When blessings triple

Salome* was wheeled into the unit in intense labour. It was four in the morning, an hour regarded as injury time in the graveyard shift. The ward was fairly quiet at this time, with the midwives taking turns to catch a snooze as the crazy night drew to a close.

Unlike other units in the hospital, the labour and delivery unit of the maternity ward exists to serve us with surprises, just like on this particular morning. Salome was accompanied by her husband, who was quite distressed. He stated that though the baby was coming, Salome’s dates indicated that she should have been expecting her baby in at least four weeks.

Salome was in too much pain to care. She just wanted the baby born. She was quickly transferred to a bed and settled in while I fetched my paraphernalia, ready to examine her. She noted this was her second pregnancy and that she had been in labour for about five hours, with the intensity increasing in the past two.

Her husband had gone to work at night. He had to leave work and find a taxi in the wee hours of the night, to get her to the hospital. By all means, Salome’s abdomen looked big enough for a baby who was due but that did not matter now, she was in advanced labour and we would know her baby’s status once they came out.

On examining Salome vaginally, I found the baby ready to come out. Her cervix was fully dilated and the baby’s head was already descending through the birth canal. We could not even transfer Salome to the delivery suite. We had to work with what we had. The midwife dashed to grab the delivery pack as she called for help.

Salome did not need much encouragement to push the baby out. When the contractions would hit her, she would bite her lower lip, hold onto her ankles and push like a champ. Three contractions later, a mop of hair came through, quickly followed by the face, shoulders and the rest of the body.

The slippery wet little girl opened her lungs and yelled out loud. She was quickly wrapped in the green towels to keep dry as we prepared to clamp and cut the umbilical cord when Salome experienced yet another strong contraction.

The baby was quickly handed over to the midwife to move her to the delivery suite where the resuscitaire was waiting to keep her warm under the watchful eye of her father. It looked like we were having another one. Suddenly the lull was broken and the other midwives jumped to action.

A second delivery set was brought in and while Salome and I concentrated on getting the baby out, the rest of the team prepared for a second twin while placing an intravenous cannula on Salome as a precaution, should she start bleeding.

Sure enough, a second mop of hair peeped through and in less than ten minutes, we had another energetic wailing bundle.

The little one was also promptly transferred to the delivery suite to join her sister in keeping warm. The mother was exhausted and overwhelmed at the arrival of the twins. She had no prior inkling whatsoever, that they were two.

As the midwife prepared to inject her oxytocin to help prevent Salome from bleeding out, I jokingly told her to hold on as we made sure that we were truly done with babies coming through.

Let’s just say, I was the one who ended up surprising myself, because, sure as day, there was a bulging amniotic sac staring right back at me!

However, Salome had no more labour pains. She was exhausted and was not even paying attention to us. However, when I told her that there seemed to be a third baby, her eyes flew open in utter shock, which quickly turned to terror.

Gently breaking the waters allowed us to assess the progress. The baby was in a breech position. The midwife quickly set up an intravenous infusion to restore the labour pains and help the little one navigate his way out.

It was now a waiting game. The contractions were slowly building up but in her shock, Salome wasn’t being too cooperative. Her urge to push was poor as she was exhausted.

The initial adrenalin rush had passed and she was starting to get cold. She was covered and kept warm as we bid our time. The baby’s heart rate remained strong. It is like he was too comfortable and was no longer interested in joining his siblings.

Salome’s husband was informed that we were waiting for a third baby. Thank God he was seated, because he very nearly passed out in shock. He started babbling about three babies, confused by the fact that even two were not anticipated.

The sympathetic nurse helped him call his mother and Salome’s brother to come and give the couple moral support. With breech delivery, the rule of the process is to hold back and let the baby find their way out for the most part.

This minimizes injury and allows the baby to find the most suitable position. The stakes are high and the waiting game is nerve-wracking for both the mother and ourselves. We kept watch as the sky turned pink outside, heralding the start of dawn.

Despite contracting well for the past hour, with renewed vigour to push, the baby had other plans. As the sun peeked over the horizon, Salome was wheeled to the operating room to help her deliver the last of the triplets through a caesarian section.

We celebrated from the labour ward as we heard the little one wail from across the unit! The triplets were finally reunited outside the womb as their overwhelmed mommy recovered from anaesthesia. Their father was still recovering from shock as the labour ward flooded with their family members.

The triplet gestation rate is about 93 per 100,000 deliveries around the world; coming with a markedly increased risk of mortality and complications for both mother and baby, in pregnancy and during delivery.

Triplets are commonly delivered at 32 to 35 weeks of gestation, with prematurity as the leading complication. Salome was extremely lucky. By her dates, her triplets were just a day shy of 36 weeks. They were pretty big, weighing between 1900g and 2100g.

What surprised everyone is the fact that Salome did not look like she was carrying triplets! Her tall stature may have masked the size of her belly. She had attended a local dispensary for her antenatal care and did not have access to a pregnancy ultrasound.

The midwife who saw her at the clinic did not pick up on the possibility of a multiple pregnancy either, hence did not refer Salome to specialized care in time.

Salome and her babies were an absolute miracle. The triplets required minimal special care in the newborn unit but were discharged home within a week.

Salome pulled through the delivery with ease, and her post-operative recovery was fairly uneventful. Her husband though, may be yet to recover from the shock of the three-in-one package of love he was presented with!

Dr Bosire is a gynaecologist/ obstetrician