Baby Henry Bryant is asleep, unaware of the hum of activity around him. For his photoshoot with The Weekly, his mother, Kirsty, has dressed him in a smart blue jumpsuit, from which his soft, pudgy legs dangle as he flops in her arms, exhausted.
He is just three months of age, but he has already been part of a big adventure; a huge, game-changing, Australian-first operation that will alter the fate of women who were told they would never carry a baby.
His adorably pinchable cheeks are a testament to the courage and determination of his mother and grandmother, and the skill and tenacity of a medical team at The Royal Hospital for Women, led by Associate Professor Rebecca Deans. As Kirsty buzzes around her home on NSW’s Mid North Coast, and her mother, Michelle Hayton, plays with three-year-old Violet, you get the impression there’s nothing these women can’t do.
Kirsty is the first Australian uterus transplant recipient, and Michelle is the first donor. In 2021, Kirsty nearly died giving birth.
She only survived the terrifying ordeal thanks to an emergency hysterectomy, which left her unable to have any more children. She awoke from surgery in a haze of conflicting emotions. She was both relieved and crushed. “It broke my life into before and after,” she says.
Some women lose their uteruses to cancer, or traumatic events. Younger women who are diagnosed with conditions like MRKH (Mayer-Rokitansky-Küster-Hauser Syndrome, which causes an underdeveloped or absent uterus) learn during their teenage years that they will not be able to carry a baby. They worry about forming relationships.
“They often say things to me like, ‘I don’t feel like a woman anymore’,” says Associate Professor Deans, a gynaecology specialist. “It’s so much part of who you are, having that capacity to carry a child. Certain racial groups where it’s really your identity as a female to have that role, I think they find it particularly hard,” she says.
These women are the reason that she has spent more than a decade trying to make this procedure available in Australia, much to the eternal gratitude of families like the Bryants. Not all women have that strong desire to mother, but Kirsty certainly did.
“She was always the mothering type. She always wanted a family,” Michelle says.
“As soon as we built the house, I knew I wanted to fill the house with children,” Kirsty adds.
“I think I always was dreaming of three or more.”
She could never have guessed that she would eventually carry a baby in the same uterus that she grew in, but she is very proud to have played a part in the clinical trials that will open the door to more women doing the same. The journey wasn’t easy, but as she softly kisses a sleepy Henry’s head, it’s clear it was undeniably worthwhile.
Kirsty and Michelle’s family has always been tight, but when Kirsty’s brother, Joel, was diagnosed with an aggressive form of testicular cancer in 2018, they become even closer. His was a particularly virulent case that spread to his lymph nodes and required surgery. Joel recovered, but the experience changed them all.
“We would all do anything for each other,” Kirsty says.
In April 2020, Kirsty and her then fiancé, Nick Bryant, were preparing for a big wedding followed by a honeymoon in Japan, when their plans were deferred by COVID. Instead, they had a small ceremony in their backyard. Most people attended via Zoom. Kirsty didn’t mind; the important people were there. Unable to go on their honeymoon, or even leave their house, Kirsty and Nick decided they were ready for a baby straight after their wedding.
“I fell pregnant the following month, which was May,” Kirsty says. She had a miscarriage in June and then became pregnant again in July. It was an easy pregnancy, just a bit of morning sickness in the early trimester.
The last weeks of the pregnancy were not as smooth as the first. The Bryant baby was in a posterior position – spine-to-spine – which was causing Kirsty some discomfort. However, she was young and healthy and considered very low risk.
She went into labour in April 2021 and recalls spending the early stages at her house, bouncing gently on an exercise ball, and watching cooking shows, as she waited for her baby to arrive. She was calm as she and Nick made their way to the hospital.
“My midwife said, ‘Pop your hand down there’. I could feel her little head. She hadn’t crowned yet, but we were very close,” Kirsty recalls.
The pain, however, was becoming intolerable. At 9pm she had an epidural and then she started pushing. But something went wrong. Her baby was lifting her head instead of tucking it. The doctors were unable to use forceps or suction to help the baby out. They made the call that Kirsty needed an emergency caesarian.
Unfortunately, the hospital was dealing with other emergencies. A young boy had broken his leg. Another pregnant woman with a haemorrhage had been raced in by an ambulance. They weren’t able to get Kirsty into a surgical theatre until midnight. Still, the sense of danger hadn’t set in. All seemed normal as they began the caesarian.
“Everyone said, ‘You’re going to meet your baby in 15 minutes’,” Kirsty says.
There had been a lot of pressure on Kirsty’s uterus, so the doctors had to use forceps to bring the baby back up and out. It was a girl! Kirsty and Nick had already picked a name: Violet. But there was no tender first meeting between mother and baby. Kirsty was hurting. She knew something was wrong. “I said to them that I was in pain, and they said: You can’t be in pain, you’ve had an epidural.”
The medical team were preparing to move Kirsty off the surgical plank onto a bed when she began vomiting. Her blood pressure dropped.
“My temperature was uncontrolled. I became really, really cold. I became hypoxic. I didn’t have enough oxygen. I was going in and out of consciousness. It was very serious.”
The doctors had to open her up again to find the bleed. “I’d lost, they estimate, four litres of blood by that stage. I ended up losing 11 litres in total.”
Kirsty went into shock.
“They’re pumping me with blood, but my body is bleeding out … People who usually go into DIC (Disseminated Intravascular Coagulation) shock are people in trauma cases – car accidents, things like that.
Your body is bleeding and you don’t have enough platelets to clot … They ran out of blood. They had to get blood on a care flight helicopter.” Kirsty was terrified.
“I’m hearing them calling in specialists. I’m hearing them calling for more blood. I’m hearing them discussing hysterectomy. I’m coming in and out of consciousness.
“They’re trying to put the oxygen mask on my face but because I was hypoxic, I thought they were suffocating me, so I kept fighting. I had a nurse on either side of me holding my arms down because I was thrashing about.”
She can remember looking at the clock on the wall and seeing time drain away. She was petrified.
“I was asking them to get my mum. I was asking them to get my husband,” she says. The nurses reassured her, saying, “We’re here with you. You’re okay.”
The head of the department arrived. They called a trauma surgeon. A general surgeon.
“I knew it was bad,” Kirsty says. One of the surgeons told her they were going to perform an emergency hysterectomy. “I said, ‘No!’ He said, ‘We are doing a hysterectomy to save your life’.”
Kirsty said, “I want my mum.” The head of anaesthesiology was holding her face from behind and said to her, “I’m going to put you to sleep.” Then everything went black.
While all this was happening, Michelle was at home anxiously waiting for news. At 5am she couldn’t take the anticipation anymore. She got dressed and told her husband she was going to see Kirsty.
“I just had a gut feeling that I needed to be at the hospital,” she says.
She found her only daughter pale, unconscious and full of tubes. The doctors had warned Michelle that Kirsty would look different. But Michelle says, “there’s no preparing for that”.
When Kirsty woke up, Nick put their baby Violet in her arms. She was so happy, but also shocked, and sad.
“You’re really walking that line of, I’m grieving my chance to have more children, but I’m also so happy that my daughter is happy and healthy,” she says.
She began having conversations with medical staff about her options for giving Violet a brother or sister. “Even in hospital the midwives were talking about surrogacy,” she says. Straight away, Michelle offered to be a surrogate for Kirsty.
“I really wanted to be a surrogate,” Michelle says. “I was the fittest I’d been in my life, I’d had my children in my twenties, and I thought: I could do this. I could help Kirsty. Because in the ICU your whole … ”
She falters a moment. “I’ve been in the ICU with both my children and, with Joel, I couldn’t do anything to fix him and as a parent you want to fix them. With Kirsty, I’m in ICU and I’m thinking, all she ever wanted was to be a mum, and I thought: I could do this!”
Kirsty was, of course, deeply moved by her mother’s offer, but she couldn’t accept. Her experience of birth had scared her and she couldn’t put Michelle at risk. She told Michelle she wanted a mum more than she wanted a baby.
To help navigate her new reality, Kirsty joined Facebook groups for people who had experienced traumatic births and hysterectomies. She loved Violet so unconditionally, but she was grieving the future she had lost.
“People would say, ‘How are you?’ I was like, ‘I’m fine’. But I was very angry, and I was very upset. But I didn’t want anyone to think I wasn’t coping. If I did have a bad day, I’d ring my mum. I didn’t want to voice it to anyone.”
Six months after her hysterectomy, Kirsty learned a uterine transplant clinic trial had been funded in Australia. The trial’s website didn’t have much information, so she sent them an email. The team replied with the necessary paperwork to get things started, but that wasn’t all Kirsty needed.
“You needed to come into the clinical trial with a donor,” she says. She posed the question to her mother: Would Michelle give Kirsty her uterus? For Michelle, there was no question.
“I had no hesitation,” she says.
More than a decade ago, Associate Professor Rebecca Deans was working in the UK when she heard that a Swedish surgeon, Mats Brännström, was working on uterine transplants. She had many patients who did not have functioning uteruses, so she emailed Professor Brännström to learn more.
She went to Sweden to learn about the procedure. “Then I went for training where I assisted in some human transplants,” she explains.
She started the first ever Australian support group for women without uteruses in 2012, the same year Prof Brännström performed the world’s first successful uterus transplant.
The impetus for this surgery was women asking for options.
“This is a really patient-driven thing,” she explains. “Even if they decide they don’t want to undertake this procedure, it just gives women hope. It makes them feel like, ‘Okay, I was born without a uterus but if I want to carry a baby, I can. There are options for me in this world.’ I think that’s a really powerful thing …
“If you’re not an individual who experiences that type of childlessness it’s really hard to know. If you talk to the patients, they’re driven. They want to do it. I see myself as a bit of an advocate for them, trying to develop this, as well as it being fascinating medically and a wonderful thing to do.”
Getting the approval to go forward with the procedure in Australia was not easy, however.
“When I took it to my superiors they were a bit sceptical,” Associate Professor Deans admits. She began her quest to get approval in 2016 and was finally able to proceed in 2022, just as Kirsty was searching for answers.
Kirsty and Michelle were ready and eager to be a part of the trial. Their blood and tissue matched, and Kirsty and Nick had created five embryos that could be used if the transplant was successful.
“We just kept ticking the boxes,” Michelle says. “We always thought, ‘Let’s give this a go and see where we get.’ We never thought we’d be first.”
Just before Christmas 2022, Kirsty and Michelle flew to Sydney for more blood tests, X-rays and ultrasounds. Then they got the call. Could they be in Sydney on January 9?
A uterus transplant is an incredibly complicated procedure that requires an army of specialists. Once it’s transplanted, the organ not only has to function, it needs to be able to support a human life for nine months.
“The uterus has to grow from the size of a pear to the size of a watermelon in nine months, so the blood supply has to really expand to accommodate the increase in size,” Associate Professor Deans says.
The blood supply to the area is unusually complicated. “You have to be meticulous with dissecting but retaining the vessels … That does definitely make it much more challenging.”
Michelle was unafraid. Her operation lasted 11 hours. Then Kirsty was taken into surgery. They woke up, side-by-side, in the same recovery room, and spent a week recuperating together. Every morning they’d give each other a thumbs up, “so we knew that we were okay,” Michelle says.
The transplant was a success, but the big question was whether Kirsty could conceive. Just 30 days after her operation, she got a period. Two months later, the doctors attempted an embryo transfer. Kirsty, Nick, Michelle, Associate Professor Deans and the whole medical team had a nervous two-week wait to see if the embryo had implanted.
“They tell us not to do home pregnancy tests, but I couldn’t help myself,” Kirsty says. “Even doing it I cried, because I never thought I’d get to do it. I took photos.”
After a few moments, the test showed a very faint line. “I rang Mum straight away!”
Henry Nicholas Michelle Bryant was born on December 15, 2023. Dr Antonia Shand, Dr Sarah Lyons and midwives from the The Royal Hospital for Women led the highly specialised pregnancy and birth care. In one year, Kirsty went from having no uterus to giving birth to her son. It wasn’t easy, but it ended in happiness, and hope for women all across the country.
“It was everything I could have wanted and more,” she says. “It’s just joy.”
Kirsty is an ambassador for the The Royal Hospital for Women Foundation. The ground-breaking research trial was funded by donations from the foundation.
