It was a defining moment for Suzanne Ackerman-Berman when, while visiting a friend in hospital, she came across a hysterical new mother whose baby had been born with a cleft lip.
"I picked up the baby and told the mom that I had had a baby born exactly like hers, and that she should look into her baby's eyes, into her baby's soul, because the lip was going to be fixed," she recalls.
She was in the right place at the right time - there to offer solace to a new mother who could just as well have been her 12 years ago, when her younger daughter, Nikita Montlake, was born with a cleft lip in a London hospital.
Today, as she and her beautiful dark-haired daughter sit recounting their story, the pride she has in her remarkable child is obvious.
For Nikita though, the repaired lip, and the perfect cupid's bow created by a London plastic surgeon, are clearly no match for her strength, courage and sparkling personality.
Nikita remembers changing schools in Grade 1 and what a shock it was when the children teased her with names like "skew lip".
But she got her own back at the end of Grade 5 when she was leaving for Herzlia Middle School and thanked her classmates for their support during the previous four years.
"When they asked why only the past four years, when she'd been there for five, she told them frankly how horrible they had been when she arrived," Ackerman-Berman recalls.
Nikita says: "Then they learnt to accept me, to accept people for what they are inside."
Nikita and her mother, a Pick 'n Pay general manager, were talking about their personal triumph over the shock and fear of giving birth to a child with a cleft lip and/or palate ahead of the 10th International Congress on Cleft Palate and Related Craniofacial Anomalies.
The conference, held every four years, is being staged in South Africa for the first time, at the Durban International Convention Centre in September.
Cape Town orthodontist Dr Haydn Bellardie, a member of the organising committee, gives his time for free every Thursday morning to treat children with cleft palates and lips at the Red Cross Children's Hospital.
It's a clinic run on a shoestring, in desperate need of help from speech therapists and psychologists, aimed at helping shocked parents and their children recover from what is essentially a completely repairable problem.
"For the majority of these children, it is possible to lead relatively normal lives. It's a physical problem, but otherwise they are as fit and healthy and intelligent as any other child," Bellardie says.
Ackerman-Berman is acutely aware of the option of aborting a child found via a scan to have a cleft lip and palate.
She was six months pregnant and living in France with her first husband when she went to London for a 3-D scan.
They detected "something wrong with the face" and Nikita's cleft was unilateral (on one side only), "going right to the back".
Ackerman-Berman was also told there was an associated 1% chance of brain abnormality, and that's all she could focus on from then on.
"It was a Friday afternoon and there were only four days before the cut-off to have an abortion.
"Thank goodness for my wonderful paediatrician, who made me look at it the other way round. He said there was a 99% chance my child was going to be amazing."
And he couldn't have been closer to the mark.
Nikita may have been born with "one huge nostril and an open upper lip" but looking at her today the evidence is barely evident.
Her palate closed, luckily, spontaneously at birth and she was immediately operated on to sculpt new lips and a septum for her nose. At six weeks old she was in surgery again and she emerged with a near-perfect cupid's bow.
At 16 she will undergo further surgery to perfect her slightly lopsided nose, but that doesn't worry Nikita at all.
It's a long-term medical issue though, Bellardie explains, and parents will be seeing a plastic surgeon, orthodontist and speech therapist regularly through the first 18 years of their child's life.
He says indications lately are that there is some genetic link to cleft lips and palates, but that many other factors have been cited too. These include alcohol intake, anti-depressants and a deficiency in folic acid.
The first three months of pregnancy are the vital ones; at about six weeks the palate is in two pieces with the tongue preventing them from joining.
Later the tongue drops down and the palate joins, courtesy of a gluey substance produced by the cells, and which in the case of cleft palates could also be at fault.
"The blood vessels that supply the area can also block off at the wrong time, so joining doesn't take place," Bellardie says.
The statistics are about one in 750 births universally, and Bellardie and the Red Cross cleft palate clinic have developed a handbook to assist parents.
Ackerman-Berman says she was lucky because she had months to get used to the fact that her baby had a cleft lip and palate, and spent hours in the medical library in London forcing herself to look at pictures of the worst-possible scenarios.
"It was still a shock, but I was lucky to have the chance to prepare myself. A lot of other parents don't have that luxury," she says.
Bellardie says that corrective surgery in Cape Town was producing excellent results, "but the reality is that you are never going to get a perfect result, regardless of the brilliance of the surgeon or orthodontist".
"You are dealing with a deficiency and it can be repaired, but the result is never going to be perfect, but the fact is that not many of our children are perfect," he points out.
It's all about how parents view the situation, and Ackerman-Berman doesn't need to say in words just how perfect she thinks Nikita is - the pride in her eyes says it all.
"She's a phenomenal child. In Grade 3 they had to prepare a talk on being different, and hers was that she was different because she was born with a hare lip. In Grade 5 they had to present a lecture on themselves and she went well over her allotted time, presenting a real biology lesson on her cleft lip."
Ackerman-Berman also knows the pain of guilt and of looking at her child daily, imagining what she would have lost if she had decided to abort Nikita.
"It's so agonising because when you find out something like this, the guilt factor kicks in immediately. You think you've failed, you question whether it's your fault.
"All the preparation you get is around perfect babies in baby ads. And your child is definitely not going to be beautiful when they're born," she warns.
But the old saying goes that beauty is in the eye of the beholder, and it would be impossible for Nikita not to know just how beautiful her mother thinks she is.
- For more information about the conference, visit the website at www.cleft2005.co.za.
Major types of cleft
- Cleft lip: A cleft of the lip may be complete or incomplete, and involves either one side (unilateral) or both sides (bilateral). The upper gum (alveolus) and nose may be affected by this type of cleft.
- Cleft palate: A cleft palate involves some or all of the soft palate, and may extend into the hard palate up to the back of the alveolus (upper gum). Occasionally, some children may have a split (bifid) uvula, a condition where the muscles beneath the lining of the mouth and the nose are not joined (submucous cleft palate).
- Cleft lip and palate: A cleft of the lip and palate involves one (unilateral) or both (bilateral) sides of the lip, base of the nose, gum and palate. Occasionally, the lip and palate are cleft, but the nose and upper gum are intact.