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The birth of triplets was not a common occurrence in Nigeria. Experts say this has changed as the country now witnesses frequent multiple births writes MOTUNRAYO JOEL
In the sleepy village of Ephugbu, Okpoitumo Community in Abakaliki Local Government Area of Ebonyi State, Nkechi Nwangele, sat on a long, brown, raffia mat breastfeeding three babies.
The spectacle was moving as she irregularly exchanged her breasts among the babies as they cried uncontrollably.
While doing this, she struggled to keep at bay a fly that kept buzzing at her feet weakened by the stress of farming.
Nwangele on July 31 was delivered of triplets, all males. She named them Justine, Valentine and Divine.
She earlier had six deliveries but one of the children died. With the arrival of the triplets, Nwangele now has eight children altogether.
As our correspondent approached her, Nwangele, dressed in a brown rapper, caressed the face of one of her triplets, eliciting smiles of a joyful mother.
“The birth of my triplets came naturally; I did not use any medicine. Some people think I did. I have never used any medicine that can make a woman have three babies at once,” she said to SUNDAY PUNCH.
A member of the community, Daneshananda Dada, said the news of Nwangele’s delivery of triplets spread round the community within a few minutes she was delivered of them.
He said, “But people were not too surprised because since I arrived the community in 2010, we have recorded five cases of triplets. She is the second woman giving birth to triplets this year in the area.”
Dada said the birth of triplets was on the increase in the community. “We also have two or three other women who are expecting triplets,” he said.
The Medical Director and Consultant Gynaecologist/Obstetrician at Dayspring Specialist Hospitals, Dr. Kayode Adebayo, defined triplets as the birth of three babies in one pregnancy.
He added that such babies may be identical or non-identical.
Nwangele’s husband is a farmer and his wife assists him on the farm. They feed from the proceeds from the sale of the farm produce.
He looked excited about his three sons, saying that God had blessed him beyond measure.
“I did not do any magic; it is God that blessed us with these babies. My heart is full of joy,” he said.
We didn’t use fertility drugs — Mothers
Just like the Nwangeles, the Etoors are also farmers. The Internet was abuzz not long ago when it was reported that Mrs. Blessing Etoor, 34, a housewife, gave birth to her triplets at home.
Etoor defied her doctor’s instruction that she would be delivered of her babies by caesarean section.
An indigene of Eleme in Rivers State, Etoor now has a total of 10 children (six girls and four boys) with the addition of two males and one female.
Since the birth of their triplets, Mr. John Etoor, 44, who is a farmer said life has been challenging for his family.
Etoor said, “My wife had to leave her hairdressing job to take care of our children. I do not make a lot of money, I am a cassava farmer. God has been strengthening me. I must say, life has been tough. I spend about N30, 000 monthly to cater for the babies.
“But I believe this is my cross, I have to face it. After all, my triplets came naturally; they are God’s will. The only thing I can say is that my wife comes from a family of twins, may be that is why we ended up having triplets,” he said.
Etoor’s claim that his wife’s family history of twins could be responsible for the births was supported by a gynaecologist, Dr. Kingsley Ekwuazi.
Ekwuazi, who is an obstetrician/gynaecologist at the Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu State, noted that there was a nexus between family history and triplets.
He said, “Genetics and family history are some of the identifiable significant risk factors associated with naturally conceived triplet pregnancy. Triplet pregnancy, once a rare occurrence, is now a relatively common phenomenon in our hospital.”
Dr. Adebayo also cited a case of a woman who had quadruplets and then triplets – without ovulation drugs.
“I remember a set of triplets I delivered at Ayinke House, Ikeja, some years ago. The woman had quadruplets three years before at a small clinic. Unfortunately, the clinic did not have a standard newborn baby care facility and she lost all four. From her history, she was never on any ovulation induction drug. Some women release more than one egg at ovulation naturally,” he said.
Two months ago, a barber, Nurudeen Nofiu’s wife, Sola was delivered of triplets – all boys, at a Lagos Island Maternity Hospital.
Since then, the family has been in a state of panic. Nofiu stated that he did not plan to have triplets. “My wife and I did not plan to have three children at once, I am just a barber, the money I make on a monthly basis is not enough to care for my family – I need help. I now have four children to feed,” he stated. The Nofius had a male child before the birth of the triplets.
Nofiu, who looked distraught, said his wife never took any drug to induce her ovulation. “Why would we take drugs? I cannot afford the drugs. The birth of our triplets came naturally,” he said.
Like Etoor, Nofiu’s wife is from a family of twins.
The magic of three
Aside family history, Dr. Adebayo said fertility drugs and a woman’s age play a role in the chance of a woman giving birth to triplets
He said, “Women above 30 years have a higher tendency and women who had delivered more than three or four times, also stand a higher chance.
“Another factor is fertility drugs – ovulation induction drugs. These drugs play a major role in multiple births. In a country where you can buy any drug, even drugs classified as ‘poison,’ without a prescription, women abuse ovulation induction drugs. Some even collect prescriptions from their friends; others go online for name of drugs, chemist stores and buy the drug. Imagine a woman ovulating normally; now imagine the result when you place her on high dose of ovulation induction drugs.”
Other factors, he said include diet and lifestyle. According to Adebayo, some studies have shown lower chance with vegetarians having triplets, and higher chance with high protein dieticians.
Almost on a daily basis, there are media reports of triplets being born in different parts of Nigeria. Apart from triplets, there has also been an increase in the number of women giving birth to quadruplets.
As far back as 1980, a study conducted by two gynaecologists/obstetricians, Rehan N and Tafida DS, among the Hausa population in Katsina State, posted on the website of the National Centre for Biotechnology Information, United States stated that 5750 women delivering between 1974-1978 had 228 sets of twins and 12 sets of triplets. The researchers said the statistics showed that there was a twinning rate of 39.7/1000 births, a triplet rate of 2.1/1000 births and a multiple birth rate of 4.1/1000; about four times the rate in western countries.
The Chief Medical Director, Medical Art Centre & Mart, Dr. Oladapo Ashiru, attested to the increase of triplet births in the country.
Dr. Ashiru hinged the increase on the availability of more IVF (In Vitro Fertilisation; a manual fertilisation process) centres. He added that many of the centres transfer more than two embryos, resulting in high incidence of triplets.
Dr. Adebayo also said recent studies show higher prevalence of triplets in Nigeria.
“Most studies quote 3-4 /1000 birth, but with the IVF and recent abuse of ovulation induction drugs, the old prevalence may no longer be correct,” he said.
Similarly, the Secretary-General, Society of Gynaecology and Obstetrics of Nigeria, Department of Obstetrics and Gynaecology, National Hospital, Abuja, Dr. Chris Agboghoroma, said there was an increase in the birth of triplets.
Agboghoroma noted, “However, no recent work has been done that really shows the exact figure. Globally, because of IVF, there seems to be the birth of multiple births – twins, triplets. It is a global increase, and Nigeria is included. There is definitely an increase.
“The increase is not a natural phenomenon, it is artificial due to the use of ovulation drugs – many women are now using ovulation drugs on their own. The use of drugs and IVF is why there is an increase in multiple births.”
Agboghorom’s submission captured the case of Omowunmi Oyebanji, who gave birth to triplets – all females, on September 6, 2015 at Atan, Ogun State.
Speaking with SUNDAY PUNCH, her husband, Mr. Olusola Oyebanji, said he waited for 11 years after the birth of his first child before his wife gave birth to triplets.
He said, “After we had waited for 11 years, my wife and I decided to go for a medical check. It was discovered that I had low sperm count. I did not believe their report though since we already had a baby. It was difficult for me to submit myself to the treatment they recommended. Not long after, my wife was diagnosed with fibroid.”
When asked if his wife took ovulation drugs, he said, “I do not know. She was placed on various drugs. All I know is that my babies came from God. But I can give you the number of the doctor that was treating her. You can find out from him what drugs she was taking.”
Oyebanji added said that he comes from a family of twins.
In a telephone interview with our correspondent, the Oyebanjis’ family doctor, Dr. Oluwole Oyewunmi, said Mrs. Oyebanji had ovulation stimulation.
Oyewunmi said, “She was having secondary infertility for close to 11 years. It was IVF; we did series of ovulation stimulation. She was placed on some ovulation drugs and we did all these with the help of God.’’
According to Livescience.com, births involving twins, triplets and quadruplets often have complications, including prematurity and low birth weight.
In those with a condition called twin-twin transfusion, one foetus siphons blood from the other, and is born with ruddy skin, while the other is pale and scrawny. Women who carry multiple babies also have a greater risk of gestational diabetes, according to the American Society for Reproductive Medicine.
Other risks include preterm labour, miscarriage, hypertension, anemia and abnormal amniotic fluid levels. The society added that triplets are more likely to have birth defects.
At the University of Ilorin teaching hospital , a Professor of Obstetrics and Gynaecology, Gafar Abiodun Jimoh said the hospital had witnessed an increase in the birth of triplets.
“I have experienced the increase within the last two years. In the last five years, we didn’t too much birth of triplets, but in the last two years, we have had double of the figure we recorded earlier.”
He said this increase is partly due to more women wanting to have their babies at once.
“For some women, having triplets is like paying for one and getting two free. If they won’t be charged for the two extra embryos transferred, they won’t mind. They don’t like the stress of having to come back over and over again. Having three saves them time and money,” he said.
At National Hospital Abuja, a former Chief Medical Director, Dr. Zaccheus Olusegun, also confirmed an increase.
“The apparent increase in the birth of triplets may be due to more women accepting assisted conception,” he said.
Also at St. Ives Specialist Hospital, Lagos, the CMD, Dr. Tunde Okewale, also attested to the increase. He said was because more women are embracing assisted conception.
“Things have changed, more women are becoming enlightened about assisted conception, especially women who are finding it difficult conceiving naturally. More so, some IVF centres still transfer more than one embryo. This then increases the woman’s chance of having triplets,” he said.
At Hope Valley Clinic, Lagos, a medical doctor who chose to remain anonymous said he had there has been increase in the birth of triplets.
He said, “One major reason is that more women want to have their babies at once. Infertility is on the increase. Some of them don’t want to wait for years before having their children. “
An increase in the birth of triplets was also recorded at Healing Balm hospital, Lagos.
A consultant obstetrician / gynaecologist, Mr. John Aniedi said it is as a result of IVF.
“More women now embrace IVF as another way to conceive, especially women who have waited for years. There is definitely an increase in the birth of triplets.
Battling with self-medication
Dr. Adebayo said more women are finding it difficult to get pregnant because of late marriages, amid other factors.
He said, “Most women these days marry late for various reasons which include long time schooling and the economic situation in the country – people want to have good jobs and be financial stable. A woman’s reproductive potential plays a big role in her fertility cycle. Many of them got pregnant easily in their early twenties while in school, and those pregnancies were terminated as unwanted pregnancies, because they were not ready for childbirth.
“A woman in her twenties is very fertile, which is the opposite for the one in her late thirties. Also, some of the early pregnancy terminations may be done by quacks, with a lot of post abortion long-term complications –inability to get pregnant again and womb damage. Since abortion is not legalised in Nigeria, the majority of abortions are done secretly by quacks.”
A pharmacist, Peculiar Onyekere, said many Nigerian couples cannot afford IVF, which accounts for why they go for ovulation drugs.
“I do not think most Nigerian couples can afford IVF, its cost is huge. The major reason for the increase of triplets is due to over usage of fertility drugs which is far more affordable than IVF. Also self-prescription is carried out by desperate, uninformed couples,” he said.
Similarly, Dr. Adebayo said quack chemists also encourage women to indulge in self-prescription.
He stated, “We live in a country where you do not need doctor’s prescription to buy any drug. The chemist boy without school certificate, treats patients. I once went to a pharmacy outlet, a woman walked in and said she wanted to get pregnant, and right there, the pharmacist sold ovulation induction drugs to her. He told her to take one tablet twice daily. The woman paid and left.”
Explaining the common types of ovulation drugs in the country, Onyekere cited clomiphene citrate and fertility aid organic supplements.
Onyekere said, “Other ones come as injectable hormones such as injectable gonadotropins. The common side effects of these fertility drugs (for clomiphene citrate) include mood swings, headache, breast tenderness, bloating, abdominal discomfort, nausea, vomiting, and diarrhoea.
“One major risk with fertility drugs is multiple pregnancies such as twins, triplets. The adverse effects of taking these fertility drugs on self-prescription include visual impairment, ovarian hyper stimulation syndrome (symptoms of OHSS include swelling of the hands or legs, abdominal pain, shortness of breath, weight gain, nausea or vomiting. OHSS can be fatal. Other potential adverse effects are cervical cancer and undesired multiple births.”
Triple births, multiple pains
Even before the country went into recession, the economy was not favourable to the majority of Nigerians.
Now, many households are finding it increasingly difficult to survive. The economic pressure is harder on parents with triple and multiple births.
This scenario is currently playing out with the Yusufs, the Ololades and the Gbarens who are nursing triplets.
Terngu Gbaren is a 20-year-old commercial motorcycle rider based in Benue State. The family has been finding it hard to cope since his wife, Aisha, gave birth to triplets.
For the Yusufs, it has been five months since Mrs. Idowu Yusuf gave birth to triplets – two girls and a boy. Instead of basking in joy that comes with the birth of children, Yusuf has been filled with ceaseless tears because of her inability to cater for the babies.
Dressed in faded attire, she looked exhausted when our correspondent met her in Lagos on Thursday.
Wiping the sweat which formed at her forehead with the tip of her wrapper, Yusuf said, “Look at me; I’ve not been myself since I gave birth to the triplets. I cry day and night because this is not the type of life I planned for my children. My husband and I are barely managing to feed the children.”
Yusuf is also from a family of twins. As she spoke, she held the hand of one of the babies who was trying to suck.
According to her, her husband, Hakeem is a commercial bus driver and returns home at 11pm every day.
“I had two children before the birth of the triplets. My husband and I with a house help sent to me by my mother from the village sleep in a room. But most times, my husband vacates the bed for the children and I,” Yusuf said.
Yusuf added that she was a petty trader but had to stop trading to concentrate on taking care of the children.
She said, “I made little profit from the petty trading but I had to stop to cater for the kids. Some people asked me if I used any drug to have triplets. Where would I get the money to do that? I gave birth to them naturally.”
The nation’s economy has been hit hard from the sharp fall in global oil prices since mid-June 2014, with adverse effects on citizens.
The economy shrank by 0.36 per cent in the first three months of this year for the first time since 2004, with the International Monetary Fund saying the country would slide into recession this year for the first time in more than two decades.
Commenting on the situation, a former Head, Department of Economics, Obafemi Awolowo University, Prof. Adebayo Abayomi, said the current economic situation would create problems for large families in particular.
“It will be challenging nurturing three babies at once except if the family is financially stable. The country is experiencing high inflation rate and this would hit hard on families, even those without triplets. Having more children means more money. This will create problems for families. The hardship may affect their education, nutrition and could lead to malnutrition,” he said.
Similarly, an economist, Mr. Bismark Rewane said families with triplets would need to source for more channels of incomes.
“The more the people you have, the more the problems you have. The man with triplets has more responsibilities and so, he will need more resources. The state cannot provide that much of support, as is applicable in developed countries. Unemployment is at its highest level, making survival difficult.
“The sad truth for families with triplets is that the woman would not be able to work; she has no salary. This means that the investment required to support the children would be higher,” he said.
For Dayo Ololade who is jobless, it’s been more difficult to feed his family after his wife was delivered of triplets.
Ololade said, “The little money I make from my menial job on a monthly basis is channelled towards the welfare of my children, especially my triplets. Most nights, I sleep on an empty stomach. Whenever I think about the future of my children, I shed tears. I do not know how I will cater for their education. The economic situation in the country is enough to kill one.”
He, however, says despite the challenges he is facing, he is grateful for his triplets.
“Times are very hard but my triplets remain a blessing,” he said.
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