One tragedy had already occurred and another was imminent--Mindy and Stephen Rosenthal's first child was stillborn after just 15 weeks in his mother's womb, and his twin brother was about to follow, with no chance, at that age, of survival.
But doctors at Shady Grove Adventist Hospital, using an unusual surgical and medical procedure, were able to keep the child in the womb for five months--possibly a world record for this emerging medical intervention, known as "arrested labor."
"If you look at the literature, this should not have happened. We should not be sitting here right now. That baby should not be here," said the perinatologist in charge of the case, Sheri L. Hamersley.
But there was little Benjamin Rosenthal, born on Jan. 3, sleeping peacefully in his mother's lap yesterday, his little, scrunched, red face peeking out from under a blue infant's cap. Despite estimates that he had less than a 5-percent chance of surviving, Benjamin not only survived, but he also appeared to be healthy--and clearly nonplused by the glare of cameras and a throng of reporters.
"There are no words to express this," said the smiling, weary-looking mother, Mindy Rosenthal, a 29-year-old teacher from Rockville. "Yes, definitely, we think it's a miracle."
The risky procedure is becoming more common in the United States--there are two or three a year now at Shady Grove--but the outcome is not always this good and the length of time labor was delayed was highly unusual.
"This is a very remarkable, wonderful outcome that has something to do with the skill of the doctors and much to do with luck. . . . This mother was very fortunate," said Frank Witter, associate professor of gynecology and obstetrics at the Johns Hopkins School of Medicine.
The extra 153 days that doctors at Shady Grove bought for Baby Rosenthal beat by one day the standing record, set in October in Cincinnati, according to Shady Grove spokesman Robert Jepson. In the Ohio case, the woman, Debbie Feitl, spent 152 days in arrested labor before giving birth to a boy, Jared.
Hamersley said she wasn't trying to set a record and didn't know the precise duration of delayed labor in the Cincinnati case. "We would have been happy with any length of time," she said, "as long as we had a healthy child."
Witter said the delayed labor procedure was being quietly tried in the United States in the 1960s and 1970s and became more successful by the 1990s, when doctors came to understand the role infection plays in stimulating labor. The protocol now includes massive doses of antibiotics, as well as drugs to inhibit labor, he said.
Before 1990 "other physicians would have looked at you like you had two heads . . . and a few heads turned when we placed the stitches in this case," Hamersley said yesterday.
Witter said delayed labor is being attempted with increasing frequency in the United States, as a result of the dramatic increase in multiple births, which are more likely to be high-risk. (Twin births went up 52 percent from 1980 to 1997.)
The Rosenthals were willing to brave the risks to Mindy--serious infection, impairment of her ability to conceive and give birth in the future, even death. "We knew the chances [of a successful birth] were slim," Mindy Rosenthal said.
After her first child was stillborn, Mindy was rushed to surgery, where Hamersley cinched the cervix closed using thick thread she compared to a candle wick. The stitching procedure is known as cerclage.
While the labor inhibitors and drugs were being administered, Mindy was put on strict bed rest.
The doctors defined bed rest as "being able to tell us every day what was on 'Oprah,' " Hamersley said.
A bedroom on the third floor of the couple's town house was outfitted with a microwave, refrigerator, television, VCR and computer--the "bunker," where she waited to see if their gamble would pay off. She said she tried not to dwell on the risks.
"People usually paint the nursery, people want a baby shower--I didn't want any of that because I didn't want--I was superstitious," she said. Until his birth, by Caesarean section, she said, "until I heard his cries, I think I was in denial. I didn't let myself believe in him."
CAPTION: Benjamin Rosenthal, born Jan. 3, is the son of Mindy and Stephen Rosenthal of Rockville. He was born 153 days after his twin brother was delivered stillborn at 15 weeks gestation.