It is Friday and Twin’s Day

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Today we have 4 sets of twins in Le Grand Salon (the post partum room):

On our first day at the clinic we were looking through the birth registration book and noticed numerous sets of twin births. I asked Awa, the sage femme, about the occurrence of twins. She stated that here are normally 2 sets born a month*** and that a twin birth was quite normal for her staff to do. She mentioned that there was a woman due to have twins around Feb. 14th and that she would call us no matter the day or hour.  Yeah!!!!!

Set #1

On Monday night/ Tuesday morning this week a woman arrived in labor, ready to push and  CheCha, one of the two mattrones, caught the babies (by herself). Baby #A was head down; Baby #B was breech. Mom and babies are fine.

Set #2

Later this Tuesday morning the clinic called us early to let us know that the women who was having twins had arrived but was only 3 cm. dilated.  So what —we rushed over as fast as we could walk on the 1 ½ miles of sandy roads (heart attack pace).

Because it was Jessica’s turn to take care of the next laboring woman (there are 2 of us students and we alternate getting the laboring women), Jessica was given this lady as her client. My turn will come.

At 11:15 a.m. a woman arrives in hard labor and her bags of water had broken at home at an unknown time; this will be her 5th child and she is assigned to me. I do the initial medical assessment; she is 8 cms., her fundal height is 37 cm. and she is moving along fast.  She does not speak French, Wolof or Jolla.

At 11:35 she pushed out a beautiful little girl who weighs 6.6 lbs. I cut the cord once it has stopped pulsating, hand off the baby to Jessica, guard the lower uterine segment and gently see if the placenta is ready to be delivered. No. It is a requirement of the Senegal Dept. of Health and a standard medical protocol of this country and this clinic that all women receive an injection of psilocin immediately after the baby is delivered. I give the injection and again palpate the uterus—it is still large and round at the top.  I ask Makeda, the preceptor, to look at this with me.  We discuss the global release of placentas,   put the mom in a squat position, and apply and little more gentle traction to the cord and out comes another baby fully enclosed in its bag of waters! A surprise twin! Makeda and I are crying for joy—a little boy weighing 5.2 lbs.

The mother had never come for prenatal care and had thought this baby was just bigger than her other 4 babies and did not move as much as the others.  Money and transportation and experience with birth contributed to her decision not to seek prenatal care. Mom and babies are doing fine.

Set #3

Jessica’s mom did not birth her twins that day. She is a first time mom and had prodromal labor (even with a pot of parsley tea) for 2 days before giving birth on late Thursday night.  CheCha, her aunt was present to catch her niece’s babies.  Things work out for the best—what a gift for her niece to have her aunt there for her. Mom and babies are fine.

Set #4

On Thursday afternoon a cab sped into the clinic courtyard and he called for help. There was a woman inside who had given birth to twins at home alone the day before; a neighbor had discovered her with a post partum hemorrhage and semi conscious. She appeared severely dehydrated, pitted edema, significant blood loss; she is standing at Death’s Door.  The twins, both girls had not been nursed; they weighed 4.2 lbs and 5.0 lbs.  This is her 3rd set of twins. Mom and babies are not doing fine.

**In Western Africa, the incidence of fraternal twins is very high. Over 20% of the births are twins.