The doctor in Sudan told the young mother she was expecting. At least three babies, the doctor said, maybe four.
Adwai Malual, a 28-year-old married bank teller, considered following the doctor's advice and going to Jordan for medical care. But then she thought of her older sister living in Prince George's County and her mother-in-law in Minnesota.
Malual's mother, Anne Abyei, explained yesterday how her daughter decided to head to the United States. The trip would allow Malual to accomplish two goals: get medical care for herself and her unborn children, and meet with her mother-in-law before giving birth, the custom in Sudan.
Malual delivered five babies by Caesarean section Dec. 2 at Anne Arundel Medical Center in Annapolis, the first birth of quintuplets in the hospital's 106-year history. Four girls and one boy, weighing between 2 pounds, 2 ounces and 2 pounds, 15 ounces, were born between 9:38 a.m. and 9:42 a.m. Malual and her girls, Nyantweny, Nyandeng, Abyei and Athei, and her boy, Deng, are all healthy.
"They're all what we call feeders and growers, warm in their incubators," said Dr. Suzanne Rindfleisch, a neonatalogist who is overseeing the babies' care. "They couldn't be doing any better."
Representatives from the team of 37 doctors and nurses who assisted with Malual's care at the medical center, and the babies' grandmother, Abyei, described Malual's journey from Sudan's capital to Maryland's capital.
Malual, who has been released from the hospital but is still recovering and focusing her energies on her babies, did not speak to reporters. Her husband, Erjok Geu, works in Tanzania as a military liaison for the Sudanese government and hopes to come to Maryland to meet his babies soon.
"When Adwai learned about her pregnancy, she had feeling of great joy and also of great worry and confusion about how this would become a reality," said Abyei, 54, who came from Sudan to help her daughter. "The gynecologist in Sudan said she didn't know how one could have more than three babies in the Sudan with our limited medical facilities."
Upon her arrival in Maryland, Malual fell ill and was rushed to an emergency room.
"With no medical insurance, it was difficult," Abyei said. "Her sister tirelessly went around" looking for a doctor to treat Malual. "Through a friend, she got in touch with Dr. [William] Sweeney, who was more than willing to see her. Through Dr. Sweeney, were able to come to Anne Arundel Medical Center."
The hospital is on pace to deliver 7,500 babies this year, making it Maryland's second-highest baby-delivering hospital. It provided Malual's care free of charge, hospital officials said.
"It was the right thing to do," said Maura Callanan, executive director of women's and children's and surgical services. "We felt that it was a very special situation, and we knew we could take care of her."
Sweeney first examined Malual at 19 weeks and determined that she was carrying five babies. Sweeney, a maternal-fetal medicine specialist, said he "made tentative plans to see her and admit her to the hospital in a few weeks." The doctor had hoped to keep Malual pregnant for at least 28 weeks, which would give the babies an adequate chance of surviving outside the womb.
At 24 weeks, the babies were treated with a course of steroids, designed to push the growth process along more quickly. The treatment was repeated at 28 weeks.
Malual made it past that milestone, but soon she couldn't eat and was having trouble breathing. Her kidneys were having difficulty functioning, and doctors worried that her blood pressure would skyrocket.
Malual delivered the babies at 30 1/2 weeks.
"She actually walked into the delivery room," said Dr. Joe Morris, an obstetrics specialist who helped deliver the babies. "She's a very tall woman, very statuesque. She took this long cloth, beautiful African print and wrapped it around her head and stood up. She said, 'We walk in my country. We are not pushed.' "
The babies are on track to leave the hospital in two to four weeks.