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Venaya Binwani
Theme: Women in medicine/Healthcare Issues
A couple of weeks ago, my mom shared one of her close friend’s pregnancy stories with me, which was unlike any other I had heard before. Hearing about Safira’s random episodes of bleeding, unpredictable contractions and 110 day stay at the hospital, I was left with dozens of questions, and a sense of admiration for the strength and courage it must’ve taken to bring her twins into the world. I was eager to learn more, and even wondered if she’d be willing to share the details for me to write about on our blog. After an hour’s long interview, I can attest to the fact that Safira’s story is both heart-warming and heart wrenching, and as an aspiring doctor, highlighted to me how scary yet beautiful the medical profession can be.
On the 27th of June 2017, Safira gave birth to her first baby boy, who sadly passed a day later, due to a blood infection. A year later on the 27th of November 2018, she found out that she was pregnant again, and with a visit to her gynaecologist she learnt that she wasn’t just carrying one baby, but two - identical twins. Upon telling me this story she described feeling fear, and thought to herself ‘how am I going to handle this pregnancy with two, when I couldn’t handle one?’, especially when carrying monochorionic twins in her condition would present an immense risk. Due to complications that arose in her first pregnancy, Safira was instructed to bed rest by her doctors, with minimal movement from the 6 week mark of her pregnancy. Her daily routine consisted of eating, sleeping, watching TV and worrying restlessly about her babies.
Given the unique risk that her pregnancy presented, she underwent two procedures to prevent her twins being born prematurely. The first of these was a cervical cerclage, to stitch up her cervix and prevent her from running into labour. This was followed up by inserting an arabin pessary - a silicon ring inserted into the cervix, to support the babies in the womb. As time progressed, Safira continued to obey the doctor’s instructions and limited herself to a life confined by the four walls of her downstairs guest bedroom. Her pregnancy appeared to be going smoothly, until her first episode of bleeding - a classic red flag in the realm of pregnancy complications. Alarmed by this, she was rushed to the hospital in the middle of the night. They pumped her full of medications to stop the bleeding and after a couple of hours Safira started having contractions, just 21 weeks into her pregnancy. Eventually, the contractions stopped and she returned home - but the doctors were unable to find the source of the bleeding. Just a week later, she woke up in the middle of the night to find herself bleeding once more. This time, she would not return home from the hospital until her babies were born. She was instructed not to move - not to walk nor stand nor sit up in bed or even turn on her side. Upon hearing of the new rules of her confinement, she expressed being overwhelmed and upset; on the verge of giving up on her pregnancy. However, she chose not to. She chose to fight for herself and her husband to bring these babies into the world at any cost. She cut off friends and family, weary of their pitiful looks and the sense that she had become a burden, but she remained resolute in her decision to do her very best to hold these babies for as long as her body would permit.
This proved to be more challenging than she had anticipated. One night, she turned over in bed to reach an itch on her back, but given how sensitive her body was to movement, this sent her into another episode of bleeding and contractions. It took the doctors another two weeks before they could find the source of the bleeding. They found an inflamed blood vessel at the tip of the cervix which would rupture from the babies’ kicking. This would explain why her bleeding episodes only occured in the middle of the night - when the mother is asleep and the babies are most active. Following this episode of bleeding, her gynaecologist feared the babies would come out soon, and so he prescribed her a medication called Dexamethasone - a steroid jab administered to mature fetal lungs expected to be born prematurely. However, the catch is that Dexamethasone stimulates contractions, and upon receiving her second dose, the doctors realised that these contractions would run her into labour. She described the contractions to be more painful than anything she had ever experienced before, and as someone with an allergy to the vast majority of painkillers, Safira had spent her whole life learning how to tolerate pain. In spite of this, she convinced her gynaecologists that she would be fine, and that she would bear the pain just to keep her babies growing in the womb for as long as possible. Unfortunately, there was nothing left for them to do, this time, the babies were going to come out.
As the surgical team prepared for her delivery, Safira sat down with her gynaecologist to ask him a favour. Throughout her two month stay in the hospital, she had complied with every one of her doctor’s instructions, she hadn’t gotten out of bed, avoided many of her favourite foods, and adhered to the poking and prodding of IV drips and injections. The night before her babies were born, all Safira wanted to do was take a shower. Upon hearing this request, her doctor started to cry. He wanted nothing more than to grant this simple favour, but it would not be possible, as two months had passed since Safira had stood on her feet, and there was no way she’d be able to walk. It would take weeks to gain back the strength she once had in her legs. Instead, she had to take her first shower after months on a wheelchair, before her doctor announced that it was time to take her into the labour room.
There were five doctors called in to perform the procedure: an anaesthesiologist, two neonatologists (one for each baby) and two gynecologists, alongside a handful of scrub nurses ready to assist. At 7:32 in the morning on the 1st of June 2018, the first of the twins were born, he was closely followed by his brother who was delivered just a minute later. They weighed a mere 1.3kg each and were immediately rushed to the NICU where they would stay for 45 days before going home. Meanwhile the surgeons attended to Safira, who had lost nearly 2 pints of blood in labour.
The morning after her twins were delivered, Safira went to the NICU to see her babies for the first time. They were tiny but by no means weak, their tests came back normal, their lungs had fully developed and they were on their way to becoming healthy babies who would soon be ready to go home. During the early part of their stay, they were fed TPN (total parenteral nutrition), a fluid administered intravenously, to provide the nutrients they needed to grow and develop. After a few weeks, their gastrointestinal tract developed and they were able to feed naturally. Soon they reached a healthy weight of 2.2 kilograms and were finally ready to go home. Safira described how much she hated the beeping sounds of the machines in the NICU, but interestingly enough her babies, to this day, can’t sleep in a silent room.
It has been over a year since Safira has given birth to her boys, who are now 16 months old. Due to their premature birth, the paediatrician expected that they’d be two and a half months behind in their development, however they appear to be progressing just as any other infant their age would.
As her story came to a close, Safira looked at me and said, ‘And you know Venaya, if you were to ask me if i’d ever have another child, I’d say yes. I’d go through that all over again, without hesitating for even a second.’ This left me shocked. I couldn’t fathom how someone would willingly stay in a hospital for 110 days, lose their ability to walk, contract and bleed and lose their appetite, develop Jaundice and live with the stress of losing their baby in order to bring another child into the world. However, it goes to show how strong a mother’s love can be. As a person who believes in science, I tend to look at things as they are, rather than what they could be. However, hearing about Safira’s journey really allowed me to understand how doctors don’t choose who gets to live and die, they can simply aid the course of life. Safira may have lost her first baby, but after a rollercoaster of emotions and despite all odds, she brought these two little boys into the world.