Strength and Grace 
By  Amanda J. Romeyn

Early in the summer of 2003, my best friend dropped by my house, to give me the wonderful news that she was pregnant with her fourth child!        

We are both garage sale fanatics, and spent many a Saturday, that summer, hunting down bargains. I remember seeing some baby items for twins at one sale, and the two of us joking that maybe she would need them!

At 17 weeks, she had her first ultrasound. Her husband was at her side, excited to see the first image of this precious baby. As the ultrasound technician concluded all her measurements, she turned the screen, to let them see. "Here is your baby," she said, "and here is your other baby." Their jaws dropped in surprise. What wonderful news! They were overjoyed at the marvelous blessing of two new babies to love.

Within the week, her family doctor called, and wanted to discuss the ultrasound, and to set up an appointment for a more in-depth scan. On that day, they drove into Vancouver, to the B.C. Women’s Hospital, and, after a 3-hour ultrasound, the doctor gave them the news. The babies had Twin-to-Twin Transfusion Syndrome. This meant that they were identical twins, and shared a placenta, and they were also sharing some blood vessels. The problem was that these blood vessels were abnormal, in that they connected the circulation of the twins unequally. This caused one baby to receive an overabundance of blood and fluids, and the other baby to receive hardly any. The smaller twin (Donor) appeared to be stuck against the uterine wall, with very little amniotic fluid, while the larger twin (Recipient) had an excessive amount of blood supply and amniotic fluid, placing undue stress on the infant’s heart. If left untreated, both babies would most likely die.

They felt like they had just been hit by a truck. Without hesitation, they asked, "What can be done?"

The doctors laid out five options. Option #1: terminate. Option #2: cut off the blood supply to the smaller twin, in hopes that the larger one would survive. These two "choices" were not what they would consider as options, since both involved killing one or both babies! Option #3: to do nothing, and hope for the best, but the doctor explained that the babies were now in the third stage of this condition, where the donor baby was completely dehydrated of fluids, and was, in effect "shrink wrapped" against the side of the uterus. If they didn’t act quickly, there would be no hope for survival.   Option #4: repeatedly remove fluid from the amniotic sac of the bigger twin.  Option 5: laser surgery.

So, they were left with two choices, and both carried high risks. The fluid reduction would be similar to an amniocentesis, where the doctor would remove amniotic fluid with a needle, to relieve the pressure on the recipient baby, in hopes that the baby’s heart would not go into cardiac arrest from working overtime. The donor baby would just keep struggling to survive on what little blood supply remained. This process carried a risk of miscarriage every time it was done, which would be 3-4 times per week, for the remainder of the pregnancy.  They quickly decided that this was not a risk they were willing to take.

The final option was laser surgery to cauterize the connecting blood vessels, to even out the blood supply to both babies. This option seemed pro-active; it would treat the problem at the source, instead of just trying to deal with the symptoms. It sounded too good to be true. There was one catch. It was a very new procedure, and  had only been done once in Vancouver.  Although this seemed to be the only option to best ensure the survival of both babies, it also carried some very high risks.  There was a chance of serious infection for the mother, even death, a high risk of physical and mental disability in the babies, and only a 50% chance of bringing one living baby home.   In the privacy of their truck the emotion finally overcame them. He felt the overwhelming desire to protect his unborn babies. That, after all, was a Daddy’s job. She felt like a weight was crushing her lungs, the physical pain of an aching heart, as she faced the possibility of never being able to hold these two little babies. They had just been given to her, to carry in her womb; would they now, so quickly be taken away?

By the time they got home, they had made their decision. Surgery, even with the risks, seemed like the only way to go. They phoned the doctor, and he began the process of rounding up a team, to assist him in performing this delicate, groundbreaking procedure.

By Monday afternoon, she was admitted into the hospital for surgery.  At this point, the smaller baby had no visible bladder, and had abnormal blood flow in the umbilical cord. The timing was crucial. The following morning, the surgeon performed the delicate procedure.  He cauterized seven blood vessels, and removed almost three liters of excess fluid. They were thrilled to hear that both babies still had a pulse, and were moving. She was still pregnant.

The day these little babies received their life-saving laser surgery, another woman, in the same stage of pregnancy, could have had an abortion.     
           
They watched and waited. The first 24 hours were critical. They struggled with fear, as she began having contractions, and was given stronger medication to try to prevent her from going into premature labor. Each day felt like an achievement.

She was in the hospital for a week, and was overjoyed when, on the last day, she heard that their little donor baby had signs of a small amount of fluid, in the tiny stomach and bladder! This little child, only about ten inches long, was fighting to survive!

Now that she was home, things would have to change. The doctor had ordered strict bed rest, to prevent pre-term labor. Being a busy mom to a six-year-old, five-year-old and three-year-old, it was going to be difficult to give up control of the household.

Their church, family and friends got to work and made phone calls and schedules, making sure everything would be taken care of.

A few days later, they went for extensive testing at the hospital again, and were relieved to find out that the surgery seemed to have been a success! The fluid was increasing around the smaller baby, and although there were still some concerns about the larger baby’s heart, they were both growing and moving. They also found out that they were girls!  They named the bigger twin Jessica, which is Hebrew for "God’s grace." They named her smaller sister Brianna, which means "strong one."

Over the following months, the babies’ growth and health was carefully monitored, and the fluid levels were regularly checked. As Brianna’s blood flow increased, it was hoped that their fluid levels would equalize, so they both got the nutrients they needed. But, there were times when it looked like the surgery may have taken too much blood supply, and Jessica’s fluid dropped so much that it became lower than Brianna’s.  There was a possibility of "Reverse Twin-to-Twin Transfusion Syndrome," where the twins’ problems became reversed.

At 27 weeks, they found out that the twins didn’t have Down’s syndrome, and that Brianna was still very small for her gestational age. They were hoping to make it to the 28-week mark, which would mean the babies had a good chance of survival outside the womb.  Their excitement was tempered with sadness, though, as they received the news that the surgeon had just performed the same procedure on another woman, and she had delivered prematurely at 20 weeks. Both babies died.

Finally, at 30 weeks, the babies’ fluid levels were equalized. What a relief. Now, the area of concern shifted to just keeping those babies safe in the womb, as long as possible. Some early contractions had started, but with the care and support of their friends and family, she was able to get the rest she needed, to keep labor from starting in earnest.

Two weeks went by, and they prayed for two more. If only they could make it to 34 weeks, the babies could be born at the local hospital, only a few minutes from home.

On December 1st, she gave birth to two beautiful little girls. Jessica came first, and weighed 4’11", and was followed, five minutes later, by Brianna, weighing 3’13". They were expected to have heart trouble, kidney trouble, and breathing trouble. They were expected to need breathing assistance, to be fed only by a tube in their noses because they’d be too weak to suck, and to stay in the hospital for about six weeks. We prayed they’d be healthy and home for Christmas. We believe in a God who likes to exceed all our expectations.

Both girls came out crying, and breathed on their own right from the start. They drank from tiny 2-ounce bottles, and maintained their own weight. For one week, they needed a feeding tube in addition to their bottle-feeding; just to help them start to gain weight. And, they were only in hospital for two weeks. They came home, welcomed into the family by their big brothers and sister, ten days before Christmas.

Brianna and Jessica just had their first birthday. They are healthy, active toddlers, climbing, exploring, getting into everything, taking their first steps and saying their first words. At mealtimes, when one twin is plopped into her highchair, she will look, expectantly, for her sister to come to the highchair beside her. They reach out to each other in excitement, and share all the experiences of the day. They always have a best friend.

Amanda J. Romeyn is a resident of British Columbia.