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Siamese twins: when fate steps in

The Astburys were optimistic about their conjoined twins. But 'bad luck' ruined the babies' chances of survival. Jojo Moyes reports
All Melanie Astbury ever wanted was "normal healthy babies". She had been "deliriously happy" at the discovery she and her husband Brian were expecting twins. But this was replaced by numbness when in May this year a scan revealed those twins were joined at the stomach. "I felt my world had fallen apart," she said.

Their consultant told them the chances of twins surviving a separation were "very good" but that they had to make a choice as to whether to abort. "We walked around for a week in a total mental fog," said Brian Astbury at the time, but added: "We never seriously discussed termination ... Our babies will be born out of love into love. Everything else rests with fate and the surgeon's skills." They rang the hospital and told the doctors the next morning. "They were delighted," he said.

Elsewhere, people were less hopeful and considerably less bullish. Dr Michael Maresh, Melanie Astbury's consultant obstetrician, warned presciently at the time that the couple seemed "too optimistic ... the risks are enormous for both children, as there could be so many abnormalities not defined in ultrasound, such as shared gut and other abdominal abnormalities". If his wife was pregnant with conjoined twins, what would he have wanted? "I would have to say termination," he said. Had he said that to the Astburys? "No."

The pregnancy continued in secret until early last month when first reports of the impending birth found their way into the Sunday newspapers. The couple's solicitor, Andrea McWatt, shielded their identity until their story was swiftly bought for an undisclosed sum by Ian Monk of the Daily Mail and a series of in-depth interviews followed.

The tone of these interviews was consistently one of hope triumphing over adversity. The article that appeared on the day before she was due to give birth described Melanie Astbury as "a picture of radiant motherhood. Her eyes shine, her skin has that special glow that pregnant women have and she exudes an aura of peace and contentment ..."

But elsewhere, the couple's decision to go through with the birth elicited a fierce debate. This was opened by Polly Toynbee who, in a response to the Mail's articles, wrote a piece in this newspaper entitled "Sentimentality is not enough", in which she suggested the couple should have been encouraged to consider abortion. This brought a fierce reply from, among others, Dominic Lawson, then editor of the Spectator and himself the father of a daughter with Down's syndrome, who said: "If anything could truly be described as chilling it is the mind of Polly Toynbee ... her argument is not only morally and emotionally bankrupt; it is also intellectually bankrupt."

Amid the relative peace of the maternity ward, Melanie Astbury gave birth to daughters Chloe and Nicole by Caesarean section at St Mary's Hospital, Manchester, on 14 September. The first conjoined twins born in Britain for nearly 10 years, they were joined from the breastbone to the navel.

Although they also shared a bowel, they had separate hearts, limbs and spinal cords. They also shared a liver, but this organ has the power to regenerate itself if divided. The Astburys were said to be "overwhelmed and speechless with joy" at their daughters' birth. Melanie Astbury, on seeing them for the first time, described them as "beautiful".

Doctors said the twins were "stable and progressing satisfactorily" in the hospital's special baby unit. Three days later, on 18 September, they underwent an 11-hour operation to separate their bowels, which had become tangled in the womb, and the following day consultant paediatric surgeon Alan Dickson, who performed the operation, described it as successful and was "cautiously optimistic" that the twins would be able to eat normally within a year.

But four days later he admitted the extent of the bowel damage was a disappointment. "It is quite likely to have implications for the separation, but I am not prepared to speculate on it," he said.

Nevertheless, the last time the hospital chiefs commented on Chloe and Nicole's condition, they said staff were "quietly pleased" with their progress. Doctors were waiting for the twins to become strong enough to undergo a full separation, which was not expected to happen for at least a year. But on 21 September they were taken off a ventilator and were able to breathe normally for the first time.

Shortly afterwards their mother was allowed home. Melanie Astbury, 25, who also has a three-year-old son, returned daily to St Mary's to help care for her daughters. "I'm washing their faces now and changing nappies, so I feel much more involved as a mother," she said. "I haven't bathed them yet but I hope to soon."

Feelings about the birth, however, were still running high. Last Monday the parents appeared on ITV's This Morning show and revealed that they had received hate-mail because of their decision not to terminate. They had thrown the letters from the "sickos" away, they said. They added that an operation to separate their daughters was "inevitable", but they had "no regrets" about going through with the births.

They had every reason to feel confident. The babies had progressed much better than could reasonably have been expected after their major operation four weeks ago. They had been fed on milk, both orally and through a tube to the abdomen. So pleased was the hospital with the twins' progress that last Friday doctors had discussed with the Astburys the possibility of the babies being discharged.

But last weekend Chloe became affected by a bowel disease known as neonatal necrotising enterocolitis (NEC), which spread to other vital organs. Joined so closely to her sister, she could not fail to pass on the disease and over the next three days both babies had gradually deteriorated from the infection - which has a 25 per cent mortality rate among babies who develop it.

Alan Dickson said yesterday that it had always been in the doctors' minds that they might have to operate to save one of the children. But both of them had deteriorated at such a rate that the doctors had decided the best option was to support them both and hope that they both made a recovery.

At 12.45am on Wednesday, Mr Dickson called the Astburys and asked them to come to the hospital. There he advised them that no more could be done for the twins and that they were going to die. "We asked if they wanted to come and spend some time with the babies then, but they were unable to do so, such was their distress," he said.

The twins were put on life- support systems, but an hour later Mr Dickson broke the news to the couple that the twins had died "of their own accord". They spent a short time with their children before leaving the hospital early yesterday morning.

Yesterday Mr Dickson emphasised that the outlook had been good for the twins and that Chloe and Nicole had been the victims of "bad luck". "It is very bad luck to be a conjoined twin in the first place. Our information on the scans was very encouraging. But, as you know, they had an operation revealing congenital problems with the gut far beyond what we could have expected," he said.

"To come through what they came through in the first 11 days of life and then to be hit with this out of the blue was extremely bad luck." The doctor said medical staff had remained optimistic that the babies could have looked forward to normal lives.

The Astburys were described yesterday as "devastated". "Melanie and Brian were full of hope and this turn of events was totally unexpected for them both," said Ms McWatt. She made a personal plea to the media to allow Mr and Mrs Astbury to grieve in private. "They have to be allowed to deal with this in their own way and, in particular, in a private way," she said.

Sources at the Daily Mail yesterday said it "had not been decided" whether the paper would run a subsequent interview with the Astburys. "I think that would be up to the parents," the source said.