Do you have trouble stacking Jenga blocks? Do your hands quiver when you try to tighten the tiny screws on your glasses? Well, meet Dr. Timothy Crombleholme, a surgeon with hands steady enough to operate on patients as young as 15 weeks. For D Magazine, Shawn Shinneman profiles Crombleholme and his growing field of fetal surgery, a field as small as the people it operates on. It’s delicate work and the stakes are very high, but for many parents, fetal surgeons are the only hope their children have. Right now, the field is so new that it’s a kind of frontier.

Crombleholme was able to problem-solve Shayla’s complications because he has so much experience in the field. The challenge with starting a fetal surgery center—why there are so few of them across the country—is that the types of procedures these surgeons perform are both exceedingly specialized and relatively rare, says Dr. Sean Blackwell, a Houston-based maternal-fetal medicine specialist who serves as president of the Society for Maternal-Fetal Medicine. “You want to have people that are higher-volume surgeons,” Blackwell says. “It’s no different than doing a heart transplant or a brain surgery—if you do six in a year, that’s different than if you do 60 in a year.”

The operations are not without controversy in the medical community. While in Cincinnati, Crombleholme pioneered an “amnioport” procedure, where a surgeon places a catheter inside the amniotic sac, attaching it to a port that remains on the mother’s abdomen throughout the pregnancy. That way, doctors can control the fluid volume in a baby that is otherwise, for whatever reason, deficient—cases that previously had no course of action.

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