Pregnancy With Quadruplets: A Rare Journey to Motherhood

Casey Dahl-Ponce and her husband, José Ponce, couldn’t wait to be parents. They had tried getting pregnant for two years after they got married, but Casey’s polycystic ovary syndrome, or PCOS, made it difficult. 

After their second try of intrauterine insemination, a fertility treatment that places sperm directly in the uterus, Casey got the call they had been waiting for. The fertility clinic nurse said that Casey’s pregnancy hormone numbers were “really high.” She was “super pregnant.” No one expected how literal that description would turn out to be.

At the first ultrasound, Casey, then 30, watched the screen as the technician moved the ultrasound wand across her belly. “The nurse said, ‘Oh, you’re having twins!’” recalls Casey. Then the tech moved the wand more and exclaimed, “Oh, you’re having triplets! Is that a fourth?”

The Challenges of Pregnancy With Quadruplets

Pregnancy with quadruplets is rare, says Jesus Rafael Alvarez-Perez, M.D, Casey’s maternal and fetal medicine OB-GYN at Hackensack University Medical Center.Pregnancy with quadruplets often ends with premature birth. “The goal is to reach 32 weeks,” he says. “We were using all the precautions to decrease the risk of preterm birth.”

On a Saturday night, five days into the 26th week of her pregnancy, Casey got up to use the bathroom and discovered some wetness in her underwear. She felt fine, but she contacted Dr. Alvarez Perez just in case. He suggested she go to the office on Monday.

On Monday, she was admitted to Donna A. Sanzari Women’s Hospital at Joseph M. Sanzari Children’s Hospital (part of Hackensack University Medical Center) as a precaution. Nine hours later, she’d dilated from 3 cm to 7 cm. It was time to bring her in for a cesarean section (C-section).

As she was wheeled into the hospital’s largest surgical room for C-sections, Casey felt calm. “Honestly, I’m usually nervous, but I was not the entire time,” she says. “I put the delivery in their hands. I felt safe the whole time.”

Extensive Preparation for the Birth of Quadruplets

Pregnancy with quadruplets meant Casey needed a huge team for the delivery of her four babies — five or six people for each baby, and the same number for Casey. That team had been preparing for this moment for months.

“At our monthly fetal care meeting, the OB-GYN department and the neonatal division discuss a list of upcoming high-risk deliveries,” says Marwa Khalil, M.D. “That way we’re prepared when the time comes.” Dr. Khalil was one of the neonatologists who cared for the babies immediately after birth and in the neonatal intensive care unit (NICU) in the months that followed.

All the advanced discussions led to seamless coordination in the operating room and the NICU. As each of their babies — two girls and two boys — was delivered, they were hustled into incubators. They eventually moved to the NICU, where the oldest stayed for 90 days and the youngest for nearly four months.

While the babies were in the NICU, the children’s hospital made accommodations for Casey to stay at the Audrey Hepburn Children’s House on the hospital’s campus. This saved her a long drive to and from the family’s home, which was more than an hour away.

The NICU team members closely monitored and cared for the babies, and now, at almost 4 years old, they’re all doing well.

In gratitude for the care they received during her pregnancy with quadruplets, Casey and her family have been regular participants in the hospital’s annualNICUSTRONG Walk. This year, 75 family members and friends joined them at the 2025 walk. Some came from as far as Florida to show their support. The quadruplets — Serena, Aaron, Maverick and Penelope — also joined in and walked alongside the team.

“It’s very meaningful for us to give back. And not just because we want to say thank you but because we can’t say thank you enough,” Casey says. “We want to make a difference in the lives of other NICU families and honor the people who cared for our children.”

By posting on social media and asking for sponsors, so far the family has raised $6,000, which was split between the NICU and the Audrey Hepburn Children’s House.

“I know it’s their job, but every single person who helped me with my kids was amazing,” Casey says. “They will forever be a part of our lives.”

Next Steps & Resources:

• Meet our sources: Jesus Rafael Alvarez Perez, M.D., and Marwa Khalil, M.D.
• Make an appointment with a maternal and fetal medicine specialist online or by calling 800-822-8905.
• Learn more about women’s health and children’s health at Hackensack Meridian Health.

The material provided through Healthier You is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.