By Sola Ogundipe
At first, Prof. Oladapo Ashiru, an experienced endocrinologist and joint pioneer of In-vitro Fertilisation (IVF) Research in Nigeria and the entire West African region, couldn’t comprehend the statement.
“Could you please repeat your question,” he remarked. Ashiru, who is the Chief Medical Director, Medical ART Centre, Maryland, Lagos, and also Adjunct Professor at the University of Illinois, Chicago, had just been asked to comment on the case of Precious Donatus, the woman reported to have allegedly given birth to seven babies within the space of 11 months.
Speaking on the telephone from the United Kingdom, Ashiru paused briefly before responding. “There is no way that can happen. The normal human gestational period is nine months, so how can someone give birth normally to several babies serially in just weeks apart? To the best of my knowledge, what you’ve just told me is quite difficult to comprehend,” he noted with finality.
The fertility expert who was evidently puzzled about the claims of the woman probed further. “When did this happen and where? What was the birth weight of the babies? This information is vital; the scenario you’ve described is not normal for humans. Things don’t work out that way. Human babies are not born that way.”
But if Ashiru was taken aback by Precious’ story, another fertility expert, Dr. Abayomi Ajayi of Nordica fertility Centre, Lagos and Asaba, was not impressed. “I don’t believe it. It’s impossible,” he remarked without much ado.
Ajayi, an obstetrician and gynaecologist of several years standing dismissed the alleged incidence with a wave of the hand.
“Where is this woman? Which doctor delivered her the first time? Her story doesn’t ring true, but even if we are assuming she is telling the truth, I need to see her first. If she would subject herself to examination, I wish to see her myself and if possible, examine her to be sure she is telling the truth.”
Probed further as to why he felt Precious could not be telling the truth, the fertility expert stated: “Once a woman has given birth, the uterus is open and must be closed up as soon as possible to guard against infection. For her uterus to remain open for such a long period would have exposed her to high risk of infection.”
Multiple birth: Sweet taste with sour flavour
When a mother gives birth to a large number of babies at one time, the world never ceases to be fascinated. Twins, triplets, quadruplets, quintuplets, sextuplets, septuplets, octuplets, etc; the list appears endless. Multiple births can be multiple blessings as well as multiple problems.
Multiple births could be a bundle of joy one minute, and a bundle of grief the next. For instance, the high cost of raising multiples alone, can bring many families to the brink of financial ruin.
On August 5, 2010, a set of quadruplets was successfully delivered at the Lagos University Teaching Hospital, LUTH, Idi Araba, Lagos.
The babies, three girls and a boy, weighing 1,056g, 1,156 g, 1,006 g and 1,006 g respectively, were born premature at a gestational age of six months and three weeks, to Mrs. Queen Itama. It was her third pregnancy, having had two girls in the first two pregnancies. Amazingly, just a week later, another set of quadruplets were delivered at the same health institution!
By all means, multiple birth is not an uncommon occurrence in the country, particularly in the southwest. From Igboora, the land of Twins in Oyo State, to Ekiti, Ondo and Ebonyi States, the story is the same.
Saturday Vanguard gathered that multiple birth is a type of multiple birth in which the mother gives birth to two or more offspring from the same pregnancy. The occurrence and frequency, however, varies dramatically.
Factors such as maternal age, socio-environmental factors, increase in the use of contraceptives, the race of human population, increase in the spontaneous abortion rate, and seasonal variations are among the factors that could influence multiple birth including twinning (two babies), triplets (three babies) and quadruplets (four babies)
Assuming they are alive, Nigeria’s first known multiple birth babies (sextuplets) would be 103 years old today.
Historical and medical records show that the birth of the first set multiple babies in the country actually dates back over 100 years ago to 1907 when an unnamed 19-year-old woman from the South East region was delivered of six babies in a row after a short labour.
Although it is not known what their male/female sex ratio was or how many of the babies eventually survived, the event, like that of the controversial multiple birth babies, elicited as much drama, and graphic insight as to just how demanding all multiple births can be.
For several decades, multiple birth has been a regular feature in Nigeria. Multiple births refers to the delivery of twins and higher order multiples (eg, triplets, quadruplets, quintuplets, etc). Multiple births occur when multiple foetuses are carried during a pregnancy with the subsequent delivery of multiple births. Specifically, since the late 1970s, the prevalence of multiple births in Nigeria has been increasing.
A combination of factors including the widespread use of assisted reproductive techniques and advancing maternal age at conception is associated with this phenomenon. Records are scarce, but it is believed that a plateau in the prevalence of multiple births is yet to be observed. The Yoruba tribe with a birth rate of 45 twins per 1000 live births, are the world beaters when it comes to twinning.
A recent study at the Obafemi Awolowo University teaching hospital (OAUTH) showed frequency of twin births of around 46.5 per 1000 deliveries and 46.2 per 1000 deliveries was recorded for Ilesa and Ile-Ife respectively. The frequency recorded for Ogbomoso and Ado-Ekiti was 38.5 and 22.1 per 1000 deliveries respectively.
The overall average frequency of 40.2 per 1000 deliveries for the four hospitals ranks among the highest recorded rates of twin births in the world. The maternal age group of 25-29 years had the highest occurrence of twin births, while the lowest was recorded in the 45-49 years age group.
In the world today, there are over 100,000 multiple births occurring each year of which high order births (three and above) constitute less than three per cent. With increasing medical advances, particularly in the areas of infertility and care of pre-term births, the number of multiple births has increased dramatically, and the need for correct care and support as well as information and support to multiple birth families and health professionals, has never been greater.
According to medical experts, multi-foetal pregnancies are high-risk pregnancies, and are complicated by a higher incidence of hypertensive diseases such as anaemia, preterm labour, and several delivery complications such as Ceasarean Section, operative delivery, mal-presentation, cord accidents, etc.
The mean gestational age at delivery is approximately 37 weeks for twins, 33 weeks for triplets and 28 weeks for quadruplets. Divergence from singleton growth curves occurs at approximately 32 weeks’ gestation in twins, 29-30 weeks’ gestation in triplets, and 27 weeks’ gestation in quadruplets.
Multiple birth has devastating physical consequences and complications both for mother and babies. . “Unfortunately, once we get more than triplets, we’re really having a lot of problems with both complicated pregnancies for the mother and certainly complications for the babies,” noted , an infertility specialist at the Lagos University Teaching Hospital, LUTH, Idi-Araba Lagos.
Why are so many women having so many babies all at one time? Part of the reason is that treating infertility has improved tremendously but causes of most of the unassisted cases remain unknown. In a study entitled “Higher-order Multiple Births in Abakaliki, Enugu State, Umeora O.U, AneziOkoro E.A and Egwuatu V.E of the Department of Obstetrics and Gynaecology, Ebonyi State University, reported that higher-order multiple births have implications for perinatal and maternal morbidity and mortality.
Indeed, the incidence of multiple births in the black race as a whole has constituted a poser to scientists for centuries. Among possible explanations put forward is that a form of malnutrition is important.
But there are arguments that the multiple birth rate in a hospital cannot be taken as a true reflection of the incidence of a whole community, but in the absence of registration of births, they are the best figures.In a 1960 report by Knox, Senior House Officer, Gynaecology, Bristol General Hospital, and one-time Medical officer, Queen Elizabeth Hospital, Umuahia, Imo State, and Morley of a detailed survey at a village near Ilesha, Osun State, first time deliveries constituted 12.4 per cent of the total.
The study entitled “Incidence and Aetiology of Multiple Births in Nigeria” concluded that the true incidence of multiple births in the whole community could be 50 percent higher than the hospital rate.
The incidence of multiple births in the Yoruba and Ibo tribes was actually estimated to be about 3.5 times the incidence in England and Wales.
According to Knox and Morley, about the incidence of multiple birth in Nigeria is about 1 in 17 of all maternities, compared to the national average of 1 in 22, unarguably one of the highest rates in the whole world.
The world record for high-order or multiple births, notably twins, belongs to the Yoruba race. For decades, it has been established that the South Western zone of the country perpetually holds the gold medal for the highest number of twin births worldwide. Statistically, Igboora in Oyo State has what is arguably the highest incidence of twin births on the planet, a fact documented far back as the 1960s.
Reasons proffered range from diet to heredity. According to a medical expert, a woman with a family history of twinning has a high possibility of giving birth to twins. Same argument goes for the man. However, trends in assisted conception are another major factor.
Use of ovulation induction agents usually lead to multiple pregnancies. They are drugs used to stimulate ovulation in women who are not naturally ovulating. They help control the menstrual cycle.