Dani Garavelli: Whose life is it anyway?

VANESSA Love was still in shock from the news that she was expecting twins when her world was shattered. She was diagnosed with acute promyelocytic leukaemia.

Days after gazing in wonder at the scan that showed two tiny heads, the medical receptionist was faced with the starkest of choices. Should she terminate her pregnancy; have chemotherapy and put her babies' lives at risk; or delay chemotherapy and jeopardise her own?

The dilemma – devastating in any circumstances – was made even more poignant by the fact she had two daughters who needed her at home. "It was very, very difficult because I was still trying to deal with the fact that I was ill and, with the best will in the world, the doctors needed us to take a decision pretty quickly."

In the end, Vanessa opted to take another, less aggressive drug to keep the disease at bay, until the twins were delivered prematurely but safely at 30 weeks in May 2005. Three years on, the boys, Blake and Rohan, have just started playgroup and are running their mother ragged while, all going well, Vanessa, who is clear of the disease, will take her last dose of medication later this month.

"I think what we went through changed us – it made us more relaxed," says Vanessa, from Westhill, Aberdeen. "We don't sweat about the small stuff any more. If the boys are running round mad and they knock over yet another plant pot, we just smile and say, 'It's only a plant pot'."

The Loves' courage in the face of a devastating chain of events is an inspiration to every parent. But for the Radio One DJ Edith Bowman, their experiences have a particular resonance.

Last week, Bowman, who is almost five months pregnant, revealed she has a bicuspid aortic valve, a condition which puts extra pressure on the heart and can deteriorate during childbirth. "We get to find out the baby's sex later this month but there are really more important things to worry about right now than the colour of baby clothes," says Bowman, 32, who is originally from Fife.

Then there is Michelle Stepney, who was last week nominated for a Woman of Courage Award by Cancer Research UK after refusing a life-saving hysterectomy when she discovered she had cancer while pregnant with twins. And – tragically – the case of footballer Gary McAllister's wife, Denise, who, after contracting breast cancer in 2000, delayed chemotherapy by two weeks until it was safe to induce her son, Oliver. Denise went into remission, but died last year after the disease returned.

So what drives so many women to put their unborn babies' lives before their own? What impact does their decision have on their families? And does the conflict between the health of the mother and the health of her unborn baby raise ethical issues for the doctors who care for her?

Michelle Stepney says her decision to continue with her pregnancy instead of having a hysterectomy was swayed by the knowledge that her daughters effectively saved her life. The accountant, who lives in Cheam, south-west London, with her husband, Scott, would not have known she was suffering from cervical cancer if Alice and Harriet, now one, had not dislodged the tumour while kicking in her womb.

Michelle had an older child – Jack, now five – a fact that weighed heavily on her. "It was a very difficult decision to make," she says. "We wanted to make sure what we did what was right by Jack, but we did not want to do what was wrong by the girls."

Michelle opted for very limited chemotherapy until the girls were delivered by caesarian 33 weeks into the pregnancy in December 2006.

"The doctors didn't know what the chemotherapy would do to the twins, and the first time I had it, I dreaded what it was doing to the girls. But they carried on growing well." Four weeks after the birth, Michelle had a hysterectomy and she has now been give the all-clear.

For Vanessa and her husband, Charlie, a termination also seemed wrong, not so much because of their religious beliefs (although these played a part) but because they had bonded with their babies after seeing the scan. They, too, had to decide whether Vanessa should undergo chemotherapy. Vanessa didn't want her girls growing up without a mother. But she also knew chemotherapy might be dangerous for the twins.

As far as Charlie, a computer studies teacher, was concerned, the decision had to be Vanessa's. "I know her really well. I think I usually know what she's going to do next. But I said to her at the time: 'This is happening to you, Vanessa. You need to decide what you want to do. The most important thing is how you feel about it and what you can deal with and cope with'."

The drug ATRA proved a more palatable option than chemotherapy, but it did not come without its attendant worries. There was no guarantee that it would work and it had been linked to low birth rate. Never the less, in May 2005, Blake and Rohan were born, four weeks earlier than had been hoped, weighing 3lbs 9oz and 3lb 5oz respectively. Within a month, Vanessa had started her chemotherapy and, a year later, she was clear of the leukaemia.

The decision to use ATRA was a gamble not only for Vanessa, but for the doctors who were caring for her. "They had never had a patient like me before, so they weren't really sure what to advise," she says. "The funny thing is my treatment worked so well, I understand they are now recommending it to leukaemia sufferers who aren't pregnant."

It must be difficult for doctors to stand by and watch women take risks to save their own babies. "In cases like this, a doctor should present his patient with all the options, and make sure they understand the possible consequences," says the medical ethics expert Professor Sheila McLean. "But it is up to the individual woman to take the final decision about whether or not she puts her life on the line."

According to McLean, the law surrounding the treatment of pregnant women was not clarified until 1997. Before that, it was not unusual for doctors to interfere in the treatment of pregnant women – albeit to protect the unborn baby rather than its mother. In 1992, a 28-year-old British woman suffering from pre-eclampsia, who refused a caesarian on religious grounds, was sectioned under the mental health act and forced under the knife in an attempt to save her baby.

In the US in 1987, Angela Carder was forced to undergo a caesarian even though she was dying of leukaemia. Neither she nor her husband wanted her to be subjected to a trauma that was likely to end her life, but a hearing convened at the hospital ruled otherwise and the procedure went ahead. This decision was later successfully appealed, but it was too late for Corder and her baby, both of whom died within days of the surgery. "Most people would want women to behave responsibly towards their foetus, but to influence it through law would be wrong," says McLean. "The same is true of those who are prepared to sacrifice their own lives for their babies. It would be unethical for doctors not to say: 'We can give you this treatment, and we think your foetus will be OK,' but if the woman is adamant, then it's her decision."

Although Edith Bowman faces an uncertain few months, she has no more big decisions to take. Having decided to go ahead with pregnancy she can do little to influence its outcome except take it easy, particularly now, during the second trimester, when cardiac output increase by up to 50%. She is being closely monitored, with extra scans, and has already agreed to an elective caesarian as a natural birth has been ruled out.

"No one, including my heart specialist, sees the point in putting my heart through extra strain," she said last week. "But I'm not one of these women who is desperate for a natural birth so I'm fine with it."

There's still plenty of worrying ahead for Bowman and her partner, Tom Smith, of the indie band the Editors. But if they want reassurance, they need look no further than Vanessa and Charlie Love.

Today, their lives are as frenetic and exhausting as you would expect of anyone with four children under nine. Life in their Aberdeenshire home is very normal. Rohan and Blake have hit the terrible twos and fight a lot.

Vanessa and Charlie haven't ticked off too many items on the "things we want to do" list they compiled when their lives first careered out of control. They've been far too busy.

But they do plan to celebrate their 10th anniversary by renewing their wedding vows – a testament, surely, to the strength of their relationship and the journey they have travelled together.