THE PARENTS: Maria Pyanov and Edward Pyanov of Elkins Park

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Edward Pyanov holds Luke, his wife, Maria, holds Lex, and between them are Liam (left) and Levi. The first three births were text-book easy, but Lex gave his mother a more difficult time.

The medical term is hyperemesis gravidarum, a Greek-Latin mouthful that means the kind of morning sickness that roils long past morning and can't be stanched with a saltine. The kind that makes a woman wobble greenly through her days.

The kind, in Maria's case, that goes on for 33 weeks.

She'd had three "textbook pregnancies," three relatively easy births. Liam arrived in the midst of a freak March ice storm, but Maria and Edward managed to reach Valley Birthplace in Huntingdon Valley in time. She labored in a Jacuzzi and recalls the birth as "a pretty relaxed experience."

The second baby, Levi, was in a hurry; it was less than an hour from Maria's first contraction until he emerged, at home, into Edward's hands, before the midwife could arrive.

And the third, Luke - by this time, the couple felt bound to use another "L" name so this baby wouldn't feel left out - came so efficiently they were able to put their older sons to bed at night, call Edward's mother to stay with them, head to the birth center, and be home, baby in arms, by morning.

This time was different. About five weeks into her pregnancy, Maria, a postpartum doula and childbirth educator, felt too ill to drive to clients' homes. It wasn't just routine nausea - "the kind where you get sick, wash your face, and go about your day" - but 24-hour, head-spinning, stomach-twisting turmoil.

"I had motion sickness even when I wasn't moving," Maria recalls. "Like I had just gotten off a merry-go-round."

She tried homeopathy and acupressure. She snacked on ginger chews. She couldn't even hold down water, and most of the foods she'd always loved - a veggie-and-fruit smoothie for breakfast, salads at lunch, salmon for dinner - seemed utterly repellent.

There were days she took in barely 500 calories, days when she would rally the strength to drive her older sons to school, then come home and collapse on the couch, eyes closed, until it was time to pick them up. Edward, a construction worker who often worked from 6 a.m. until 5 p.m., did all the cooking and laundry, every bath, every bedtime, every night.

The pair had met challenges before, individually and together: the childhood taunting Edward endured as an immigrant from Ukraine; that impossible tent they tried to set up at Creation Fest, a Christian music gathering, where they met in 2005; or when Edward was in Siberia, doing mission work, just as Maria found out she was pregnant with Liam. But this pregnancy strained both of them.

"At the table, it was just me and the boys, and she'd be on the couch, nibbling something," Edward recalls. "There were times I'd get frustrated and think: Suck it up; you can do this."

Maria - despite her professional expertise and the online forums that helped her find comfort and advice - also wondered if the wracking sickness was all in her head. "I would think: Maybe I'm crazy, maybe I'm overreacting. Nobody gets this sick."

After two visits to the emergency room for IV fluids, Maria began taking medication that helped quell the motion sickness just a bit. She still couldn't read - the print made her dizzy - or watch television, with its quick-cut motion and jumble of colors. At one point in her first trimester, the smell of people - not sweaty strangers, but her own husband and sons, fresh from a bath - made her feel ill. When she went outside, she wore a scarf spritzed with perfume or lemon juice to block other odors.

She ate potatoes, sipped lemonade, and developed a craving for buffalo sauce, the kind used to glaze chicken wings. "I don't even like spicy food, normally, but I was tempted to drink it," she recalls.

The days crawled by: twelve weeks. Sixteen weeks. Thirty. Finally, Maria felt steady enough to check e-mail or spend 10 minutes on Facebook. She could manage the carpool line at her boys' school without fear that she'd have to bolt for the nearest trash can.

On May 10, she cheered at Liam's baseball game and shared celebratory hoagies - a child-size portion - with the family afterward. Her water broke early the next morning. Though Edward was ready to leave for the birth center - he wasn't eager to catch another baby at home - Maria held off until nightfall, insisting she wasn't really in labor.

After a few evening hours at the birth center, Maria ordered everyone out of her room: Edward, the midwife, a too-eager midwifery student whose attention was making her edgy. She lay there in the darkness. Then, a familiar tug and urge to push.

"I said, 'He's coming out!' They all rushed in, and he was born. I remember just being relieved that it was done. All pregnancies feel long, but this one felt like an eternity."

This baby, too, needed an "L" name to match his brothers. It took Maria and Edward four days to come up with "Lex." In the meantime, Maria and the baby had been transferred to Abington Hospital; she had a low-grade fever, and doctors were playing it safe.

One day, an orderly brought her a tray of chicken marsala. Hospital food. And she ate it. Though she'd almost forgotten what hunger felt like, Maria began dreaming of real meals, the kind her family used to relish: pasta and crab cakes, sushi and tacos. Gradually, those months of misery began to fade.

In their stead is Lex Jonathan, a calm and cuddly baby. There is the daily tumble of boys, the big family Maria and Edward wanted. For both, there is the sharpened gratitude of having endured and survived.

"My favorite moments," says Edward, "are when we go to the beach. It's organized chaos. The kids are arguing and screaming, but there's a realness to it - packing the car, playing in the sand, the kids running back and forth in the waves, just enjoying family time."