||22 July 2012 07:00
Devi Sankaree Govender
|Show: ||Carte Blanche|
It's just before 9am on Tuesday the 10th July at the Netcare Umhlanga hospital in Durban.
Devi Sankaree Govender (Carte Blanche presenter): "A medical miracle is unfolding behind these doors. A baby is about to be delivered... a baby which, just weeks ago, was given only a 10% chance of survival."
I'd hoped that when Tarryn and Haden Ford's baby is born, he would have fought incredible odds and won, thanks to a team of brave Durban doctors who performed surgery on him while he was still in the womb.
But before Baby Ford is born, we need to go back five months [to March 2012]. He was just a 17-week-old foetus when, during a routine scan, it was discovered he'd developed an extremely rare medical condition called chylothorax.
Tarryn Ford: "You know, we were actually going to find out the sex of the baby. We were looking forward to it and its all bets on, and you know - boy, girl..."
Hayden Ford: "And then you hear the dreaded: 'I've got something that I'm concerned about.'"
Obstetrician, Dr Carlos Hartmann successfully delivered the couple's first son two years before and was the first to pick up that there was a problem with their new baby.
Dr Carlos Hartmann (Gynaecologist & Obstetrician): "There is nothing more difficult than to break bad news to a parent."
Blocked lymphatic ducts in the chest had caused fluid to leak into the torso.
Devi: "Simply put: fluid had filled his chest cavity, compressing the lungs and displacing the heart... neither organ was able to grow properly and there was a chance the pressure could stop the heart from beating."
Dr Hartmann: "It's very, very rare. The incidence of pleural effusion is about one in 10 to 15 000 pregnancies. So it is very, very rare."
In 20 years, only 250 cases have been documented worldwide. Without surgery, 90% of these cases die in the womb, or two to three weeks after birth - terrifying for any parent.
Tarryn: "We can't explain it. You can't - it's devastating."
Hayden: "Take the reverse of 'you've won the lotto' and then undo it, but put it on the emotional side. And I think for any parent the hardest thing is to receive bad news."
Dr Hartmann called in foetal-maternal specialist, Dr Ismael Bhorat.
Dr Ismael Bhorat (Foetal Maternal specialist): "It's the duty of the foetologist to make a call on whether to institute foetal therapy or foetal surgery, or to wait until the baby is born and then to institute that therapy."
At that stage the Fords were given some hope. The doctors believed it would be safe to deliver the baby and then remove the fluid, as only one of the lungs appeared be compressed.
The heart and second lung were developing normally. The parents breathed a sigh of relief.
Dr Hartmann: "We were hoping at least to reach 34 weeks, because if we had reached 34 weeks we would have delivered the baby without the need of any procedures in utero."
But, just two weeks short of their goal, everything changed - the fluid in baby Ford's chest cavity increased and filled to capacity, meaning he could go into cardiac arrest at any moment.
Dr Bhorat: "I realised at 32 weeks that if we didn't do anything this baby was going to die."
Tarryn: "All of a sudden, you know, you've gone from a stable situation to this chronic situation where we've got no choice and we've actually got to do surgery."
Hayden worked as an ambulance chopper pilot for many years and says he saw many sick and injured children beat the odds.
Devi: "But he never dreamed that one day his own unborn child would be placed in a life or death situation."
So, when the doctors suggested a largely experimental procedure involving pinhole surgery while the baby was still in utero, Tarryn and Hayden agreed.
Tarryn: "That was our lifeline."
With time running out, a medical team of experts was assembled within 24 hours.
Dr Bhorat made a call to Dr Samad Shaik, a paediatric surgeon, who agreed to do the procedure.
Dr Samad Shaik (Paediatric surgeon): "What we did in Baby Ford is something we call 'image guided surgery' or 'foetal image guided surgery'. And the technique we used was ultrasound to help see where the baby was lying, to see exactly where the fluid was and then to guide the entry into mommy's tummy from there into the uterus and then into baby itself."
Footage captured by the surgeons on the day of the operation and ultrasound imagery shows how the surgery was carried out [on 2 June 2012].
Key to the success of the procedure was the insertion of a shunt into the baby's chest to drain the fluid.
But, because the medical condition was so rare, no shunts were available in the country.
Dr Shaik: "There was one tube available in South Africa, but unfortunately it had expired because it had been brought in some time ago."
Thankfully a local agent was able to mobilise his international partners and a shunt was flown in overnight.
Dr Shaik: "Within about two to four hours on the Friday afternoon everything had been set up and on Saturday morning the parents came into hospital."
The 90-minute procedure took place on Saturday the 2nd of June at the Netcare Parklands Hospital in Overport.
Hayden: "I don't know how Dr Shaik did it, but he managed it. He definitely grabbed the rabbit out the hat."
A 2.1 mm wide needle was used to insert the shunt.
First it was pushed through Tarryn's stomach and uterine wall. The needle was then guided through the baby's ribs and into his chest cavity.
Dr Shaik: "Once we have started the procedure, we do give baby a bit of sedation to make sure he doesn't feel any pain."
Devi: "According to Dr Shaik, a lot of things could have gone wrong. Tarryn could have gone into premature labour, there could have been a problem with the actual technical operation or her placenta could have separated."
Tarryn: "I started going into labour and they gave me some fancy drugs and everything... And, luckily after, I think it was about a couple of hours, it started wearing off. But that was the biggest risk... going into premature labour."
Devi: "How big was this baby?"
Dr Shaik: "Baby Ford was approximately just over one kilogram. It's not a very small baby, but what we look at rather is the actual gap between the ribs, because that is the sort of space we need to get into the chest wall. And the space between the ribs is about three millimetres."
Dr Shaik explained how the shunt works. It's made of a special type of plastic which is coiled at both ends.
Dr Shaik: "Basically what happens with the shunt is that, once it enters baby's chest wall, this is the bit [on screen] that enters the chest wall; it untwists itself when it goes in."
This ultrasound footage shows the shunt twisting as it's pushed out of the needle into the cavity.
Dr Shaik: "And then once we pull the wire back, it twists again."
The second twist sits outside the baby's body so that it's not dislodged.
The pressure, created by the excess fluid inside the thorax, is higher than the pressure outside. So, as soon as the shunt is inserted, the chest cavity starts to empty into the amniotic fluid.
With the specs all worked out, Dr Shaik, supported by Dr Hartmann and Dr Bhorat, inserted the shunt.
Dr Hartmann: "My role was going to come if the baby had to be delivered at that point."
Dr Bhorat helped to guide the surgery using a system of screens set up in the theatre.
Dr Bhorat: "It was a very good collaboration between three fields here, which is foetal medicine, paediatric surgery and obstetrics and gynaecology."
The procedure was a success and a post-operative scan showed that the baby's lungs had already expanded and he was out of danger.
Devi: "We are calling you the three medical musketeers - one for all, all for one."
Dr Hartmann: "Absolutely!"
Devi: "Does it feel like that?"
Dr Hartmann: "Definitely yes!"
Tarryn was now able to carry her baby to term. A Caesarean section was booked for 37 weeks [on 10 July 2012].
We were there for the birth.
Devi: "So how are you feeling?"
Tarryn: "Excited, nervous, anxious and very excited."
Hayden: "Hopefully it all goes as it's been explained to us, but I'm sure it's going to be a bit busy in there."
While Dr Hartmann helped Tarryn and Hayden get prepped for the birth, we got suited up.
The big day had finally arrived and while everyone was excited to finally meet baby Ford, the stress was beginning to take its toll on mom.
But the doctors were positive.
Dr Hartmann: "Baby is going to be fine. We are very, very confident that all the problems have been sorted out in uterus."
Dr Bhorat explained that they would be performing a special Caesarean or 'exit procedure'.
Dr Bhorat: "The baby is going to be extracted with cord still attached to the placenta; we are not going to transect the cord."
Keeping baby connected to the placenta meant he will still be able to get oxygen from his mother, giving him a better chance of surviving if something went wrong.
Devi: "I'm actually feeling very, very nervous. I think the enormity of what's happening here is just really beginning to hit me now... I'm just crossing fingers for this small little baby."
With Tarryn sedated, Dr Hartmann began the Caesarean section, and it wasn't long before we got our first glimpse of the baby. At a healthy weight of 3.32kg, the doctors were pleased.
But there was a way to go; the shunt was still lodged in the infant's rib cage.
As soon as the shunt became visible, Dr Shaik clamped the tube shut. The little boy was then immediately incubated, as a precaution to help him breathe.
It took a few minutes for him to respond.
With oxygen turning his body pink and Tarryn stable, the doctors cut the cord to the placenta.
Dr Hartmann: "The operation went successfully. Mommy is absolutely fine. And I think that baby is absolutely fine! Wonderful."
Devi: "How do you feel?"
Dr Bhorat: "We are all shaking (laughs)."
Devi: "Can you finally tell us the baby's name?"
Hayden: "It's Joel Hayden Ford."
There were congratulations all round.
Devi: "High 5!"
Hayden: "You can have a hug Dev'!"
Devi: "It really is an absolute miracle: Joel Ford, born at 17 minutes after the hour. He's going now into the neonatal ICU, just as a precautionary measure. But his attending paediatrician says he is A for okay."
And within a few hours the shunt was removed and he was taken off oxygen.
Because she had been under general aesthetic, Tarryn wasn't able to see her baby until later that night.
Tarryn: "I get to see my baby!"
It was an emotional reunion.
Tarryn: "I'm just so relieved, so happy... He's beautiful!"
Joel was discharged from hospital this past week... a perfectly healthy baby.
IMPORTANT DISCLAIMER:While every attempt has been made to ensure this transcript or summary is accurate, Carte Blanche or its agents cannot be held liable for any claims arising out of inaccuracies caused by human error or electronic fault. This transcript was typed from a transcription recording unit and not from an original script, so due to the possibility of mishearing and the difficulty, in some cases, of identifying individual speakers, errors cannot be ruled out.