Despite major medical advances, pregnancy and childbirth remain complex, risky, and challenging events for mothers, babies, and providers. The process from the fertilization of an egg to the delivery of a healthy baby is one of the most complicated in human biology, and even in a “normal” pregnancy, things can easily develop into a precarious and even dangerous situation for mother and child.

But what if you were facing an extraordinary, high-risk pregnancy that required the most advanced research and clinical care? A circumstance so rare that it had never been seen by a longtime obstetrician with a 50-year career? A sharing of responsibility so deep and moving that it required collaboration between families and doctors across the Atlantic? Or a record-breaking premature delivery that beat all the odds?

Where would you turn if you faced such a situation?

The answer: UAB Hospital, where a team of high-risk obstetric physicians and nurses, maternal-fetal medicine specialists, neonatology teams and a Level IV RNICU makes it one of few places in the United States with the resources and knowledge to provide these families with the best- possible outcomes.

December 2023: The Hatchers

Kelsey Hatcher arrived at UAB Hospital on Dec. 19 for a scheduled induction for her fourth pregnancy. Many would assume Kelsey would be something of an expert on childbirth, since she had three prior healthy pregnancies.

But Kelsey walked into UAB with a pregnancy classified as one in a million: She has a rare double uterus and was pregnant with a baby in each.

A rare condition

When Kelsey was 17, she was diagnosed with uterus didelphys, a rare congenital anomaly that occurs in 0.3 percent of women. The condition occurs when the Müllerian ducts fail to fuse together and subsequently form two uterine cavities. Each uterus has one fallopian tube and one ovary. In Kelsey’s case, she also has two cervices.

At Kelsey’s first ultrasound, she was unaware of her double pregnancy and was pleased to see her baby was doing well. But for good measure, she asked the technologist to check her second uterus. “As soon as she moved the wand to the other uterus, I gasped,” Kelsey recalled. “Sure enough, there was another baby. We just could not believe it.”

Kelsey’s obstetrician, Shweta Patel, M.D., assistant professor in the UAB Department of Obstetrics and Gynecology, was in disbelief at the news until she was able to look at the scans herself. While it is not as uncommon for women with a double uterus to have a pregnancy with one baby in one uterus, as Kelsey had carried three times before, having a baby in both—also known as a dicavitary pregnancy—is an estimated one-in-a-million chance.

“I knew I would need additional expertise,” Patel said. “Luckily, I was able to reach out to my UAB maternal-fetal medicine colleagues who specialize in high-risk obstetrics cases and unique pregnancies.” Richard O. Davis, M.D., professor in the UAB Division of Maternal-Fetal Medicine, co-managed Kelsey’s pregnancy with Patel.

Over the next nine months, Kelsey rotated between her obstetrics and maternal-fetal medicine team for routine checkups and ultrasounds. Other than a few additional appointments, her pregnancy was routine.

Delivery dilemma

Due to the rarity of dicavitary twins, Patel and Davis had only a handful of case reports to use to guide a plan for delivery. In some cases, both babies were born vaginally; in others, the cervices would dilate only to a certain point, thus resulting in a double cesarean section. There were also cases where one uterus went into spontaneous labor and the other did not.

“While C-sections may be a more controlled delivery option for high-risk cases like this one, we did not want to jump to the third plan immediately, knowing Kelsey’s history of successful vaginal births from both uteri,” Patel said. “We also listened to Kelsey’s wishes. She wanted to aim to have the same birth experience for the girls as her other children, if safe and possible.”

Double labor, double birthdays

The ideal scenario would have been for Kelsey to go into labor on her own. But since spontaneous labor did not occur, she was induced at 39 weeks.

On the morning of Dec. 19, the team began the induction process and waited to see if one baby would progress further than the other. Since she had two uteri, she required twice the monitoring and charting, and was assigned two labor and delivery nurses to monitor each uterus and baby.

Her right uterus—which had already had two pregnancies—began progressing further than the left, and the baby’s head was lower. The team decided to focus on the baby on the right and moved ahead with breaking her water on that side. A few hours later, Baby A, named Roxi, was delivered vaginally at 7:45 p.m., weighing 7 pounds, 7 ounces.

“There was a cheer from everyone in the room when the first baby was delivered, but there was another baby left,” Patel said. “Kelsey was essentially laboring in the left uterus while simultaneously undergoing the postpartum process in the right. She was having contractions with Baby B while breastfeeding Baby A.”

After Roxi arrived, the team listened to Kelsey and Baby B for the best course of action. They continued with an induction on the left side, but Baby B was not descending as anticipated for another vaginal delivery. A little over 10 hours after her sister was born, Baby B, named Rebel, was delivered via C-section on Dec. 20 at 6:10 a.m., weighing 7 pounds, 3.5 ounces.

Prior to Kelsey’s case, neither Patel nor Davis, who have close to a combined 60 years of experience, had delivered dicavitary twins. They relied on each other and the rest of the UAB women’s health team to ensure the result was two healthy babies and a healthy mom.

“It takes a team of experts from obstetricians to amazing nurses and a skilled anesthesia team to take care of such a rare pregnancy,” Patel said. “I am grateful that Kelsey was at UAB, where we could provide her with that interdisciplinary care.”

April 2024: The Pascoes

During the media coverage of Kelsey’s delivery, which received national and international attention, Richard O. Davis, M.D. said, “If you count my training, I’ve been doing obstetrics for about 50 years, and while I’ve seen many twin pregnancies, I’ve never seen a pregnancy with a twin in each side of a double uterus.”

Little did he know that just a few months later, he would be seeing another Alabama mother with exactly that kind of pregnancy.

Another one-in-a-million case

Several months prior, Shellie Pascoe waited with bated breath as the ultrasound technician began her scan. After two miscarriages within the past year and a half, Shellie and her husband, John, were cautiously optimistic they would walk out of the seven-week appointment with signs of a healthy and growing baby.

Instead, they received a surprise of a lifetime: Shellie was pregnant with two babies, one in each uterus.

Shellie discovered she had a double uterus, or uterus didelphys, after her first miscarriage. “When we found out about my condition, we were informed about the higher risk of pregnancy complications and potential fertility issues,” Shellie said. “I had a second miscarriage not long after the diagnosis. By the time I got pregnant again, we were extremely nervous that we would have another loss.”

Shellie, who is a physical therapist in the U.S. Army and stationed at Fort Rucker, was immediately referred to UAB to visit a maternal-fetal medicine physician who specializes in high-risk and rare pregnancies.

“We see unique pregnancies daily, but I knew Shellie’s case was on a whole new level,” said Brian Brocato, D.O., associate professor in the Division of Maternal-Fetal Medicine.

Brocato worked closely with Shellie’s obstetrician near her home to co-manage Shellie’s pregnancy, with the Pascoes making the three-and-a-half-hour trek to Birmingham every four weeks. While the pregnancy progressed in a typical fashion, one question loomed: how and when to deliver the babies.

Teamwork

Brocato turned to his maternal-fetal medicine colleagues for help on Shellie’s case, since no one else on the team had incurred this type of pregnancy. Or so he thought.

“We soon realized we had two patients with the same once-in-a-lifetime pregnancy,” he said. Kelsey Hatcher, UAB’s first dicavitary pregnancy patient, was two months ahead of Shellie in her high-risk pregnancy. While the two pregnancies had slight differences, Brocato was excited to have another case to learn from and colleagues to lean on for advice.

And Shellie had Kelsey to lean on for advice, since a member of Shellie’s church and a member of Kelsey’s church were related and helped introduce the two.

“It is scary going through two losses and then finding out I have a rare condition and pregnancy,” Shellie said. “Connecting with Kelsey, being able to follow her journey and seeing her babies come out healthy provided us hope. It was also comforting to know that the UAB team was going to have hands-on experience to learn from.”

Delivery day

While Kelsey delivered one baby vaginally and the other via C-section, Shellie and her care team opted for a scheduled cesarean section at 39 weeks. Brocato says the decision was primarily because Shellie had never delivered a baby vaginally prior to this pregnancy.

On March 6, 2024, Kaylee and Kamden Pascoe were delivered at the UAB Women and Infants Center.

“We had some concerns about making two internal incisions due to potential blood loss,” Brocato said. “Thankfully, the babies were positioned to where we could get both out with one larger incision. Kaylee, who was in the right uterus, came out first, followed by Kamden only two minutes later.”

Three days and some rest later, Shellie and John packed up their minivan to make the journey back to Dothan, this time as a family of four.

“We knew our journey to have children would not be without challenges, but it made being able to finally take Kaylee and Kamden home that much richer,” John said. “We hope our journey will be a source of encouragement to others in the same way the UAB team and Kelsey were to us.”

May 2024: The Bryants

In the early morning hours of Friday, May 31, 2024, nearly 30 maternal-fetal and neonatology experts filled an operating room at UAB. They were called in for an emergency cesarean delivery of quadruplets who were only 23 weeks and four days’ gestation.

As the babies were quickly delivered, the interdisciplinary team of physicians, nurses and respiratory therapists jumped into action, fighting to keep the babies alive.

Little did they know they had delivered—and were going to save—the Guinness World Records title holders for the most premature quadruplets, breaking the record set back in 1997.

Suddenly seven

In Feb. 2024, Becca and Lavareis Bryant attended a routine ultrasound appointment in their hometown of Auburn, Ala. With three older children, the couple was excited to get their first glance at their fourth baby. They were also nervous as they had recently experienced a miscarriage.

“The ultrasound tech started moving the machine around, and I started to notice one big spot and two smaller ones,” Lavareis said. “The next thing I know, she’s counting—1 … 2 … 3 … 4!”

They stared at each other in disbelief. The final baby of the family was actually four babies.

Becca’s pregnancy was now considered high-risk, so her obstetrician referred her to the UAB maternal-fetal medicine team.

Multiple pregnancies are rare, with twins occurring in one in 80 and quadruplets occurring in one in 700,000. Becca had a trichorionic quadra-amniotic pregnancy, meaning there were four babies and four sacs but only three placentas.

“The odds of this specific type of quads are around one in 7 million,” said Ayodeji Sanusi, M.D., Becca’s maternal-fetal medicine physician at UAB. “Three eggs were fertilized; but one split, making two of the babies identical and two fraternal. It also added on to the complex and high-risk nature of her pregnancy.”

Changing timeline

To minimize her risks, Becca alternated weekly scans with her OB in Auburn and the UAB team.

When her cervix began to shorten at 19 weeks, Becca was admitted to UAB Hospital for continual monitoring for the duration of the pregnancy.

“It was hard to leave my other kids; but I knew how important it was for me to be at UAB, where they had the resources and expertise needed to care for us.” Becca said.

The original goal was to get the babies to at least 32 weeks’ gestation, to balance the risks of prematurity and those of continuing pregnancy. Once Becca’s cervix shortened, the goal became 28 weeks.

But the timeline was accelerated when Becca’s water broke when she was only 23 weeks and three days along. Since she was not experiencing any additional signs of labor, her care team was hopeful that they could delay delivery a little longer and adjust to a new plan.

That night, Becca developed a high fever and abdominal tenderness, and her heart rate and the babies’ heart rates started racing, pointing to an infection.

“After discussions with the Bryants and the neonatology team, it was mutually decided to proceed with an emergency C-section,” said Sanusi, who is also an assistant professor in the UAB Department of Obstetrics and Gynecology. “It was an all-hands-on-deck situation. We even had team members who were not working come in to assist.”

The Bryant quads made their entry into the world in the early morning of May 31, 2024—Lainey at 2:15, Kali at 2:16, Lennon at 2:17 and Koen at 2:20 a.m.

Defeating the odds

The neonatology team rushed the quads to the Level IV Regional Newborn Intensive Care Unit, where they started UAB Golden Week protocols.

“The highest risk of complications and mortality for extremely preterm babies occurs during their first week of life,” said Colm Travers, M.D., associate professor in the UAB Department of Pediatrics and director of the UAB Golden Week program.

“The program focuses on minimizing complications in babies through that first critical week because it typically means a greater chance of survival and going home.”

Surviving the first week was only the beginning. Babies born severely premature can face complications including severe brain bleeds, chronic lung disease, bowel injury, infections, and sepsis. Each of the quads required multiple forms of ventilation, medications, and numerous central lines. All experienced their own medical challenges as well.

“There were so many times we were so close to losing one of them,” Becca said. “But I kept saying, ‘We came in with four, and we’re taking four home.’ We were going to do whatever it took to get there.”

Over the next five months and little by little, the quads began to grow and improve. The numerous machines that kept them alive were slowly taken away as the quads’ own strength took over. In November, they were all stable enough to be transferred down to the UAB Continuing Care Nursery, a milestone for RNICU babies. Soon after, the babies were ready to go home.

Guinness World Record holders

When Travers first met the Bryants, he discussed the risk, complications, and chances of survival for babies born at 23 weeks. He also realized he did not know of another instance where quads were born that early and all four babies survived.

Travers secretly continued to research extremely premature babies, and before the last Bryant baby was discharged, Travers had one more conversation with Becca and Lavareis.

“I realized there was a high chance the Bryant quads were the most premature quads to survive in the world,” Travers said. “Being able to tell them the exciting news, especially when our first conversation was not as optimistic, was a full-circle moment.”

The couple was, once again, in disbelief.

“Hearing our babies were the most premature quads put into perspective how lucky we were that all of them made it,” Becca said. “We had our family and friends, as well as the UAB team, there the whole way. Fighting for our babies, fighting for our family.”

May 2025: The Tobins and Zoy Ferguson

British citizens Becca and Jake Tobin welcomed their first son, Theo, in England in 2016. During the pregnancy, Becca developed placenta accreta, a condition where the placenta attaches to the uterine wall and can cause serious bleeding and complications.

“I needed a partial hysterectomy to save my life, but we knew that meant I may not be able to carry another child,” Becca said. “After a year of follow-ups, we were given the word that another pregnancy would be too dangerous for me.”

But Becca and Jake still dreamt of growing their family, so they started pursuing surrogacy.

Their journey led them to an agency based in the United States where they matched with Zoy Ferguson, a surrogate from Fort Payne, Ala.

“When I met Becca and Jake, I knew immediately that these were my people,” Zoy said. “This was the family I was meant to help.”

The families instantly bonded during an initial virtual meeting. It was a unanimous decision to officially begin the surrogacy process. A few months later, the families received the sign they were looking for: a positive pregnancy test.

A complicated road

The first trimester went smoothly with Becca and Jake making the international trek for ultrasounds and milestone appointments. At the 13-week appointment, concerns arose. By 16 weeks, serious complications had developed, and the pregnancy became high-risk.

Fortunately, Zoy lived an hour and a half from UAB Hospital, where a team of high-risk obstetric specialists, neonatology experts and a Level IV RNICU made it one of few places in the U.S. with the resources and knowledge to give the baby, named Jude, the best opportunity.

Zoy began weekly appointments with the UAB maternal-fetal medicine team. At 23 weeks, she was admitted to the UAB Women and Infants Center for continual monitoring for the duration of the pregnancy. Zoy’s and Jude’s health started to decline a week later due to an infection. To ensure their safety, Zoy needed an emergency C-section.

Jude Tobin arrived on July 19, 2024, at 24 weeks and 5 days old, weighing only 1.7 pounds.

The fight for Jude’s life

Babies born at 24 weeks have a variety of challenges, from breathing to brain bleeds, to gastrointestinal issues. For Jude, it was his lungs.

Colm Travers, M.D., is a UAB neonatologist who specializes in extremely preterm babies and met Jude during his first week in the RNICU.

“At that age, the lungs are typically underdeveloped. In Jude’s case, he also had pulmonary hypoplasia, which made his lungs even more underdeveloped, stiff and fragile,” Travers said. “It made it difficult to get him the oxygen he needed while avoiding injuring his lungs. He was exceptionally sick during his first week.”

Seeing clearly now

UAB's optometrists have also landed some big baby wins. In early 2025, new parents Lindsay and Adam dutifully took their infant son Charlie—who was meeting standard developmental benchmarks—to his required checkups with their pediatrician.

Little did they know he couldn’t see much of anything.

But after a routine pediatric screening indicated Charlie was severely farsighted and that he needed to be referred for comprehensive care, Lindsay and Adam booked an appointment with UAB Eye Care before leaving the clinic parking lot.

Kathy Weise, O.D., pediatric optometrist and professor at the School of Optometry, gave Charlie a thorough eye exam and got a precise measure of his farsightedness. The timing was fortuitous, since Charlie was moving into more complex developmental stages.

"When it came to start moving around—crawling and pulling up—Charlie’s visual world was more limited than it should have been,” Weise said. "His eyes were not providing the full picture.”

Two weeks later, Adam and Lindsay brought Charlie in for his fitting. “I was holding the camera to document the moment, and I melted,” Adam said. "It was magical to see him see a new world. It was the first time he saw his parents clearly.”

Charlie is now approaching his first birthday, and the new glasses have only accelerated his development.

“As parents, it fills us with pride that we were able to find out what our child needed so early and take action,” Lindsay said.

–Tehreem Khan

Jude spent the next five months in the unit receiving 24/7 care from the interdisciplinary team of nurses, neonatologists and respiratory therapists. All the while, Becca and Jake rotated being by Jude’s bedside and spending time back home in London.

“There were a lot of highs and a lot of lows. We really had to take everything day by day, hour by hour, and minute by minute,” Becca said. “And Zoy and her family were there for us every step of the way.”

For Zoy, supporting the Tobins and visiting Jude provided her healing from the rollercoaster of emotions from the high-risk pregnancy.

“When I got to hold him for the first time, I felt like everything was going to be OK. It repaired a part of my heart that I didn’t realize wasn’t there,” Zoy said. “He defied all odds. He’s a miracle, and he’s amazing. He’s so perfect.”

A trans-Atlantic partnership

Despite many challenges, Jude began to improve. Once Jude came off the ventilator, the question became how to get him home to the United Kingdom.

Travers, who is from Ireland, became more than Jude’s neonatologist. He became an international liaison for the family. He contacted neonatology colleagues in the London area and connected the family with key organizations and resources. He ensured Jude’s medical information and needs were accurately translated from the American to British medical perspective.

“We use different values and medical terminology than across the Atlantic, so I was there to make sure everyone was on the same page,” Travers said. “Our goal is to get our babies home and help our families however we can, and many times that means going past our bedside care.”

On Jan. 9, 2025, Jude was transported by a medical team to a London-area hospital. Five weeks later, he was fully discharged. The Tobin family was finally reunited under one roof.

For Becca, leaving UAB and Zoy left her with mixed emotions. On one hand, Jude had improved enough to finally go home. On the other, they were saying goodbye to a place that had become their second home and a team that had become their village.

“We had no clue the journey that we would end up on, but I am so grateful we ended up at UAB,” Becca said. “Between the resources and the kindest medical staff, we couldn’t have ended up anywhere better. This is where we were supposed to be.”