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VALLEY: Abigail Trafford holds her dad’s hand.
Photo by Beth Ward
VALLEY: Abigail Trafford holds her dad’s hand.

Abigail and Samuel

Birth | A pair of tiny twins illustrates the agonizing challenges that premature births present to parents and doctors

Issue: "Boy Scout dilemma," May 18, 2013

Life with a premature baby is a journey with sharp cliffs, switchbacks, and beautiful views. Some trails descend to valleys, others snake to mountaintops. One couple from Evans, Ga., has traveled it all.

Married in 2007, Robin and Derrick Trafford, 32 and 33, were unable to conceive naturally and turned to in vitro fertilization. Their fertility specialist transferred two embryos—small enough to fit on the tip of a pen—and Robin became pregnant with both.

Except for a temporary problem with one baby’s placenta, the first few weeks of the pregnancy were uneventful. When Robin went for a 19-week checkup, though, she learned she was 3 centimeters dilated: Going into labor at that stage would mean certain death for the twins. Call your husband, Robin’s obstetrician said. Tell him you’re on your way to the hospital.

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Extremely premature births create some of the most difficult moments parents and doctors ever face. Although medical science has greatly improved the survival odds of babies as small as 23 weeks of gestation, it’s still difficult to predict which ones will live or die. Doctors must make difficult decisions about when to push for survival, and when to relent. Parents like the Traffords must decide when to hold on or let go.

Happily for Robin, the staff at University Hospital in Augusta, Ga., was able to halt her labor with a dose of magnesium sulfate. She began bed rest in hopes of maintaining the pregnancy at least until 24 weeks, when the survival chances of the twins—a boy and girl the Traffords named Samuel and Abigail—would be much greater. (A normal pregnancy lasts 40 weeks.)

But a few days later, Samuel’s water broke. The lack of fluid surrounding the baby meant his lungs might not develop properly. Robin’s doctors hoped the ruptured membrane would heal, and ultrasound technicians checked Samuel’s fluid level each day while the Traffords looked on and prayed.

Derrick began keeping a journal to “vent,” he says, and addressed each entry to the twins. Robin says she learned what Scripture means by “be still and know that I am God” during the bed rest.

Robin was able to keep the twins in her womb until 27½ weeks, when Samuel’s placenta separated from the uterus, restricting his supply of oxygen and nutrients. Doctors performed an emergency cesarean section on a Saturday morning in April 2012. Abigail weighed 2 pounds, 4 ounces. Samuel was an ounce smaller.

To help the babies breathe, doctors inserted a ventilator tube through Samuel’s mouth and into his lungs. They provided Abigail with a “CPAP” system that delivered constant, light air pressure to her nostrils.

Twelve hours after delivery, one of the doctors told the Traffords Samuel had taken a turn for the worse. The baby’s lungs, weak and underdeveloped, had burst under the pressure of the ventilator.

Derrick and Robin went to the neonatal intensive care unit, where nurses had been trying to resuscitate Samuel for 20 minutes, using tiny chest compressions. “I don’t think there’s anything more we can do,” said the doctor.

From her wheelchair, Robin recalls praying aloud, “I speak the life of Jesus into my son!” Derrick remembers a stunned look on the doctor’s face as he bent to check Samuel one last time with a stethoscope. “I hear a heartbeat!” the doctor said. “It’s getting faster!”

The medical team worked to stabilize the baby, but told the Traffords 20 minutes without oxygen might have caused irreversible damage to Samuel’s brain. 

Back in their room, the couple prayed: “Lord, we have no idea what to do. Just show us. If You want us to fight, we will.”

Parents aren’t the only ones who wonder when to fight or let go. Neonatologist David Levine wonders, too. The Columbus, Ga., physician has cared for newborns for more than 30 years, and currently works at Columbus Regional Medical Center.

To Levine, the question of resuscitation is clear when a premature baby is just 20 weeks developed or less. In those cases he explains to parents there’s no medical technology to sustain a baby that small.

If a baby is a little older and larger he assesses each case individually. He thinks about what he’ll have to do to keep alive a baby that is dying at birth: “We have to put a tube down the baby’s throat, we might have to squeeze on the baby’s chest, we could break some ribs. It’s a very traumatic process. And we’re talking still about maybe a 10 percent survival rate, maybe a 75 percent handicap rate.”

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