How our miracle babies survived preterm birth

At the time of birth, what ought to have called for a celebration for having brought forth quadruplets turned out to be one heart-rending and confusing experience for Beatrice Mbalawa, a mother of four and resident of Mbezi.

A day after she had given birth at the Aga Khan Hospital in January 2018, Beatrice was told that it was time to see her babies.

The doctors, alongside her husband, who had already seen them, gave her glum smiles, uttering, “Congratulations! Your children are so big!”

One look at the tiny babies that did not look quite like human babies as they lay in the neonatal intensive care unit (NICU), and she was in great pain, denial and shock.

She froze in her tracks and felt woozy; the babies were so tiny—the size of a smart phone.

She had never before seen babies that size in all her lifetime. They were unlike what she had imagined.

As she walked towards them, all sorts of thoughts were coursing through her mind. Why me? She wondered inwardly.

She gave birth at the 28th week of her gestation period, the eighth month of her last trimester. The premature births followed false labour pains that had begun in the sixth month of pregnancy.

“Once, during those jovial times before the birth, my husband would joke that we would have to pay tuition fees for the children four times. Things changed when premature labour pains developed weeks before I was due for birth. That was in the 28th week, but I was due in the 37th week,” she told this writer ahead of World Prematurity Day.

World Prematurity Day is observed worldwide on November 17th every year to raise awareness of preterm births, including prematurity-related fatalities, challenges, and affordable ways to prevent them.

Beatrice recounts that when she laid her eyes on the two baby boys and two baby girls, she noticed their fragile and sallow skin pigment and other features on their bodies that made her feel somewhat partially responsible for causing them to be born as preterm babies.

Each baby had a nurse assigned to it who monitored them 24/7 to ensure that nothing went wrong.

Doctors, especially her doctor, who was attending to Beatrice and the babies, kept encouraging her to make sure she provided enough milk to the babies as their survival and growth solely depended on it at the same time, discouraging the use of formula.

“In some instances of frustration, I felt like being honest with them and telling them to their faces that it couldn’t be done. I felt like no one quite understood my ordeal, and this was slowly driving me into depression,” says Beatrice.

Doctors encouraged her to take walks along the beach opposite the hospital premises, but she declined because she was afraid that her growing suicidal thoughts would win and she would end up drowning herself in the ocean.

Insomnia set in for the couple, as Beatrice had been instructed to feed the babies at an interval of two hours apart.

It was then that the heart of the baby named Paul had stopped, and he was rushed to the ICU.

Two other babies, Peter and Precious, had developed apnea.

Apnea of prematurity occurs when newborns, especially those born prematurely, stop breathing for short periods of time. Apnea can be caused by the immaturity of the brain and the weakness of the muscles that keep the airways open.

The challenges did not stop there but she had to try and cope with them as they came. Two months after birth, Beatrice and the babies were discharged.

One morning, Beatrice and her husband noticed that one baby, Princess Esther, had difficulties breathing.

She was rushed to the hospital, where doctors gave her the assurance that all would be well and that the condition was not serious. Princess was whisked to the emergency department.

“We had taken the other three babies to the clinic, but when we came back, our doctor informed us that the baby had been taken to the ICU to prevent possible infections in the other three babies,” explains Beatrice.

“My husband remained at the hospital to keep watch over our daughter. I was hesitant, but the doctor cautioned me that the wellbeing of the other three depended on my decision to leave or not to leave the hospital.”

The next day, her husband came back with bad news: Esther’s lungs had been severely damaged, and the doctors had done everything in their power. They recommended that the oxygen on which Esther’s life depended be removed. Beatrice had no choice but to allow the procedure to be carried out. She died.

On funeral day, the other three were rushed to the hospital because their health conditions suddenly deteriorated. Apnea was again stalking Peter and Precious. At the same time, Paul’s condition had worsened. He was whisked to the ICU. Beatrice and her husband were later informed that Paul could not pass urine anymore.

The doctors advised Beatrice and her husband to evacuate to either Kenya or South Africa, where there was a machine that would save Paul’s life, because there was nothing more they could do.

Things moved quickly, and in two days, they found themselves at Aga Khan Hospital in Nairobi, where a series of new tests on the now-three babies began.

Situations drastically changed as the doctors informed Beatrice and her husband that it was Peter and Precious who had complications. Paul’s tests showed that he was doing well. In about a week, the babies got better, and the family was reunited again. The healthy triplets are now five years old and will be joining Standard One early next year.

“Tanzania has to extend maternal leaves for mothers with preterm infants from three months to at least six months because the conditions of preterm babies demand close supervision and more time to stabilise. Mothers of preterm babies either lose their jobs or their babies because they have to choose between the two. No mother should ever have to choose,” she advises.

She further insists on the need for counselling for such mothers before and after birth because this would help mothers understand prematurity in its entirety and help them manage the stress that comes with nurturing preterm infants.

“Every expectant woman should be very prepared and equipped with knowledge that would help them to manage the situation in the absence of doctors and nurses,” she stresses.

Dr Robert Moshiro, a paediatrician at the Muhimbili National Hospital in the Neonatal Unit, advises mothers with preterm babies not to worry that their babies will grow differently than other newborns. The first months of prematurity do not dictate the baby’s entire growth process.

“When a baby is born prematurely, there is a likelihood that the parents might give up on nurturing the baby due to the complications that come with prematurity; however, these babies grow up to become just like any other child; initial health complications should not discourage parents about the future of babies born prematurely,” he says.

Founder and Executive Director of the Doris Mollel Foundation, Doris Mollel, whose organisation primarily deals with premature babies, explains that Tanzania has to invest in having more neonatologists to serve in different parts of the country.

“The country has made several strides in the neonatal sector, especially in terms of investment in equipment for NICUs. However, there are still a few neonatologists in the country. The presence of more experts in this field could bring about many changes,” she emphasises.

Doris provides further details: “Key partners and stakeholders need to support scholarships for Tanzanian students willing to study neonatology because this would increase their numbers of these professionals in turn, decreasing the number of premature baby deaths across the country.”