Sarabeth and Amelia Irwin have had a unique story, right from the start. The identical twin sisters were born conjoined from their chests to their bellies on June 11, 2019, in a carefully planned delivery at Michigan Medicine's Von Voigtlander Women’s Hospital in Ann Arbor. When they were born, they were lifted out of their mother's womb with their arms wrapped tightly around each other — an instinctual embrace they remained in for the next 14 months. But last month, doctors were able to successfully separate them in a medical achievement that's as rare as it is impressive.
The surgery took doctors a painstaking 11 hours to complete.
The procedure required many hands on deck, between two teams of surgeons (one working on each girl) and the dozen-plus medical staff on hand for assistance.
But in the end, it was well worth it. Sarabeth and Amelia were officially separated on August 5, 2020, and are expected to lead healthy and fully independent lives, doctors say.
Now, more than a month later, their mother says they're "doing great."
Their father, Phil Irwin, can't believe the progress they've made.
"Other than taking our word for it, you would almost never know that they were conjoined," Phil told the Detroit Free Press in mid-September.
The chances of a birth like theirs is extremely rare.
Dr. Marcie Treadwell, director of Michigan Medicine’s Fetal Diagnosis and Treatment Center, told the Detroit Free Press that only 1 in 100,000 to 1 in 250,000 pregnancies involve conjoined twins. Few of those babies actually survive the delivery, and it's even less likely that they live long enough to head home from the hospital.
The fact that Sarabeth and Amelia did all that — and much more — is quite remarkable, but them being able to be separated and thrive is even more impressive.
The girls are the first conjoined twins to be successfully separated in Michigan.
That certainly provides some sense of how rare the instance of conjoined twins is in the US, let alone the world. In fact, when the girls' parents first learned they had cojoined twins in February 2019, they admit they were floored.
Mother Alyson, 33, told the newspaper that she had a feeling something was "different" but couldn't put her finger on what it was.
"I thought we were going to have a boy," admitted the mother, who had only been pregnant once before with her daughter Kennedy, now 3.
When the ultrasound technician paused during her 20-week scan and excused themself from the room, the couple started to worry.
"It may have been five minutes, but it seemed like forever," Phill recalled. "That's when we found out they were conjoined."
The news hit them like a ton of bricks.
"It kind of felt like the worst news you could receive, you know?" Alyson shared, "especially because the statistics are not good."
Speaking to her doctors didn't exactly settle their nerves.
"They had never seen anything like that before," Alyson shared. "So they said their hearts were breaking for us … but there wasn't anything they could do."
The couple soon met with a high-risk obstetrician.
Such doctors specialize in high-risk prenatal care and work with a patient's other doctors, nurses, and birthing staff to ensure they're receiving the best possible medical management.
Some 15 months after the twins' birth, the Irwins clearly feel they made the right decision. According to both, they've watched in awe as their little girls have begun to do things they never could have before — such as crawling and exploring independently.
It never could have happened without the help of experts like Dr. George Mychaliska, a pediatric and fetal surgeon at C.S. Mott Children's Hospital, where the twins were ultimately separated. Mychaliska first met with the couple back in March 2019 to see their health status and felt hopeful.
"Even at that time, we had pretty good prenatal imaging, which indicated that they really had all separate organs, except a liver was fused in the midline," Mychaliska told the newspaper.
"I told them separation of the two babies seemed possible but much more evaluation and planning would be required," he explained. "I remember it very well. I didn't want to be too optimistic because this was (going to be) a really long journey for us. We had never done it before. But I do remember being very hopeful with the family, that it's something that certainly was possible."
Still, there were a lot of what-ifs.
Would they be healthy enough to survive the birth? If so, would it ever be possible to separate them?
When the girls were finally born, their parents were relieved to find they were both relatively healthy. They each weighed more than 4 1/2 pounds (or just over 9 pounds combined), and though they were sent to the NICU immediately afterward, doctors say they did well from the start.
"They were both vigorous when they came out," Treadwell shared. "What I remember is the joy of seeing them, and the fact that they both looked good."
Before the birth, the Irwins spent months prepping themselves for a new reality.
This meant explaining to their toddler daughter how her sisters would be different (they say it didn't faze her), and even preparing their car and home to accommodate the girls' special needs.
Their first challenge? Getting the girls home safely. According to Phil, 32, that meant preparing what's known as a car bed for the girls.
"It's got a couple handles that you can run the seat belts through, [and] a couple attachment points to reach up to the mounting points on the front seats," he explained.
A manufacturing company graciously made the family a custom swaddle sack that was built into the car bed. ("It had some zippers and a buckle attachment," Phil shared. "And then there is a cummerbund that had super sticky Velcro that would reach across them. And that was great.")
Friends and family rallied around them too. A GoFundMe page set up to support the family through their challenging year raised more than $8,700.
Over the next year, the parents waited patiently.
An initial separation surgery was scheduled for February 2020 but was postponed because one of the twins had a cold. Then came the pandemic, which pushed back the timeline even further. This summer, the Irwins were finally given the thumbs-up that separation was possible, and on August 5, they nervously kissed their girls goodbye as they were wheeled into the operating room.
Because of COVID-19 restrictions, the Irwins had to sit outside in their car during the 11-hour procedure, patiently waiting for updates. The anticipation was certainly intense, and not just for the parents but also for the doctors.
"One thing that we really didn't know until they were separated and the breathing tube came out was what their chest wall mechanics would be like," Mychaliska told the Detroit Free Press. "Breathing is a complicated thing that involves your lungs, your diaphragm muscle and your chest wall, and it has to all kind of work in sync. … We really didn't know how well their chest wall would work, but it worked actually beautifully."
Those days are long gone.
Now, the Irwins can place the girls in their very own car seats — and the significance of that means more than they can say.
"For us it's been a whirlwind, an absolute whirlwind," Phil shared.
Although the girls still need occupational therapy (Sarabeth is on an oxygen tank), they've sure come a long way so far.
"You look back at it, and it's like man, remember what used to stress us out?" their dad said. "It's perspective."
