DO YOU BELIEVE THIS WOMAN WILL GO BACK TO SUDAN WITH 5 ANCHOR BABIES?

Happiness Times Five
Prognosis Is Good for Quintuplets Born to Sudanese Woman in Md.

(Courtesy Of Anne Arundel Medical Center - Courtesy Of Anne Arundel Medical Center)

By William Wan
Washington Post Staff Writer
Wednesday, December 17, 2008; Page B01

The woman called the hospital and said she had traveled from her home in war-torn Sudan to the United States. She was seeking her mother-in-law's blessing of her pregnancy, but now that she was here, she feared there was something wrong -- and any trouble would be multiplied by five.

So the staff at Anne Arundel Medical Center told her to come in right away. When physician William Sweeney gave her an ultrasound, it showed all he needed to know: quintuplets at 19 weeks of development.

If mother and children were to survive, the doctor concluded, they would need all the help they could get. That began 11 weeks of intensive treatment involving more than 30 physicians, nurses and other specialists at the hospital in Annapolis.

Yesterday, doctors and the woman's family announced the good news. Mother and the five babies, born Dec. 2, were just fine. They were the first quintuplets in the hospital's 106-year history, the first in Maryland in more than three years. And although they will spend the next three weeks in the medical center's neonatal unit, the prognosis is good.

"With quintuplets, you take all the difficulties that can happen to a normal pregnant woman and multiply by five," Sweeney said. "We were prepared for the worst and got the best."

Adwai Malual, 28, had come to the United States to obtain the blessing of her mother-in-law, a family figure who traditionally plays an important role in a woman's pregnancy, family members said. Her husband stayed behind in Sudan, where he serves in the military.

She traveled to her mother-in-law's home in Minnesota, but while she was there, she suffered complications and had to be taken to an emergency room, doctors said. When it became clear she would need more sophisticated treatment, she traveled to Prince George's County to stay with close family members -- and that eventually led her to Anne Arundel Medical Center, a few miles away.

"When Adwai learned she was pregnant, she had mixed feelings of great joy and, at the same time, great worry and confusion of how this would be," said her mother, Anne Abyei, at yesterday's media briefing at the hospital. Medical conditions are poor in Sudan, but now -- "thanks to God," Abyei said -- Malual was in a modern facility, with trained doctors and staff.

Within the first few days, Sweeney formed a team of specialists. Their goal was to extend the pregnancy as long as possible without risking the health of Malual or her babies. She came to them at 19 weeks, with a womb already stretched almost to the equivalent of a full-term 40-week pregnancy. Every week they could wrest from nature gave the babies a better chance at life.

"Twins average 36 or 37 weeks, triplets 32 or 33. With quintuplets, beyond 28 is great," said obstetrician Joseph E. Morris.

Doctors had her eating constantly. But with her swollen belly, she couldn't eat more than a few bites without feeling full.

When Malual reached 30 weeks, she exceeded doctors' greatest hopes. Already her body was showing the signs of wearing down -- shortness of breath, an overworked heart and a tiring kidney. So they scheduled surgery for Dec. 2, a slow morning in the delivery room.

The team had practiced for weeks, staging four walkthroughs to get the complex choreography of equipment and surgical procedures exactly right. Nurses had color-coded equipment and alphabetized hats and tags so they could tell the babies apart.

The morning of Dec. 2, doctors went to Malual's room with a wheelchair. But she said no.

"I will not be wheeled to my babies' birth. I will walk," Malual told them. "I am from Sudan, and we walk in Sudan."

Putting on a deep red and mustard-colored wrap, she stood up. "She walked into the delivery room like she was the queen of the hospital," Morris said, "sat down and she said to the anesthesiologist, 'I'm ready to have my baby.' "

Five obstetricians stood by. The doctors made the incision and reached in to remove the babies. The first was Nyantweny, the biggest of the five at 2 pounds, 15 ounces. A boy, Deng, came second, then the rest of his sisters: Nyandeng, Abyei and Athei, who was the smallest at 2 pounds, 2 ounces.

They were already in great shape. Like many premature babies, they had to be fed milk through a tube, and three of them required humidified air for their first day to support their breathing and open their lungs.

"At this point, they just need to grow and thrive," neonatologist Suzanne Rindfleisch said at yesterday's briefing.

"I keep telling my daughter, 'This is God's work. This is a miracle,' " Abyei said. She was able to tell the babies' father and grandfather in Sudan about the births.

The family does not have health insurance. It typically costs $1,150 a day for a baby in the intensive care unit. Hospital officials, who declined yesterday to put a final price tag on the weeks of treatment and the choreographed births, said they would work with the family on payment and absorb some of the cost if necessary.

As for the quintuplets, after a few more weeks, once they can feed on their own and maintain body temperature, they will be ready to go home, although it remains unclear where that home ultimately will be.

In the short term, Malual has told her doctors that she intends to stay with her family in Prince George's for a few weeks.

"They're absolutely part of the family at the hospital now," said nursing director Misa Ewin. "It'll be sad to see them go."

http://www.washingtonpost.com/wp-dyn/co ... 02670.html