Twins...

When we first arrived the labour ward team was very anxious about twin deliveries. They know all too well the kind of things that can go wrong - epitomised by a young woman who died in our unit recently. She had delivered in another facility - twin 1 survived but twin 2 died. Then she had a post-partum haemorrhage, a late decision to procede to hysterectomy, and she eventually sustained severe brain injury do to lack of oxygen. She never regained consciousness after surgery and was transferred to us essentially to die. We looked after her during her final week of life and our paediatric team helped the family to prepare for how they could look after the surviving twin.

But although twins are certainly a challenge, delivering them safely is one of the most rewarding parts of my work. For the last six months Sara and I have been working with our midwives and interns, encouraging them to develop their skills and experience, and we have seen them grow in competence and confidence.

This is Pauline, one of our new interns, with a set of twins that she delivered. We supervise our interns very closely to ensure that they are well supported and learn safe management from the beginning.

I also have the midwives manage these deliveries whenever possible, though again, I am always present for supervision and support. After this woman delivered her managing midwife was very pleased with how things had gone. 'I am so happy to be working in this hospital,' he announced to me. 'In most other hospitals in Kenya this would have been an automatic caesarean section. But here we know how to safely deliver twins.'

P.S. The little girl was named after me. :-)