Over the next two weeks, we learned everything we could about clefts. I spent hours surfing the Internet, which is loaded with depressing material; joined a chat group, Cleft-Talk, for parents of kids with clefts; and researched scientific and medical journals, reading dozens of studies. We spoke with geneticists, obstetricians, neonatologists, pediatric cardiologists, radiologists, plastic surgeons, and psychologists.

We drove to Philadelphia for a day of meetings with specialists at the Children’s Hospital of Philadelphia (CHOP), one of the nation’s top pediatric medical facilities. A neonatologist and a fetal surgeon there warned us that twins in one sac could be born as early as 31 weeks, and on average would come out at 321⁄2 weeks, meaning there was a significant risk the babies would be born before their lungs were fully developed.

Nevertheless, all the ultrasounds and fetal echocardiograms indicated that, other than the clefts, the babies were fine. Their hearts were beating perfectly, the four chambers all well formed, their brains were developing normally, and their limbs were in perfect alignment. And they were active. In fact, during the sonogram at CHOP we watched as Betsy (then “Twin A”) kicked at Elana’s face (“Twin B”), Elana employing a rope-a-dope position to protect herself.

Most important of all in our preparation was meeting other parents and their children who had been through cleft surgery, patients of Grayson and Cutting’s who were willing to share their experiences.

We took the subway up to Inwood to meet the Ruckers, recent arrivals in New York from Utah. Lori and Justin’s daughter, Abby, was born with a cleft lip and palate. After reading so much about the potential problems confronting children with clefts and having had some very sober discussions with doctors, we found meeting Abby—a delightfully playful, gorgeous 9-month-old—incredibly uplifting. Only upon close inspection could one see the faint red line running down below her left nostril.

But Abby had a unilateral cleft, not the more complicated bilateral. So we visited families in Cobble Hill and Woodbury to meet kids with repaired bilaterals. They too looked wonderful (two pale red lines instead of one). The parents did warn us, however, that preparing the kids for surgery was a huge undertaking. “I can’t imagine two babies with clefts,” remarked one mother, staring at Robin’s stomach.

I asked Cutting’s staff if we might meet any twins he had treated. There was just one pair: daughters of an Orthodox Jewish woman from Brooklyn who didn’t even know she was having twins, let alone with clefts, when they were born fifteen years earlier. The Kizelnik twins, Dina and Devorah, offered to visit us. The next Sunday we held a “cleft graduates” open house at our apartment, hosting both the Kizelniks and another family whose baby daughter had recently had bilateral surgery.

Night after night, we used orthopedic plates, little red rubber bands, and a variety of surgical tapes to reshape our babies’ lips, gums, mouths, and noses.

The teens were beautiful girls who had clearly shrugged off their birth defects as “no big deal” and were fascinated to meet a baby who had just completed the surgical journey they had traveled so many years before (and had no memory of). The kids we met, as well as their parents, inspired us. We had completed our homework.

Not long after, my father lost his life to colon cancer after a courageous five-year battle. During his final hours, I wept by his bed at Boston’s Brigham and Women’s Hospital, knowing my prayer that he would meet his grandchildren would not be answered—and pledging to raise daughters who would make him proud.

Robin worked through her 34th week, defying the medical experts by delivering the twins at 38 weeks, essentially full term, in July 2002. They were even facing head down, leading us to anticipate a vaginal delivery. But after Robin received the epidural, Twin B’s heart rate began declining, triggering Buterman to declare, “We’re going in. I can’t take the chance.” Ten minutes and one C-section later, our twins came out kicking and screaming, Betsy weighing in at 5 pounds 7 ounces, Elana at 4 pounds 8 ounces.

“While I was pregnant, I saw them twice a week on the sonograms,” Robin recalls. “So when I met the babies in person, the clefts were exactly what I had expected. I was thrilled when the doctor placed the babies on my chest.”

The newborns were brought to the Neonatal Intensive Care Unit, where they would be monitored closely and receive special care. We took Betsy home three days later, while Elana stayed in the NICU for ten days owing to a low blood-sugar count.

Because of the clefts, the twins could not achieve proper suction to breast-feed or suck from a regular bottle, so Robin and I learned to use the Haberman Feeder and the Mead Johnson bottle, designed for squirting formula into the baby’s mouth. Proper feeding would be one of our great challenges.

At 1 week of age, Betsy had her first appointment with Grayson to have a mold made of her mouth. Elana, freshly out of intensive care, went the following week, and a week later the twins had their molding plates: clear, hard-plastic orthopedic devices that would shape their mouths during the coming months.

As different as Betsy’s and Elana’s conditions were, so too were the purposes of their plates. The goal for Betsy was to create symmetry in the gum ridge of the upper jaw (also known as the alveolar ridge). The hard plate would force the two sides of the gum pads to grow toward each other. Pressure from the plates would also push the upper gum pad in, further helping to reduce the cleft, because the farther back the gum pad, the more coverage the lip on either side of the cleft could provide.

Elana’s premaxilla projected out of her mouth toward the tip of her nose. So her plate’s primary purpose was to gradually push the premaxilla back into the mouth.

“It fits like a keystone into a Gothic arch,” Grayson explained. He described the molding process in artistic terms learned during his days as an art major at the original High School of Music and Art on 135th Street. “Sculpture was my specialty—I spent four hours a day working in a studio,” he recalls. “The nose, lips, and gum pads are a sculptural form. We’re modeling and shaping them.”

But if the concept is artistic, the day-to-day routine is hard labor. After cleaning the plate, we would cut patches of thin, transparent adhesive dressing called Tegaderm to be gently applied onto each cheek, an attempt to minimize irritation and bleeding. (Unfortunately, Tegaderm could do only so much; the babies’ cheeks were beet-red for months.) Then we’d cut rectangles of surgical adhesive tape, insert one end of the tape through a tiny red rubber band, and fold it over to secure the band. The rubber band looped over a post protruding from the plate (Betsy’s plate had one, Elana’s two). That was the prep work. Then came the nightly battle with the babies.

“It was frustrating,” Robin recalls. “Often the Tegaderm stuck to itself or we failed to cut the tapes the proper length and would have to start from the beginning.”

It was on to the changing table for the first baby of the evening. We took turns assuming the two primary job roles: restraint and insertion. One of us would hold the baby down with her hands to her ears, while the other would insert the plate into the mouth, making sure it was properly aligned. Then, while holding the plate in place, we pulled each piece of tape toward the back of the head, which applied pressure to the plate. Finally, we stuck the tape onto each cheek, then reinforced with additional tape.