Spectrum | Sundayobserver.lk

For Champika and her husband Amith, of Pitabeddara, Matara it was the happiest time of their life, a time to dream beautiful dreams. They yearned for a token of their love to symbolise the special bond they shared. To have healthy babies, to hold, cuddle and grow old together watching them grow!

Finally 25-year-old Champika showed signs that her dream was about to come true. Her bulging belly and changing appearance got Amith to get closer to and love her even more. Their happiness doubled with yet more surprising news - they were going to have twins. The expectant mother and father were elated.

A routine ultrasound scan was scheduled when Champika was five months into her pregnancy. This is when the bombshell was dropped.

Consultant VOG at Mahamodara Dr. K. Gunaratna came out clean. "You have a very unique case. The babies inside you have not completely separated. You will be giving birth to conjoined twins."

No one can be prepared to brace the shock of such news. That was the last thing they wanted to hear - their babies were not alright. "I felt my heart stop," the mother said. "We could not explain the pain we felt." They grappled unsuccessfully to come to terms with reality.

Champika attended the regular maternity clinic at Karapitiya Teaching Hospital. But soon after the discovery of her condition, she was referred to the Castle Street Maternity Hospital in Colombo, a specialised Gynaecological and Obstetric hospital with the capacity to handle special cases of pregnancy such as Champika's.

Their life became a constant struggle from then onwards. They had to attend clinics at Castle Street Hospital which is over 150 kilometres away from their home town in Matara. Despite the shocking news, the mother and father were determined to do whatever possible to bring their babies to this world as healthy as they could be. She followed the doctor's advice to the letter, to keep them strong within the warmth of her womb.

Champika got herself admitted to Castle Street Hospital well in advance of the due date, as per the medical advice to deliver her 'different babies'. Each day of the pregnancy brought new fears and nightmares. She hoped from deep within for doctors to be wrong.

Together they weighed 4.2 kg. The identical twins vowed not to let go even after birth, their bodies were fastened together. The two appeared as if they had just one tummy.

Champika's heart sank.

The doctors, after medical examinations said the twins shared one liver. Some 'layers' of the' heart wall' (Pericardium) were also common to both. But luckily they had two hearts. Soon after birth the babies were transferred to the Lady Ridgeway Hospital for children in Borella.

The doctors and nurses at the special care unit of the LRH began treatment. Her babies must be at least nine months old to undergo surgery to separate them, Champika learned from the doctors there.

The staff at the LRH accommodated the mother in the hospital. She received special training to tend to her new born babies.

For three months their life was spent at the LRH. After three months Amith rented a small house at Narahenpita. To be near his wife and the babies he had to live in Colombo. He was jobless by this time and without an income.

Their families had been an enormous strength and the two grandmothers and an aunt took turns in looking after their new born grandchildren until they were fit enough for surgery.

According to the mother despite their awkward position, they grew up as normal babies. "They even wanted to turn and crawl like ordinary babies do."

On January 10, 2011, a special three-member team of paediatric surgeons, one heart and thoracic surgeon and a team of four anaesthetists assisted by a 25-member senior Nursing and other staff prepared for the historic moment.

The two babies, Deneth and Denuwan were to be separated. Doctors deemed that the babies who weighed 10kg by then, were fit for separation.

There had been a surgery at LRH before in 2006 to separate conjoined twins, but it had not been a success. Amith and Champika said this was the most gruesome moment of their ordeal. They found it difficult even to breathe.

The surgical team struggled with them for over six hours till around 2.30 p.m. Deneth and Denuwan who went inside as a single unit came out as two individuals and occupied two separate beds in the Surgical ICU.

Although covered in numerous, different sized tubes and machines, they both looked peaceful in their deep sleep. A day after the surgery the media was allowed to see them from a distance.

A nursing sister attending to the babies who were recovering at the Surgical Intensive Care Unit said the doctors did not have to reconstruct bones in their bodies.

They were all intact. The liver had to be cut in half as they shared this vital organ. The layers of the heart wall which they shared had to be attended to and reconstructed.

The doctors believe Deneth and Denuwan are on the path to complete recovery. But they are cautious to say anything more. Champika and Amith heaved a sigh of relief with the happy news for which they anxiously waited for the past 10 months.

The babies are still in the surgical ICU and the doctors said it was too early to predict when the babies could be sent home with their parents.

Highly remote

Dr. Hemantha Dodampahala, Consultant Obstetrician and Gynaecologist at De Soysa Maternity Hospital and Senior Lecturer of Feto-Maternal Medicine of the Colombo Medical Faculty said every expectant mother should not be paranoid of having Siamese twins (conjoined) because the chances of such a birth is highly remote.

"The chances of having Siamese twins are about one percent of the births of ordinary twins. The chances of pregnant mothers having twins are about three percent of an ordinary birth."

But, Dr.Dodampahala said, because of fertility treatment and IVF, there is an increase in multiple pregnancies. As a result --- the incidents of conjoined twins too have slightly gone up. But among the ordinary mothers who have had no such treatment, the chance of having a Siamese twin is highly remote.

"The Siamese twins are the result of a partially separated fertilised egg. If the egg is separated within the first ten days of fertilisation, there is no issue. There will be two identical twins," he said.

"Thanks to new inventions in obstetrics and ultrasound we are able to diagnose such conditions early in the pregnancy, as early as 10 weeks, simply by observing if the foetuses share the same sex, position and movements."

In the developed countries all these babies are terminated in the early stages with the permission of parents. But in Sri Lanka, the law does not permit termination. So once it has been continued, the paediatric surgeons will be entrusted to separate the conjoined twins.

Not all twins are difficult to separate. Only those who share vital organs and major blood vessels will be difficult to separate. The babies joined in the chest will not be difficult to separate if they do not share a single heart. Those who are linked from head can also be separated without much difficulty if they don't share a single brain. "Overall I feel this is not a pregnancy that should be continued," Dr. Dodampahala added.

Born together to live separately

Champika's heart sank.