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As she stood up to leave, Frana Sadler embraced her friend Susan Dunaway, then gently kissed the newborn triplets who were dozing on Susan's lap. The infants had recently been released from the neonatal intensive care unit where they'd spent the first days of their lives, and Frana was paying them a visit. Now she needed to get back home -- to the condo next door, across a five-foot landing -- to her own three children. She was about to close the front door when Susan called after her. Frana then stuck her head back in the room. "Thank you so much," Susan whispered.
"Oh gosh, of course," Frana replied, as if Susan was thanking her for a casserole she'd brought over. The two women -- Susan, 29, a slim blonde, and Frana, 37, still in hormone overload from her recent pregnancy -- smiled at each other, then both burst into tears.
"It was just so emotional," Susan explains. "I was finally holding my babies in my arms, but if it weren't for Frana, that moment never would have happened."
It was "that moment" that the two women and their husbands had been working toward for the past year. In an extraordinary feat of teamwork, Frana had carried Susan's unborn triplets for eight months as a surrogate mother, while Susan acted as another kind of surrogate mom to Frana's three children, moving across the country and taking care of them while their mother was incapacitated by her high-risk pregnancy.
The story of how it took a village not to raise children but in this case to give birth to them could happen only in the 21st century -- but its themes of sacrifice, friendship, and longing for family are as old as time.
The Keith and Weber clans of the Texas Hill Country, north of San Antonio, have been extraordinarily close for nearly half a century. Frana Keith Sadler's father not only practiced law with Susan Weber Dunaway's grandfather and father, but he and Susan's father were also best friends. Growing up on neighboring ranches, the three Weber kids and six Keith children drifted in and out of one another's homes almost like cousins. In fact, Susan remembers, as a girl she idolized Frana and used to fantasize that Frana was her elder sister. "She always had a magnetic personality and charisma," Susan says, "and she still does." The two families shared good times, as well as tragedies. The worst of these were the deaths of Susan's father when she was 13 and of her 27 -year-old brother eight years later.
Both men died of complications from an inflammation of the heart muscles called cardiomyopathy. Susan had inherited the same condition but was able to manage it with medication. The drug she takes, however, is known to cause severe birth defects. A few days before Mother's Day 2008, Susan's cardiologist gave her some devastating news: It was absolutely unsafe for her to go off the drug for nine months of pregnancy.
"Of course, I knew he might say that, but I still wasn't emotionally prepared," says Susan. "I grieved that I'd never experience a pregnancy. At some point I'm sure we would have considered adoption. But then we didn't have to."
That's because Frana, upon hearing about the cardiologist's verdict from Susan's mom, immediately piped up, "I'll have a baby for her." (Not for nothing is the five-foot-tall former designer known within her family as "Ready, Fire, Aim.") Yet Frana felt confident about volunteering because she'd had easy pregnancies and delivered her two younger kids without drugs. "I'm a go-for-it kind of person," Frana says, "and I thought Susan had already had enough disappointment."
But first she had to run the idea past her husband, Mike. "I've stopped my wife from doing a lot of crazy things," he says, "but this seemed different. I could tell how important it was to her."
Frana e-mailed Susan that she and Mike were willing to explore the option of surrogacy with Susan and her husband, Scott. Susan was stunned. "We were still processing our sad news," she says, shaking her head in wonder, "and then we got this amazing offer."
Tentatively, Susan and Scott decided to do some research with Frana. The first step was to meet with a fertility expert to find out what was involved for both the biological parents and the surrogate. Frana would be a gestational surrogate -- only the carrier. The embryos would be created in a lab with Susan's eggs and Scott's sperm and then transferred to Frana's uterus. Next, the two couples consulted a therapist to ensure that there were no psychological obstacles, and then they legally formalized their agreement at a lawyer's office: Under its terms, Susan and Scott would pay for all expenses Frana and her family incurred, but Frana would receive no fee. "This wasn't about money -- it was all about my connection to Susan and her family," she says. "I couldn't be a surrogate for someone I didn't love. It's too emotional."
Once the contract was signed, Frana and Susan both started on hormones -- Susan to produce eggs and Frana to prepare her uterus. Then the project hit a slight bump in the road: The Sadlers moved from Texas to Laguna Beach, California, for Mike's new job in high-tech sales. So in late September, Frana flew back to Texas for the embryo transfer. After some deliberation, she, Susan and Scott decided to improve her chances by implanting two embryos. If both happened to "stick," they figured they could handle twins.
A month later a pregnant Frana returned to Texas for a first look at the fetus. As the fertility doctor listened for a heartbeat, Frana, Susan and Scott braced themselves for the news that there was more than one. But when the doctor announced that there were three heartbeats, they were speechless. The doctor explained that both embryos had taken and one had split into identical twins. And, alarmingly, the doctor couldn't tell if each twin had her own amniotic sac. (Twins sharing an amniotic sac are at a higher risk of being conjoined or getting umbilical cords wrapped around each other.)
"We were all so scared," Susan remembers, "especially when the doctor immediately began to talk about selective reduction." Selective reduction means aborting one (or more) fetus to lessen risks to the remaining ones -- a process that may jeopardize all fetuses. Instead of relishing a joyful event, everyone went away from the doctor's office feeling terror-struck. They were told to return in two weeks so the doctor could check whether separate amniotic sacs had formed.
Frana didn't stop crying during the entire flight back to California. "Believe it or not, I never really worried about myself -- about whether I could do it, or would get huge, or be sick," she says. "I just didn't want to deliver dead babies. I know someone who had that happen. Her twins, who shared an amniotic sac, strangled themselves on their cords at 24 weeks. If it happened to us, I'd have to deliver two dead babies and have the third at risk of dying, too."
Of course, Frana was also aware that carrying three babies increased her chances of severe complications such as preeclampsia, diabetes, and preterm labor . The contract stipulated that they would follow the doctor's advice for any medical decision, but from a legal perspective the choice of whether to proceed was up to Frana, since she was the person who was pregnant. "I thought, 'How can I live with myself if they want me to have all three babies and I say no?'" she recalls.
With these difficult questions hanging in the air, both couples gathered in Texas the night before the follow-up visit and talked about their worst fears. "That was key," says Susan. "This would have been impossible if we hadn't been able to be totally honest with one another." Everyone, including Mike, agreed that if the amniotic-sac issue cleared up, they wanted to go ahead with triplets.
Fortunately, the perinatologist they saw the next day found that each twin clearly had her own sac. The doctor reviewed all the possible complications with Frana but told her firmly, "You can do this." The goal was 28 weeks gestation as a minimum, 30 weeks if at all possible. Any time beyond 32 was a bonus. "After that, we never looked back," says Frana.
For the first several months of the pregnancy, Frana carried on with life as usual in Laguna Beach with her children, Enzo, 8, Amelie, 6, and Dempsey, 4. Susan flew in from Texas for doctor's appointments and tried to deal with the feelings of powerlessness that accompany a vicarious pregnancy. After Frana lost weight at one checkup, Susan grew alarmed. "I would've brought her a 1,000-calorie cinnamon roll every morning if she'd let me," she says, "but since the doctor wasn't concerned about her weight, I tried to let it go."
In mid-February, when Frana was 23 weeks along, Susan, who'd quit her job in children's ministry at her church, moved to Laguna Beach to help Frana as she grew too tired to manage many of her daily tasks. As it happened, the condo next to Frana's was available for short-term rental.
At 25 weeks Frana's doctor, Marvin Posner, MD, a specialist in high-risk pregnancies , put her on strict bed rest -- a common restriction during a multiple pregnancy. This meant that Susan's help was even more crucial to keeping the Sadler family on track. As Frana basically ran the household from the sofa, like a general instructing troops from her horse, Susan cooked meals, did the laundry, cleaned house, chauffeured the kids to and from their activities, and helped get them dressed in the morning and into bed at night. Initially the Sadler kids had trouble adjusting to a mom who couldn't take them to the bus stop or the beach. But before long the kids grew accustomed to their fill-in mom and the ordinarily super-charged Frana made her peace with immobility. The view of the Pacific from her living room and manicures from visiting friends helped. Meanwhile, sonograms showed all three babies to be nicely formed and growing steadily.
The two women were feeling almost cocky when, at a routine checkup during Frana's 31st week, Dr. Posner found that one umbilical cord was too close to the cervix, which could cause dangerous complications if her water broke. He ordered Frana into the hospital immediately; once there, she started having contractions every two minutes, and later her cervix dilated to 1 centimeter. It seemed that the "Cervix of Steel," as Dr. Posner jokingly referred to her, was giving out. To stop labor, he prescribed heavy-duty drug intervention.
Frana's being sent to the hospital rocked the two families to the core. Mike worried about his wife's health, but relaxed a little when Dr. Posner reassured him that he was not about to put Frana at risk. Susan had no trouble keeping the home front in order, but her emotional state swung wildly as she watched her old friend being buffeted by such powerful drugs. "It was painful," says Susan, who developed mouth sores from the stress. "I was so conflicted. I wanted to encourage her but didn't want to sound as if my motive was purely the babies. Thankfully, Frana was just as committed to making sure they stayed in."
The magnesium drip, a muscle relaxer, was the worst of the drug arsenal. When Scott arrived from Texas one day, he was horrified by Frana's state. "Her speech was slurred and she had a hard time opening her eyes," he recalls. Nearly overcome with emotion, he whispered a prayer at her bedside: "Please, God, let these babies know how much Frana loved them over the home stretch."
Frana, who was a competitive runner before her third child was born, says she got through this grueling period by comparing it to a marathon. "When you run a marathon, miles 17 to 25 are really hard," she says. "That's what it was like in the hospital. I'd tell myself, 'You can do this. Let's finish strong.' I wasn't afraid for myself and I trusted my doctors. I just needed to keep my mind peaceful."
Everyone on "Team Triplets" was on deck for days, in case delivery was imminent, but Frana's body got a second wind. Her contractions eased, the umbilical cord problem cleared up and she was weaned off the despised drugs. But there was no going home, since she could deliver at any moment.
Each weekly milestone was cause for celebration since every day in the womb meant less time the babies would spend in the NICU. Frana and Mike celebrated their 10th anniversary in her hospital room. She tacked the kids' drawings on the wall -- one read "You're a babby matchine" -- and welcomed their rather rowdy visits.
On May 6, when Frana was at 34 weeks, Dr. Posner saw that her kidney and liver functions were declining. He scheduled a C-section for the following morning. The babies had already gone longer than anyone expected and steroid shots had ensured their lungs were ready. When they got the word, Scott, his parents and Susan's mother back in Texas dropped everything and jumped on planes to reach California; Frana's parents got in the car and drove to Laguna Beach. Susan was overwhelmed. "I'm going to be a mom tomorrow, just in time for Mother's Day," she kept saying, as the reality soaked in.
The next day, starting at 8:23 a.m., almost a year to the day from Frana's first offer, Ann Francis, Ashley Michael, and Jon Sadler Dunaway (his middle name in honor of his surrogate family) entered the world healthy and weighing a total of 12 pounds. They went straight to the NICU, where Susan and Scott first held them. "I had waited eight months for them to grow in Frana's belly," Susan says. "Now I finally got to meet them."
Frana's contribution was almost done, but not quite: She pumped breast milk for the babies six to seven times a day for the next several weeks. On May 10, Mother's Day, Dr. Posner sent Frana home. Sitting on the grass in the front yard, already having lost 27 of the 38 pounds she'd gained, she serenely watched her kids play and sipped a longed-for beer. "I felt such peace and accomplishment knowing I had done the best I possibly could for those babies," she says. But Frana insists she doesn't long for the babies she carried for all those months. "I always knew they weren't mine," she says.
Her fondest hope is that her own children have absorbed valuable lessons about service and sacrifice. "I want them to see how good it feels to do something beautiful for someone else. This was just a blip in our lives, but for Susan and Scott it's huge: We gave them a family."
Originally published in Ladies' Home Journal, October 2009.