By Barbara E. Stefáno, Contributing Writer, St. Louis Nursing News

Fully alert and with nerves on edge, the troupe of 100-plus stages for its performance. The members have all learned their moves and now take their marks. Each stands at the ready, prepared to spring to life when cued.

No, it''s not a production of "Swan Lake." It is the team of doctors, nurses and support staff who brought a rare set of quintuplets into the world at Barnes-Jewish Hospital. The quintuplets, born to Jennifer and Pete Ferrill of Illinois, were delivered in December 2006 and cared for by staff from Barnes-Jewish Hospital, Washington University and St. Louis Children''s Hospital.

Now, the three institutions are sharing that rare learning opportunity with other nurses and physicians in a jointly sponsored conference on higher order multiples, scheduled for Nov. 1 on the Washington University campus.

"Just staging those (multiple) deliveries and orchestrating that and having the teams of people required to take care of those babies within moments – just within a matter of seconds – requires quite a choreography," said Judy Paull, APRN, CNAA-BC, director of patient care for the emergency department, psychiatry, and women and infant services at Barnes-Jewish Hospital.

Paull, a conference organizer, was responsible for planning and organizing the procedures for the Ferrill quints'' delivery.

Time and again, Paull reverts back to the term "choreography" in her description of the planning process. In order to accommodate one or more obstetricians per child, scrub nurses, anesthesiologists, circulators, resuscitative teams, OR techs and transport teams, plus their respective equipment, the "dance" had to be flawless.

"There is choreography involved. For the quints we created teams, A through E, and each was assigned a baby," she said. "We drilled and we practiced the hand-offs and the cutting of the cords. We practiced how long it would take to go from baby A to baby E."

Cramping the theater further was a camera crew from The Learning Channel (TLC), which followed Ferrill and the medical staff in the weeks leading up to the birth. (A special program, "Quintessential," aired in February, and a second is expected to air next year, Paull said.)

"We did walk-throughs with people standing in. We took measurements of all the equipment and decided who would stand where," she said. "We had to actually bring that many people in the room and see how we were going to do this, and we simulated stuff and did it several times until we had it down. I was so glad we did that, because that day it was like we''d done it before. It went off without a single mistake."

Quadruplets are fairly unusual – Barnes-Jewish Hospital handled only two or three cases over the last 12 months – and the quintuplets were a first for Paull and her staff. But professionals who attend the November conference will benefit from the unique experiences of Paull and other conference speakers in their care of higher order multiples.

"There''s not a lot out there for this and your own (hospital) geography drives what you can and can''t do," she said. "Our hope is that we can share some of the things we learned."

In addition to Paull, conference speakers will include Dr. Michael Paul, who was Jenny Ferrill''s primary obstetrician, and Dr. Kelly Ross, a mother of triplets and member of Mothers of Super Twins and Mothers of Multiples. The first episode of "Quintessential" will air during lunch. But the speaker Paull is most excited about is Ferrill herself; her quintuplets will be about 11 months old at the time the conference is held.

"I''m curious to know how they''re doing," said Paull, who last saw the quints six or seven months ago. "They just looked fabulous. They were big, they were healthy. They were smiling, interactive. They were just beautiful, normal-looking babies."

The conference runs from 8 a.m. to 4 p.m. on Nov. 1 at the Eric P. Newman Education Center, 320 S. Euclid Ave., on the campus of Washington University. Tickets are $75 in advance, $85 at the door and $60 for students. For more information, call (314) 362-6674.