Many explosions and gunfire abroad': Giving birth in the Ukraine of war

MYKOLAIV, Ukraine – Amina Tsoi's twins are healthy girls.

They fight, as siblings do, and both have a curious appetite for cheese, "like little mice," their mother says.

But they are small for a year old, inherited from their premature birth during the first weeks of Russia's invasion of Ukraine.

Medical staff attend to a premature baby in an incubator at a hospital in Mykolaiv, Ukraine. Doctors and hospital officials have warned of a sharp increase in maternal health problems during the war. Photo by Finbarr O'Reilly for The New York Times

For seven months, Tsoi had enjoyed a happy and healthy pregnancy, with virtually no complications.

Then, one morning in February last year, explosions rumbled through the town where he lived, near Mykolaiv in southern Ukraine, which was facing increasing missile attacks and ground skirmishes.

"My mother-in-law came into our room and said, 'The war has started,'" Tsoi said. "And I started to panic."

Tsoi, then 20, escaped the bombing and emerged apparently unharmed.

But in the following days he lost sight in one eye and gained 14 pounds because he retained water.

After an emergency caesarean section, during which she lost so much blood that she needed two transfusions, her daughters, born six weeks early, clung to life in incubators.

Russia's invasion of Ukraine has killed tens of thousands of soldiers and civilians, and wounded many thousands more.

The mental burden of war has also taken a heavy toll.

Risks

For pregnant women, stress can be especially dangerous, and doctors and hospital officials warn of a sharp increase in maternal health problems, such as premature births.

Babies born preterm are more likely to develop respiratory, neurological, and digestive complications.

Those born especially prematurely can have serious physical and mental health problems.

Twins or other multiple births are likely to be born prematurely, even at normal times.

After more than a year of war, official statistics on maternal health in Ukraine are scarce.

Figures on preterm births, for example, can be misleading because many pregnant women, especially those with health problems, were evacuated to other countries after the start of the Russian invasion.

But doctors interviewed, particularly in areas close to the fighting, reported high rates of premature birth, higher cases of hypertension during pregnancy and a higher rate of caesarean sections, blaming the complications on the extraordinary stress of having a child at a time of danger and uprooting.

"We see that the course of pregnancy has become harder," says Dr. Liudmyla Solodzhuk, 58, medical director of a hospital in Mykolaiv, a town near the front.

"Normally, the birth of a new human being is happiness, and now it's anxiety," he added.

Protecting pregnant women from the stresses of war has become a medical priority, Solodzhuk said, and medical staff are trying novel ways to distract patients from the brutal sounds of war abroad.

"We've been saying that the bombings are fireworks," he said, "in honor of the birth of their children."

Solodzhuk Hospital in Mykolaiv has reported that the number of caesarean sections and preterm births has increased by 5%.

Government statistics show smaller increases in preterm births in the Mykolaiv region overall and in other parts of southern and eastern Ukraine, where fighting is heaviest, but those figures are complicated by the large number of residents who have fled.

The musical duo Tvorchi, Ukrainian participant in the Eurovision Song Contest held in Liverpool (England) last month, gave more publicity to the theme when, in an act with red carpet in the prolegomena of the contest, the performers wore costumes with the names and weights of babies born prematurely.

Threat

For pregnant women who stayed behind after the Russian invasion, any hope that the fighting would soon end proved illusory.

Inna Harbuz, then 30, was pregnant with twins and living in Mykolaiv when Russian missiles began hitting the city.

His family decided it would be safer to move elsewhere, but an early Russian advance took the nearby village they had gone to.

As much as possible, the family tried to go unnoticed.

"We started hiding in the basement every day, mostly for fear that the Russians would find us," Harbuz said, adding that the fear of being discovered by invading troops was worse than facing rocket fire in Mykolaiv.

On October 28, Harbuz suffered internal bleeding from placental abruption.

By then, Russian troops had withdrawn from the village, and her family rushed her to a hospital in Mykolaiv, where she underwent an emergency caesarean section.

Her twin sons, who were born prematurely, received ventilation.

Seven months later, the two children are doing well.

But the family has decided to stay in the village rather than return to Mykolaiv, which is still regularly bombed.

After birth, Tsoi's twins had health problems, and she said she needed to regularly monitor her heart rate, eyesight and weight.

At 9 months, they still can't stand and the family was starting to worry, but "now they're both running," she said recently.

Tsoi blames the war for turning her pregnancy into an ordeal.

Even during the caesarean section, conflict was inescapable.

"I started crying on the operating table," she says.

"It was very scary because I heard a lot of explosions and gunshots outside."

She was not reunited with her daughters until the eighth day after delivery.

At the time, they were still being fed through tubes and fighting outside was getting worse.

At one point, hospital staff and patients were forced to huddle in the basement for safety.

The traumatic experience was almost too much for Tsoi.

"After a month, I had a horrible crisis," she says.

"I yelled at my husband to take us abroad, otherwise I couldn't stand it, I wouldn't survive."

Tsoi's husband drove the family to the Moldovan border, but had to return to Ukraine, as men of fighting age are not allowed to leave.

A few months later, Tsoi and her daughters returned to Ukraine and rented a house near Odessa to be closer to her husband.

Girls are healthy, but they lag behind normal growth and development goals for their age.

For Tsoi, the war turned her pregnancy from a happy experience to one she would rather forget.

"I still can't believe I survived," he says.

c.2023 The New York Times Company

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