2016, ALL POSTS, Caesarean birth, Charlene Yared West, Hospital Birth, Magazine: Life Healthcare, pregnancy, pregnant

Prenatal Surgery: Saving a baby’s life in utero

In July 2015, Eunice and Nathi Motha finally became pregnant via in-vitro fertilisation and their joy at the news turned to pure elation when they found out they were pregnant with twins; a boy and a girl. After an uncomplicated pregnancy until 18 weeks, the couple readied themselves for the arrival of their babies. Sadly, however, the amniotic sac of the boy foetus ruptured and his leg protruded through the cervix. This made life in the womb for the boy unviable and the pregnancy needed to be terminated – or did it? According to gynaecologist obstetrician, Dr Deon Van der Merwe at Life Midmed Hospital, the girl foetus could be saved and the pregnancy for one of the twins could continue, the boy however, had to be removed from the uterus either vaginally or via caesarean birth.  

Not just another day at the hospital

It was the second time in 15 years that Dr van der Merwe performed an operation of this nature and he consulted with colleagues to gauge their informed opinions. “It is not an operation that is taken lightly as the dangers are immense; there is the risk of uterine rupture to carry the second twin to term after a caesarean at 19 weeks, there is also the risk of bleeding and sepsis and lastly, miscarriage, as the cervix was already dilated to 3 cm,” said Dr van der Merwe. “Even with all these risks, I had to help Eunice, as she had conceived under trying circumstances through IVF and she wouldn’t entertain me terminating the pregnancy.” 

Eunice relates how Dr van der Merwe explained the termination procedure and how she refused to listen to his words. She believes that after seeing their desperation and sadness in addition to her husband Nathi’s pleas to save one of the babies, he decided to do the work. “Even before Dr van der Merwe saw that my son’s leg was protruding through my cervix, I just knew something was wrong. For me his little leg kicking felt like a wriggling worm – a feeling I would never wish on anyone. It broke my heart to know that he would not make it,” says Eunice. “When they did the scan, I could still hear his heartbeat and I was so worried about if he would be hurt when the procedure was done; either vaginally or via caesarean. There was also no time for me to process all of these thoughts and we had to make the decision to save one baby or risk losing both babies… We chose to save our daughter.” The membranes were already ruptured for one week and the decision could not be delayed any longer. 

Emphasising that the operation was not an everyday procedure, Dr van der Merwe set to work, trying to remove the male foetus vaginally, but it was not possible and so a caesarean was performed. “We put the patient under general anaesthetic and after trying to remove the foetus through the cervix, which would not open enough, we knew the only way to save the second foetus’s life was to remove the first one via caesarean.” he said. 

Eunice remembers how she felt after the first operation. “I did not expect to have the burning sensation in my belly, as I assumed they would be able to remove him vaginally. I was denied pain medication so that they could do a scan after the operation was done to make sure my daughter was ok,” she says. “I knew I could endure anything for her well being, so that when I heard her heartbeat on the scan I was so happy, but it was also mixed with a deep sadness for the loss of my son, who I had never met, but who I had only felt – in my cervix. I still wish I had had the opportunity to see him with my own eyes, just to say goodbye – and that I was sorry.” 

A challenging caesarean section

Dr van der Merwe explained how the incision was made only after carefully ascertaining where the girl foetus’s placenta was. It was imperative not to accidentally rupture the amniotic sac of the second baby, as that would mean a complete termination of the pregnancy. “There would be no way to save the female baby if the membranes ruptured, so we had to be extremely careful. The incision was followed by removing the male infant with the ruptured sac and then putting the undamaged sac back into the the mother’s uterus to enable her to continue with the pregnancy,” he added. A stitch was also made around the cervix, as the pregnancy needed to continue – and because she had already dilated to 3 cm. “The risk of preterm labour of the other baby increased, as well as the chances of infection and so we had to be very cautious after the operation too. The longer the foetus could stay in the mother’s womb the better for it’s overall health and development,” said Dr van der Merwe. 

D-day for the girl twin to be born

Eunice’s pregnancy progressed to 35 weeks when she went into natural labour. She proceeded to go to the hospital immediately and underwent a second caesarean in the space of 17 weeks after her first caesarean. “The second caesarean was far less complicated; as the baby was ready to be born, although five weeks premature,” said Dr van der Merwe. “There was absolutely no way we could allow for an attempt at natural birth either, because of the danger of uterine rupture as a result of the very recent previous caesarean earlier in her pregnancy.” Eunice remembers meeting her daughter a day after she was born, as she was admitted to the neonatal unit for what became 13 long days after the birth. 

“After the caesarean, I was so confused and exhausted, so I slept a little while. On that same evening, I got up, had a shower and felt better. After getting dressed, I took a wheelchair up to see my baby girl… and I could not stop staring at her beautiful face,” says Eunice. “She was so amazing and just so beautiful and I will always be grateful to Dr van der Merwe who saved my baby’s life. My husband and I cannot be more thankful than we will always be to him. We named her Thembelihle, which means Good Hope; as she gave us hope when we almost lost everything.”

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