Abby can roll onto her stomach, hold up her head and flip the pages of her favorite story books. Her sister Erin can now sit up on her own, and she has started to think about crawling by holding herself up on her hands and knees.
At 10-months-old, twins Erin and Abby Delany are no longer fused at the top of their heads.
With a complex separation surgery at Children's Hospital of Philadelphia behind them, concerns for the twins hasn't ceased. They could be left with complications that could include neurological damage.
“Both girls had some brain bleeds happen while they were in surgery, Abby significantly more than Erin. So we are waiting to see exactly what that means,” their mother, Heather, wrote on her blog a week after the procedure. “These days are scary. Yes, the girls got separated, but this is only the beginning.”
The surgery that infants underwent was so rare that it has only been performed about 60 times worldwide since 1952 and never at the Children's Hospital of Philadelphia.
Conjoined Before Birth
When Heather had an ultrasound at 11 weeks of pregnancy, it was revealed that she was carrying conjoined twins.
“Riley and I already love our children more than we could possibly imagine, and that is what makes it so hard,” she wrote in March 2016 after the ultrasound.
“We are choosing to believe that God has a plan for them, and it is to prosper them and give them hope and a future,” she added.
Heather and Riley married in October 2015 and were overjoyed to learn that they were pregnant three months later. Even though Heather has younger identical twin sisters, she was surprised when she found out that she, herself was carrying twins.
“I mentioned to the doctor about how they seemed very close,” she wrote on her blog. “That is when … something that was 100 percent joy turned into almost 100 percent terror. He said very abruptly that he thought they might be conjoined.”
Being attached by the head is particularly dangerous because if more than a little brain tissue is shared, the twins usually die during pregnancy or in the first few days after birth.
Soon after their early ultrasound, the couple began biweekly treks to Philadelphia from their North Carolina home for meetings with professional to help them along their journey.
“I have met with lots of doctors, social workers, psychologists, midwives, surgeons, and the list goes on,” Heather blogged. “They make me feel almost normal. To have a place that makes me feel like I’m doing a good job is wonderful.”
By 20 weeks of her pregnancy, Heather was moved into the hospital so she could be closely monitored. That was when it was discovered that Erin was the dominant twin, while Abby had signs of insufficent blood flow.
“It has gotten a little worse every time they have scanned,” Heather wrote a year ago.
About a month later, the twins were delivered by cesarean section, about eight weeks premature. They each weighed 2 pounds and 1 ounce.
From here the babies steadily grew and started to reach developmental milestones.
Doctors began using 3D imaging to make models and create a plan for the surgery to separate them.
“Abby would be left with very little [of the sinus], meaning that Abby would have a much harder time and a much greater chance of death,” Heather wrote. “When you are told that sort of information, your world stops.”
“We know that children heal better and faster the younger they are, therefore our goal for Erin and Abby was separation as soon as possible with minimum number of surgeries,” reconstructive surgeon, Dr. Jesse Taylor said.
Doctors originally came up with a plan for a multi-stage surgery, two weeks apart, which would allow shared blood flow to be rerouted and reduce complications.
That's when the plans changed.