The pitter patter of 40 tiny toes

Multiple pregnancies run in the family for both El Shima Kamel Deen and her husband, Mubarak El Busher Abdullah, which may explain the arrival of their quadruplets this week.

Mubarak El Busher Abdullah and his wife El Shima Kamel Deen with their newborn quadruplets at the Corniche Hospital in Abu Dhabi. Silvia Razgova / The National

Wrapped in fluffy blankets, two-day-old babies Fatima, Zayed, Khalifa and Saif are the first - and most probably last - quadruplets to be born in Abu Dhabi this year.

Conceived naturally, the four tots were delivered by Caesarean section at the Corniche Hospital to Sudanese parents El Shima Kamel Deen, 26, and her 35-year-old husband, Mubarak El Busher Abdullah.

The couple, who also have a three-year-old son called Mohammed, travelled to the capital from their home in Khartoum for the birth.

Discovering their family was going to increase in size was a happy surprise, although Dr Deen revealed multiple pregnancies run in both sides of the family.

The anaesthetist, who named her four new additions after the UAE's royal family, including the country's late founder, Sheikh Zayed, said: "My grandmother had three sets of twins. My grandad had twins, and [Mubarak's] eldest brother has twins. We have a rich history." Dr Mariam Al Mazrouei, deputy chief financial officer at the hospital, also said the family's hospital expenses were paid by the office of the Crown Prince of Abu Dhabi.

The non-identical quadruplets were delivered without complication, said Dr Gowri Ramanathan, a foetal medicine specialist and consultant obstetric gynaecologist at Corniche Hospital. "It was a beautiful delivery. Surgery did not take long and I think from skin to skin [the initial physical contact between mother and child] it was between half an hour and 45 minutes."

Fatima, who came in weighing 2.19lbs, was the first to be born at 10.19am last Monday. As with a normal Caesarean, the babies were delivered in rapid succession, said Dr Ramanathan.

"When we do a C-section, getting the baby out is quite quick. It took four minutes [for Fatima] and then they came out literally one after the other."

The remaining babies, all boys, were delivered within three minutes of each other, weighing 1.92lbs, 2.27lbs, and 2.38lbs.

Although a pregnancy such as this puts the mother at risk of heavy bleeding, everything was kept under control.

While the atmosphere was initially tense, the delivery was fine, said Sreela Anil, an obstetric nurse. "She [the mother] was quite normal and excited," said the nurse.

Unassisted pregnancies involving such a large number of babies are extremely uncommon, said Dr Ramanathan.

The odds of having four babies naturally at once is between 1 in 570,000 and 700,000 births.

"Spontaneous quadruplet pregnancies are very, very rare in these days of IVF [in-vitro fertilisation] and infertility techniques. About 90 per cent arise from assisted conception."

This was the first quadruplet birth in the hospital since November 2010, which was an assisted pregnancy. The hospital has a history of successfully delivering multiple births, although the vast majority have been twins. Last October, an Egyptian woman gave birth to the city's first sextuplets. The children, who were premature, were kept in the neonatal intensive care unit for several months.

Complicated pregnancies can often lead to babies being delivered before full term, said Dr Ramanathan, who added that a woman with triplets had been brought in yesterday.

"[The] term for twins is 36 weeks, for triplets it's 34 weeks, and for quadruplets it is 32. For quadruplets, if we get to 32 weeks we are very happy."

Babies born before the 37th week of pregnancy are premature, but the babies delivered on Monday have very good weights, she added.

Dr Deen first visited the hospital when she was at 30 weeks gestation, said Dr Ramanathan. Although there were no complications, the number of babies meant there was no other option than to deliver by Caesarean. The couple's first child was also delivered by this method.

Multiple pregnancies put a mother at high-risk, so a natural birth is not considered, said the doctor. "Absolutely not. With twin pregnancies you can deliver normally provided the first twin is in the right position, but the difficulties are not whether they can come out or not, but how we monitor more than two babies."

Malpresentation in the womb such as the baby being in breach -which is when the feet are closest to the birth canal - means that no more than two babies can be delivered naturally at one given time.

Although the couple are still coming to terms with their newborns, who will remain in the hospital for at least one more week, they have not ruled out increasing their brood, said Mr Abdullah.

"It is too much to ask of me if four is enough?" he said. "I want more. This is no problem."

"You want more babies?" said Dr Deen. "If he wants more, he has to help me."