE"

By MICHAEL D. LEMONICK

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 miracles--by doctors as well as relatives--may 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 children--possibly 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 toll--physical, emotional and financial--their 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 treatments--not 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 away--though, 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.

It was an ambitious goal. The more babies a woman is carrying, the earlier they try to force their way out. On average, triplets emerge at 33 weeks, seven weeks before full term, and quadruplets at 31 weeks. No figures exist for quints and other multiples because so few are born, but the trend isn't encouraging.

To keep things as stable as possible, Drs. Mahone and Drake ordered Bobbi to bed just three weeks after the septuplets were discovered. On Oct. 15 she was moved into the Iowa Methodist Medical Center, where she could be put on medication to stave off labor and where she and the babies were within easy reach of the labor team that had already been assembled.

Surprisingly, it wasn't until Bobbi entered the hospital that word of her remarkable pregnancy became public, though it had been an open secret in and around Carlisle for months. That may seem incredible for anyone who hasn't experienced the close-knit solidarity of a small Midwestern town. But while Bobbi's condition was discussed freely in Carlisle, the McCaugheys' neighbors quietly agreed that word shouldn't leak to outsiders. Says Kay Scholl, who runs Carlisle Foods with her husband: "Nobody asked us personally to keep it a secret, but it was known that this was the family's wishes. I'm extremely proud that we honored that." Even reporters at KCCI, the CBS affiliate in Des Moines, who got wind of the story early on, agreed to keep it under wraps. "Even if the ethics debate was raging in our minds," explains KCCI reporter Steve Karlin, "we have to live here."

Aside from the antilabor drugs, Bobbi had no special medical intervention; her treatment consisted mostly of downing vitamins, minerals and high-protein nutritional supplements. And while the risk of miscarriage, high blood pressure or other complications was always present, she stayed healthy right up to and through the magic 28-week barrier. Finally, last Tuesday, in the middle of her 30th week, the contractions that had been kept under control by medicine increased to 10 an hour.

More drugs might have helped Bobbi delay the inevitable, but, says Drake, "she'd had it." It was time to execute the plan that had been worked out over the previous two months. The delivery took place in a two-room surgical suite that normally serves cardiac patients. At 12:30 p.m. on Wednesday, Bobbi was partly anesthetized; 18 minutes later, the boy nicknamed Hercules (he'd been supporting the weight of all his siblings in the womb) was lifted out. "There was a lot of pressure," says anesthesiologist Dr. Dirk Brom, "but it all went like clockwork." Bobbi was quiet, Brom recalls, but "there were tears in her eyes as her babies were being born." Before she left the operating room, Bobbi was reportedly given a tubal ligation.

As they were delivered, each infant--Kenneth Robert (a.k.a. Hercules), then Alexis May, Natalie Sue, Kelsey Ann, Brandon James, Nathan Roy and, finally, Joel Steven--was taken to an adjacent room, placed on a warmer bed and given a ventilator tube and an intravenous line; then each was moved to the intensive care unit at the Blank Hospital. All the babies were initially listed in serious condition, which is actually better than expected, considering they were 10 weeks premature. Joel was briefly downgraded to critical on Wednesday because of blood loss. But by evening he had rebounded, and he has as good a chance of thriving as his siblings.

Despite their lack of growing space and premature delivery, the septuplets were surprisingly big, ranging from a respectable 2 lbs. 5 oz. for Kelsey to a (relatively) strapping 3 lbs. 4 oz. for Kenneth. Still, like most preemies, all the babies had trouble breathing at first. Dr. Robert Shaw, the neonatologist in charge of the babies' care, originally predicted that this condition would last four or five days. But by Friday, Kenneth had begun breathing on his own and had his status upgraded to fair. The rest remained in serious condition, but that's par for the course. "We're trying to let them rest, limit their exposure to infections and let them grow stronger," says Shaw. "We're working at maintaining their temperatures, which is not easy to do in an Iowa winter."

If all goes well, the kids will be out of the hospital by late January--which is when they would have been born if they had gone full term. Their mother, who has been visiting her babies by wheelchair, may leave the hospital early this week. In a television interview Friday, Bobbi said she'll be home for Thanksgiving "if I have to walk home."

Over the next few weeks, the medical team will try to wean the babies off their breathing tubes and IV infusions, and then start them on breast milk and formula to get their tiny digestive systems working. All the while, the doctors and nurses will be watching carefully; they're well aware that in the only other live septuplet birth, to a Saudi woman in September, three of the babies died a month later. They'll be giving the parents as many chances as possible to touch, hold and care for their children. On Friday, Bobbi and Kenny held Kenneth for the first time. "It was incredible," said Bobbi. "I can't wait to hold all of them."

Even after the septuplets go home, they won't be out of danger. As preemies, and especially as multiple preemies, they'll continue to run a higher risk of developmental problems. Shaw explains that the parents will be encouraged to put the babies through screenings at four months, nine months, 18 months and 30 months to assess their motor and cognitive development. Ideally, every stage--from when they sit up to when they crawl, walk and talk--should be scrutinized by experts. It may be years before their full physical and mental potential is known for sure.

As the McCaugheys negotiate the trials of parenthood, now increased sevenfold, they're determined not to let public attention get any further out of hand. They have been approached about doing a book or a movie based on their story, but they're moving carefully. "The big fear," said Kenny, "is that this could turn into a big show. This is my family...and we're not on for display."

Fertility experts are worried that all the attention being paid to the birth of seven healthy septuplets against monumental odds will convince others that such births are safer and less tragic than they so often turn out to be. Nevertheless, while she never set out to have septuplets, Bobbi has no doubt that she did the right thing.

"They're my children," she said on Friday, "and I wanted them."

--Reported by Wendy Cole/Des Moines, Kevin Fedarko/Carlisle and James L. Graff/Chicago

With reporting by WENDY COLE/DES MOINES, KEVIN FEDARKO/CARLISLE AND JAMES L. GRAFF/CHICAGO