Cape Town - It took eight rounds of in vitro fertilisation, four miscarriages, 75 days in hospital, and a heartbreaking journey to premature birth for a brave and tenacious new mother to bring her baby home.
A few months on, this committed parent can say with certainty – it was worth every moment. Tired of waiting for “the right guy” to come along, Robyn Ireton decided to take her future into her own hands three years ago at the age of 37, opting to join the ranks of single mothers by choice through sperm donation and in vitro fertilisation (IVF).
“I could never have imagined just how long and hard the road would be, the pain my body and heart would endure, or what my children would go through,” she said, reflecting on the tragic loss of her baby girl Libby at 24 weeks and the premature birth of twin brother Thomas at 29 weeks.
Dr Nelis Pretorius, a gynaecologist and obstetrician practising at Netcare Blaauwberg Hospital, notes that pregnancies involving multiple babies carry a high risk for premature birth. While the hope was for Robyn to carry two healthy babies as close to term as possible, the focus shifted to keeping Thomas safe in the womb when Libby’s chance of survival diminished.
“Each of the babies had their own sac and placenta, which is not always the case with twins, as sometimes the sac and placenta are shared. When Robyn’s water broke at just 18 weeks into the pregnancy, we quickly ascertained that it was only Libby’s sac that had burst. It would not be possible for Libby to survive outside the womb at this stage, and the chances of her sac repairing were negligible.
“At the same time, we were very concerned about Thomas and were trying to avoid his sac rupturing early too. Furthermore, with the first sac having broken, there was a risk of infection, which might have made it necessary to terminate the pregnancy completely and perform a hysterectomy as a last resort in the case of severe infection or sepsis to ensure Robyn’s safety. It was a challenging set of circumstances, and we had to take it step by step, but our aim was to try to see both babies through without jeopardising Robyn’s health,” says Dr Pretorius.
Knowing the risks, Robyn forged ahead. However, a few weeks later, she went into labour with Libby, who tragically passed away.
“It was heartbreaking,” said Robyn. “Everyone had fought so hard for her, and losing her was devastating, but I am very fatalistic, and in a way, it’s like she sacrificed herself at that moment so that her brother could live because she left us without impacting Thomas’ chance at life.”
Dr Pretorius explains that after Libby’s delivery, Robyn’s cervix closed again – a natural response enabling Thomas to remain safely undisturbed in the womb. He notes that a delayed interval between the delivery of twins is uncommon and comes with its own set of challenges. In this case, Libby’s placenta had remained in the uterus, and Thomas was still at risk for premature birth, so Robyn remained in the hospital until the birth of her son so that they could be closely monitored.
When Robyn experienced some bleeding – a sign of possible early labour – she was given antenatal steroids, which have been proven to help with foetal lung maturity, prevent brain bleeds, boost vital functioning, and decrease infection in the gut of the newborn.
According to Dr Ricky Dippenaar, a neonatologist at Netcare Blaauwberg Hospital, these steroids should ideally be administered between 24 hours and seven days prior to delivery.
“The longer the antenatal steroids have to work, the better an unborn baby is prepared to transition to life outside the womb,” said Dr Dippenaar.
Robyn does not recall feeling any contractions on the day of Thomas’ birth, but she had experienced some bleeding, and during a check-up with Dr Pretorius, it transpired that she was already 7cm dilated. Her baby boy would soon arrive. At just 29 weeks old, Thomas was born and taken straight to the neonatal intensive care unit (NICU), where he was placed under the expert care of Dr Dippenaar and his multi-disciplinary team.
Despite a relatively quick labour, Robyn experienced sudden blood loss shortly after the birth and was rushed to surgery by Dr Pretorius, who stresses that post-partum haemorrhaging is one of the top five causes of maternal death and requires immediate intervention. Fortunately, Robyn was able to receive life-saving surgery and blood transfusions in time.
“Dr Pretorius really fought for what I was trying to do and found solutions to the many challenges of my pregnancy and the birth. I felt incredibly supported by him and his colleagues at the hospital, obstetrician and gynaecologist Dr Sumaya Shah and Dr Ricky Dippenaar.
“Dr Lou Pistorius, a foetal specialist here in Cape Town, also played a significant part in our journey. All the while, the nurses in Netcare Blaauwberg Hospital’s maternity ward were my hospital family and helped keep me sane during my lengthy stay,” laughs Robyn.
“They were amazing.”
Thomas spent two months in the NICU, where he grew from strength to strength until finally being discharged as a healthy, happy baby to go home with his mother at last, only returning to the hospital for routine check-ups with paediatrician Dr Sheilie Eloff.
While Robyn’s journey to parenthood may be out of the ordinary, premature birth is fairly common, and Dr Dippenaar advises expecting parents to be informed about what this can entail.
“If your pregnancy includes risk factors for premature birth, it is important to put a plan in place early on. Visit the NICU, make an appointment with the resident neonatologist or paediatrician to discuss the way forward and ascertain which facility will be best suited for your delivery based on the needs of your premature baby.
“This will help to avoid hospital transfers, which are generally problematic for premature infants. The level of neonatal care depends on available equipment and expertise, and you want to deliver at the hospital with the right level of care for your baby’s needs.
“Preserving life and boosting development are also significantly influenced by maternal breastmilk, which provides nutrients, growth hormones, and stem cells. New mothers can expect to express milk throughout the day to ensure continued access to this ideal source of nutrition for their babies.
“While no outcome can ever be certain with premature birth, and the experience can be tough on parents, we are reminded every day of how strong the will to survive is, even in cases of extreme prematurity.
“The role of the NICU is to provide medical intervention in a supportive capacity until such time as a baby is ready to go home, and we consider parents very much as part of the treatment team in getting to that happy stage,” concludes Dr Dippenaar.