Annie and Issie Bateson like the closeness one would expect from identical twins.
“They have so much space to play,” says her mother, Hannah, gesturing across her airy living room. “But it’s like there’s some kind of magnet pulling them together.”
Of course, that doesn’t mean they don’t have moments. “Don’t get me wrong, these are typical sisters,” she laughs. “One moment they’re waving at each other and clapping their hands, the next they’re arguing and arguing.”
In fact, Annie and Issie are anything but typical. When they were born in March last year, they were bandaged from chest to pelvis. Now, 14 months later, they are among the few conjoined twins to have successfully undergone grueling separation surgery.
Whilst scientific advances have led to remarkable developments in treating the medical complications of our youngest citizens, it was revealed just last week that the first baby in the UK was born with the DNA material of three ‘parents’ to prevent a hereditary birth genetic disorder – the procedure the girls underwent is still very risky.
Twins Annie and Issie Bateson, pictured with their parents Hannah and Dan Bateson, are among the few conjoined twins to successfully undergo grueling separation surgery
“Little” probably doesn’t quite sum up how rare these little girls are. Just look at the statistics: Conjoined twins occur in one in every 60 to 190 million pregnancies worldwide, with only 7.5 percent surviving. If they make it to surgery, a staggering 40 percent don’t survive.
So it’s no wonder that 32-year-old Hannah and her 33-year-old husband Dan prefer a less scientific term to describe their twin daughters. “They really are miracles,” says Hannah.
At the family home in Toomebridge, County Antrim, it’s clear that these little girls are forces of nature.
Although they each have only one leg left after separation surgery, both are exceptionally adept at shuffling the floor of the family home. Then there are their developing personalities. “Issie found her voice, she babbles – a real chatterbox while Annie is more of a quiet rascal,” says Hannah.
“She’s the adventurer who just disappears silently behind the TV or the sofa.”
She shakes her head, her joy palpable. No wonder the last few months have been emotionally draining and stem from years of infertility.
“We have a lot of unknowns ahead of us, but for now we are still confident that they are alive, surviving the birth and surgery,” says Hannah.
The couple were once teenage lovers and began trying for a child after marrying in 2016. After two years with no success, they were referred to a fertility center in Belfast, where Hannah – a senior NHS worker who weighed 20 grams at the time – was told she needed to lose weight before the couple could have any medical intervention.
When they were born in March last year, they were bandaged from chest to pelvis
After a mini gastric bypass, she managed to lose 11th place within a year. The couple were told to wait another six months before being given the fertility drug Clomid. Luckily, Hannah became pregnant in the first cycle in the summer of 2021 and the couple discovered they were expecting twins at the 12-week check-up that followed.
Except . . . something was wrong.
“We could tell from the sonographer’s behavior that she was concerned,” says Dan. “Then she told us she thinks the babies could be MCMA twins.”
MCMA (monochorionic monoamnios) is a rare type of identical twins who share not only the same placenta but also the same amniotic sac. They carry a higher risk of complications, from miscarriage and fetal abnormalities to stillbirth.
The terrified couple was immediately referred to an expert advisor. “It was incredibly scary,” Hannah recalls. “I remember the way I described it to our family: MCMA are the highest risk twins and the rarest — and the only thing rarer would be conjoined twins.”
Just days later, another scan at the Royal Victoria Hospital in Belfast confirmed their twins were experiencing this even rarer phenomenon.
“I don’t even know if we actually processed the information,” Hannah recalls. “I did all this research for MCMA twins, which was a big deal – then we found out they were conjoined and there was so little information.” I found that hard.’
At that point, the couple were simply told that the babies were joined from chest to pelvis and that, crucially, their hearts were separate. Fortunately, there was no sign of any other genetic abnormality.
“The most important thing that makes a breakup possible or not is separate and healthy hearts,” says Hannah. “With every scan, we were dying to see the beat of these two hearts, but at the same time, it was terrifying to see how close they were.”
It was two and a half months after the split before doctors pronounced Annie and Issie strong enough to travel, and the family of four was able to return home in time for Christmas in early December
The girls were fused at the liver, but since this organ has a unique ability to regenerate, it was able to be divided.
Her next appointment was in October at University College Hospital London (UCH) where the couple were given an option to terminate the pregnancy.
“It was never a conversation for us,” says Dan. “It was also made clear that if we made a commitment to the pregnancy, we would have full support — and we did.” “We are so incredibly grateful to everyone who took care of the girls.”
At the same appointment, the couple were told that Hannah would need to move to London in January – around week 26 – to be close to the hospital and its specialist teams.
“I was scheduled to have a cesarean for about 35 weeks, but once I went into labor it was very unlikely that the girls would survive without immediate intervention,” says Hannah. “At that point we had just moved so there was a certain amount of panic and we were worried about money too.”
With the support of a politician in their area, the couple received money for a self-contained apartment about a five-minute walk from Great Ormond Street Children’s Hospital (GOSH), where the babies were to be transferred immediately after birth.
March 8, 2002, the scheduled day of the operation, passed without incident. UCH had conducted repeated drills in preparation for the seismic event, with two separate teams of nurses assigned to each baby.
“They asked us to pick colors for each girl and for all the gear, and the staff then color coordinated.” “Annie was pink, Issie was yellow, so each side of the cribs had tape and stickers on them to show , who was who, as well as every machine and also every nurse,” says Dan.
The couple had also been given a tour of the neonatal intensive care unit (NICU) at GOSH.
“I’ll never forget the feeling of walking in and seeing all these little babies and gadgets,” says Hannah. “We both started crying. I think it showed everything that was coming.’
“But we were lucky,” adds Dan. “There are many families who end up in intensive care with a child without expecting it. At least we were able to know so we could prepare for it.”
Still, Hannah was “terrified” when she was brought into the operating room – and neither she nor the medical team knew exactly what to expect when the babies were finally delivered via cesarean section at 9.51am.
“I remember how tense it was in the room,” Dan recalls. “Then there were loud screams and you could feel this huge sigh of relief. No one had been sure the girls would be born breathing, and here they were screaming.’
The babies were quickly taken to an adjoining room where they were examined and stabilized. “One of the doctors came back and said they should have stopped Annie from pulling out all the tubes,” Hannah laughs. “No one expected them to do so well, that it would be so difficult.”
The birth was not without trauma, however: Hannah had lost a great deal of blood and had to be stabilized, meaning she had to remain in the convalescence phase while the girls were taken to Great Ormond Street, their concerned father with them in the ambulance.
Hannah had to wait another 24 hours before she could see her daughters.
“Of course it was difficult, but I had prepared for it,” she says. “At that point, they were still alive and doing better than anyone expected – that’s all I needed to know,” she says.
Their first cuddle the next night in GOSH’s ICU was “magic”.
“It was a bit of a logistical nightmare because there were pipes and wires everywhere, but finally being able to hold them – it was incredible,” she says.
In fact, the girls were doing so well that they were able to leave the NICU after four days, while the family was able to return home just over three weeks later.
At that point, the separation surgery was already scheduled for the following month but as the girls contracted mild Covid it was pushed back to July.
“It was never a consideration for us not to separate them,” says Dan. “They had separate hearts, they could be separated, so for us it was the only choice.”
But that surgery was in turn postponed, meaning worried new parents had to wait even longer.
“It was hard to have that date in my head and then push it back,” says Hannah. “You live in limbo.”
The twins’ surgery was eventually pushed back to September 19 – later announced as the day of the Queen’s funeral, meaning even more uncertainty.
As the morning of the surgery broke, the couple focused on the positive. “We didn’t focus on the girls not surviving,” says Hannah. “We just believed that we had her and that we weren’t going to lose her now.”
The girls were rushed into the operating room at 9am, the start of a marathon 18-hour procedure, while their worried parents paced outside. “It was the longest day,” says Dan. “The medical team kept us as informed as they could throughout the procedure, but the wait time was terrible.”
Finally, in the early hours of the next day, surgeons showed up and announced the split was a success – although more drama was to follow. “The next day Annie had a hemorrhage, so she went straight back to the theater,” says Hannah.
It was the beginning of seemingly endless further interventions.
“Over the next two and a half months, there were 30 procedures, including 20 surgeries,” she continues. “When the girls got separated, they got silos.” [an external pouch to contain some of their internal organs]So they had to keep going to the operating room to have their abdominal muscles gradually contract. There were other complications too.
“There were times when I would run to the anesthesiologist’s room with one child and while the recovery was beginning, I would walk downstairs with the other. “We were prepared for the aftermath of the breakup to be harsh, but it was worse than we ever imagined.”
Dan and Hannah say the fear of caring for their daughters meant it took them some time to realize that they are now separate beings.
“There was one day, maybe a week after the surgery, when they were crying and I was running from one side of the dressing room to the other, and that was the first moment of ‘Oh my god, they’re separated.’ “Hannah recalls. “It took a while to realize that.”
It was two and a half months before doctors pronounced Annie and Issie strong enough to travel, and the family of four was able to return home in time for Christmas in early December.
Since then, each month has brought the ever-evolving changes of growing babies as the duo learn to play, interact and move. Over the next few months, they will each be fitted with braces that will give them a prosthetic leg to help stabilize their growing bodies.
“We thought prosthetics would only be on the way for the next few years, but they’re very interested in getting the ball rolling,” explains Dan. “They will help them sit unaided, although we don’t know if they use them long-term.” Some formerly conjoined twins prefer using crutches; others use wheelchairs.’ Beyond that, the couple will have to wait and see.
“There will be more surgeries over the years – we have to adjust little things that will be different for both girls,” says Hannah. “But we’re both just going to take it as it comes.”
With Hannah no longer able to work due to the girls’ complex care needs and long journeys to and from London, they have started a donation page to help with the expenses they incur during the trip.
In the meantime, however, they enjoy every day with their “two little rascals”.
“We’re going to have a lot of work to do,” adds Hannah. “They are definitely characters. They are very determined – but that determination has gotten them to where they are now.”
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