Thumbs up for KwaMashu CHC Maternity ward for successful delivery of twins in breech position

04 March 2018

KwaZulu-Natal Health MEC Dr Sibongiseni Dhlomo has congratulated the maternity department of KwaMashu Community Health Centre for the successful natural the birth of twins who were in the breech position.

Ms Ziphi Precious Ndlovu, 26, recently delivered her twin girls Ziyanda and Azande Mtshali at KwaMashu CHC, with the assistance of advanced midwife Sr Doreen Nontlahla (spelling correct) Ndawonde and her team. They were born 35 minutes apart, weighing 2.3kg and 2.5kg respectively. Both were in a breech presentation during birth, which is when a baby’s head does not move closer to the birth canal a few weeks before birth. In such cases, the baby's buttocks and/or feet are positioned to be delivered first.

Speaking to the KZN Department of Health today (04 March 2018), Sr Ndawonde said: “Delivering a breech is within my scope, but it is a challenging situation, especially when it is twins. You may never know the outcome. That is why they are usually not delivered at clinics because things can get complicated. I did what I could, and am happy that it all went well.”

Dr Neil Moran, the Head of Clinical Department: Obstetrics and Gynaecology in the KZN Department of Health, says that in South Africa twin pregnancies occur on an average rate of 1 in 50 pregnancies. And about 15% or these will have both babies in the breech presentation at the time of delivery.

“These days the great majority of breech presentations would be delivered by caesarean section, and so it is quite unusual for both twins to be delivered vaginally. Well done to the midwives involved for a professional job done.”

He adds that twins in general are higher risk than singleton pregnancies both for the mother and for the babies – and that unusual presentation of the babies at birth is more common.

“For the mother, a particular risk around the time of delivery is an increased risk of post-partum haemorrhage (heavy bleeding after the delivery of the baby). The mother is more likely than usual to go into preterm labour than with a singleton pregnancy, which means that the babies are more likely to suffer complications of prematurity. Malpresentations of the babies at are also more common, which can lead to difficult or traumatic delivery if no one with advanced skills in conducting delivery is present.”

When asked what complications could have typically arisen in a case like this, Dr Moran said: “As the babies were smaller than average newborns, the mother was probably a little bit preterm and had gone into preterm labour. If the mother had arrived in time at the hospital, when she was still early in labour, the doctors would have probably chosen to do a caesarean section because both twins were breech. In less skilled hands breech deliveries by the vaginal route can be problematic as the baby can get injured or stuck during delivery. This could lead to injury or even death of the baby.”

Dr Moran adds that all doctors and midwives who work in maternity should be taught how to deliver breech babies and conduct twin deliveries. This, he says, is part of the standard Essential Steps in the Management of Obstetric Emergencies (ESMOE) course that is used to improve and sustain skills of doctors and midwives working in maternity.

“ESMOE is one of the important skills that all Advanced diploma midwives should be competent in. Fortunately, the attending midwife in this case was an advanced midwife. She obviously applied what she had been trained to do and successfully conducted the breech deliveries without any complication. In the end it was a better outcome than having a caesarean section. Also, the mother recovered well without excessive bleeding.”

The twins’ mother, Ms Ndlovu, thanked the maternity team at KwaMashu CHC and said the two week old babies are healthy.

“They are doing well, and growing slowly. I am very pleased with the way I was treated at the health facility. I was extremely worried, and had doubts that my babies would live because I was told that the breech presentation is very risky. I am extremely grateful to the nursing staff at KwaMashu CHC.”

She says that although the father of the babies is unemployed and she is looking after the twins herself at KwaMashu Hostel, where she lives, she is planning to register the babies with the South African Social Security Agency so that she can receive a child support grant.

Reacting to the uneventful birth of these twins, MEC Dhlomo says: “We wish to congratulate all the midwives involved in the delivery of these babies. It is always touching to see our healthcare professionals succeeding in complex clinical situations. This is once again testimony that we have among us people who are highly skilled, committed and dedicated to their work. We are extremely proud of them, may they continue working hard.”

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This page last edited on 05 March, 2018

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