Billie-Joe is pregnant with twins, and she and her boyfriend Josh are excited about becoming parents – except that having children has become more complicated than the couple imagined it could be.
Billie-Joe has a rare twin pregnancy, where one of the twins has no formed brain or heartbeat, but is taking the nutrients and oxygen from the healthy sibling, which is working so hard to support both of them that it is at risk of having heart failure and dying at 20 to 24 weeks.
Thanks to medical progress, however, surgeons are able to operate on the unborn babies in the womb to try to change a bleak outcome into a positive one.
The doctor for this highly specialised job is Professor Mark Kilby, a clinical scientist and consultant in foetal medicine at the Birmingham Women’s Foundation Trust Hospital.
Saving lives before they’ve begun
“This rare twin condition happens in one in 100,000 pregnancies,” he tells i. “It doesn’t seem many, and it isn’t, but because we get referrals from all over the north of England, the Midlands and the Home Counties, we probably see one of these every two weeks.”
With the help of his team, Kilby threads a skinny needle into Billie-Joe’s stomach, and into the womb. Ultrasound is the only way he can see his tiny patient in utero. “One of the biggest developments in the last 100 years,” he says, “has been the development and refinement of ultrasound.”
The needle disperses heat using radio waves, which cuts off the bloody supply from the healthy baby (known as the pump twin) to the parasitic foetus, to let the developed baby grow. The entire procedure takes under an hour and if all goes well, the chances of the healthy baby surviving is eight or nine out of 10.
Kilby’s procedure on Billie-Joe is shown as part of the BBC’s new fly-on-the-wall series Life and Birth, narrated by Suranne Jones, which looks at life on the labour wards of three Birmingham hospitals.
“I knew things could go wrong in pregnancy, but I didn’t know about this,” Josh says. “We just have to wrap our heads around it and think of what’s best for the baby.”
Good outcomes
After qualifying from Guy’s Hospital medical school in London 36 years ago, does Kilby still feel the pressure? “What I find so interesting about this area,” he replies, “is that you have two patients, the mum and her unborn baby, and that’s extremely unusual.”
While his work mostly benefits the baby, there are risks of still-birth, miscarriage, premature birth – and a small chance of infection. “We go to great lengths to stop that happening, but it’s at the back of your mind,” he says.
“Some of the tension relates to wanting to do the best for the baby, but also realising you’re operating on two people. And the mother is more than an innocent bystander in all of this.”
Before the first foetal therapy was carried out in the 1960s, no babies or their mothers had the chance of help like this. For Kilby, who was the first person in his family to go to university, it is this fact that propels him through his research.
“Generations of babies were born dead or in a very poor condition,” he says, “with physicians and specialists knowing that if they had been able to intervene many weeks before, while the baby was still in womb, the outcome would have been very different. Now, being able to change the course of a disease in utero hopefully leads to a very good outcome for mother and baby.”
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As well as intervening in complex twin cases like Billie-Joe’s, Kilby operates on babies in the womb at risk of heart failure from an abnormal build-up of fluid in their chest, which squashes their lungs.
He does this by threading a catheter into the womb and under the baby’s chest to drain the fluid and let the lungs grow. Kilby also performs 40 to 50 blood transfusions a year on anaemic babies before they are born. “The majority of parents have none of these problems,” he says. However, he sees the ones who do.
With his own children now grown up, how does he switch off when he gets home? “You don’t always. It’s incredibly difficult, and I’m not sure I’ve made a success of being able to do that perfectly. But learning to wind down is part of medical training.”
What brings him joy is hearing from the parents he has helped. “It’s very nice to hear when kids are growing up and things have gone well. I have to say, though, it’s when things don’t turn out happily ever after that stick in your mind.”
The future looks hopeful for foetal medicine, with UK scientists working with colleagues across the world. “I’m pleased with the way things have been going,” Kilby says; “but the challenge is now to perfect non-invasive procedures, to use technology to minimise the impact on the baby and mother – but that’s probably a little way off.”
For now, the surgeon has to get back to mothers such as Billie-Joe and give their babies the best chance of being born healthy and ready for the world.
Lockdown — ‘Work goes on’
With most of the NHS’s attention focused on the coronavirus crisis, how is this affecting maternity units and Professor Kilby’s delicate work?
“Work is continuing,” the surgeon says, “but I wouldn’t say it’s continuing as normal. We rely on people performing other roles at other hospitals first, and then referring people to us from their centres; so if someone who performs an ultrasound is sick, and staff numbers are reduced, then there is more limited screening of babies with problems.
“The pressure on medicine is immense at the moment. Of course, pregnant women also get Covid-19 – so again, that leads to a change of focus when it comes to the mother.
“However, for the most part, work goes on. There is limited evidence that the virus has a direct effect on babies, but indirectly it can raise risk of complications in pregnancy.
“There are many viruses that can attack a baby in the womb, and so far evidence is that Covid-19 does not. But it is early days.”
Life and Birth begins on Tuesday on BBC1 at 8pm
