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Healthy and thriving at more than 9 pounds each, they smile and wiggle, preemie twin boys whose mother feared the worst when she went into labor about four months early. But mom Elene Cowan calls their survival a miracle after her sons were born 39 days apart, another unusual instance of tiny twins arriving on different days.
“I didn’t think miracles happen but I know they did,” said Cowan, 30, an emergency room nurse who slipped her engagement ring around her firstborn son’s wrist when he was about a week old. “When your ring can fit around your son’s arm and now you’re holding him and feeding him and playing with him on the floor, that can only be a miracle.”
Cowan, who delivered Carl at 24 weeks on Jan. 20, and David Jr. at nearly 30 weeks on March 28, credits her doctor with making the right decision to delay the second delivery for as long as possible to improve David’s chances despite the risk of infection or other complications.
The five weeks between vaginal deliveries at Research Medical Center in Kansas City, Missouri, were agonizing for Cowan, who was torn between tending to Carl in the neonatal intensive care unit and resting to protect her fragile pregnancy.
“It was awful being pregnant and going to the NICU and being worried about one baby inside of you and worried about one baby outside of you,” Cowan said.
Her scary ordeal began in January, when she and her husband, David, flew home to Missouri from Saudi Arabia, where he works as an emergency room doctor. Within hours, she didn’t feel right and wondered if she was dehydrated.
But doctors found that Carl’s amniotic sac was entering the birth canal, Cowan’s cervix was starting to dilate and she was having contractions. With medication and other treatments, her labor was stalled for about a week, when she gave birth to Carl, tiny at 1.4 pounds.
“I just thought there’s no way he’s going to survive,” Cowan said. But in the silence of the operating room, she knew he was alive. “He had two little cries. That made me really happy.”
Her obstetrician, Dr. Howard Schwartz, said in an interview that he believed that Cowan suffered from an incompetent cervix, a condition where weak cervical tissue can cause premature birth. He placed a stitch to hold her cervix closed, and ordered antibiotics and medications to stall labor.
“The opportunity to buy time was the reason for trying to do the procedure to separate their births,” he said, noting that there is about a 50 percent chance of survival for babies born at 24 weeks.
Cowan’s labor became unstoppable again in late March, when David was born, weighing more than twice that of brother, at 2.9 pounds.
“I thought, ‘Oh my gosh. He is the biggest baby ever,’” she said, noting that her husband watched the birth from Saudi Arabia through a video call.
The boys stayed in the neonatal intensive care unit for weeks, finally going home in late May, about a week after their due date of May 11. Doctors told Cowan the fraternal twins, will be “perfectly healthy normal little boys,” though Carl remains on oxygen.
Schwartz said he has treated at least six women carrying multiple fetuses with an incompetent cervix the same way as Cowan over the last 15 years. It is not commonly done, he said, because doctors are taught to deliver multiples at the same time. The delayed approach, he said, is “outside the normal mindset.”
But, Schwartz said, with the right conditions and willing parents, it can work. “Thirty-nine days apart with both babies surviving is unusual, and yes, beats the odds,” Schwartz said.
When the news of twins born 24 days apart in Boston aired on her local television station recently, Cowan called the station to share the news of her boys’ wider spread. “Kansas City has to be better at Boston in something,” she joked.
The terrifying experience of bringing her boys into the world has left Cowan extra grateful for all they’ve been through.
“I’m just reminded of the miracle and really appreciate my babies,” Cowan said. “I have a much greater appreciation for them than if they had been born full-term. I think it’s kind of a blessing in disguise. I appreciate those dirty diapers even more.”
Lisa A. Flam is a news and lifestyles reporter in New York. Follow her on Twitter.