In Rwanda, Mother Gives Birth to Twins, Four Days Apart
PIH staff conduct delayed interval delivery, rare and complicated procedure
Alice Ukwitegetse, 20, was excited to become a mother of twins; she had already thought of names for her babies, who were due in late 2020. The only concern in the expectant mother’s mind was how she would be able to tell them apart. Then, she started to experience serious complications.
When Ukwitegetse kept suffering from progressive pain and bleeding, she was concerned and decided to visit Gahara Health Center, a clinic in eastern Rwanda supported by Partners In Health. There, she learned that her cervix had started to open three months before the due date—a condition that could cause miscarriage and other problems.
“I started to feel my chances of being a mother fading away,” said Ukwitegetse.
Fortunately, the team at the health center, already familiar with the procedure that would be needed, transferred her to Kirehe District Hospital for emergency care. Partners In Health, known in Rwanda as Inshuti Mu Buzima, has supported Kirehe District Hospital since 2006 with staff, resources, and funding.
In Ukwitegetse’s case, urgent care would be essential to save her life and her babies.
A Premature Birth
Despite significant progress by the Rwandan government in reducing maternal and newborn mortality, 203 maternal deaths per 100,000 live births occur each year due to birth- or pregnancy-related complications.
As it seeks to eliminate all preventable maternal deaths, Inshuti Mu Buzima works with the Ministry of Health to improve the quality of maternal and newborn care, provide timely access to care, update maternal health infrastructure, and offer family planning and counseling services.
This partnership has helped to avert many preventable maternal and newborn deaths. When Ukwitegetse arrived at Kirehe Hospital, the team was ready to put their skills and medical technology to use. But there was another challenge.
“When we received Ukwitegetse on September 6, 2020, she had strong contractions and signs that giving birth was very close,” said Dr. Sadoscar Hakizimana, an OB-GYN surgeon and Inshuti Mu Buzima’s Kirehe program director. “This was dangerous for the mother and baby because it was not yet her due date.”
Babies born before 37 weeks of pregnancy are considered premature and can have health problems at birth and later in life. With Ukwitegetse’s pregnancy having been less than 29 weeks, her babies were at an even greater risk of suffering from health complications or dying within hours of birth.
Inshuti Mu Buzima staff knew that delaying contractions could help prevent premature birth and save the mother and babies’ lives.
“We gave her medication to stop contractions,” said Hakizimana. "But it was too late.”
Ukwitegetse gave birth—to one girl—without a C-section. The newborn was transferred to the neonatal intensive care unit. Healthy newborns typically weigh at least 5.1 pounds. Ukwitegetse’s daughter weighed 1.7.
In the delivery room, the team found themselves faced with another dilemma.
“The cervix closed and the contractions stopped before the second baby was born,” said Hakizimana. “This was the first time such a case had happened in the hospital.”
Three lives were at stake: the mother, the newborn, and the baby still in the womb.
The newborn needed milk, ideally breastmilk, to survive—but pumping it from the mother could trigger the birth of the baby still in the womb. More time in the womb would help the unborn baby develop further—but it would risk the life of the newborn, who wouldn’t have breast milk.
‘A rare and delicate procedure’
For four days, the team monitored the health of the newborn day-and-night in the neonatal intensive care unit to give her a fighting chance, while also caring for the mother to prevent any infection.
But two questions loomed: how long could they keep the unborn baby in the womb and where would the milk for the newborn come from?
“There were two possible options,” said Dr. Angelique Charlie Karambizi, a pediatrician with Inshuti Mu Buzima who was caring for the newborn. “A mother to donate milk or a milk bank. Unfortunately, there was neither a donor at the hospital nor milk bank in the whole country.”
Inshuti Mu Buzima buys and provides preterm infant formula to those in need at Kirehe District Hospital, but it is only used as a last resort. Breastmilk—which is rich in the nutrients that help brain growth and substances that boost the baby's immune system—is crucial for newborns.
“The first baby needed breastmilk to survive,” said Karambizi.
Finally, after day four, the team made a decision: they decided to pump breast milk from the mother to save the life of the newborn.
As a result, the second baby was born prematurely. But the extra days she had spent in the womb had increased her odds. She weighed 2.6 pounds, and her organs had developed significantly.
“It was a rare and delicate procedure,” said Hakizimana. “The twins [will] celebrate their birthdays on different days.”
After almost a week, Ukwitegetse met her babies. She was overcome with emotions when she visited the NICU where they had been under constant monitoring.
“On the delivery bed I had a picture in my brain of a very tiny baby that had spent her first days on earth fighting to live,” said Ukwitegetse. “When the doctors finally took me to see my twins, I couldn’t hold back my tears.”
‘I spent the whole day holding them’
In the days and months that followed, Inshuti Mu Buzima staff at the hospital worked to ensure that Ukwitegetse and her daughters not only survived but thrived.
“We have a well-equipped neonatal care unit,” said Karambizi. “As the babies were being monitored to ensure the development of their organs, we focused on training the mother on how she will care for them after getting out of the neonatal intensive care unit.”
Karambizi and his team connected Ukwitegetse with expert mothers and hospital staff for training in breastfeeding techniques, hygiene, assessing health risks, and other parenting skills.
After three months at the hospital, in December 2020, she was able to return home with her twins. She gave them similar Kinyarwanda names but with profound meanings: Shimwa (“thankful to God”) and Himbazwa (“praise to God”). Now, more than a year later, Ukwitegetse and her daughters regularly visit the one of the PIH-supported Pediatric Development Clinic at Rwantonde Health Center, where premature babies are monitored to ensure their full development.
“The doctors (meaning all hospital staff) taught me so much before I was able to touch my babies,” said Ukwitegetse. “When I was finally able to hold them, I was an expert. I spent the whole day holding them; it was the best time of my life.”