Triplets in Nigeria: “The whole maternity unit went wild with excitement”

Martins works for Médecins Sans Frontières / Doctors Without Borders (MSF) in Jahun, a town in Nigeria's Jigawa state. He supports a maternal healthcare project that aims to reduce the high number of women and children that die during childbirth.

Jahun is such a great place to be, but this is hardly the first impression you get as you drive into town.

It is easier to notice the dryness of the air here, then the large expanses of sand that stretch into the distance away from the tarred road you travel on. You can tell that these bare lands are not capable of supporting agriculture, so you wonder how the people here grow the food they eat.

Another thing that would likely hit you is the very hot weather, with temperatures often as high as 40 degrees Celsius on sunny afternoons. There are rarely any clouds to cushion the scorching effects of the sun as it blazes overhead, except during the few months of scant rainfall that come every year.

Not very many visitors expect to stay here for long.

There have been nights when as much as 40 deliveries were recorded – leaving the midwives on duty totally exhausted before morning."

It is common for our Nigerian staff, who arrive from other parts of the country where the weather is much milder, to think that dehydration can kill fast in Jahun.

Delivering a thousand babies a month

Despite coming from different backgrounds (and despite the weather, also) the staff who work here are able to go beyond the professional ties they share and begin to bond in beautiful ways – inspired by their shared values and a belief in what MSF are doing.

How they continue to stay refreshed and maintain motivation for their full assignment remains a mystery. Especially when you consider that the work schedule is tight - usually around 52 hours per week!

With a monthly admission of up to a thousand or more emergency labour patients, the maternity unit here is always busy.

And, while one would think that night shifts should be less busy, this is not always the case. There have been nights when as much as 40 deliveries were recorded – leaving the midwives on duty totally exhausted before morning.

At this point, there is nothing exciting anymore, as fatigue takes over.

“The whole maternity unit went wild with excitement”

There are, however, those rare occasions when the joyful atmosphere of the maternity unit overrides the stress of work, like recently in February, when the news broke that triplets had been delivered in the operating theatre during the night.

It was an unusual case. The mother was due to have a cesarean section, however, she ended up giving birth to all three children vaginally, without surgical intervention. This was almost unheard of.

The reaction was so overwhelming that even the staff that were off-duty came rushing into the MSF hospital to join in the celebration. It was a fiesta!"

The MSF surgeon on duty, Marcella, and the rest of the operating theatre team were there to carefully oversee the births.

The first of the children was delivered normally. The second child was a breech delivery, born bottom first instead of the usual head first. While the third child required a procedure known as "internal inversion" during the delivery.

This is when the unborn child is stuck at an unusual angle inside the mother and must be manoeuvred by hand during delivery. However, the procedure comes with a considerable level of risk, meaning surgery is usually considered the safest option.

Caesarean at Jahun

MSF surgeons deliver a baby by cesarean section at Jahun hospital. Photo: Maro Verli/MSF

You can understand why the whole maternity unit went wild with excitement as the news broke that the triplets had been delivered naturally and safely.

The reaction was so overwhelming that even the staff that were off-duty came rushing into the MSF hospital to join in the celebration. It was a fiesta!

Triplets are not regular news here, and most of our staff and volunteers witnessed their first birth of triplets on that day.

Coping with complications

While the triplets were great news for the team at Jahun, not every delivery here is without at least a few complications.

This is largely due to the fact that women often only arrive during a late stage of labour – having travelled far from their village to the MSF maternity unit.

Most pregnant women in the area are still unable to access antenatal care and have no idea of their expected delivery date. As a result, many often have no opportunity to prepare for motherhood.

In most cases, attempts are first made by local midwives to handle the delivery at home. When this fails, women will go to their closest healthcare centre. However, most of these have no facilities to support complicated deliveries. The patient will then be referred to MSF in Jahun.

By this point, saving the lives of both mother and child can become a very urgent concern.

Most times, our medical team is able to save lives, but other times they are sadly unable to do so - despite giving it their best shot. It’s very sad for everyone involved – the MSF team as well as the patients' relatives.

However, the outreach team of midwives and health educators are painstakingly mapping out strategies aimed at engaging rural women and their communities to prepare for childbirth. This has included inviting women to antenatal classes at their local healthcare centres and encouraging them to seek professional medical assistance during their delivery.

Currently, we have reasons to believe that these efforts will yield impressive results in future.

When this happens, Nigeria, Africa and the entire global community will experience a drop in maternal and neonatal mortality and morbidity rates.

Top image shows a mother being introduced to her newborn child by an MSF midwife. Photo: Maro Verli/MSF