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Conner and  Carter Mirabal are conjoined twins born to Michelle Brantley and her fiancé, Bryan Mirabal. They are being treated at Wolfson Children's Hospital.
Jax Daily Record Tuesday, Jan. 6, 201512:00 PM EST

A mother waits to hold her babies; conjoined twins to be separated in about 6 months

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by: Kevin Hogencamp  Contributing Writer

Michelle Brantley gave birth to her baby boys more than three weeks ago.

But the 23-year-old Jacksonville mother has never held her babies.

Conner and Carter are conjoined twins, born Dec. 12 at UF Health Jacksonville to Brantley and fiancé, Bryan Mirabal. The boys are joined at the upper abdomen. They share a small intestine and their livers and bile ducts are fused.

Doctors are planning to separate the boys in six months.

Brantley said Monday she visits the newborns nearly every day, rotating shifts with Mirabal and the babies’ grandparents. She and doctors from Wolfson Children’s Hospital talked about the twins at a news conference.

When Brantley was asked about holding the twins, she broke down into tears and had to leave.

Wolfson doctors said the longer the twins can remain on friendly terms and stay a similar size, the better their prognosis for a path to separation.

Dr. Daniel K. Robie said if the brothers develop a tendency to tussle, or if one significantly outgrows the other, their planned separation surgery will be performed sooner than the six-month timeline in place.

Physicians are hoping to surgically separate the boys after their bodies are much more developed than they are now. A 1-in-200,000 occurrence, conjoined twins are two babies that are born physically connected to each other.

A primary concern for physicians is that Conner is slightly ahead of Carter’s development, and seems to be prevailing as the two vie for shared nutritional resources.

“We want them to eat and grow and behave,” said Robie, Wolfson’s and Nemours Children’s Clinic’s pediatric surgery chief.

The Mirabal twins are expected to remain in Wolfson’s Newborn Intensive Care Unit until after their separation surgery, which physicians predict will be successful.

“Our goal is to separate Conner and Carter when it is safe to do so,” Robie said.

Wolfson President Michael Aubin says the Mirabal twins evidently are the first conjoined twins to be treated at the hospital – and perhaps in Jacksonville.

Hours after the twins’ Caesarian-section birth, physicians repaired a potentially life-threatening condition in which their shared small intestine had ruptured the abdominal wall. A temporary plastic mesh patch was put in to mount the intestine in the babies’ bodies.

“Think of it as a very thin membrane, perhaps as thin as a piece of Saran Wrap, but much more fragile, almost like wet tissue paper,” Robie said.

On Friday, the twins underwent a successful procedure to remove the mesh patch and partially separate the small intestine to enable them to ultimately feed by mouth.

Robie and Nicholas Poulos, Wolfson’s and Nemour’s primary pediatric surgeon, headed the surgical team for both procedures. More than 20 medical professionals, including five anesthesiologists, participated in Friday’s surgery.

“This is a once-in-a-career type clinical scenario,” Robie said. “The good thing is that their hearts are separate. That’s a huge positive.”

Cortez said the twins’ respiratory signs are strong and that they may begin feeding orally, rather than intravenously, this week.

Before Brantley left the news conference, she recalled how she and Mirabal, 26, were overwhelmed after learning July 31 the twins were conjoined.

“At first, it was very scary. It was very touch-and-go and we didn’t know how it was going to go,” she said. “But we’re excited — more so than scared now. And we’re ready for our upcoming challenges.”

Mirabal’s sister, Jasmine Mirabal, says the family is optimistic, grateful and prayerful.

“We have a lot of faith and we have a lot of support,” she said.

Jasmine Mirabal said Conner and Carter, her godchildren, were baptized Dec. 31. The family has a Facebook page titled “Prayers for Carter & Conner.”

Conjoined twins develop when an early embryo partially separates to form two individuals. Although two fetuses develop from the embryo, they remain physically connected, often sharing one or more internal organs. Most conjoined twins are stillborn or die shortly after birth.

While Robie and Poulos were involved in the care of conjoined twins during their fellowship training, neither has performed a separation surgery.

Wolfson physicians are consulting with a pediatric surgeon who is among the most experienced surgical experts on conjoined twins and separation surgery, hospital officials said.

After the separation surgery, Conner and Carter will be able to go home where their 1-year-old brother, Gage, is waiting.

And they’ll finally be able to be held by their mother.

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