A few minutes after giving birth to her daughter, Philasande Mbutuma (30) from Kraaifontein in Cape Town felt something unusual, a movement in her stomach that she couldn’t explain.

“I felt something moving inside me right after giving birth naturally.  I immediately told the doctors about it while I was still in the delivery room,” she says.

Doctors performed a scan to investigate the ongoing movement in her abdomen, and what followed shocked not only her, but the medical team at Karl Bremer District Hospital.

While nurses were examining her newborn in the hospital delivery room, Mbutiuma was surprised to be told she was still pregnant with a second baby. 

Mbutuma says she had a healthy pregnancy. She attended regular prenatal checkups at Kraaifontein community health centre, but no one ever mentioned that she was expecting twins. 

“At the beginning of March I started feeling labour pains. My husband hired a car to take me to Karl Bremer Hospital. I was not nervous as this was my second baby,” says Mbutuma. 

At the hospital she gave birth to a healthy baby girl weighing 2.88kg.

“However, I felt something moving in my stomach. I alerted the doctor about this. He put me under a pregnancy scan and said there was another baby but I have to wait before delivering her because she is still tiny,” she says. 

Doctors told her she was experiencing a rare pregnancy known as delayed interval delivery, where one twin remains in the womb after the first is born. This is to give the second baby more time to develop and increase their chances of survival.

Professor Ray Maharaj, head of the obstetrics and gynaecology department at the University of Free State, says interval births have been documented globally and in South Africa. But it’s not known how many people have experienced delayed interval delivery in South Africa. The global statistics are limited too.

Maharaj explains that the process of interval delivery happens when a pregnant woman goes into preterm labour while the other baby is not fully developed. He says the first baby is delivered normally while the second baby is left inside.

“This may occur spontaneously and be related to a previous history of preterm delivery, weakness of the cervix (mouth of the womb) or infection. The doctors will then leave the other twin in the uterus to grow and develop further,” Maharaj says. 

The birth of ‘miracle babies’

Mbutuma says she was shocked to hear that she would give birth to her twins on different days as she had never heard about babies being born apart. 

“The doctor told me to go home and when I feel dizzy, or nauseous, I should go to the local clinic because I won’t experience labour pains in the usual way,” she says. 

Maharaj says the second twin can be left inside the uterus if it is normal and healthy with no additional complications. The process requires close monitoring of the pregnancy. 

“The second twin can grow to term, but if complications such as infection, distress or other medical conditions develop, the second twin may be delivered early,” says Maharaj.

On 5 April, nearly a month later, Mbutuma began to feel unwell. She went to Kraaifontein Community Health Centre where she gave birth to another girl weighing 2.84kg.

“When I got home, my husband jokingly asked if I was sure there was not another baby left in the stomach,” she says.

Even though this is a rare incident, a similar case was reported in South Africa this year. A Northern Cape woman gave birth to twin boys 14 days apart: the first baby was delivered at Kuruman Hospital on 27 March and the second on 10 April at Universitas Academic Hospital in Bloemfontein on 10 April. Unfortunately, the second baby didn’t survive. 

Health complications 

Maharaj says in delayed interval delivery, the second baby has a lower risk of death compared to the first, especially if the delivery of the first twin occurred during the six months of pregnancy.

“However, the second baby may be exposed to risks such as chorioamnionitis (infection of the baby’s placenta), preterm delivery, placental abruption (bleeding of the placenta) and death, especially if the pregnancy is not well monitored,” he says.

Maharaj explains that generally, the outcome of the first twin is poor, as they may be born with severe prematurity.

“If the second twin can stay and develop in the uterus without further complications, the outcome will be better if they reach maturity,” he says.  – Health-e News