Tia Bridge was not quite halfway through her pregnancy with identical twin girls when doctors delivered dire news – without surgery inside her womb, both her babies would die.
Not even 24 hours later, the mum from Queensland's Sunshine Coast was fully conscious as doctors performed the intricate in-utero operation.
At almost 19 weeks gestation, Mrs Bridge and husband Toby — already parents to son Lachlan, now two-and-a-half — were told their diminutive daughters had twin-to-twin transfusion syndrome (TTTS).
The life-threatening condition occurs in less than 10 per cent of cases when identical twins – or other multiples — share a placenta.
Blood vessel connections on the surface of the placenta that were supplying oxygen and nutrients to the babies – then dubbed twin A and twin B — were not evenly shared.
The blood vessels also transport waste products from the babies back into the placenta so they can be excreted.
Twin B was receiving too much blood and twin A was not getting enough, a risk to both girls.
"It was life or death," Mrs Bridge said.
"Doctors told us: 'If you don't do this surgery, you're going to lose both girls.'
"My husband and I were like: It's a no-brainer. We have to try. We have to do something."
The first fetal laser surgery to treat twin-to-twin transfusion syndrome in Australia was performed in 2002 at the Mater Mothers' Hospital in South Brisbane.
But Mrs Bridge was unaware in-utero surgery was possible before her twin pregnancy.
"It just opens you to this world that you didn't know existed," she said.
Understanding the surgery
Maternal fetal medicine specialist Sailesh Kumar, based at the Mater, performed the minimally invasive surgery, known as a fetoscopic laser photocoagulation, in a bid to save the tiny sisters – an operation only performed about 15 to 20 times a year in Queensland.
The procedure lasted about an hour.
Professor Kumar made a small cut into Mrs Bridge's abdomen and uterus, then passed a small camera, into her womb.
He located the abnormal blood vessel connections between the babies on the surface of their shared placenta and sealed them using a laser.
"There are risks to the procedure including the possibility of pre-term birth, brain injury, or demise of both babies," he said.
"However, parents are always counselled that the procedure may be curative and that there is more than an 80 per cent chance that at least one twin will survive."
About three weeks after her surgery, Mrs Bridge was told one of her twins had died.
By then, the Bridges had named their daughters Chelsea and Imogen. They were devastated to learn Imogen's heart had stopped beating.
Giving birth to the twins
Mrs Bridge's waters broke 23 weeks into the pregnancy.
She was admitted to the Mater Mothers' Hospital – the largest provider of maternity services in Australia — to prepare for a premature birth.
On September 27 last year, at 25 weeks gestation, she delivered the babies naturally – surviving twin Chelsea Madison Bridge arriving first at 6:53am, weighing just 635 grams.
Mrs Bridge was only given a glimpse of Chelsea before her first-born twin was whisked away.
"I wouldn't have got to see her for more than two seconds and they were like: 'Look, here's your baby. We need to intervene now'," she recalled.
"She looked so tiny. I thought: 'Oh my goodness'."
Imogen Grace Bridge was born 34 minutes later at 7:27am.
Mrs Bridge spent the next 24 hours cherishing time with her stillborn daughter before being discharged.
"I got to talk to her and sing to her," she said.
"We got to have really, really special time with her. I … just told her how much I loved her."
A day after giving birth, Mrs Bridge had to leave both her babies behind in the hospital when she was allowed home, unable to see Chelsea, who was being cared for in the neonatal intensive care unit (NICU).
The young mum had been diagnosed with COVID-19 and could not risk passing the virus on to her daughter, or any of the other babies in the NICU.
"It was horrible," she said of leaving the hospital with empty arms.
Finally bringing Chelsea home
The 30-year-old would have to wait until three days after the twins' delivery before she was finally allowed to hold Chelsea for the first time.
"She was so tiny, she would fit in the palm of my husband Toby's hand," Mrs Bridge said.
"Her skin was see-through."
In the weeks afterwards, Chelsea teetered between life and death.
"We were told a couple of times that she wouldn't make it," Mrs Bridge said.
"She started having problems with her breathing and her lungs. They were just so under-developed.
"You sit there, and you listen to the monitors beep. You fixate about what her numbers are doing. It's overwhelming.
"But Chelsea's a survivor. It gives me goosebumps just to say that.
"She just wanted to be here and prove everybody wrong. She's just amazing."
Chelsea was finally allowed home in January – four months after her birth.
She still requires supplemental oxygen and is tube fed.
"We have good days and bad days, but we're getting there," Mrs Bridge said.
As she continues to care for Lachlan and Chelsea, she also allows herself time every day to think about Imogen.
"Every time I see a butterfly, I think of her," she said.
Mrs Bridge plans a low-key Mother's Day with her family today, reflecting on being a mother to three children — Lachlan, Chelsea and a little girl she has nicknamed "Immy", who never drew a breath.
"I'm just so blessed to be their mum," she said.
