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joseph_kipikasa_0527.mp3
By Emily Berry
Staff Writer
From her hospital bed, Kim Rehring watches the antics of her four tiny babies on a sonogram screen: Sydney puts her hand to her face, Maggie stretches her limbs, Patrick wiggles and Tommy sucks his toe.
"I just trust that they're fine," Mrs. Rehring said from her room at Erlanger hospital, where she has been on bed rest in the maternal care unit for six weeks.
Mrs. Rehring, 29 weeks pregnant, and her husband, Matt, are about to join an exclusive group -- parents of quadruplets.
Births of quadruplets have increased since 1980 but still are extremely rare, said Dr. Joseph Kipikasa, the high-risk pregnancy specialist who is caring for Mrs. Rehring and the quadruplets.
Even more unusual is the type of quadruplets the Rehrings are expecting -- two sets of identical twins.
Use of fertility medications, in-vitro fertilization and more older women becoming mothers drove a rise in multiple births from 1980 to 1997, according to the Centers for Disease Control and Prevention. Mrs. Rehring was taking a medication to stimulate ovulation when she became pregnant.
The number of triplets and so-called "higher-order" multiples -- quadruplets, quintuplets, sextuplets and septuplets -- rose by 404 percent between 1980 and 1997, according to the CDC. Since then, the numbers have stabilized and, in some cases, even dropped slightly, according to multiple birth statistics from the National Organization of Mothers of Twins.
The Rehring quadruplets will be the third set of quads born at Erlanger in the last 20 years, according to reports.
Surprise!
When she learned she was pregnant late last year, Mrs. Rehring said doctors told her she was carrying twins.
A week later, she went back and was told triplets were on the way. Another week later, the doctors broke the news about the fourth baby they spotted.
"I just laid there and cried," Mrs. Rehring said. "I said, 'Look, if you're going to keep going up every week, I'm not coming back!' "
Doctors put Mrs. Rehring on bed rest at home starting Feb. 27 and admitted her to the hospital six weeks ago. She gets up only to use the restroom -- about every half hour during the day and every hour at night, she said. She stays in touch with family and friends via e-mails she sends from her laptop. Fans blow an air-conditioned breeze to keep her cool.
Each morning her husband emerges from the heavy blankets he sleeps under in her room and tells the babies goodbye.
"They go crazy when they hear Daddy's voice," she said.
Her priest comes to give her communion at the hospital, and the babies roll around as he sings to them, she said.
PRECAUTIONS AND RISKS
Bed rest and close monitoring of Mrs. Rehring are two precautionary measures doctors have taken to delay delivery of the quadruplets as long as possible to allow the babies to mature.
An average gestation for a single baby is 40 weeks; the average gestation for quadruplets without older siblings is about 31.7 weeks, according to a survey by Mothers of Supertwins, a group for parents of higher-order multiples. The survey found the average weight for quadruplets was 3 pounds, 6 ounces, and quadruplets spent an average of 29 days in a neonatal intensive care unit.
Doctors' best estimates are that the babies' weights range from 2 pounds, 12 ounces to 3 pounds, 1 ounce, Mrs. Rehring wrote in an e-mail last week.
The quadruplets will be at risk for a host of illnesses affecting their brains, hearts and lungs, Dr. Kipikasa said, though sometimes the smaller babies in a multiple set do better, he said.
"They are actually under more stress, and the stress kind of helps the maturation process," he said. "It's kind of counterintuitive. You would think the little ones would do worse."
Multiple births are physically dangerous for both mothers and babies, a fact that is sometimes overlooked, said Dr. Louis Keith, president of the Chicago-based Center for Study of Multiple Birth.
"I think that the public thinks all these things are wonderful: 'Let's go to a party because she's having four babies,' " he said.
Planning for the unknown
When Mrs. Rehring learned she was carrying quadruplets, she realized she would not be able to return to her job as office assistant at University Surgical Associates. After she resigned, she and her husband moved from East Ridge to Mr. Rehring's parents' home in Harrison, where they will live after the babies are born.
Dr. Keith said the Rehrings certainly will need the help.
"It is not an easy task to raise four children at once," he said.
Monica Rehring, Kim's mother-in-law and a mother of four, said she and her husband, Tom, are ready to help.
"It's going to take a lot of hands, and we just thought it wouldn't be fair to let them flounder out on their own," she said.
Kim Rehring, who already has joined a support group for mothers of multiples, said she isn't sure what to expect after the family is home from the hospital.
"At first I just picture total chaos," she said.
Her good organizational skills should help keep the "chaos" to a manageable level, she said.
The twins will sleep in two cribs in a Winnie-the-Pooh-themed nursery painted four colors, which coordinate with each baby's personal color: Sydney is lavender, Maggie is pink, Patrick is green and Tommy is blue.
Dr. Keith said the families who do well with multiples plan out their lives to the extreme.
"The ones who are more successful make it almost a military regimen," he said. "Things have to be done according to the rules."
E-mail Emily Berry at eberry@timesfreepress.com
By the numbers
United States 2003:
* 136,328: Number of multiple births
* 128,665: Number of twin births
* 7,110: Number of triplet births
* 468: Number of quadruplet births
Source: National Center for Health Statistics
