Natalie and Anthony Consolo wanted to expand their family. But not this much and not so fast.
Natalie is due to have quadruplets three girls and one boy sometime in the next two weeks. And the Ogden-area couple didn't use artificial fertility methods to conceive, according to Natalie's mother.
When they were told at their first ultrasound they were going to have four babies, not one, "Natalie just laughed. She thought it was a joke," said her mother, Linda Edmonson.
Once the babies are born, the couple will have five children under the age of 2: Their daughter, Dorothy, turns 2 on April 1.
And they've been married only three years.
"They wanted to have a nice-sized family," said Edmonson, who left her San Jose home to take care of Dorothy because Natalie, 30, was hospitalized in early January. "They didn't plan on it being this quickly."
Quadruplets are rare but not unheard of: In the past five years, four sets of quads have been born in Utah. Twins are much more common: Nearly 800 sets are born a year.
The chances of spontaneously having quadruplets meaning without in vitro fertilization [IVF] or fertility drugs is 1 in nearly 572,000, said obstetrician C. Matthew Peterson, chairman of the University of Utah's obstetrics and gynecology department, who is not involved in Natalie's care.
Quadruplets would also be unusual for women receiving IVF: Guidelines limit the number of embryos transferred because having multiple births can be difficult for the mother and babies. Guidelines recommend one or two embryos for women under age 35. In the majority of reproductive clinics, data show, the average number of embryos transferred for women over age 40 is three.
Natalie is on bed rest at Intermountain Medical Center in Murray, where doctors will induce her if she doesn't go into labor in the next two weeks. They don't want her to be pregnant past 33 weeks gestation, said Edmonson, who said Natalie is too uncomfortable to give interviews. "She is not feeling well. ... She's huge and uncomfortable."
Physician Cara Heuser, the specialist taking care of Natalie, said she's been amazed that the pregnancy is going so well. With higher-order multiple births, babies are at risk of not growing large enough. But all four are the size of a single baby at 31 weeks gestation.
"Can you imagine? They're probably all in the 3 to 4 pound range," Heuser said. "It's been a big challenge keeping her comfortable. There's four 4-pound babies in there, plus the placentas and the fluid. ... She's really been quite a trooper."
Natalie has a massage therapist and physical therapist, an air mattress and rigging to help her get in and out of bed. Mothers carrying four babies can gain from 40 to 100 pounds.
The babies have a daily ultrasound to monitor their heart rates and activity levels. The births will be by Caesarean section and will be coordinated with the hospital's newborn intensive care units, which will need to have four teams on hand.
The potential risks to the mother and the babies are too high to keep the pregnancy going much longer, Heuser said. Such risks include maternal high blood pressure and even death.
While Heuser can't predict how the babies will do developmentally, she said the expected outcomes are "generally quite good."
It's also unclear if the girls will be identical: They have their own placenta, which means they could have developed from three separate eggs, from one egg or even from two eggs.
"I'm really hopeful for a great outcome," Heuser said. "I'm excited to meet this little guy and his three sisters who are sitting on his head. He'll have to be kind of tough."
Just carrying quadruplets can be dangerous to the mother and babies.
Amy Montoya, of Layton, had quadruplets in 2008. She now has a pacemaker, inserted after she had a heart attack, brought on by the difficult pregnancy and "sheer exhaustion" afterward. She also has pelvic adhesive disease, in which scar tissue is stuck to her organs, also a result of the pregnancy.
"It's just plain hard," she said of having quadruplets, along with a 5-year-old and 18-year-old. She said her parents initially moved in to help out, and she continues to rely on help from family and her LDS ward. Money was also raised for the family by a high school.
Two of her quads, William and Leah, are in a care center with feeding tubes, tracheotomies and ventilators, and they may not return home.
Their conditions are caused by chromosomal abnormalities, not from being born as quadruplets, she said. Until recently, they lived at home and required 24-hour care.
Her other two quads, Joseph and Sarah, are healthy and busy 3-year-olds.
"I always wish [William and Leah] were good and wish they could run around with us. When I have the three, I wonder how could I do it with two more?"
Still, the 40-year-old doesn't regret going through with the pregnancy with all four doctors typically give the option of aborting one or two despite the exhaustion, expense and heartbreak. She had four miscarriages, she said, before she became pregnant with the quads through artificial insemination, sometimes used in fertility treatment.
"I wouldn't change a thing. I love them. I love being a mother even though it is just very tiring."
Like with Montoya, Natalie's doctor had given the option to selectively abort some of the fetuses to give the rest the best chance of surviving and thriving. But the LDS couple refused, said Edmonson.
"It was against everything they believed in. It wouldn't be something they would ever consider for the babies," she said.
The names are picked out Lucille, Anabel, Charlotte and Daniel but little else is prepared: The family has three cribs but no car seats, diapers or strollers, Edmonson said.
But she said Natalie is up to the task. She started attending a community college in San Jose at age 13 and transferred to Brigham Young University as a senior at age 19. She majored in microbiology and plans to homeschool her family, as she was homeschooled.
"She's got it all figured out," said Edmonson, who will also be on hand to help.
"I'll be staying as long as they need me."
The Consolo family is seeking donations for baby supplies. Contact them at firstname.lastname@example.org.