One of my patients today had an interesting birth. She had not attended for any antenatal care so we weren't expecting her, she didn't know her dates so she wasn't really expecting anything at any particular time either.
This was her first pregnancy and when she arrived we could already see the top of the baby's head so we expected to see a baby soon at this point at least! We had very little time for doing a thorough check, just enough to know the mother and baby were both doing fine. She was very calm, she came in alone having been contracting a few hours.
She delivered her baby boy easily and the cord was so short I couldn't actually do anything except to hold the baby in mid air so I called for some help. Wanjiru came to help me, the first thing she said to me as she walked in when I said the cord was short was 'is there another baby?'. I moved from 'what?' to 'oh, my word, there is another baby' in a split second after looking up from the baby to the mothers abdomen! It wasn't the right shape! So we informed the mother, confirmed that the next twin was coming feet first and waited. And waited. And then helped it along with some drugs to get some contractions back. And it finally came a couple of hours after its brother, a footling breech delivery!
Thank God for such a great outcome considering all the factors! And thank goodness for such a great midwife in charge today who supported me through the surprise breech birth. Although not my first breech delivery it being an undiagnosed twin pregnancy, with an undiagnosed breech presentation, needing augmentation and with some fetal distress in a small unit in Sierra Leone was certainly a first for me and one to remember, although I fear (and am kind of excited about too if I'm honest) that it won't be the last!