In early 2025, Keishera and Greg Joubert were overjoyed to learn they were expecting a second son. But at 19 weeks, a devastating diagnosis shattered their excitement: Cassian had Congenital High Airway Obstruction Syndrome (CHAOS), a rare, usually fatal condition where a thick membrane blocks the airway.

Refusing to give up, the Catholic couple found hope in Dr. Emanuel Vlastos at Orlando Health Winnie Palmer Hospital in Florida. When a standard prenatal surgery failed to cut through the membrane, Dr. Vlastos proposed a radical, groundbreaking alternative. At 25 weeks, doctors partially delivered Cassian via C-section — bringing only his head and arms out of the womb. Still sustained by the placenta, specialists performed a delicate tracheostomy to create an airway before returning him to safety inside his mother. 

Six weeks later, Keishera’s water broke. A massive team of 30 medical professionals mobilized for a final surgery to secure Cassian's breathing outside the womb.

He was, quite literally, born twice.

“When I first learned of the diagnosis, it was completely devastating,” Keishera Joubert told the Register. “I immediately broke down crying. ... I ran into the room and I bawled myself in the corner. There was a chance he wouldn’t even survive pregnancy.” 

The diagnosis is overwhelmingly fatal for most babies. When meeting with  Vlastos, Keishera noted, terminating the pregnancy “never even came across his mouth.” Instead, the doctor was proactive, outlining a plan to treat Cassian in utero. 

When an initial laparoscopic laser surgery failed to pierce the dense blockage, the medical team pivoted to a radical, groundbreaking alternative: an EXIT (Ex Utero Intrapartum Treatment) procedure. 

During the highly complex surgery, doctors partially delivered Cassian via cesarean section — bringing only his head and arms out of the womb. While still entirely sustained by his mother’s placenta, an ear, nose and throat (ENT) specialist team successfully carved a small hole below the blockage to perform a lifesaving tracheostomy. Once the airway was secured with a tube, Cassian was placed back inside the womb to continue growing. 

Following the surgery, Keishera spent six weeks on strict bed rest in the hospital’s antepartum unit, hooked to fetal monitors 24/7. 

“I sort of had to settle into the realization that I might be here until I’m full term,” Keishera recalled, noting how she had to shift her perspective from her own discomfort to a deeper spiritual focus. 

“I had to turn my perspective towards God and say, ‘God put me in this room for a reason. ... I need to make it not about myself, but about saving my son and serving the Lord.’ So that’s how I essentially spent most of my time. I did pray a lot.” 

The medical roller coaster peaked six weeks later, when Cassian was delivered. His NICU stay was marked by incredible uncertainty, including a terrifying moment during a routine tracheostomy cleaning when the infant nearly coded.

“I had to stand there helplessly as multiple people rushed in the room,” Keishera said. “There was absolutely nothing else that I could do but watch the monitors and pray to God that his will once again may be done.” 

Just one week after that brush with death, Cassian was cleared to go home. 

Today, at nine months actual age, Cassian is thriving alongside his nearly-3-year-old big brother, Matthias. 

Reflecting on the whirlwind year, Keishera views her son’s medical milestone as a testament to absolute surrender. 

“Right now, I know about one year after we learned about his diagnosis ... God chose us so that Cassian can make this leap in medical science,” she said. 

“God turned what was our greatest heartbreak into a leap of medical science, and now there’s a whole new era of treatment for these babies ... [who] previously [faced] a devastatingly fatal diagnosis. Now we can say that these babies have a good chance of survival.”