Surgeons at Seattle Children's Hospital successfully separated them when they were seven months old during a pioneering 31-hour surgery in September 2000. Each infant was left with one leg and a reconstructed reproductive system.
Their mother, Vaneice Lincoln, said she and her husband Greg feared for their daughters' lives and did not know how much quality of life they'd have if they survived. "There were so many unknowns at that point that we didn't know if they would live, let alone be separated," said Lincoln, who lives in Harrisburg, Ore.
But last month, one of the sisters, Charity Lincoln Gutierrez-Vazquez, 21, was back triumphantly at the Seattle hospital where she was born. This time she was recovering after giving birth to her first child.
"It was a little surreal to end up in exactly the same hospital where Charity and Kathleen were born," said Vaneice Lincoln, 52, about the University of Washington Medical Center.
Charity said she felt an enormous sense of accomplishment after she delivered her baby. Her health had long been a focal point in her life.
"Growing up, our parents showed [Kathleen and I ] news clippings about our birth and our mom made us photo albums as we went through surgeries during our childhood," she said. "I always knew that I wanted a family."
Charity, who lives in Junction City, Ore., took Alora home in late August. She was eager to bring her daughter home so she could introduce her to the rest of her family, including her twin sister who lives 10 minutes away. Visitors were limited at the hospital because of the pandemic.
The sisters have always been close in part because of their shared challenges, she said. When they were younger, they endured multiple surgeries and learned to get around on one leg by using crutches.
For Kathleen Lincoln, watching her sister's journey to motherhood has been emotional. "We've been through a lot together and I'm really proud of Charity reaching this moment," said Kathleen, who recently graduated from college with a bachelor's degree in family and human services and hopes to become a social worker.
"Growing up, there were lots of doctor appointments, but we also had a lot of fun," she added. "We played outside a lot and were always cheering each other's accomplishments. Today, we still talk on the phone every day."
When the twins were born on Feb. 21, 2000, their parents knew they all had a long road ahead.
The reconstruction of the girls' reproductive systems and their shared liver, bladder and bowel was a long and complicated operation that required the expertise of 30 doctors and nurses at Seattle Children's Hospital. The girls each had one leg and a third shared leg that wasn't functional, said John Waldhausen, the lead surgeon that day.
Waldhausen said that when the Lincoln babies had their surgeries, there were fewer than two dozen sets of conjoined twins in the world that had been successfully separated at the abdomen. He kept in touch with the twins over the years and followed their medical progress, and he even attended Charity's wedding in December 2019.
"When you do a complex separation and organ reconstruction, you really do not know if things are going to work out as well as you hope," he said.
Waldhausen referred Charity to Edith Cheng, an obstetrician who specializes in high-risk pregnancies at the University of Washington Medical Center where the sisters were born.
Cheng said she was also concerned about how much Charity's abdominal wall would stretch. She put together a team of nearly two dozen experts to help Charity get to 34 weeks of pregnancy.
In her third trimester, when Charity developed preeclampsia and her blood pressure shot up, Cheng decided it was time to move ahead with delivery six weeks before full-term.
The plan that had been carefully coordinated with her medical team allowed the C-section to proceed smoothly without complications, she said.
"I'm struck by Charity's maturity, her trust in us and her guts to push the limit," Cheng said.
"She and her husband are amazing young people who are calm and have perspective," she said. "I see them in the NICU and they're so calm with the baby. They don't sweat the small stuff."
Charity said she is hopeful that she'll one day add to her family and give Alora a little brother or sister to grow up with.
"I'm thankful and so happy now to be a mom," Charity said. "When I met my daughter for the first time, I couldn't take my eyes off her."
Of course, said Kathleen Lincoln, there will be no shortage of babysitters.
"I'd better be the first person she calls," she said.