Last week Kourtney Kardashian Barker, who is pregnant with her and rocker husband Travis Barker's first child together, shared that she had undergone "urgent fetal surgery" and credited doctors with "saving our baby's life." The reality star did not share what necessitated the in utero procedure, though fetal surgery is used to treat a number of health conditions.
What's it like to be carrying a child who needs fetal surgery? Two families share their emotional experiences, while an expert explains what the procedure entails.
What is fetal surgery?
Fetal surgery refers to a procedure that is performed on an unborn baby, or fetus, while in utero. Dr. Magdalena Sanz Cortes, a fetal surgeon at Texas Children's Pavilion for Women, tells Yahoo Life that fetal surgery is "not that common," but because "indications for surgery are so heterogeneous," or mixed, it's difficult to determine how many patients actually undergo it. The most common reason for fetal surgery is to treat twin-to-twin transfusion syndrome, a rare pregnancy condition in which the placenta that identical twins share does not work evenly so that one twin has an excess of fluid and the other doesn't have enough. Without fetal surgery, "babies will die or will have permanent damage," Cortes says.
Another example of a "lifesaving" situation that may involve fetal surgery is fetal anemia, in which a baby desperately requires a blood transfusion in utero. However, there are some fetal interventions that are not considered lifesaving, Cortes notes. Babies diagnosed with spina bifida, for instance, might have in utero surgery to repair their spinal cord.
"We're not saving the lives of those babies, but we will hopefully get them a better quality of life, better chances of walking independently when they are older," for instance, she says. "So we use the same term, 'fetal surgery,' but there are different types of indications and different purposes."
The criteria for fetal surgery are "minimally restrictive" when a baby's life is on the line. "If it's a lifesaving procedure, basically we just have to do it," Cortes says. "It doesn't matter if the mom has a medical condition, if there's a risk for preterm birth ... If you don't do the surgery, the babies will die."
If the situation isn't life-or-death, however, more factors are taken into consideration before surgery can proceed. "We need to make sure that that's a good case that is actually going to benefit from an improvement in the quality of life," she explains, noting that fetal surgery increases the risk of preterm birth. "So in cases of spina bifida, if the mom has a baseline condition, we wouldn't offer it. If the mom has a history of previous preterm birth, we wouldn't offer it. If the baby has multiple other anomalies, same thing — we wouldn't do it. ... We need to make sure that this is a good candidate and that we're not going to be doing more harm than good if it's just to improve the quality of life. If it's lifesaving, we go all in and we bring the patient in right away."
The surgery itself can also vary. Some lifesaving surgeries are performed using lasers and are thus minimally invasive and require little downtime for patients. Other surgeries can be more complex; an open repair for spina bifida, for example, involves a larger incision that Cortes likens to a C-section.
'I was just in survival mode, doing what I needed to do for my child.'
When Alisha Staten was about 19 weeks into her pregnancy, she learned that the baby she was carrying had spina bifida. The first-time mom spent the next few weeks meeting with doctors from Intermountain Primary Children’s Hospital and University of Utah Health and having testing done to determine whether she was a good candidate for fetal surgery.
"I was just in survival mode, doing what I needed to do for my child," Staten, who is based in Idaho Falls, Idaho, but was treated at the Utah Fetal Center, tells Yahoo Life.
On April 6, 2021, exactly 24 weeks and two days into her pregnancy, she underwent the first fetal surgery to be performed in the state of Utah. She and her baby, a girl she and her husband would go on to name Abigail, each had their own team of specialists during the procedure. Doctors used an ultrasound to find out precisely where the baby was positioned, then opened up Staten's uterus and amniotic sac to expose Abigail's spinal cord and perform an open repair. While the baby was otherwise submerged in the womb, with a warm saline solution used to refill the amniotic fluid, her bottom and back were exposed during the surgery. April 6, therefore, has become known as Abigail's "butt birthday."
Abigail's actual birthday is May 9, 2021, on Mother's Day. About a week and a half after the surgery, Staten lost her mucus plug — the premature rupture of the membrane that Cortes cited as a risk of fetal surgery — and began to leak amniotic fluid. She spent the rest of her pregnancy in the hospital.
"It was a long healing process, and it was uncomfortable," she says of that time. "There were moments where I was just like, I can't do this anymore. My body cannot do this anymore."
Staten held on until week 29 — a full-term pregnancy lasts 40 weeks — and delivered Abigail in an emergency C-section. She was released from the hospital a few days later, while her daughter stayed in the neonatal intensive care unit (NICU) until July 23 — her original due date.
Abigail, who has a heart-shaped scar on her back from her fetal surgery, is now 2 1/2 years old. Between having spina bifida and being born prematurely, Staten's daughter has health concerns, such as mobility and bladder control. "There's just some things that we have to adapt for ... but we meet her where she's at and we treat her just like we would a neurotypical 2-and-a-half-year-old," Staten says. "But she's funny, she's charismatic and there's just something about her that attracts people."
Fetal surgery, she adds, "turned out to be the best decision" she and her husband have made. "She's happy, she's thriving. Yes, we have our setbacks. However, the fetal surgery has given her so much, and if I had to do it again, I would."
'Anything you can do to save our child, we're in.'
The ob-gyn that Samantha and Joey Paris went to see for their anatomy scan last Christmas was an old family friend, so it was easy for the Dallas-based couple to quickly figure out that something was wrong when he looked at the ultrasound.
"He's very thorough but jolly and always in good spirits," Joey tells Yahoo Life. "And within minutes of the appointment, his face turned pale white and he took a very calm tone."
The ultrasound showed signs of pleural effusion, or a buildup of fluid; his "lungs were totally pancaked and the body was just totally filled with fluid," shares Samantha, who was about 23 weeks into her pregnancy. The baby was diagnosed with hydrops fetalis, a life-threatening issue in which excess fluid can cause heart failure, and Samantha was booked to undergo fetal surgery at Texas Children's Hospital in Houston within days.
"They kind of just told us the only option is you can either not do anything, but you'll probably lose the child very quickly or have a stillbirth, or we can do this surgery and have the best chance of saving your child's life," Samantha says. "And we said, 'OK, how soon can you do it?' While it was scary, it was one of those no-brainers to say, 'Anything you can do to save our child, we're in, we'll do it.' It was definitely a whirlwind. And I think before that day I had no idea [fetal surgery] was even a thing."
While the couple rave about the hands-on care they received, the situation was touch-and-go. Samantha went into early labor for a few hours after the first surgery to have shunts placed in her baby's chest to relieve the buildup. "We were so stressed ... we were like, 'It's not time for the baby to be born yet, keep the baby in,'" she remembers. Due to complications with the shunts, Samantha had to undergo additional surgeries and had to remain on bed rest — temporarily relocating to her parents' house in Houston — for the duration of her pregnancy. Samantha visited doctors twice a week and had a total of 61 ultrasounds done.
But there were highs, too. Despite the risk of preterm labor, Samantha made it to 39 weeks, vaginally delivering a baby boy. Somehow the couple had managed to keep their child's sex a surprise throughout the process, and they named him Richard Joseph Paris IV, or "Archie" for short. After three days in the NICU, the family returned home to Dallas.
Now 4 1/2 months old, Archie recently had his shunts removed and will have routine monitoring for the first few years of his life.
Other than that, "he's just living his happy baby life — eating and sleeping and pooping like every other baby," says Samantha. "It truly is such a gift and a miracle."