Imagine going for a routine ultrasound expecting to see one heartbeat, only for the technician to point out four. Now imagine learning that all four babies originated from a single fertilised egg that kept splitting.
That is exactly what happened to 34-year-old Jenitar Na'amoana at the Royal Brisbane and Women's Hospital. Already raising four young kids between the ages of one and ten with her husband Jortham, Jenitar was still breastfeeding her youngest when she found out she was pregnant again. The arrival of Emily, Harriet, Catherine, and Alexa on July 14 turned a family of six into a household of ten overnight.
While natural quadruplets are rare enough—occurring roughly once in every 700,000 pregnancies—spontaneous identical quadruplets (monozygotic quadruplets) are a medical phenomenon estimated at one in 15 million. In fact, medical professionals believe this is the first documented case of naturally conceived monozygotic quadruplets born in Australia.
Here is how a single egg splits into four, why these pregnancies carry extreme risks, and what it actually takes to care for high-order multiples.
How Monozygotic Quadruplets Form Naturally
Most multiple pregnancies happen when a mother releases multiple eggs during ovulation, leading to fraternal twins or triplets. Monozygotic multiples happen when a single fertilized egg splits early in development.
For identical quadruplets to form without fertility drugs or IVF, one of two biological anomalies must occur:
- Three sequential splits: A single fertilized egg splits into two separate embryos. Shortly after, both of those embryos split again, creating four distinct, genetically identical embryos.
- A single quad-split: Though far less common, early cell masses can separate into four distinct clusters during the blastocyst stage.
Because these babies originate from one single egg and one sperm, they share 100% of their DNA. They are always the exact same biological sex and share identical genetic traits.
The Medical Risks of High-Order Multiple Pregnancies
Carrying four babies simultaneously strains the human body to its limit. When all four share a single placenta—a condition known as a monochorionic pregnancy—the risks climb exponentially.
In a typical single pregnancy, the placenta supplies nutrients and oxygen to one fetus. In a shared placenta environment, babies must compete for blood flow. This setup exposes the pregnancy to serious complications:
- Twin-to-Twin Transfusion Syndrome (TTTS): Unequal blood vessel connections in the shared placenta cause one baby to receive too much blood while another receives too little. Left untreated, it can be fatal for both.
- Severe Intrauterine Growth Restriction (IUGR): Limited placental space means some babies stop growing at a normal rate due to restricted nutrient supply.
- Extreme Premature Delivery: The uterus can only stretch so far. Most quadruplet pregnancies struggle to reach 30 weeks.
Maternal-fetal medicine specialist Dr. Alexa Bendall—who managed Jenitar's pregnancy and eventually had one of the quadruplets named after her—noted that reaching 28 weeks was the critical milestone.
The four girls were delivered via emergency C-section at 28 weeks and four days. Their birth weights reflected the intense physical strain:
- Emily: 1,025 grams
- Harriet: 1,121 grams
- Alexa: 1,120 grams
- Catherine: 1,151 grams
Sailing through a monozygotic quadruplet pregnancy without major placental complications is practically unheard of in obstetrics.
What Happens After a 28-Week Quadruplet Delivery
Delivering four premature infants requires a massive medical operation. Hospitals routinely prepare separate neonatal resuscitation teams for each baby—meaning at least 15 to 20 doctors, nurses, and specialists occupy the delivery room during a quadruplet C-section.
Once born at 28 weeks, infants face an extended stay in the Neonatal Intensive Care Unit (NICU). At this stage of development:
- Lungs are underdeveloped: Preterm infants born before 32 weeks usually lack sufficient surfactant, a substance that keeps the air sacs in the lungs from collapsing. They require mechanical ventilation or CPAP support alongside synthetic surfactant administration.
- Temperature regulation is fragile: Lacking body fat, babies must spend weeks inside temperature-controlled incubators.
- Feeding requires tube assistance: Preterm infants at 28 weeks cannot coordinate sucking, swallowing, and breathing simultaneously. They receive nutrients through a nasogastric (NG) tube or intravenous TPN (total parenteral nutrition).
The babies will remain in the NICU until they reach full term, building muscle mass and learning to feed independently.
The Logistical Reality for a Family of Ten
Media coverage surrounding high-order multiples often focuses on the miracle of birth, but the practical reality of raising four newborns alongside four young children is daunting.
Consider the daily resource demands for four infants:
- Diapers: Newborns average 8 to 10 diaper changes daily. That totals roughly 32 to 40 diapers per day, or over 1,000 per month.
- Feedings: Premature infants feed every two to three hours. That equals 24 to 32 separate feeding sessions every 24 hours.
- Transportation: Standard sedans and 7-seater SUVs cannot accommodate eight child safety seats alongside two parents. The Na'amoana family launched a GoFundMe to purchase a 10-to-12-seater passenger van just to make doctor visits possible.
Managing sleep schedules, laundry, medical follow-ups, and financial pressures requires round-the-clock logistics that mirror running a small enterprise rather than a traditional household.
Actionable Steps for Families Expecting Multiples
If you find yourself expecting twins, triplets, or high-order multiples, take these concrete steps immediately:
- Transfer Care to a Tertiary Maternal-Fetal Medicine Center: High-order multiples require specialized obstetricians skilled in high-risk pregnancies and a Level III or Level IV NICU equipped to handle micro-preemies.
- Audit Your Support Network Early: Establish a practical schedule for friends, family, or hired help to handle non-baby tasks like meal preparation, laundry, and watching older siblings.
- Build a Strict Organizational System: Label clothes, tracking sheets, and medication logs with unique colors or initials for each child to prevent mix-ups once everyone is home.
