Doctor’s take on distressed mother with unplanned twins

Just the other day, an old classmate came to our hospital with a concern. She needed to see a clinician urgently, despite the fact that she wasn’t ill.
She was in distress.  After a brief chat with her, she went on to explain that she had become a blessed mother of twins, six months ago, and,  a happily married wife for a year now.
Then, as a doctor, I went on to inquire what bothered her—that made her come to the hospital.
“I think I am pregnant again Ludo…” she replied, softly; while avoiding eye contact. But she went on to say, “I am scared of taking a urine test, I haven’t even opened up to my husband yet.”
Looking at her, I could see a sense of guilt. After a few minutes, she gained confidence and went on to speak her mind.  Her fears were based on what people would think of her new pregnancy—coming especially at a time when she was still breastfeeding her twins. She feared that her family would see her as irresponsible.
Learning her ordeal, I quickly intervened. “We haven’t even checked the tests yet,” I told her. At the back of my mind, I doubted if my quick intervention would make a difference in any way. Nonetheless, it seems to have calmed her down.
I used that moment to counsel her on the likelihood, implications and different sentiments surrounding unplanned pregnancies. I even intimated to her about the infamous saying of ‘mapacha wa nje’, literally meaning: siblings born in succession and unplanned.  She laughed. She hadn’t heard such a phrase before.  Then, she agreed to the test. When the results for urine pregnancy test came out positive, her obstetric ultrasound showed two eggs at five weeks of gestational age in her womb. She almost lost control of herself. I could see shame, denial and confusion written on her face.
This account got me thinking of countless related incidences that I have encountered in my medical practice so far. Quite often, the birth of the child provides joy and completion of the union of a man and a woman.  
The naked truth
However, the truth is that when children come before we are ready to receive them as parents, they invariably become source of anger, frustrations, betrayal, financial constraints and perception of social outcast, just to name few.
Think about this scenario for a while. That if all goes well, the lady in question will have second set of twins around July next year. By then her older set of twins’ children will be merely one year and five months old. Think about the cost for raising four children by such a young couple.  
Think about the necessary man power that is required to ensure they are well nursed. In these times of financial uncertainty; will the parents be able to provide undivided attention to all of them? I honestly logically doubt that.  
Moreover, subsequent pregnancy within 18 months of a previous one have been linked with increased likelihood of complications in the latter child; including fetal death, low birth weight, prematurity and small size for gestational age due to maternal nutrients depletion from previous pregnancy.
Consequently, due to these unforetold nightmares, it’s about time we should question our belief systems, society’s norms and myths on family planning.
Contraception is still vital
Although many young parents these days are always keen on preventing occurrences of unwanted pregnancies following the births of their children, very few pay attention to family planning.
Medically, we say family planning is the deliberate, conscious effort to control the number of children one ought to have, including the intervals between their subsequent births through artificial contraceptives methods or voluntary sterilisation.
UN Economic and Social Affair report on “Trends in contraceptive use worldwide (2015),” delineated that around 64 per cent of women in reproductive age are using contraceptives worldwide.
However, the trends were lowest in least developed countries where contraceptive use accounted for only 40 per cent and in particular 33 per cent among reproductive married or in-union women in Africa.
Another report by Population Reference Bureau titled “Reproductive health in sub-Saharan Africa (2008),” affirmed that in 2005 alone 536,000 women worldwide died from largely preventable and treatable pregnancy and childbirth-related causes including illegal abortions.
Most of these maternal deaths occurred in sub-Saharan Africa. Hormone related contraceptives prevent contraception by suppressing ovulation as well as thickening the cervical mucus plug making it impenetrable to the sperm. They include oral contraceptives, injectable contraceptives and implants.
Their success rate ranges between 95 per cent to more than 99 per cent if properly used. Other methods include intra-uterine devices, sterilisation, periodic abstinence/calendar method and coitus interruptus.
It’s important to note, however, that proper uses of contraceptives will not only decrease trends of illegal abortions and their complications but also relive family dependency, which is always the matter with large families especially in economic stagnant African nations where even food security is a fairytale.
As my friend continues to ponder on how she is going to raise her two pairs of twins I believe it is about time that women started being proactive in matters related to their reproductive health.
Henceforth, it’s wise to consult your obstetrics/gynecology specialist and have power over your life, dreams and most importantly family’s future.
The author is a medical doctor at Rabininsia Memorial Hospital in Dar es Salaam.