Lesa West heard tiny cries that New Year's afternoon in the delivery room. Her daughter, Molly, had just been born. Three months premature, the infant could be held in one hand. Her chance of survival: 1 percent.
Simultaneously, doctors scrambled to stop contractions that threatened to force Molly's twin from his mother's womb.
Mrs. West was less than six months pregnant, and delaying birth by even a day would give the remaining twin much better odds.
The Elkridge parents felt numb, drained by weeks of hoping, crying and worrying. "We knew it had come down to this one moment," said Mrs. West, 31.
What physicians at the University of Maryland Medical Center accomplished ranks among the rarest of medical cases and almost ties a world record.
They delayed the birth of Benjamin David until last Saturday, 90 days after his twin sister was born.
The world record is believed to be a 1994 New Orleans case, with 95 days between the birth of a boy and his twin sister.
Last November, a Pennsylvania woman gave birth to a daughter and, 85 days later, to the girl's twin.
A search of medical literature found fewer than 20 such cases worldwide.
The West siblings are living examples of the risks of premature birth and the benefits that every added day in utero can confer on a developing baby.
More than once, Molly almost died. She battled a lung disease, meningitis and other common complications for babies born at 23 or 24 weeks gestation.
But Molly's brother, who was carried almost 37 weeks, or just shy of full term, emerged a robust 5 pounds, 13.5 ounces. He stayed in the hospital just a few days and already weighs more than his 3-pound, 12-ounce sister.
The parents, who finally took Molly home yesterday, consider both children miracles.
"She's a miracle because she survived," said Mrs. West, holding Molly safe against her chest and stroking her head. "He's a miracle that he was able to stay inside long enough to be healthy."
David West, 32, holding Ben and patting his back, said the experience has been "surreal."
The Wests weren't shocked by the prospect of twins because Mrs. West's extended family includes seven sets of twins over the last few generations. But they feared they would lose both babies when she began having contractions in mid-December.
The power of modern drugs helped stave off labor. Several new medications that prevent contractions helped delay Molly's birth for a few weeks and Benjamin's birth for three months.
A decade ago, with few medicines to curtail labor, both babies would have been born too early and died.
"This is a very different age in terms of capabilities and what you can do," said Dr. Lindsay Alger, the obstetrician-gynecologist who handled the case and the medical director of labor and delivery at the Medical Center.
It's not uncommon for twins to be born a few hours or days apart, said Dr. Russell Moy, director of the office of maternal health and family planning at the state Department of Health and Mental Hygiene.
Such separations are usually dictated by the mother's physiology. Labor can take a different course for each baby.
But in cases such as the Wests, physicians use medical means to postpone the births of any remaining fetuses.
Mrs. West was in the hospital when her water broke Jan. 1. That turned out to be the amniotic sac surrounding Molly Erin, who was born at 5: 31 p.m.
Dr. Alger said Molly's sac was infected, and that probably sparked the premature labor.
The doctor told the parents that although there were risks, they could try to keep the other twin in utero.
"They weren't sure it would work, but every day counted," said Mr. West, 32. Said his wife: "It was unbelievable. After all we had put into this, and how badly we wanted these babies -- to think that we were losing them."
After Dr. Alger delivered Molly, she severed the umbilical cord as high up as she could, leaving part of the cord and the placenta that had nourished Molly.
Dr. Alger feared that since the placentas of twins often fuse, she might disturb the other twin if she tried to remove the first placenta.
The physicians bombarded Mrs. West with antibiotics to kill the infection and several medications to hold back any more labor.
Mrs. West's cervix closed up and her uterus returned to a state of normal pregnancy, as if it had been carrying one baby all along, Dr. Alger said.
The next three months the Wests lived in fear. They crossed off day after day on the calendar. Mrs. West used a monitor twice daily for an hour to detect any contractions. She wore a device that pumped medicine into her body around the clock, to prevent contractions. Doctors couldn't answer many of their questions about what would happen, since it was such an unusual case.
They visited Molly in neonatal intensive care, where they could do little but watch her and touch her. She struggled on a ventilator and had bleeding in her brain.
"On the one hand, we were afraid the phone would ring and give us terrible news about Molly," said Mrs. West. "We were also afraid I would go into labor."
Last Saturday, Ben was born at 5: 55 p.m. Although he had jaundice and needed a little oxygen at birth, his prognosis is excellent, said Dr. Timothy Palmer, a neonatologist at the medical center.
Molly went home with a heart monitor. She faces the risk of developmental delays that range from sitting up or talking later than her brother, to more serious cognitive difficulties.
Yesterday, packing Molly's white crocheted cap and pink cotton blanket to go home, her parents said she had earned the right to celebrate her birthday first.
Said Mr. West: "We just assumed their birthdays would be the same day."
Pub Date: 4/04/96