My Thoughts On A Historic Intrapartum Surgery
I read an article in the New York Times about a remarkable surgery that doctors at Baylor College of Medicine and Texas Chidren’s Hospital are doing to try to repair a spine defect in a fetus still in his mother’s womb. The article chronicled the surgery that Lexi Royer, 28 had decided to undergo for her unborn child and talked about the fears that Lexi and her husband Joshuwa had after learning from Lexi’s OBGYN that their unborn child had spina bifida.
During the surgery, Lexi and Joshuwa’s unborn child, 24 weeks and two days old, less than two pounds, underwent surgery to repair his spine, all while remaining in his mother’s womb. The child had a severe form of spina bifida, in which the backbone and spinal cord do not develop properly. Spina bifida occurs early, at three to four weeks of pregnancy, when the tissue forming the spinal column should fold into a tube but does not close properly. It’s a rare condition with just 1,500 to 2,000 cases a year in the United States. Children born with this condition usually cannot walk, and suffer from fluid buildup in the brain, lack of bladder control and other complications.
Here is a graphic from the article that shows the development of Lexi’s child and the area of the spinal opening/lesion:
The doctors performing the surgery are Dr. Michael A. Belfort, the chairman of obstetrics and gynecology at Baylor College of Medicine and obstetrician and gynecologist-in-chief of Texas Children’s Hospital, and a pediatric neurosurgeon, Dr. William Whitehead.
Doctors have been performing fetal surgery to repair spina bifida since the 1990s; it is not a cure, but can lessen the degree of disability. But now Dr. Belfort and Dr. Whitehead are testing a new, experimental technique — one that some in the field are eager to learn, but that others regard warily, questioning its long-term safety for the fetus. The surgeons had made a wide incision in the mother’s lower abdomen, gently lifted out her uterus — still attached internally — and made two tiny, 4-millimeter slits. In one, they inserted a “fetoscope,” a small telescope fitted with a camera, light and grasping tool. The second slit was for other miniature instruments.
While the children we care for are not injured as a result of a genetic or metabolic defect that leaves a vital organ, their brain or spine, malformed during their pregnancy, the parents we represent have been through many of the same things that I imagine Lexi and Joshuwa are going through with their unborn son. If you have been a parent, you know that feeling of utter hopelessness you feel when your child isn’t “ok”. You have probably wished you could trade places with them and take on whatever suffering they have to endure – to spare them from having to go through it.
I imagine, without knowing, that the parents we represent have an additional layer of suffering they go through because the injuries to their child were preventable. We have lots of families come to us and we spend lots of time learning what they are going through, reviewing medical records, and consulting with medical experts. But we only take on cases where we can prove that preventable medical error – often understaffing, or poor communication between doctors and between nurses – caused the child’s injuries.
My heart breaks a little every time I learn about a child who is suffering, regardless of whether it is genetic or was caused by carelessness of the medical team. We only take on a few cases every year, but we believe that we are making a difference in these families’ lives. Our hearts go out to Lexi and her unborn child and we will pray for their swift recovery.