Adetoun Oyenubi had just about given up hope.
She wanted, more than anything else, to have a baby, but trying to get pregnant was proving to be extremely difficult and frustrating. Unsuccessful in her attempts to conceive naturally, she turned to in vitro fertilization (IVF). Finally, in 2012, Adetoun, at age 36, became pregnant.
“I was overjoyed,” recalls Adetoun, a business analyst who lives in Oakville.
But then, 23 weeks into the pregnancy, she started feeling “strange.” She was diagnosed as having an “incompetent cervix,” a condition in which the lower portion of the uterus begins opening too soon in pregnancy.
Labour was induced and the baby – a boy born four months too soon – died shortly after birth, in her husband’s arms.
She remembers the experience as “quite traumatic.” It was last year, when Adetoun found the courage to begin again. There was a second attempt at IVF at a clinic, which was also unsuccessful, but the third try produced twin embryos.
Adetoun’s age and medical history made carrying twins a risk. The doctor at the IVF clinic recommended selective reduction – limiting the pregnancy to one child, who’d then have a better chance of survival. “I was in tears,” she says. “I had prayed for twins. I didn’t want to lose one of them.”
So Adetoun consulted with Dr. Jon Barrett, head of Sunnybrook’s specialized clinic for multiple births.
Instead of selective reduction, Dr. Barrett performed a cervical cerclage – stitching the cervix to hold it closed and prevent pregnancy loss or premature birth.
“He’s the guy to go to if you’re having twins or triplets,” she enthuses. “I felt like I had won the lottery!”
The doctor at the IVF clinic had warned Adetoun that mothers carrying twins are not good candidates for cervical cerclage, but according to Dr. Barrett, the procedure could work, with close monitoring.
“That’s why this is a miracle,” says Adetoun. “It was very risky, really scary, but I knew I had the best care.”
She had the surgical procedure done 16 weeks into her pregnancy. Overcoming a few ups and downs, her twins remained snugly in utero until the scheduled C-section, at 37 weeks, a healthy length of pregnancy.
Chinasa and Chidinma, who were born last August, are healthy and thriving, according to their mother.
Dr. Jon Barrett. (Photo by Kevin Van Paassen)
“Multiple pregnancies have a very high risk of preterm birth, compared to single basics and we’re working on more ways to prevent preterm birth when we can,” notes Dr. Barrett, who holds Sunnybrook’s Waks Family Chair in Maternal Fetal Medicine Research.
His work on cervical length as a predictor of premature labour offers the possibility of targeted intervention to reduce the numbers of babies born too early.
“Preterm babies lead to almost 80 per cent of adverse outcomes in our newborn population – death and disability, [such as] cerebral palsy, blindness, deafness, and learning disabilities. There’s also evidence of longer-term childhood diseases among these infants, respiratory or gastrointestinal.”
Not only is this difficult for both the children and their families; it’s also extremely costly to society, as a range of supports must be provided at every stage of the lives of these babies, who are at increased risk of developing cardiovascular disease and diabetes in later life.
High-risk obstetrics has engrossed Dr. Barrett since 1995. As director of Sunnybrook Research Institute’s Women and Babies Research Program, he leads a team that is exploring every aspect of preterm birth in Ontario, from pregnancy and delivery to support systems after hospital discharge. Prevention of early birth is his main priority.
“That’s why this is a miracle. It was very risky, really scary, but I knew I had the best care,” says Adetoun Oyenubi, patient.
“There’s the ability to predict who’s at risk for preterm birth and the ability to prevent it,” he explains. “But what we lack is the mechanism in the health-care system to get to that population and engage them in preventative measures early enough. We have proven ways to do it. It’s just going to take money and a system change.”
It is Dr. Barrett’s hope to create the Alliance for the Prevention of Preterm Birth and Stillbirth in Ontario. Families, maternal and newborn care providers, hospitals and researchers would come together to reduce preventable preterm births and stillbirths in Ontario, improving infant health outcomes and quality of care for families.
“It’s this kind of network that can improve system coordination in the future,” Dr. Barrett predicts. “For the first time, hospitals [in Ontario] would start to say, ‘Instead of working in isolation on research projects, let’s start working together.’”
Database integration would be a big part of the story. “Ontario already has a fantastic system that can connect data and reach patients,” he says. “But no one has closed the loop to make sure the best screening and treatments reach patients. That’s what this initiative could do.”
That’s very good news for families across the province. And it’s comforting for Adetoun to know her experience will help identify and treat women at higher risk for preterm birth, saving families from the immense stress of having a premature baby.
