One pregnancy.
Nine babies.
And, against an extraordinary combination of medical risks, every one of them survived.
When Halima Cissé became pregnant in Mali in 2020, neither she nor her doctors could have imagined that her pregnancy would eventually become one of the rarest and most remarkable multiple births ever documented.
At first, doctors believed she was carrying seven babies.
That alone would have been an extraordinarily high-risk pregnancy.
But the true number was even greater.
On May 4, 2021, at a specialist clinic in Casablanca, Morocco, Halima underwent a Caesarean section at just 30 weeks of pregnancy.
One baby was delivered.
Then another.
Then another.
By the time the medical team finished, there were nine newborns.
Five girls.
Four boys.
Each was tiny.
Some weighed barely 500 grams — approximately 1.1 pounds.
All were premature.
All required intensive medical support.
And yet all nine survived.
Their birth would eventually earn the Cissé family an official Guinness World Records title for the most children delivered at a single birth to survive.
It was not simply an extraordinary birth.
It was the first known case in which a set of nonuplets survived beyond the immediate period after delivery.
And today, more than five years later, all nine children are still alive, healthy and preparing to begin school.
A Pregnancy That Was Already Extraordinary
Halima Cissé was 25 years old when the unusual nature of her pregnancy became clear.
She and her husband, Abdelkader Arby, already had an older daughter.
Then doctors discovered that Halima was carrying an unusually large number of fetuses.
Initial examinations in Mali suggested seven.
Even septuplets are extraordinarily rare.
A pregnancy involving three or more fetuses is medically classified as a higher-order multifetal pregnancy, and the risks increase dramatically as the number of babies rises.
According to the American College of Obstetricians and Gynecologists, or ACOG, multiple pregnancies carry higher risks for both the mother and the babies.
Preterm delivery is one of the most important dangers.
ACOG notes that triplets and higher-order multiples are almost always born prematurely.
Mothers carrying multiple fetuses also face increased risks of complications including high blood pressure, preeclampsia, gestational diabetes and postpartum hemorrhage.
The babies face their own risks, especially those associated with being born too early.
The more fetuses a uterus must support, the harder it becomes for a pregnancy to continue to the standard 39 or 40 weeks.
With seven babies apparently developing at once, Halima's pregnancy required specialist care.
The Malian government became involved.
On March 30, 2021, Halima was flown from Mali to Morocco so she could be treated at Ain Borja Clinic in Casablanca, a facility equipped to manage an extremely complicated delivery.
Guinness World Records later confirmed that the transfer was arranged specifically because of the exceptional medical risks involved.
Seven Became Nine
The story took another extraordinary turn after Halima reached Morocco.
Doctors discovered that she was not carrying seven babies.
There were nine.
Two had apparently not been identified during earlier examinations.
Suddenly, an already extreme pregnancy had entered territory almost never seen in medicine.
Nonuplets means nine babies developing in a single pregnancy.
Such pregnancies are so rare that most people will never encounter a documented example in their lifetime.
Before Halima's children, sets of nine babies had been recorded before.
But they had not survived.
The most famous earlier case occurred in Australia in 1971, when Geraldine Brodrick gave birth to nine babies at the Royal Hospital for Women in Sydney.
Two were stillborn.
The others died within days.
Guinness World Records records that none survived beyond six days.
So when doctors in Casablanca confirmed that Halima was carrying nine babies, the challenge was not simply delivering them.
It was giving all nine a chance to live.
Every Additional Day Mattered
The medical team tried to keep the pregnancy going for as long as safely possible.
That is often critical in premature birth.
A full-term pregnancy lasts about 40 weeks.
Each additional week — and sometimes each additional day — inside the uterus can improve a premature baby's chances by allowing the lungs, brain, digestive system and other organs more time to mature.
But with nine fetuses competing for limited space and resources, reaching full term was never realistic.
Eventually, doctors decided delivery could no longer be delayed.
Halima was 30 weeks pregnant.
Under standard obstetric definitions, all nine babies were therefore significantly premature.
ACOG classifies any birth before 37 weeks as preterm.
Babies born before 32 weeks are considered very preterm and can face serious medical problems, even with advanced neonatal care.
At 30 weeks, the babies would likely have immature lungs, difficulty maintaining body temperature and challenges feeding normally.
Their extremely low birth weights made the situation even more complex.
May 4, 2021
On May 4, the medical team prepared for the Caesarean section.
This was no ordinary operating room.
Guinness World Records later reported that 32 medical and paramedical professionals participated in the delivery and immediate care surrounding it.
Every child needed a team.
Every child might require breathing support.
Every child needed to be stabilized quickly.
There also had to be specialists focused on Halima, whose own life was at risk from complications such as severe bleeding.
The Caesarean began.
Then the babies arrived.
Five girls:
Adama.
Oumou.
Hawa.
Kadidia.
Fatouma.
And four boys:
Oumar.
Elhadji.
Bah.
Mohammed VI.
All nine were alive.
Their weights ranged from approximately 500 grams to one kilogram — around 1.1 to 2.2 pounds.
To put that in perspective, a healthy full-term newborn commonly weighs several times that amount.
Some of Halima's babies were small enough to fit easily into the hands and forearms of the specialists caring for them.
But delivery was only the beginning.
The next challenge was survival.
Nine Incubators, Nine Fragile Lives
Immediately after birth, the nonuplets were transferred to neonatal care.
They required incubators.
They needed carefully controlled temperature and humidity.
Their breathing, heart rates, oxygen levels and development had to be watched closely.
Premature babies often cannot regulate their own body temperature effectively because they have little body fat.
Their lungs may not yet be fully mature.
They can have difficulty coordinating sucking, swallowing and breathing, which makes feeding challenging.
Their immune systems are immature, increasing the danger from infection.
Other risks can include bleeding in the brain, intestinal complications, eye problems and long-term developmental difficulties.
Managing one extremely small premature baby can require an entire team.
Halima had nine.
Dr. Khalil Msaif, the clinic's pediatric neonatologist, described the babies in the early period as extremely immature and fragile.
But they were alive.
And day after day, they remained alive.
That was already remarkable.
The Mother Was at Risk Too
The survival of the babies naturally attracted international attention, but Halima herself had just undergone an extraordinary physiological ordeal.
Carrying nine fetuses placed tremendous strain on her body.
Multiple pregnancies increase the mother's blood volume, nutritional requirements and physical burden.
The uterus becomes greatly distended.
After delivery, one major danger is postpartum hemorrhage, because an overstretched uterus may have difficulty contracting strongly enough to stop bleeding.
Dr. Rochdi Talib, president and director general of Akdital, the group operating the clinic, later explained that the medical team had been particularly concerned about preventing serious hemorrhage after the delivery.
According to Guinness World Records, the clinic reported that Halima avoided the feared complication.
The delivery had succeeded not only in bringing nine living babies into the world but also in keeping their mother safe.
A Father Watching From Mali
Halima's husband, Abdelkader Arby, was not initially able to be beside her throughout the early months after the birth.
He remained in Mali partly to care for the couple's older daughter while Halima and the newborns received specialized treatment in Morocco.
Abdelkader, who served in the Malian Navy, later spoke about the extraordinary situation with a combination of gratitude and disbelief.
“We started with seven, and Allah blessed us with nine,” he told Guinness World Records.
For months, much of the family's life revolved around medical updates.
Were the babies breathing properly?
Were they gaining weight?
Were they feeding?
Were they developing normally?
For parents of premature babies, progress can be measured in tiny increments.
A few grams of weight gain.