When a woman is eating for seven, nutrition becomes a battle. This is the lesson Heather Carroll, mother of the Alabama sextuplets born over Father's day weekend, learned. The 5 feet, 2 inch, 30-year-old from Plantersville packed away 6,000 calories a day -- the same as a Navy Seal in training -- just to keep her six babies alive until her scheduled Caesarean section last Saturday.
"It was very hard. All of the snacks ... every day they would start bringing me snack foods and desserts. I mean it was very good, but I can't imagine doing that again," Carroll said at a press conference Tuesday.
Though the six infants were scheduled to be delivered two months ahead of schedule, Carroll still had to spend the month leading up to the C-section on bed rest at the Brookwood Medical Center in Birmingham. While hospital staff ran drills to prepare for her multiple birth, Carroll was hooked up to an IV drip and chugged vitamin-enriched milkshakes (with a few Krispy Kremes to supplement) just to get enough nutrients to her babies.
"We think she's the smallest girl in the U.S. to carry sextuplets with survivability," says Carroll's ob-gyn, Dr. Bill McKenzie, at Brookwood. "She's just a little hiccup of a girl and had no real fat stores starting out, so I told her we needed to be as aggressive as we could with nutrition."
The hard work paid off on Saturday when, despite the high risk inherent in carrying and birthing sextuplets, five baby girls and one baby boy, all under 2½ pounds, entered the world between 8:05 and 8:08 a.m. All six infants are currently doing well at Brookwood Medical Center, and Dr. McKenzie says they can probably go home around Labor day.
The idea behind the "aggressive nutrition" was to increase the infants' chance of survival, and McKenzie believes it paid off. "They really act like they're older [than 28 weeks]. Their lungs are more mature. They've surprised us all with how quick they came off of ventilators and were breathing on their own."
Eating For Two, or Three or Seven?
Heather Carroll's herculean nutrition needs highlight an area of maternal fetal medicine that is relatively new: With the increased popularity of fertility treatments that can increase the incidence of multiple births, obstetricians and maternal fetal medicine experts must tackle the dilemma of how to correctly gauge high multiple birth nutrition.
"Nobody has done research on this," Dr. Alan Peaceman, chief of maternal fetal medicine at Northwestern Memorial Hospital, says. While the Institute of Medicine has recently set new, more modest guidelines for how much weight women should put on when carrying one child, there is not enough research to make good predictions about how many calories women with multiple births require and how much weight gain is optimal, says Peaceman.
To some extent, it can be guesswork, estimating the extra needs according to how many calories women carrying one child need, says Dr. James Lemons, professor of pediatrics at Indiana University.
"Generally, we say that the average singleton pregnancy requires the woman to eat an extra 300 calories per day after the first trimester. So with six babies, that would be an extra 1,800 calories," he says.
But when onr gets past quintuplets, McKenzie says the math behind calculating calories breaks down.
Feeding Sextuplets on the Way
"You can apply some calorie formulas, but there's no way you can really provide the kind of calories that six babies need. We set the bar pretty aggressive for her, because she had no fat stores on her body to speak of when she got pregnant," he says. Carroll had been on a 4,000 calorie a day diet in the months leading up the birth, but a month before delivery, she was hospitalized and given an extra 2,000 calories a day via IV drip.
"6000 calories a day is definitely not an overestimate of the calories needed with sextuplet pregnancies," says Dr. Kelly Ross, director of Pediatric Hospitalist Medicine at Missouri Baptist Medical Center. "We like to see these women gain between 70 and 100 pounds. Bigger multiples tend to be healthier at every gestation, thus caloric intake as paramount to a good outcome."
In addition to the IV and a high-protein, high-fat diet, Carroll was given six times the amount of folic acid normally recommended for pregnant women, alongside extra iron, vitamin D and magnesium. For the final month before the infants' birth, she was receiving around the clock extra nutrition via IV.
"Everything was medically selected and very nutritious, though rumor has it that Krispy Kremes and Starbursts played a pretty big role as a supplement," McKenzie says.