In August 2017, an alert flickered across my email: The Jones quintuplets were celebrating their fifth birthday!
It’s hard to believe so much time has passed since Aug. 9, 2012, the day we delivered Carrie and Gavin Jones’ five preemies in five minutes at the old St. Paul hospital here in Dallas. The milestone prompted me to reach back through my collection of photos from their birth – and to recall the weeks of planning to ensure a safe experience for the babies and their mother.
The success of the delivery was due to a massive team effort, expertise, and careful attention to detail. In the days leading up to the births, Patricia Santiago-Munoz, M.D., and Julie Lo, M.D., who worked together to deliver the babies via cesarean section, participated in drills with the delivery and neonatal intensive care unit (NICU) teams to make sure everything was ready to go. Below, Dr. Santiago-Munoz shares her perspective from the moment Carrie was referred to us mid-pregnancy all the way through the successful delivery of the quints.
How Dr. Santiago-Munoz and her team prepared to deliver five babies
Carrie and Gavin came to us for care when Carrie was close to the middle of her pregnancy. They wanted to be close to family, and to have the expertise of our maternal fetal medicine team, which cares for women with complex or high-risk pregnancies, including higher order multiples. We recommended that Carrie be admitted to the hospital five weeks later. She was heavy and tired from carrying all of those babies!
Carrie required specialized care to protect her health and the quints. We scheduled weekly visits to evaluate her health and multiple ultrasounds to monitor the babies’ progress and growth. Carrie needed weekly iron infusions to meet her nutritional needs as the growing babies pulled resources from her body. Prenatal iron-deficiency anemia is fairly common in single-baby pregnancies. Just think about five babies sucking up all of your nutrients! Carrie also dealt with cholestasis of pregnancy, a condition that causes severe itching due to hormone changes.
Despite these challenges, Carrie was healthy during the pregnancy. We were amazed that she didn’t develop gestational diabetes or severe preeclampsia, two common pregnancy conditions that can lead to health risks for moms and babies. Both Carrie’s parents and Gavin’s gave their full support, helping to care for the Joneses’ older son, Isaac, and taking on responsibilities in their home while Carrie was hospitalized. And as the family rallied around Carrie, Gavin, and their son, my team huddled and planned what would be one of our most challenging deliveries to date.
Planning for the delivery
For several weeks, the team prepared everything for the delivery – literally everything, from tiny labeled blankets and nursery beds all the way to security detail at the hospital.
One of the most important factors in our planning was who would be involved in the delivery and aftercare of the babies and Carrie. Our “hands-on” delivery team would include Dr. Lo as surgical assistant, two of our maternal fetal medicine fellows, a very experienced scrub nurse, and myself as the delivering physician. We recommended a C-section because, with that many babies to deliver, it’s hard to monitor all of their heart rates at once to make sure everyone is tolerating labor. Also, there was a high chance that the babies wouldn’t all come head first. But it was super busy, even with a planned C-section!
Once the delivery team was set, we planned the equally important support teams. These individuals included NICU specialists, anesthesiologists, obstetrical nurses, respiratory therapists, pharmacists, security officers, and members of our public relations team. We also arranged for the St. Paul inpatient pharmacy to be on standby for the medications preemie babies usually need right after birth. Many meetings were held in preparation for this delivery.
Another major consideration was where the delivery would take place in the hospital. Of course, it would take place in one of the operating rooms in Labor and Delivery, but we also needed more space than usual, so we turned one of our adjacent operating rooms into a miniature intensive care nursery. In the space, we amassed the collection of equipment we’d need to deliver and support the quints. Each baby would have its own mobile NICU bed, which would facilitate easy transfer from the operating room to the NICU. We ordered extra equipment, such as special ventilators, just in case every baby needed extra help with breathing or other functions.
The five beds and five sets of equipment were labeled A through E, one letter for each quint based on birth order, and color-coded with pastel labels. This protocol not only made it easier to ensure we had five of everything we needed, but also helped us keep each baby’s blood draws and other birth information straight.
We practiced drills, including how we would transfer the newly born babies from the operating room table to the waiting arms of the delivery teams and how we would relay messages about the babies’ arrival to other team members. The team even taped off areas on the floor where each of us was supposed to stand!
On Aug. 8, my family left Dallas for summer vacation. I opted out, concerned that the quints might make an early appearance. After all the time spent planning for the delivery, I really didn’t want to miss it. My hunch was right – Carrie’s water broke on Aug. 9, right around her 28th week of pregnancy. This is incredibly premature for one baby, considering full term is 40 weeks. But in multiple pregnancies, we subtract three weeks from the due date for every additional baby to get an approximation of when to expect delivery. Twenty-eight weeks (the start of the third trimester) is pretty common for quintuplets, but it’s three months earlier than a healthy single-baby pregnancy.
Five babies in five minutes
I got chills of nerves and excitement when “Code 5 Quintuplets” flashed across my pager. It was time to put our weeks of planning into action. The team assembled and prepped Carrie for surgery. Then she and Gavin, along with the delivery team, got ready to meet the babies.
Just like we practiced, we delivered the babies via C-section one at a time over about five minutes. We formed a “baby assembly line,” transferring the babies to their mobile NICU nursery beds. Their labs were drawn and labeled according to their birth order, and the NICU team wheeled the babies out of the operating room to the nursery for observation. The color-coded labeling worked perfectly as we delivered the first three babies: Will, David, and Marcie. Seth came forth and wound up with a lovely pink set of labels! Grace was Baby “E.”
After the delivery, Carrie stayed in the hospital recovering for just five days or so. She was normal weight and fit and had no preexisting conditions before pregnancy, so that was definitely a health bonus for her and the babies. Of course, the pregnancy strained her muscles and back, but she followed our recommendations to a T and recovered relatively quickly from the C-section.
But being born three months early is tough on tiny bodies, and we wanted to be sure the quints were fully developed and healthy before sending them home. Will, David, Marcie, and Grace stayed in our NICU for a few months. Seth, who was the sickest of the quints, was transferred to Children’s Health for specialized preemie care. David got to go home in October. Next came Will, Marcie, and Gracie in November, and Seth finally joined his siblings at home in January 2013.
I cannot overstate the importance of the family support that Carrie and Gavin received during and after the pregnancy. Another couple in this situation that didn’t have that support might be much more stressed, physically and mentally. And please understand that the Jones family’s results are not typical. Most quintuplets simply don’t thrive as well as Carrie’s and Gavin’s have. In fact, the American Society of Reproductive Medicine discourages fertility treatments that result in twins or more. While the Joneses hadn’t planned for all the “more” that came their way, we’ll always remember this remarkable family and how close their delivery brought our various teams, and we consider ourselves lucky and blessed for their positive outcomes. It truly took a village to deliver the Jones quintuplets.
It’s tough enough bringing home just one new baby with an older child at home, let alone five! But the Jones family did it, and they’re currently loving life in Papua New Guinea, where they live and work as missionaries. You can follow their entertaining and inspirational story on their family blog.
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