VANCOUVER — As two nurses spread their hands over her swollen belly, searching for the heartbeats of rare twins within, Felicia Simms leans her head back against the wall and waits.
The external microphones being slid over her skin by Cordelia Merritt and Cathy West, members of the Antepartum Home Care team at BC Women's Hospital & Health Centre, are probing for a sound few people ever hear: the reverberations of two separate but linked hearts.
When it comes, insistent and urgent, it will charge the room with emotion.
The identical twins that Ms. Simms has now been carrying for 31 weeks are conjoined, which occurs only once in every 100,000 births.
The twins -- already named Krista and Tatiana, after fairies -- are joined at the head where skin, bone and possibly the brain are connected. They exist in this way because the embryo didn't separate completely when it split to form identical twins on about the 13th day after conception. The two embryos have since developed into two healthy, but partially fused, fetuses.
On Oct. 26 at BC Women's Hospital, which handles 7,000 births a year, a special team of doctors is scheduled to deliver the babies by cesarean section. Douglas Cochrane, a pediatric surgeon on the team assessing Ms. Simms, told The Canadian Press recently that a group of leading experts would be put together to handle the case.
"And if that takes us to the far corners of the world, so be it," he said.
At some future date, if both babies survive, a decision will be made as to whether or not to surgically separate them.
Among high-risk pregnancies, few can be more extreme than conjoined twins. About 40 per cent of conjoined twins are stillborn, and 75 per cent are either stillborn or do not survive more than 24 hours.
But those daunting odds don't appear to be weighing heavily on Ms. Simms, a 21-year-old mother of two, with long, dark hair and a serene countenance, who is at peace with the form her babies have taken, and who says she thinks everything is going to be alright.
I feel confident," she said just before her first of two daily checks by nurses to see whether the twins were healthy.
"It's scary and you worry a lot, but I know that they are going to make it."
As Ms. Merritt gently traced the outline of one baby, Ms. West found the other and glanced over at the electronic fetal monitoring machine recording the heartbeats in two continuous parallel lines. A loud squelching sound came from the speakers whenever one of the babies moved.
Fading in and out, as the microphone lost contact, was a single, faint heartbeat.
"Mothers need to be patient for this test," Ms. Merritt said calmly. "We're only listening to one heartbeat at a time. . . . There we go. We've got two of them."
From the speakers on the electronic fetal monitor came the pattering of two tiny hearts, racing like the hoof beats of galloping horses.
Ms. Simms smiled slightly and closed her eyes.
What's it like to hear those two hearts beating?
"Calming," she answered. "Actually it makes me want to go to sleep."
As the fetal monitor recorded the track lines of the twin hearts, the nurses seemed satisfied that both babies were healthy. For now.
"It's sort of like taking a picture," Ms. Merritt said. "It doesn't predict what's going to happen in the future."
Standing nearby, Louise McKay, who is Ms. Simms's mother, and Rhea McKay, her younger sister, embraced and let out a sigh.
"It makes me teary-eyed," Rhea said of the heartbeats. "Makes me want to cry whenever I hear it." A tear ran down Rhea's cheek and her mother brushed it away.
Outwardly, Ms. Simms and her family seem calm. But when her mother, Ms. McKay, was told that, she laughed.
"On the outside!" she said, before describing the inner turmoil she has experienced since learning her daughter was carrying conjoined twins.
"It's been an emotional roller coaster. I'm one day feeling okay and the next day I'm feeling anxious and panicky and you know, wondering what's going to happen. It's hard to say. . . . I just try to push it to the back of my mind. You know, you've got to do what you've got to do. . . . Will they make it? That's the big one. Other than that nothing [is important], because it doesn't matter to me about them being born [conjoined]. We're all going to love them just as if they were separate."
