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Until recently, operations were performed on
children in the womb only when the child's life
was at stake. Now, some physicians are attempting
to repair or minimize conditions like spina bifida
through a new surgical procedure which involves
lifting the uterus out of the mother to better
reach the child nestled within.
Dr. Joseph Bruner, Kelly's surgeon, is one such
doctor. Since 1994, Dr. Bruner has performed a
number of maternal-fetal surgeries, but many were
unsuccessful. With the new procedure, the rate of
success is improved, but the risk of premature
birth is still greatly increased. So much so,
that some in the medical community argue that the
possibility of positive results does not outweigh
the risks.
Still, Kelly and Michael were willing to take the
chance, and at 24 weeks, Kelly and baby Abigail
underwent surgery. After the amniotic fluid in
the womb was suctioned off and set aside, Dr.
Bruner incised the uterine wall with an instrument
resembling a staple-gun. In fact, it is a kind of
staple-gun that both cuts tissue and inserts
staples to minimize bleeding.
Beneath the fist-size incision lay Abigail, face
down, with part of her back showing, and the spina
bifida lesion exposed. Bruner's colleague, Dr.
Noel Tulipan, continued. Using delicate and
precise instruments, he lifted the tissues
surrounding the baby's lesion and carefully closed
the hole with tiny stitches. Then Dr Bruner
stepped up to close the uterus. A photographer
captured this amazing moment, as the baby's tiny
hand appeared to be reaching out to shake Dr.
Bruner's hand. After gently replacing Abigail's
arm, the surgeon sutured the mother's womb and the
amniotic fluid was reinjected. The uterus was
then pushed back into its home within Kelly's
abdomen.
Kelly then had to recover from surgery while
waiting through several more months of
uncertainty. Within two weeks of the operation,
the Hastens discovered that Kelly's amniotic fluid
was leaking. Eventually, all of it was lost,
leaving Abigail without the liquid cushion that
both protects her and helps her develop normally.
Now at home and hundreds of miles away from Dr.
Bruner's team, Kelly and Michael depended on
Kelly's obstetrician, Dr. Frank Andersen, who
decided to schedule a Caesarian.
Six weeks shy of her due date and weighing about
five pounds, Abigail was lifted from her mother's
womb, with a neonatal team standing by. When she
didn't begin breathing as she should, they set
immediately to work on the infant. At last she
started to cry, and everyone breathed a sigh of
relief.
But there was more to come. With her fragile
lungs under pressure, air had accumulated in her
chest cavity. She was placed on a ventilator and
a tube was surgically inserted. As she gradually
improved over the next few days, her lungs grew
stronger. Eventually, she was strong enough to be
moved, and fifteen days after her birth, baby
Abigail headed for home.
An MRI subsequently performed at the hospital
showed no excess fluid on Abigail's brain--a
positive sign. It may be years before Abigail's
surgery can be truly declared a success, but for
now she is doing fine, and her parents are more
than pleased.
Photo credit: Alexei Hay for The New York Times
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While only 18-weeks pregnant, Kelly Hasten and her
husband Michael discovered that their unborn
daughter had spina bifida, a defect of the spinal
cord that occurs when the skin of a fetus fails to
close around part of the cord. Surgery after
birth--when most of the nerve damage would have
already occurred--seemed to be the only option. Or
abortion, which they refused. Then the Hastens
found an experimental alternative: maternal-fetal
surgery.