Unexpected triplets: What a Christmas surprise!

The holiday season is a time for family, love and good cheer for all of us across board. We get to kick back, relax after a long year, spend time with family and friends and count down the year as it draws to a close.

However, those of us who work in the maternity units, our cute little guests do not have any appreciation for the break. As the baby-welcoming committee, we remain on standby at all times, because, well, babies show up whenever they feel like! Our busy maternity units remain fully manned irrespective of the holidays. During my post-graduate training period, I spent my Christmas nights in the labour ward, lined up to sing merry Christmas to the little persons joining us. We had made peace with the fact that we would have to spread good cheer away from our families but we would not let go of the holiday spirit.

A well-wisher had brought some colour into our unit by stringing a bunch of Christmas decorations around the ward and a little tree was lit at the entrance, lights blinking away in the corner. I clocked into my shift at eight in the evening, and my colleague gleefully handed over the patients and took off to salvage whatever little he could of family time. I figured my colourful scrubs and flowers in my hair would do well enough to keep my spirits up.

The patients were many and babies popped all around, their first cries filling the air with wonder, while mums sobbed with relief. Melody* lay on her side trying to control her breathing as the contraction peaked, while her hand held her thigh so tightly. I was sure she was going to leave behind red welts.

I rubbed her back gently as the contraction subsided, before peppering her with questions regarding her labour. She was a first-time mother, expecting twins. They were both coming head first as per her last scan and she was scheduled for a vaginal delivery. She was now 36 weeks pregnant, feeling like a whale and glad that they were finally coming.

Another contraction later, she told me she had been in labour for about four hours. She had not broken her waters and had no bleeding. The contractions were, however, getting quite frequent and the pressure in her pelvic floor was getting unbearable.

I noticed she was bearing down and I abandoned my conversation with her and opted to examine her first, to ascertain her progress of labour. What I wasn’t expecting to find was a huge balloon of amniotic fluid billowing out of Melody. The baby was coming, whether I was ready or not!

I shouted for help and the midwife came running with a delivery pack. I told her to grab a second one as we were anticipating twins. There was no time to move Melody to the delivery room or couch. She was dead set on completing this business right here.

I quickly cleaned and draped her, broke the waters myself, letting out a big splash and within seconds, our first baby was here. The midwife received a healthy baby girl who was yelling loudly at the sudden exposure to cold while we cheered her on. Melody did not have a break, less than a minute later, another gush of warm amniotic fluid drained out of her as curly black hair peeked through. These babies clearly had a mind of their own. With one big push, the second baby girl was here with us. She was almost as loud as her sister, but quickly settled in as she was taken away to the warmth. Melody groaned again while the nurse was preparing to give her a shot of oxytocin to prevent her from getting post-partum hemorrhage. I turned to her and noticed she was bearing down again! I wasn’t expecting that. All that was left was to deliver the placentae. Yet here was Melody having another contraction and grunting hard as she bore down. I quickly re-examined her, only to feel a third head making its way through!

The nurse held back the injection as I supported Melody through the birth of her unexpected third bundle of joy. The baby took a little longer than the first two and melody had to have several more contractions and bearing down before we got there. She was exhausted, sweating up a storm and clearly terrified at the through of a third baby. The nurse kept checking on the heartbeat of the little one as we awaited the delivery, reassuring us that we were still on course.

The midwife had called for help and the junior doctor was already fixing an intravenous access for Melody in order to give her intravenous fluids and to run an oxytocin infusion. The night duty nurse-in-charge had notified the newborn unit doctor on call to come down to maternity and receive the triplets.

It took almost half an hour before our third triplet made a majestic entrance. He outweighed his sisters by a whole 500g and let out a loud cry that triggered a round of applause from the whole assembled team. He had arrived! Melody was almost passed out. She was too exhausted to say anything. A quick examination revealed that we were actually done and could now proceed with the third stage of labour. The placentae came out fused into one large one. Melody held her own very well, with the uterus contracting and the gush of blood slowing down to a manageable trickle. She had sustained minimal lacerations that did not require repair and was essentially in need of a good cleanup and some well-earned rest. But first, she needed to meet her triple Christmas blessings!

Triplet deliveries are uncommon, with an incidence of one in 7,000 to 10,000 live births. It is even more uncommon for them to make it to 36 weeks, with many being delivered by caesarian section at approximately week 34 to 35 of gestation.

For Melody, her triplets were completely missed. Melody had attended clinic at a local dispensary and it wasn’t until she was 20 weeks that the midwife noted that her womb was growing way too fast for the pregnancy age. She was then referred to the local sub-county hospital, where an ultrasound done noted twin pregnancy. Her pregnancy remained uneventful and she was referred to our facility at week 32, to complete her clinic and have a planned mode of delivery. A repeat scan still missed the third triplet and she was scheduled for delivery vaginally, pending no other complications. All precautions were taken to ensure the babies would be safe. Melody and her triplets were extremely lucky. They came through just fine. The little ones weighed between 2,200g and 2,700g. They were all fit to go home after 48 hours of monitoring. They were able to breastfeed well and Melody was producing enough for all three at the moment. What a Christmas surprise!

Dr Bosire is an obstetrician/ gynaecologist