Twins: double the joy, challenges

SUNDAY VISION

By Agnes Kyotalengerire

Most parents of twins receive their double bundle of joy with excitement, wonder and sometimes worry. For Jane Walukhu, she had to ask her father for a cow to supplement their feeding

Jane Walukhu gave birth to fraternal twins, Jesse Wamono and Jeremiah Mukhuana, seven years ago. Walukhu did not want to do any ultra-sound scan when she conceived, but her gynaecologist demanded that she does it at two months.
“I was shocked when the scan revealed that I was carrying twins. Actually, I could not believe it until I gave birth and saw them,” she recalls.

She says carrying the pregnancy was very uncomfortable especially in the later stages. And even after the babies were born, nursing care was stressful; feeding and baby-sitting was very tiresome.

“Caring for twins comes with a lot of hard work. I had to be on my feet all the time because the boys would sleep in turns,” she recounts.

The other challenging bit was breastfeeding the babies exclusively.  Walukhu lacked sufficient breastmilk  for the two boys and had to resort to giving them formula milk. It was expensive. The couple was spending over sh150,000 per week on formula. Walukhu approached her father in Mbarara and asked him for a cow to provide milk for the twins.

“I had to bring the cow to Kampala and kept it in my backyard. Luckily, the cow was in-calf and it delivered after a week and my milk problem was sorted,” she narrates with a chuckle.

But still, they had to buy double of everything, including getting two maids to baby-sit the boys. Walukhu has no regrets because her husband was supportive and her two maids were dedicated.

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A mother's joy: Walukhu, who is a twin herself, says carrying the pregnancy was not easy. PHOTO/Agnes Kyotalengerire

Joyful moments

Walukhu recalls that the twins were very tiny at birth; they only weighed 2kgs each. But now that they are all grown up every day is a joyous moment and she is proud of who they are becoming. Mukhuana, who came first, wants to become a policeman because he likes the uniform, while Wamono wants to be an engineer.

Their mother says apart from looking out for each other, the twins’ characters are completely different.
“Mukhuana is warm, compassionate and caring, while Wamono is a little reserved,” Walukhu says.

No myths

Walukhu and her husband, Gershom, do not believe in any myths surrounding twins. Immediately they were born, they took them to church and dedicated them. But they had to give them twin names for purposes of identification.

Giving birth to twins did not come by surprise, it runs in the family. Walukhu herself is a twin. Her twin name is Nyangoma. Originally, Walukhu’s target was to have four children and the twins added up the number. To her, they are a blessing.

What Walukhu dreads most about getting twins is a flabby tummy. “Carrying twins stretched my abdominal muscles,” she laments. Nevertheless, Walukhu is determined to get back in shape. She exercises regularly and has developed healthy eating habits.

trueJesse and Jeremiah. Doctors say where there is no successful cell division, the babies come out as siamese or co-joined twins. PHOTO/Agnes Kyotalengerire

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How twins occur

By Agnes Kyotalengerire

Twin pregnancy is one among the multiple pregnancies which are more common than they were in the past. According to Dr Charles Kiggundu, a senior consultant gynaecologist at Mulago Hospital, one in every 60 pregnant women is carrying a twin pregnancy. He says twins are usually conceived the natural way and they can either be identical (monozygotic) or fraternal (dizygotic).

Dr Evelyn Nabunya, a senior gynaecologist also at Mulago, says identical twins form when a woman produces one egg (ovum) and it is fertilised by one sperm, but splits and develops into two babies with the same genetic formation. She explains that such twins are usually of the same sex and share similar features and characteristics.

This explains why in some cases, you cannot tell the difference between twins since they look exactly alike, are the same height and speak in the same manner. If one was naughty, you might not be able to tell who it is.

Nabunya explains that one in three sets of twins is identical. “This happens because the fertilised egg divides in two while it is still in a tiny collection of cells. The separate halves then develop into two babies with exactly the same genetic formation,” she says.

Fraternal twins, however, come about when two eggs are produced and fertilised by two separate sperms to form two genetically unique babies. 

Kiggundu says because the ova is fertilised by two different sperms, the babies can be of same (both girls) or mixed (boy and girl) gender. They grow in separate sacs and have different placentas.

Conjoined twins

Kiggundu says for successful separation, cell division should start after seven days and should be complete within 14 days. Any division beginning after two weeks leads to incomplete separation which results in conjoined or Siamese twins.  

Gestation period

Kiggundu says though some mothers carry the twin pregnancy to term (40 weeks), others may deliver them between 36 weeks and 37 weeks. There is a tendency of delivering them preterm. To guard against this, Nabunya says expectant mothers are usually put on bed rest.

Why the increase in twins

The incidence of twins appears to be on the rise in Uganda. Dr Kiggundu says one in every 60 expectant mothers they see at the gynaecology department in Mulago is carrying twins.

Apart from genetic factors, he notes that more women are delaying giving birth. He says women in their 30s and 40s have higher levels of oestrogen hormone than young women, which means that their ovaries are stimulated to produce more than one egg at a time, leading to multiple pregnancies.

Nabunya says the rise in number of twins being born might also be due to assisted reproductive techniques, in particular the use of fertility drugs and IVF.

Dr Daniel Zaake, a gynaecologist at Life Sure Fertility Centre in Kampala concurs with this view, saying: “Most career women prefer to have children late. And when they do, they want to have many babies at a go, so they opt for in vitro fertilisation to have twin pregnancies.”

Zaake says a quarter of babies born through IVF are usually twins and 5% are triplets. He says since the technology was introduced in Uganda in 2004, over 400 babies have been born that way, with the first Ugandan IVF baby being about 9 years old now.

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