Year Twins Triplets Quads Quints+
2000 118,916 / 6,742 / 506 / 77
2001 121,246 / 6,885 / 501 / 85
2002 125,134 / 6,898 / 434 / 69
2003 128,665 / 7,110 / 468 / 85
2004 132,219 / 6,750 / 439 / 86
2005 139,816 / 6,208 / 418 / 68
2006 137,085 / 6,118 / 355 / 67
2007 138,961 / 5,967 / 369 / 91
2008 138,660 / 5,877 / 345 / 46
2009 137,217 / 5,905 / 355 / 80
Source: National Center for Health Statistics
By Mariann Martin
Multiple birth rates -- particularly for triplets or more -- have leveled off and even declined in recent years.
The 2009 statistics, the latest year available, show that twin birth rates also have slowed but are still increasing.
The rates for all multiple births rose more than 400 percent during the 1980s and 1990s, peaking in 1998. Rates since then have fluctuated, but generally trended downward. The 2009 rates were about 20 percent lower than the 1998 peak.
The increase in rates during the 1980s and 1990s is associated with the older age of mothers at childbirth and the expanded use of fertility-enhancing therapies. The lowering rate may be influenced by guidelines from the American Society for Reproductive Medicine intended to reduce multiple pregnancies. Changes in assisted-reproduction technology procedures also may play a role.
In 2009 as in other recent years, multiple birth rates rose steadily with the age of the mother. Less than 2 percent of births to teen mothers was a twin, compared with more than 20 percent of births to women aged 45 and older.
Multiple births are likely to result in lower birth rates and the smaller size of multiples leaves them eight times as likely to die within the first month of life.
Source: National Center for Health Statistics, 2009
Everything comes in birth order in the Rehring family.
The four sets of clothes laid out on the back of the living room chair every afternoon. The four backpacks lined up for school the next day. The four dinner plates on the table.
Even the four Easter buckets Kim Rehring stacks without thinking about what she's doing.
Sydney. Maggie. Patrick. Tommy.
"I do it without thinking; I've done it ever since they were born," Kim said.
"The moment you put something out of order, it crashes the whole system," Matt Rehring added, taking a quick break from pushing four children on the swing set in their Chattanooga backyard.
It's one way Matt and Kim manage the challenges -- and rewards -- of parenting four 4-year-olds.
Parents know the juggling act that comes with children -- getting them ready for school on time, finding a missing shoe, cooking dinner with the help of an extra pair of tiny hands or simply keeping track of little bodies that can disappear in seconds.
But for the Rehrings, quadruplets make the idea of having one child or two children born several years apart seem easy.
With four children you learn to improvise, to save where you can and not stress about the little things, Matt and Kim said. And it's also important to savor each moment, whether it is a morning of playing in the backyard or trying to fold laundry with four preschoolers modeling the clean clothes.
"They're my life," Kim said, sitting at the Imagination Station playground in Collegedale with the leftovers of a tuna sandwich picnic spread around her. "There is no other job in this world like being a mom. It's not always sunshine and rainbows, but there's more good than bad."
Even before they were married, the Rehrings talked about having children.
They wanted four but planned for two or three because they couldn't afford to pay the bills with that many children.
Then came the positive pregnancy test and the trips to the doctor. In one ultrasound, their doctor pointed out two babies. The next time, they were told they were having triplets. Ultrasound number three showed four babies.
"I told them if they keep counting, I'm not coming back," Kim joked.
Kim, who had at least one miscarriage before getting pregnant with the quads, was taking medication to stimulate her ovaries. Twins run in both of their families, so they planned for the possibility of two.
The quads were born at 32 weeks, and about a month later, all four were home from the hospital.
Nearly five years later, it is hard for Matt and Kim to remember life without Sydney, Maggie, Patrick and Tommy.
"I wouldn't trade it for anything on this earth or outside of it," Kim said.
Every day is a whirlwind. The four are normal preschoolers, constantly running, jumping, talking, arguing and banging their knees.
"Being around them changes how you look at the world," Kim said. "Every day is an adventure, looking at life through the eyes of a 4-year-old."
Maggie is a petite blonde, the smallest of the bunch. She is quieter than her more rambunctious brothers and sister. Sydney has her mother's red hair. Falling off the swing or getting into a standoff with her brother over whose turn it is on the swing elicits loud complaints.
Tommy is the ringleader, figuring out how to unlock safely padlocked doors and making toaster waffles for the four the minute Kim turns her back. Patrick and Tommy can be hard to tell apart if they both have their hair cut short and wear similar clothes.
The four get into normal arguments but are fiercely protective of one another.
The Rehrings try to balance the fact that parenting four children is different from one, but that each quad is his or her own person.
"Each one you have to parent differently," Kim said.
They have four bunk beds, but the girls usually sleep together; the boys have adjusted to each sleeping in their own bunks.
At preschool, they are split -- one boy and one girl to a classroom -- making life a little easier for their teachers but still allowing them to be with one of their siblings.
They take weekend camping trips with grandparents, have play dates and picnics in the park, go for swimming lessons at the YMCA and took a recent trip to Dollywood.
People stop and stare, walk up and ask questions. The quads have adopted their own system to put an end to the barrage of questions and comments.
When someone approaches, one quad will quickly say, "We're quads. That's four," before the person can even ask the question.
Life isn't always easy when you are seeing double -- and double again.
The family lives in a 907-square-foot frame home -- three bedrooms and one bath -- with a fenced backyard and a large swing set. Kim does at least three loads of laundry a day, often four, and folds it on the back porch as she keeps an eye on the kids.
They drink six or more gallons of milk a week and countless cartons of juice. Two weeks' worth of groceries costs $300, even with bulk purchases.
Matt works at Wal-Mart, often taking overtime hours for the extra money. When he is at home, he is the swing-pusher and the final word in settling arguments. Both sets of grandparents help out with money and an extra pair of hands, but it still can be a constant struggle.
Many things really do take four times as long. Just last week, the parents spent an entire day filling out forms to admit their children to kindergarten. Each child had eight forms -- 32 pages.
"My hand was cramping; I was so tired of writing," Kim said.
Sometimes the quads beg for a brother or sister.
Matt and Kim answer that question in unison.
It's not happening.
The logistics have gotten easier as the four grow up -- in a way, Kim said.
You don't have to change diapers, and they can pick up after themselves. But they also can climb fences and unlock deadbolted doors meant to keep them all within earshot.
The quads started preschool this year, and Kim went back to work part time as a cafeteria worker for the Hamilton County school system. Her hours allow her to drop them off and pick them up from school.
When Kim takes them to the park by herself, she pins their names and her cellphone number to their clothes -- just in case. She has learned to listen for their voices as they disappear into a maze of slides and swing sets.
"You don't know what it's like to have eyes on the back of your head until you become a mother," she said.
Kim laughed as she recalled one of those mom moments you never forget.
The quads had picked up a stomach flu. Three were throwing up at the same time -- on the bed, on the floor, into the sink. The fourth was yelling he was going to throw up. Kim began retching herself, as she tried to wipe mouths and hold back hair from their faces.
"We got a big bucket and all threw up together," she said. "It was just easier that way."
Now that's love.