Triple delight as Otto, Kit, and Fred entered the world at TUH

When Makala and Aaron Casella arrived for their eight-week pregnancy scan in early April last year, nothing could have prepared them for the news they were about to hear.

After a year of trying, and with a pregnancy loss, the Cairns couple was excited for the first pictures of their much-awaited firstborn only to be told there was not one but three babies on the way.

“There was a lot of profanity in the room, mostly from Makala,” Aaron laughed.

“She was shaking, and we were laughing and crying at the same time.”

Triplets Otto, Kit, and Fred were born on 20 August last year weighing 910g, 930g, and 915g respectively.

Otto and Fred are identical twins.

While Otto was the first to go home on 28 November followed a week later by Kit, the journey continues for Fred who has been through three surgeries and is still in hospital in the care of neonatal team.

“We were able to take Otto and Kit back to Ronald McDonald House with us while we wait for Freddy,” Makala said.

The triplets were naturally conceived after a Monash fertility specialist advised the couple to do ‘cycle tracking’.

“He told us he didn’t think we needed IVF and instead we should track Makala’s cycle which included ultrasounds of her ovaries,” Aaron said.

Makala’s first two ultrasounds showed two follicles (round structures that become ova or eggs) on her ovaries.

“I joked with our doctor that it could be twins,” she said.

“He said, ‘oh no, no’ and we fell pregnant during that cycle.”

Aaron described the eight-week scan as ‘the moment when everything changed’.

“The look on the sonographer’s face convinced us something was wrong,” he said.

“Then she held up three fingers.”

A smooth pregnancy followed, and the couple decided on a ‘Babymoon’ at Ardo to coincide with an appointment with the fetal maternal medicine team at Townsville
University Hospital.

“I woke up in the middle of the night with some fluid loss; I went to TUH where we discovered one of the amniotic sacs had ruptured so our journey in Townsville
started,” Makala said.

“I managed to carry them for another 15 days before I went into labour, and they were born at 26 weeks and six days.”

Neonatologist Dr Sue Ireland, who was at the birth, said she quickly became concerned about Fred.

“The first two babies were straightforward 26-weekers, but we soon realised that Fred had oesophageal atresia, a rare condition, where the oesophagus has a blind
ending and isn’t connected the stomach,” she said.

“Fred went to surgery urgently that night.”

Further surgeries, including repair of a bowel perforation, followed for Fred some of which were harrowingly touch and go.

“Our surgeon Dr Harry Stalewski was incredible, and Freddy is a fighter,” Aaron said.

Aaron, a plumber, and Makala, a nurse, are looking forward to being at home as a family of five which Dr Ireland said she hoped would be in the next few weeks.

“Freddy comes off high-flow oxygen for a few hours a day and we’re hoping to reduce that in the coming weeks,” she said.

“It’s been a complete privilege to look after these babies; our staff have created a beautiful bond working with Aaron and Makala to care for the triplets.”

Aaron and Makala said they wanted to thank the neonatal team, paediatric surgeons, and Ronald McDonald House.

“We’ve had such wonderful care, and we are so grateful.”

Fetal maternal medicine director Dr David Watson said the odds of spontaneous triplets with separate placentas was around one in 8,000.