Author: Lynda Haddon

Lynda Haddon is the mother of four grown-up children, including dizygotic twin daughters as well as a delighted and proud grandmother. She has been involved with multiple birth issues for over three decades, is a Past President of Multiple Births Families Association in Ottawa, Canada, as well as of Multiple Births Canada, Canada’s only national support organization for multiples and their families. She runs two blogs, Forever Angels and Linda on Multiple Births, and also operates Jumelle, a site and app devoted to everything you need to know about expecting and raising twins, triplets and more!

Breastfeeding Fathers/Partners

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On the surface, it doesn’t appear that Dad’s or Partner’s role could be very important in the breastfeeding department. But the truth is a Father/Partner’s role is essential to successfully breastfeeding multiples. Detailed communication between the parents before the babies’ arrival and a commitment to give them the best start in life, sets the stage for a successful breastfeeding experience for the whole family.

Here are some hints and tips to guide you in your breastfeeding support role:

  1. You and your partner have discussed in detail that you want to give your babies this important start to their lives. Reinforce this decision whenever it is necessary, to other family members, friends, to each other.
  2. Consider asking for extended parental leave from your job so that you can be available in the first few weeks after your babies are home. Even if your workplace doesn’t offer extended leave, ask anyway. Explain why this extended would be an asset. Each time an employee asks for this type of extended leave, a seed is planted. Companies are often rethinking employee benefits and extended leave for the parents with multiples might become automatic.
  3. Bring your partner a nutritious snack and a glass of water each time she breastfeeds. Help to get her comfortable by putting pillows under her elbows, behind her back and a stool under her feet.
  4. Actively involve yourself in the care of the babies. Don’t wait to be asked. You may change diapers before breastfeeding and burp, cuddle and talk the baby who finishes first so that Mom can focus on the other (next) baby.
  5. Take breastfeeding classes, ask questions and check out the vast array of books on breastfeeding. Learn how to put babies to the breast, and about proper latching on so that you can assist your partner at those important first feedings. You will be a big support during those initial attempts at simultaneous breastfeeding.
  6. With the birth of multiples, it isn’t unusual for there to be a shift in the family roles, especially if the babies were delivered by c-section. A c-section is major surgery and it takes at least six weeks for recovery. Dad/Partner needs to be prepared for a variety of duties: grocery shopping, laundry, childcare for other children and food preparation, for some examples.
  7. As breastfeeding progresses and the milk supply established, Mom can express breast milk so that you can feed one of your babies with a bottle, if this works for the both of you.
  8. Breastfeeding is a learned art for both a mother and baby. Don’t stay on the sidelines. Get involved, offer encouragement and problem solving techniques to your partner as they are needed.
  9. It is important to remember to look after your relationship with your partner. Try and do something together at least once a week: Go for a walk or for a coffee and conversation. Arranging time together as a loving couple will help reinforce your togetherness and decision to breastfeed.
  10. You may need to reevaluate your feelings about your partner’s breasts. While initially you may have thought of them sexually, after a birth, things turn can around as those same breasts become a source of nutrition for your babies. Be aware of your feelings and keep the lines of communication open with your spouse. These conflicatual feelings are normal.
  11. It isn’t unusual for a father/partner to feel jealous of the mother and babies’ physical connection. Try not to feel rejected or displaced. You continue to be an important person and a leading role player both with your babies and with your partner.
  12. If you feel that Mom is having difficulty with breastfeeding, encourage her to attend a La Leche League meeting or arrange for a consultation with a Lactation Consultant. Some of the latter make house calls and with a quick consultation, matters can quickly be rectified.
  13. It isn’t unusual for multiples to arrive early, i.e. before their due date. One of the amazing miracles of breastmilk is that each mother’s milk is specifically suited for her child’s gestational needs. During the early days after your babies’ births, you may need to provide encouragement and support as Mom pumps for your babies, if they are unable to breast feed independently.
  14. Have faith in yourself and your capabilities. These are your children too and looking after yourself as well as your partner and babies, will help you all have a satisfying breastfeeding experience.

For more information about fathering, parenting, breastfeeding:

www.dadscan.ca
www.fathers.com
www.fathersforum.com
www.lalecheleague.org

Reviewed and with very helpful input provided by Erin Shaheen, Child Birth Educator and Social Service Worker, Ottawa, Ontario.

Multifetal Pregnancy Reduction

Posted by on in Bereavement Support, Loss of a baby, infants or children, Pregnancy, Prenatal Education1 Comment

Note: The term used by the International Society of Twins Studies (ISTS) is “Multifetal Pregnancy Reduction” and is the one used here. For the Reader’s information, this procedure may also be referred to as “Selective Reduction”.

Couples who are expecting three or more babies may wish, or be advised, to consider reducing the number of viable fetuses to two. The reduction procedure is usually performed between the 10th and 12th weeks of pregnancy by injecting one or more of the fetuses. Fetal reduction increases the chance of a mother having one or two healthy babies instead of a miscarriage or very premature delivery of three or more babies who are much more likely to die or to suffer from long-term disability.

The balance of risk and advantage will be different for each couple but nevertheless for all there will be a sense of responsibility and much anxiety. For couples considering multifetal pregnancy reduction, there are additional issues that compound their anxieties.

Firstly, many couples have struggled with becoming pregnant, sometimes for years. Here they are pregnant, with some type of fertility assistance, but they are carrying triplets, quadruplets, quintuplets, sextuplets or more. To now have to consider reduction (killing?) of some (or even one) of the babies that they have strived so hard to conceive, goes against all of the time, energy, disappointment, heartbreak and money that was invested in getting pregnant in the first place.

Secondly, when it is determined that there are three or more fetuses, the timeframe for the multifetal reduction choice is often very narrow, sometimes as short as only 3 or 4 days. In that small window, the parents have to learn all they can about the procedure, perhaps connect with others who have had the procedure, learn about the risks to mother and the remaining fetuses and come to grips with losing (aborting? killing?) one or more of their unborn children. This is enormous pressure to endure, to come to terms with and to decide upon in a few, short days.

Thirdly, and as yet perhaps one of the most unstudied and unrecognized issue, are the possible long term psychological effects on the parents and by extension, the children as well of choosing a multifetal pregnancy reduction procedure. Some of the questions that have been bandied about my parents having had the procedure are: “Did we kill our son?” (this from parents who had two beautiful daughters from a triplet pregnancy); “Am I a murderer?” “How and when do we tell the others (surviving children)?” Some parents have reported fantasizing about the baby(ies) that was reduced and wondering about the sex of that child(ren), if they would have looked like their co-multiples and even if they should tell the siblings about the reduction. Some parents have named the reduced child(ren) in an attempt to come to terms with their decision and to find some peace regarding this socially unrecognized loss.

Regarding telling the other children about the procedure and what it could entail, once again the answer will be individual and personal. If you have shared with other family members that you are carrying many fetuses and are considering multifetal reduction, then have the procedure and wish to keep hush regarding your decision, it may already be too late. If parents choose not to tell their surviving children but have conferred with other family members regarding the procedure, then there is always a risk that someone will tell, even inadvertently, your surviving children. Secrets in a family are extremely hard to keep and usually fester and erupt at a most inopportune time and sometimes awkward moment. It stands to reason that parents considering the multifetal reduction procedure would want to confer with other family members who love and care for them, as they struggle with emotions, guilt, worry and anxiety over their babies. To share personal information and then to expect silence may be too much. A child who discovers, from someone other than his parents, an important piece of his history can become confused and angry regarding this important piece of his life which has been kept from him.

With families being more open these days and encouraged to speak of their dead baby, this could be helpful all around. It is usually better for children to know from the start that they were once a part of a set. The reaction of each child will be unique and personal and parents will need to provide age appropriate feedback and information to their children’s questions. The beauty of this approach is that, a child asks at his or her own rate and in a manner that meets his or her needs at that time. Expect questions at all stages of their lives.

When considering multifetal pregnancy reduction, there are many questions and the answers will need to be considered individually and as will affect each family’s personal situation. Here are a few common questions:

I am expecting quadruplets and am being asked to consider reducing to twins. I know it is possible to carry healthy triplets, what do we do?

You are correct, many families have carried triplets to a healthy outcome. There are many considerations and only you, your partner, informed healthcare professionals, perhaps other multiple births parents, genetic counselling can help you reach a decision.

Some things you might consider:

Ascertain the health risk vis-à-vis the mother and all of the babies. If one (or more) fetuses have anomalies, you may feel that reduction is the decision to make, thereby giving the healthy fetuses a better chance at a healthy gestation and life.

Learn the survival statistics

  • 70% of quadruplets survive. Of that figure, 50% of them have disabilities ranging through a series of impairments such as blindness, to cerebral palsy. The average gestation for quadruplets is 28 weeks.
  • 85% of triplets survive and 10% impairment rate can be expected, with an average gestation of 30-33 weeks.
  • 98% of twins survive with a 5% impairment rate and the average gestation is 35-38 weeks (NOTE: a singleton gestation rate is based on 40 weeks).*

*Statistics quoted from research paper by V.M, quadruplet Mom who reduced to triplets and gave birth at 34+ weeks to three beautiful, healthy babies. Their weights ranged from 3.12 lbs. to 4.9 lbs. and the family brought them home from the hospital within 15 days.

Did we do the right thing?

This is such a difficult question and there are no easy answers. Even though the timeframe for decision whether to have the procedure or not is so short, be sure and do your homework. Below are some Internet Sites to visit, talk to other families who have considered the procedure, learn as much as you can about the procedure and the possible ramifications. Knowledge is Power and permits you to make the best possible decision for your personal situation.

I must go back to V.M. thoughts and wisdom. As V puts it:

Someone once said to me “make the decision from your head, not your heart”. I agree with the intent of that comment. An informed decision is the best decision. However, you can never really feel good about such a decision, and you will never be 100% certain of your choice. You can survive this and one day you will be at peace with it. Recently I was able to answer a question that had tormented me from the beginning. “How do I ask forgiveness or understanding from that lost child – the one I never gave a change at life?” The answer – there is no need to ask for forgiveness for a child loves unconditionally. The love we have for that child was and is equally returned. It was through love that my husband and I conceived and it was with love that we reduced. It is the love not the loss that I chose to hold onto. Somewhere between your head and your heart, what you know and what you feel, you will find the answer. Allow yourself to listen to both.

We have lost a child(ren). We hurt so much and we cannot share nor openly talk about our pain.

Multifetal pregnancy reduction is one type of loss that is nearly impossible to ‘share’ with others let alone have them fully understand the anxiety and dilemma that has been faced. We conceived many babies and chose to reduce one (or two, or three). While our dream has been drastically altered, we may choose to keep our personal feelings to ourselves and if not, our loss(es) may not be acknowledged, recognized or even fully understood by others in a manner that we might feel fitting or helpful. A sense of isolation coupled with the grief of the new reality can combine to make the pain greater.

It may not be unusual, like a miscarriage, for others to have difficulty in relating to your loss. “Well it wasn’t a baby yet” or “you have others” may be expressed to you. Try and find a caring and understanding person to share your pain and grief with. It might be a special friend, grief counsellor, religious leader, family doctor or bereavement support gorup. Grief is personal and knows no timetable. Grief is a journey not a destination and may require some support at different stages of your life. It is important to recognize the pain, possible feelings of guilt and grief and to work with them, address and acknowledge them. Only then can we move on, forever changed and with a new reality. Don’t be afraid to cry or seek appropriate professional support, if need be.

Sources

Bereavement: Guidelines for Professionals, These guidelines focus on the particular issues raised by the loss of a twin, triplet or more by Elizabeth Bryan, MD, FRCP, FRCPCH and Faith Hallett, The Multiple Births Foundation
Selective Reduction: Research Tools for an Informed Decision, by V.M.
Twins! Pregnancy, Birth and The First Year of Life by Connie L. Agnew, M.D., Alan H. Kein, M.D., and Jill Alison Ganon, 1997, Harper Perennial

Breastfeeding: How will I recognize if my babies are drinking enough milk?

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The following breastfeeding information is provided for healthy, average term babies.  If you feel that your babies are not eating well, drinking enough milk, or taking in enough nourishment, contact your doctor for feedback on your personal situation.

There are several ways to determine whether or not your babies are eating well and the most obvious is by what comes out the bottom end.

  • In the first two days after birth, on average each baby should have 2 wet diapers and 1-2 soiled diapers.  Right after birth, the first stools will be a thick black consistency.  This is called maconium.
  • On days 3 to 5, each baby needs to have at least 2 wet diapers a day and 2-3 soiled diapers.  Stool colour will be green, yellow or brown in colour.
  • From 6 days to 5 weeks, look for each baby to have 6 heavy, wet diapers per day and 1 or more soilings of a yellow colour per day.

Some signs to let you know that the babies are getting enough milk:

  • are sucking strongly, slowly and steadily
  • has a strong cry and moves actively
  • your breasts feel softer and less full after each feed

When baby is full:

  • will break the latch and let go of the breast of his own accord
  • hand lies gently and open against your body, showing contentment

In the initial days after birth, sleep overtakes a full tummy, especially for preterm or low birth weight babies.  They just don’t have the stamina to keep on feeding.  If your baby falls asleep at the breast after a few sucks, you will need to try and wake him up.  This can be done by stretching him by holding him up under the arms, try to get a good burp out of him, move him around your body, don’t let him snuggle, and some parents will undress the baby to stimulate him to continue eating to fill his tummy.  If babies do not take in enough milk, you will be back to feeding them again in a very short time frame.

Babies’ approximate tummy sizes:

  • Up to 2 days after birth, is about the size of a chickpea
  • 2-10 days about the size of a hazelnut
  • 10 days to 1 month about the size of a walnut.

This is what you are trying to fill at each feed so it is helpful to make sure the tummy is as full as possible each feed.

Vanishing Twin Syndrome (VTS), Part 1

Posted by on in Bereavement Support, Loss of a baby, infants or children, Pregnancy1 Comment

Vanishing Twin (VT): Frequently Asked Questions (FAQs)

To my surprise, the Vanishing Twin article is the most hit-on article on my Site. Due to very early ultrasounds (5 or 6 weeks) we learn early if we are pregnant and with how many. By about week 12, things can drastically change. Following are some FAQs on Vanishing Twin:

LYNDA IS NOT ABLE TO ANSWER MEDICAL QUESTIONS. ANSWERS PROVIDED ARE GENERAL IN NATURE AND MAY NOT APPLY TO YOUR PARTICULAR SITUATION. IF YOU HAVE ANY CONCERNS AT ALL ABOUT YOUR HEALTH OR YOUR PREGNANCY,PLEASE CONSULT YOUR DOCTOR!!

Q – How long will I continue to bleed?

Ans: Each woman is unique as is each pregnancy, even for the same woman.  Duration of bleeding can depend upon when VT occurred. For example if it occurred at 7 weeks, a woman may not bleed as long as if it occurred at 10 weeks. Some women don’t bleed at all and their body reabsorbs the VT tissue with no outward indication of the loss.

Q – Will the VT hurt the other baby (ies)?

Ans:  In the majority of cases, if the other baby(ies) is healthy, it(they) will be fine. Your doctor can confirm, through ultrasound and fetal monitoring, the health of your remaining baby(ies). Generally there will have be no difficulty as the pregnancy progresses through to a healthy birth.

Q – Will there be any evidence left at the birth of the survivor?

Ans: Usually at birth, there is little if anything left of the VT. There might be a “thickening” of a portion of the placenta.  It depends upon when the VT and the birth of the surviving baby occurred as to whether or not the VT is visible. For example: if say the VT occurred at 8 weeks and the birth of the survivor occurred at 39 weeks, there is little chance of any remaining physical evidence of a VT. If the VT occurred at 12 weeks and the survivor is born prematurely, say at 32 weeks, then there may be some evidence of VT or there may not.

Q – What caused the VT? What did I do wrong?

Ans: It isn’t fully understood why VT occurs but it can be surmised that an embryos did not properly attach to the uterine wall and therefore failed to receive adequate nutrition to grow and develop. As can be appreciated from the scenarios mentioned in Ques. No. 3, there can be little to study after birth in order to ascertain why a particular pregnancy failed to produce healthy multiples. Early ultrasounds (at 5 to 6 weeks), can indicate a woman is pregnant and with how many. Two decades or more ago, the first ultrasound occurred much later in a pregnancy, about 16 to 20 weeks, well past when a woman would have known that she was initially carrying two or more. As a result she would have no knowledge that she had been carrying more than one.  It is generally felt nowadays that many more of us begin life as twins than was previously thought. What can be assured is that VT isn’t anyone’s fault and neither parent did any thing wrong.

Q – How long will it take for the empty sac to be reabsorbed by the mother’s body?

Ans: Each case is unique and needs to be evaluated on an individual basis. Your doctor is the best person to advise you for your particular case.

With ultrasound, it is now possible to know as early as five or six weeks that you are pregnant. However, with these first trimester, early ultrasounds an interesting side effect has occurred. The early ultrasound confirms two or more fetuses and a subsequent ultrasound reveals the ‘disappearance’ of at least one of the fetuses and an empty sac may be visible. This ‘disappearance’ is called Vanishing Twin.Researchers now suspect that many more multiples are conceived than previously thought and unexplained bleeding early in the pregnancy may be the miscarriage of a multiple. In the past, women usually had their first ultrasound later in their pregnancy (after 12 weeks pregnant) and therefore would never have known that they were carrying multiples. Nowadays the use of early ultrasound (in some cases as early as five weeks pregnant) can confirm a multiple birth pregnancy, while a later ultrasound confirms the loss of one or more of the babies. While not all cases of vanishing twin are associated with bleeding, this may explain why some women experience some cramping, bleeding or passage of tissue early in their pregnancy, but nevertheless the pregnancy continues, is uncomplicated and culminates with the birth of a healthy child(ren).

Vanishing twin can also occur within higher order multiple sets. I made an initial contact for registration for multiple birth prenatal classes with a family 8-1/2 weeks pregnant with triplets. When they arrived for the first class at just over 13 weeks pregnant, they advised that a subsequent ultrasound had shown that they were now carrying two babies and an empty sac was visible on the ultrasound. This family had very sad feelings because two other families in the class were carrying triplets and they should have been part of that group.

It is not uncommon for families with vanishing twin to experience feelings of sadness, grief and loss as they had anticipated and looked forward to a multiple birth.

It is not clear why one (or more) fetus fails to develop and is either miscarried or reabsorbed into the mother’s system.

For additional information, please see Vanishing Twin Syndrome, Part 2

Some Resources on Vanishing Twin

Twins! Pregnancy, Birth and the First Year of Life, by Connie. L. Agnew, Alan H. Klein and Jill Alison Ganon, Harper Perennial
Multiple Blessings, by Betty Rothbart, Hearst Books
Double Duty, by Christina Baglivi Tinglof, Contemporary Books
Mothering Multiples, by Karen Kerkhoff Gromada, La Leche League International
The Art of Parenting Twins, Patricia Maxwell Malmstrom and Janet Poland, Ballantine Books

Website: www.vanishingtwin.com

Please Note: I am unable to answer any medical questions. If you have any concerns regarding your medical situation, please check with your healthcare professional.

Additional information about ultrasounds and sonograms – particularly relating to diagnostics, exposure principles, and the role of an ultrasound technician – can be found through a variety of medical resources.

Miscarriage

Posted by on in Bereavement Support, Loss of a baby, infants or children, Pregnancy, Prenatal EducationLeave a comment

Miscarriage is the unplanned ending of a pregnancy before the 20th week of the pregnancy. 15 to 20% of all pregnancies end with a miscarriage. 75% of miscarriages occur within the first trimester (12 weeks) for several possible reasons: improper attachment to the uterine wall, imperfect fetus either genetically or more usually, by a chance mutation of cells at the time of conception. 25% of miscarriages occur during the 13th to 20th week. Usually the fetus is normal but there may be other problems: improper attachment of the placenta, uterine difficulties or an incompetent cervix.

There may be several reasons for a miscarriage as discussed above or a mild virus, more serious disease or infection may be the cause. Environmental facts and malnutrition of the mother are two more possible causes.

Many times there are no definite reasons for a miscarriage and we, who prefer answers, may have some difficulty in coming to terms with that fact.

If you lost one more or all of your babies through miscarriage, you may feel empty, angry or let down by your body. Even worse, you may find that family and friends don’t properly acknowledge the pregnancy or the depth of grief. In fact, society tends not to think of miscarriage as a real loss. People tend to think that because you didn’t know the baby, you shouldn’t feel too sad. The loss is downplayed and the parents are often advised to “try again.” If parents are to have any hope of healing, many of those whom have dealt professionally with pregnancy loss or studied it, agree that parents need to grieve their baby’s loss if they are to heal.

If it is possible to see your child, ask the hospital staff in this regard. They are best suited to advise you. Even if the baby can’t be viewed, it might be wrapped in a blanket and brought to you to hold. The physical sensation of holding your child gives you tangible memories of the baby’s real existence as a part of your family. Other mementos, such as copies of early ultrasound photographs of the multiple pregnancy with all fetuses intact, are cherished by many families.

If it is not possible to see the baby due to the miscarriage at too early a stage, it still may be possible to arrange formal burial or cremation with the cooperation of the hospital and a funeral home. If this is not an option for you, it is helpful for many families to hold a memorial ceremony, either officially with religious involvement or personally with only family and friends. You might decide to plant a tree(s) in a special location in memory of your child(ren).

It is important to find a safe place to grieve your loss. You may join a bereavement support group, see a therapist who specializes in pregnancy loss issues, find a caring friend or relative to share your feelings and emotions. Research has shown that parents who do not talk about a tragedy pregnancy take much longer to resolve their grief.

Women usually will grieve longer than men and want to speak of the miscarriage for weeks or months afterwards. Mothers may be receiving adequate care and attention afterwards, but bereaved fathers are sometimes overburdened and overlooked. Not only must they console the mother who just suffered a loss and who may be seriously ill herself, but they must also deal with their child(ren)’s death and memorial arrangements while also juggling household duties and possibly a job as well.

This article was written with grateful input and assistance from:
Dr. Elizabeth Pector, Illinois, U.S.A.

Sources

Bereavement in Multiple Birth, Part 1: General Considerations, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, November, 2001
Miscarriage, pamphlet prepared by Canadian Mental Health Association, Windsor, Ontario, Canada
At a loss, article by Kimberly Pfaff, printed in The Walking Magazine, September/October, 2001

Reading Resources

Twins, Triplets and More, Elizabeth M. Bryan, M.D., St. Martin’s Press
Guidelines for Professionals: Bereavement, Bryan, EM; Hallett F, Multiple Births Foundation, London England www.multiplebirths.org.uk
Living Without Your Twin, Betty Jean Case, Tibbutt Publishing
Bereavement in Multiple Birth, Part 2: Dual Dilemmas, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, May, 2002
The Worst Loss: How Families Heal from the Death of a Child, by Barbara D. Rosof, Henry Holt
Empty Cradle, Broken Heart: Surviving the Death of Your Baby, Deborah L. Davis, Fulcrum Publishing
Men & Grief, Carol Staudacher, New Harbinger Publications
Trying Again: Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss, Ann Douglas and John R. Sussman, M.D., Taylor Trade Publishing
Empty Arms: Coping with miscarriage, stillbirth and infant death, Sherokee Ilse, Wintergreen Press

Other Organizations

Bottle Feeding

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As with many parenting issues, the pendulum of public opinion swings from one extreme to the other over time. In the breast versus bottle debate, breastfeeding is enjoying a renaissance, and ads in magazines, bus shelters and on television can be seen encouraging breastfeeding as the optimum (the only?) method for feeding your baby. So much emphasis has been placed on promoting breastfeeding in recent years that it has become virtually impossible to find information on how to effectively bottle-feed your infant.

My own feeding story began with a strong motivation to breastfeed our twins exclusively for at least six months, more likely a full year. Thanks to the availability of material through a comprehensive public health campaign and my friend Carole, a committed breastfeeder, I had stocked up on all the pro-breast propaganda, and was convinced that anything other than exclusive breastfeeding would constitute my complete failure as a parent. So persuaded was I that I was rather rude to a woman in my office who gave me a “starter kit” of bottles as a shower gift a month before the arrival of our twin boys. How dare she jeopardise my plans to give my little babies the best start in life! Didn’t she know that studies show breastfed babies are healthier, happier and smarter? Obviously, we wouldn’t be needing any bottles in our home.

It wasn’t long after the birth of our little ones that I realized this was a more complex issue than my pre-purchased nursing bras and perfectly sub-sectioned breastfeeding information binder could address…

As per our carefully constructed birth plan (of which we had distributed multiple copies to any and all health-care providers we came into contact with throughout the pregnancy), Alex and Simon were placed on my body within an hour of their birth by Caesarean-section, where they quickly snuggled into my chest (skin-to-skin, just as the literature had suggested), and began rooting, as predicted. Simon even found a breast and immediately got to work. Great, I thought, he’s a ‘boob man’! This is going to be a cinch!

By the end of the first 24-hour period, however, both boys were still losing weight, and things were getting pretty sore at the feeding trough. Furthermore, Alex and Simon were doing lots of screaming and crying. And by now the novelty of the birth had worn off for me, and the early effects of sleep deprivation combined with major surgery had definitely kicked in. Yes, I was feeding often, yes, I had several people “check the latch”, yes, I continued to breastfeed and hope for the best.

When my physical pain became so unbearable that I tensed up all over at the mere thought of feeding, I began applying various ointments and magical creams which my breast-militant friend had procured from Dr. Jack Newman, guru on the womanly art. But I didn’t quit. Yet. I did all the “right” things—I learned how to feed from a little cup so that the boys wouldn’t suffer “nipple confusion” by using a bottle. When another nurse arrived at shift change, she suggested we try finger feeding with a tube, since that would help the babies developed the suck reflex for when I was ready to let them back on the real thing. In the meantime, I was advised to pump, since it would be gentler, less painful, and would encourage my milk to come in. I did so every two to three hours.

The tube/finger-feeding business was a complicated affair, and required many skilled hands and about 35 minutes per baby. Then there was the pumping to keep up between finger-feeds. We proceeded for another 24 hours. Sleep deprivation consequently grew worse. Post-partum depression set in and was joined by tremendous guilt when we finally gave Twin A the first bottle of formula (oh how he sucked it back, the poor starving child!)

Finally, on Day Four, we elected to move entirely to bottles, despite the damage this would inevitably incur on our psyches and our wallets. While my dear husband fed the boys each a bottle of formula and then wheeled them in their bassinet down the hospital hall for a little “walk”, I slept for a glorious three hours. Delightful! The road to recovery could begin. When hubby returned, I was awake enough to count my babies’ fingers and toes for the first time since their birth several days earlier. They each had twenty in total. Now I knew.

The following weeks were difficult ones, as readers who have recently gone through the birth and early parenting of multiples can surely relate to. In addition to the chaos of bringing home more than one baby and acclimatizing to the accompanying lack of sleep for the next six months, there was the unexpected twist of having to learn about bottle feeding: Buying formula (thank goodness for those crack-open, ready-to-feed cans—they are worth every extra cent on the line of credit), washing and preparing bottles (wisely, we had kept the unwelcome shower gift from a month ago and now my husband scrambled to find where we had stashed the box we never thought we’d use) and calculating how much formula to feed….

But another, more disturbing aspect complicated our early months as parents, and that was the barrage of uninvited comments from strangers with regards to our feeding methods.

Once a judgemental non-parent myself, prone to give dirty looks to bottle-feeding mothers on the bus or subway, I now found myself the object of scorn for precisely the same reason: I remember attending a baby shower for a friend of ours with a singleton when our boys were about three months old. While we were there, it was feeding time, and out came the bibs, burp cloths and bottles. As my husband was warming the formula in the kitchen, I wandered out to the garden with one of the babies. Immediately I was surrounded by aunties and grandmothers who wanted to meet “the mother of the twins”. I patiently answered the usual battery of stupid twins questions, and was mid-sentence when one old battle-axe called out in a rather loud and matter-of-fact voice, “you’re breastfeeding of course”.

I should have ignored her or told her as politely as I could that it was none of her business. But that pressure-induced guilt inside of me welled up, and I felt compelled to explain myself.

“Actually, we’re not,” I responded tentatively.

“Oh?” was her open-ended reply.

“Yes, well, we had a lot of trouble at the beginning.” I continued, “having twins posed different challenges than I had anticipated.”

“My niece had twins, and she breastfed for months and months”, responded the battle axe.

“I had a C-section, so there were come complications”, I meekly offered.

Wouldn’t you know it, the battle axe’s niece had also had a C-section, but of course she had had no trouble at all with breastfeeding. I burst into tears and rushed back into the house, where my husband took one look at me and was ready to kill someone. Instead, we fed the babies (bottles), packed up, and went home.

This emotionally draining experience and many others prompted me to do some research around bottle/formula-feeding so that I could do it “right”, and also so that I could be armed with data, should I need to defend myself in the future. When we had first come home from the hospital, I had called our public health nurse, who naturally knew nothing about bottle-feeding, though she did encourage me again with the breastfeeding, reminding me that it really was best for the babies. I then looked up bottle-feeding in one of our baby books, and found a chapter on how to sterilize bottles and prepare formula. (Already figured that one out from the instructions on the package.)

Finally, I stumbled across a glorious little book called “When Breastfeeding is Not an Option; A Reassuring Guide for Loving Parents” by Peggy Robin.

The more research I did on breast and formula/bottle feeding, the more I began to wonder: “Is breast really best?”

At issue are the claims that breastfeeding increases intelligence, lowers incidence of childhood illness and increases the mother-infant bond. I can assure you that our rocky but determined beginning did little to increase any type of bonding as I was so exhausted and freaked out, I barely knew which end was up on my babies! As for the other two claims, I began to have my doubts on their simplistic validity. After all, the baby formulas of today are scientifically formulated to emulate breast milk as closely as possible. All include essential nutrients, vitamins and minerals, and many now boast DHA and other ingredients hitherto only found in breast milk. In fact, the more I looked into the studies on breastfeeding and its positive effects on babies, the more I questioned whether it was the breast milk itself, or the act of cuddling and holding a baby close (which could easily be done with bottles) that caused the benefits in question.

In particular, I was intrigued to learn that infant massage, which has been studied in the West since the 1970s*, claims to produce similar benefits to breastfeeding: Weight gain (especially in preemies), neurological development, decreased hospitalization and improved digestion are all qualities noted in children who have experienced habitual infant massage. Perhaps most exciting for parents of multiples is that unlike breastfeeding, infant massage (and bottle-feeding) can be done by both parents and other care providers, a real advantage with more than one baby in the mix. (Why wouldn’t you want to sharethe joys and burdens of feeding more than one at a time with willing helpers?!) Indeed, other than the antibodies found naturally in breast milk, I really couldn’t find hard data that proved the superiority of breastfeeding as an act in itself for the babies.

My research aided me in charting a course that would best meet the needs of my family, and my husband and I made a pact when we moved to bottles: As often as possible, the babies would be held and cuddled when being bottle-fed. We wanted to emulate the physical closeness of breastfeeding as much as we could, and so we wanted to learn to bottle-feed well, to become “bottle-feeding experts”, if you will. (We also began incorporating a daily regime of infant massage into the bath time/bedtime routine, and I am convinced that it was this daily opportunity for bonding through physical touch that helped Alex and Simon grow healthy and strong, and assisted us in growing more attached to our new babies, despite various other challenges.)

Having lived through this new parent experience, I am concerned now with the multitudes of mothers who—for whatever reason—do not end up breastfeeding, but have little support in alternative feeding care. Sure, the formula packages include instructions on how to prepare the formula, but there is little guidance on how to lovingly administer the bottle to your baby. Did you know, for example, that you are actually supposed to hold the infant slightly upright when feeding, in order to prevent ear infections? And knowing what we know about the benefits of skin-to-skin contact in newborns with their parents, why not bottle-feed naked? (In a warm room with a blanket, of course, and perhaps not publicly!) The emotional high that comes from snuggling with your little ones while you feed not only transfers to the babies, but also builds confidence in the parent who knows she has fed her babies competently.

One of the many reasons I decided to become a prenatal instructor was so that I could present objective, comprehensive, research-based information on feeding options to parents expecting multiples. Don’t get me wrong—I’m all for breastfeeding, when it’s a good fit for a particular family. But the first few weeks and months of life with new twins, triplets and more are so wrought with anxiety, I feel it is important for parents to be knowledgeable about some different feeding scenarios, so that whichever option or combination of options they choose for feeding their little ones, they will be confident in the knowledge that they are “doing it right” and that it is good for their babies.

Breast- or bottle-feeding shouldn’t be a decision based on pressure from those around us. Every parent is an expert on his or her own family, and has the responsibility and the right to make an informed decision about how best to meet the feeding needs of their newest family member(s). And now that we have more comprehensive data on different factors that can impact newborns’ physical and emotional health, I hope that future public health campaigns and also individuals who mean to help will focus on supporting all appropriately-researched feeding methods to the best of their abilities in order to provide the best start for our youngest members of society and their emotionally vulnerable and sleep-deprived parents.

* for more information on infant massage, see the work of Vimala McClure and others

Websites:

Article is by Vera Teschow. Vera is a full time teacher, and the mother of Alex and Simon. Visit her online at www.verateschow.com.

Singleton Siblings of Multiples

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Singleton with twin siblings‘Things were just great around here until they came along!’ 17-year old brother of 1-year old twin sisters.

‘You always loved them more than me!’ 6-year old sister of 4-year old twin sisters

Our 9-year old son has consistently acted maturely and responsible towards his twin brothers (aged 3 years) since their birth. From the beginning we involved him in their care (they were premature) and he seems to be very proud to be the brother of twins. Mother of 9-year old singleton and 3-year old twins.

My son is 13-1/2 months older than his twin sisters. He learned to talk and speak up very early to make his needs known.  Mother of 3-year old son and 2-year old twin daughters.

I loved being the singleton child in our family. Twins were the norm and I was one the who was ‘special’.  Singleton sibling, with FOUR sets of twin siblings, two older and two younger!

For parents, the arrival of twins, triplets or more is cause for a rollercoaster ride of emotions: how will we cope? This is SO cool! Can we afford them? How will I carry them all? and feelings of over whelming joy, to name a few. Even though the impending arrivals is shared with the older child(ren), it is very difficult for him to comprehend the effect of the arrival of so many babies and how it will affect him. Parents are very sensitive to the needs of their singleton child(ren), and do their best to explain what will happen and that no matter, “Mommy and Daddy will still love them to the moon and back.”

In spite of the parents’ best preparation efforts, the arrival of two, three or more siblings, can be a challenge for singleton siblings, especially if they have been the King/Queen of the Castle for some time.

Initially the multiples’ arrival may not impact the siblings too much but give it a week or 10 days and the realization sets in that Mommy and Daddy are not as available and behaviours may change. One 3-year old singleton said to his parents, “OK, that’s enough. Take them [his twin siblings] back to the hospital now.” Another 3-year old yelled at his parents, “I only want one!”

Reactions aren’t limited to the younger set: A 15-year old girl put herself in foster care when her twin sisters arrived, and a 17-year old young man (yes, young man), didn’t speak to his parents for weeks and stayed in his room as much as possible when his twin siblings arrived.

Following are some examples of, but not limited to, possible behaviour which may be exhibited by singleton siblings:

  • refuses to give up the bottle/reverts back to the bottle;
  • wishes to breastfeed again;
  • seeks your attention when you are less able to provide it and rejects you when you are available;
  • there could be problems with toilet training, i.e. a set back or refusal to use the potty;
  • speech regression or refusal to speak;
  • is clingy and/or excessively whiny;
  • plays rough with the babies;
  • may pinch, hit or bite them when alone with them; or
  • unresponsive to direction, refuses to co-operate.

There are some ways to support the singleton child(ren) and to assist him (them) in coping with the new arrivals:

  • avoid calling the babies, “the twins” or “the triplets.” This label automatically leaves out any singleton children and gives the impression that those with this label are more special. Correct others each and every time they use the label. As the parents others will take their cue from you;
  • presenting the multiples as a package will ensure that they are perceived as a package. Continually dressing them alike and giving them rhyming names reinforces the “package” mentality and the singleton child(ren) is left out;
  • arranging special play dates or preschool for an older child allows her to have her own special time, activities and things to talk about;
  • include them in the decoration of the babies’ room (should we use yellow or green paint?) can be helpful;
  • allow them to help put the babies’ clothes in the dresser drawers;
  • don’t use your older child(ren) as “gophers.” They can quickly resent being sent on an excessive number of fetches. This doesn’t mean they can’t help (could you please get Daddy a diaper for your sister?), but don’t get caught in the habit of using them on a continual basis;
  • provide lots of positive feedback. “You were SO helpful today!” “You are so special to me and have been such a good girl/boy today.” “Thank you for being so patient;”
  • if there is bottle or toilet training regression, just go with the flow. Don’t make issues of it and handing them a bottle plays down the issue rather than have it escalate out of control and become a temper tantrum and make of control. It won’t take long for them to realize that they are not babies and a bottle can be hard work. Leave the potty out in plain view, but don’t over focus on it;
  • set aside some time each day for him. It can be bath time, bed time and story, grocery shopping, play time but the important thing is for him to be the full focus;
  • if you can’t be available when she requests attention, buy a little timer and give it to her. Set it for 15 minutes (or what works for you) and say, “When the bell rings, we will read (play) together” and then keep your promise;
  • if you can’t keep your promise, and there will be times when you can’t, let your child(ren) know that you are sorry and realize you have broken your promise but will make it up to them as soon as you can. Two things are important here: 1) you have taken responsibility for your behaviour, and 2) you have taught your child it is OK to take responsibility for one’s behaviour. Such an acknowledgement helps a child learn that others have limits and it isn’t their fault you weren’t available. Children tend to internalize things when they don’t work out as planned and see themselves as being “bad” as a result. Clearing the air is most important. But do try to make it up to them as soon as you can;
  • you can give your child(ren) some feelings of control in the life but giving them simple choices: what would you like to wear today, the red outfit or the blue? What would you like for breakfast, cereal or toast?

Multiples in public cause a stir and attract a lot of attention. It will be important to include your other child(ren) in the conversation when necessary. A simple, “This is their older sister and she is such a help” goes a long way to soothing hurt feelings.

As one 4-year old asked her Mom after some strangers had made a fuss about her triplet siblings and not even spoken to her, “Didn’t they see me standing there?” It is important that parents advocate for all of their children.

Splitting up the kids for an outing can change the group dynamics. Take an older child and one baby to do groceries. It gives everyone a change of pace.

Give your singleton child(ren) time to make the adjustment to the arrivals. Be as patient as you can. Just as it will take parents time to get into a proper routine, it will take a child(ren) time to adjust to the changes in his/her own routine.

Younger Singleton Siblings of Multiples

Some parents go on to have singleton children after the birth of their multiples. These singleton children are born into the situation and may have less adjustment to make as a result but there are no guarantees. When two or three siblings are all having a birthday party at the same time and you are not, feelings can be hurt and the tears flow.

Patience and understanding works wonder. Some parents will buy that child a gift too. I’m not sure that is the way to go because the world will not make room for you just because your feelings are hurt. Cuddling and words of explanation may be a better approach than expecting a gift on your siblings’ birthday and is an important learning tool that the world does always cater to you. Explaining that his birthday will come and he will get to blow out the candles himself on his own cake, separates the events and gives each child a chance to have a special day to all his own.

Sometimes an issue of the multiples ganging together and “bossing” a younger sibling(s) occurs. If such is your experience, appropriate guidelines will need to be put in place so that a younger one does not feel bullied or ganged up on. Explaining to everyone that “Mom and Dad set the rules, not the kids” and “two (or three) against one amounts to bullying” can be helpful. Be prepared to go over these rules on at least a semi-regular basis and perhaps to have consequences in place when necessary, e.g. no TV/internet tonight, put 25 cents into the jar (for allowance-aged older multiples) at each offence.

It is human nature to adjust and most of us get over having siblings. Being guided by the loving adults in our life can make the journey more tolerable.

Additional Resources

The Singleton Siblings of Multiples, Multiple Births Canada, booklet.

Surviving Co-Multiples, Twinless Twin, Lone Twin

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Twinless Twins, Surviving Co-multiple(s), Lone Twin, all of these terms have been used to describe a co-multiple(s) who has survived his or her multiple birth sibling(s).

The death of a co-multiple might have occurred in utero, been a stillbirth, occurred in early infancy, through an accident, murder, suicide, illness or natural causes. The effect on the survivor(s) has only recently been researched and acknowledgement made that this type of loss may be more difficult for the survivor, regardless of the age the loss occurred, than was previously thought.  Some survivors call their loss (as it occurred later in life) ‘worse than losing a spouse.’  If one thinks about it, co-multiples have been together since conception and share a unique bond and lifestyle journey that majority of us do not. Changing “we” into “I” is not an easy transition and the first shared birthday alone, for example, can be extremely difficult.  For surviving co-multiples who look a lot alike, looking in the mirror can be emotional as they are reminded of their deceased co-multiple or get mixed up as to who is really looking back at them, a challenge the majority of us do not have to face.   It is important to not only recognize that this loss is unique, but that it also requires unique skills on the part of the professional for supporting and assisting survivors.

From time to time, I am approached by surviving co-multiples who would like to connect with other survivors. If this is you, send me an e-mail. Please include your age, age at loss, type of loss (e.g. illness, accident, stillborn, etc.) , whether you are male/female and gender of that of your co-multiple(s).  I will do my best to find a connection for you.

If you are a multiple birth survivor and would like to share your story, please send me an email and let me know about how your loss has affected you.  By sharing your story, it may be possible to help other surviving co-multiples with their grief journey. Please accept my sincerest condolences on your loss.

A neglected area of support, counsel, resources and understanding for twins, triplets and more are the experiences of those who lose their co-multiple(s). Multiple-birth individuals begin their lives together, but the odds are stacked against them in leaving the world at the same time.  Whether the loss occurs in utero, at birth, shortly thereafter or along life’s journey, for the survivors the loss can be devastating.

Studies have shown that multiple birth babies begin their unique relationship in utero. The special bond that they have with each other doesn’t terminate with the death of one (or more) of them.  While death may end the life of one or more co-multiple, it does not end the multiples’ relationship with each other. Turning ‘we’ into ‘I’ is not a simple task for the survivor(s).

I have been contacted by many multiples who lost their sibling(s) in utero and they express feeling “empty and/or unable to make and keep friends or have meaningful relationships.”  Some indicate they feel robbed, unworthy, stalled in their life, having to make their parents happy by living a life for two, trying to live a life for two because they do not want their co-multiple’s life to have been wasted, survivor’s guilt, and so much more.

Monozygotic [MZ] (identical) multiples often feel as ‘one’ and may feel each other’s pain, share each other’s thoughts and report feeling incomplete when they are apart. They are reminded of their sibling each time they look in the mirror and several surviving MZ men report having a difficult time shaving after the death of their co-multiple.  The task of shaving, which is common to most men, becomes an overwhelming reminder on a daily basis of his loss for the brother. One survivor grew a beard so that his reflection would not be a reminder of his brother. One MZ woman, who lost her twin sister in a car crash, reported being traumatized when she looked in her sister’s casket and thought she saw herself, dead. These types of blurring of the boundaries between one and the other are particularly difficult.

This does not mean that dizygotic [DZ] (fraternal) multiples do not also feel an intense bond between them. One adult woman who lost her co-multiple (a brother) from a childhood disease as 6-year olds noted that all of her life she had felt “lonely and alone,” in spite of a successful marriage, career and 3 beautiful children. “There is no one to watch my back,” she advised. Not only was she dealing with the loss of a special brother, but she also reported feeling guilty about surviving the disease that terminated her brother’s life. 
To make her mourning even more difficult, his things were packed up, given away and his name never mentioned again after he died.  She was old enough at the time of his death to remember him well and was upset and confused by her family’s decision to pretend that he had never lived.  Their decision left no space for her grief or the profound affect his loss made on her life.

It isn’t uncommon for surviving multiples to be very driven, often trying to live their lives for two, one for themselves and one for their deceased co-multiple(s). They may also feel a need to succeed in order to try to make their parents feel ‘happy.’

Or the opposite – a surviving triplet recounted that one sister died shortly after their births. A phone call to the family from the hospital indicating a second triplet had also died halted the funeral service, so that the two babies could be buried together. The wee survivor fought valiantly in hospital and had had 4 open-heart surgeries before she was 5 years old. At the age of 22 years, she was “stuck” in her life. Although she had managed to finish high school, she had done little else and felt she was drifting. She reported feeling melancholy, sad, guilty for putting her parents through the worries of her precarious health when they had already lost two babies, and very guilty that she had lived while her co-multiples had not.

It is highly unlikely that a deceased co-multiple would want their surviving co-multiple(s) to change places with them. I believe they would want their co-multiple(s) to live his or her life to the fullest, to succeed, to prosper and be happy. I would also suspect that they would want to be thought of from time to time, and have a little place in their sibling’s heart set aside to remember them.

Some concrete ways to remember your sibling(s) can include volunteer work in their memory, or making a donation to a special charity (perhaps annually – say your Birthday, or choose a date that is either meaningful to you or your deceased co-multiple), or having a tree planted in their memory. You might even find that when you have a child of your own, you may use your sibling’s name, even as a second name. All of these ways celebrate your sibling and his or her life, no matter how short.

If you feel that you simply cannot get over losing your co-multiple(s), consider asking your doctor to refer you to a bereavement counselor who understands the unique bonds that multiples share and what it can mean when those bonds are broken. Looking for support and understanding about what you are feeling doesn’t mean forgetting your co-multiple, but it does mean addressing your sorrow and pain and learning to handle it constructively so that you can indeed live your life to the fullest.

Here are a few resources, I have found which may assist you.

Bibliography

Living Without Your Twin, by Betty Jean Case, 2001, Tibbutt Publishing
Twin and Triplet Psychology, Edited by Audrey C. Sandbank, 1999, Routledge

Reading Resources

Who Moved the Sun?  A Twin Remembers, by Ron McKenzie, D.E.M. Publishing, 2011
The Lone Twin: Understanding Twin Bereavement and Loss, by Joan Woodward, 1998, Free Association Books
Entwined Lives, Nancy L. Segal, Ph.D., 2000, Penguin Books
Forever Linked: A Mother’s Journey Through Twin-to-Twin Transfusion Syndrome, by Erin Bruch, Philatory Ink, 2011
Men & Grief, by Carol Staudacher, 1991, New Harbinger Publications
On Children and Death, by Elisabeth Kubler-Ross, 1983, Collier Books
A Child’s View of Grief, by Alan D. Wolfelt, Ph.D., 1991, Center for Life and Transition

Organizations

Twinless Twins was founded by Dr. Raymond W. Brandt many years after the accidental electrocution of his monozygotic brother, Robert, at age 20 years. Dr. Brandt died in June of 2001 and was buried on the 52nd anniversary of his brother’s death.

Study on the effects of losing a twin

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The purpose of “Two in One: Once a Twin, Always a Twin” is to study the effects of a twin losing his or her twin and to investigate the differences of the impact based on when the twin loss took place (Early loss, Childhood loss, Teen loss, Adult loss). I contacted hundreds of twinless twins and emailed them questionnaires about how it was to interact with their twins and what the affects of losing a twin are, among other questions. Through this twin loss study, it is evident that all twinless twins feel a significant loss in their lives. Early loss twins have always felt that something is missing from their lives and they find it difficult to talk to their parents about the loss of their twins. Most of the adults who lost their twins later in life went into a deep depression. The common denominator among all twinless twins is that they feel significant losses in their lives and many limit themselves to talking to few people outside of the Twinless Twins Support Group.

Two in One: Once a Twin, Always a Twin, a study written by Robin A. Phelps

From Lynda: Robin is a 17-year old monozygotic young woman who lost her twin sister, Jacqueline, shortly after their birth. Robin has struggled to understand why she survived and her sister did not and her feelings around the loss of a special relationship with Jacqueline. At the encouragement of a special teacher in her life, Robin has written her story. If you would like to connect with Robin, she can be reached at raphelps2@yahoo.com

Purpose/Hypothesis

“Two in One: Once a Twin, Always a Twin” discusses twin separation. This project covers the differences in ages of twins when the separations occur. My hypothesis is while no matter when someone’s twin dies, it is an extremely difficult loss; however, because Adult loss twins had the time to develop and nurture their relationships, their losses have a greater impact than Early loss twins’ losses.

Background Information

I pursued this project because of a personal experience. My identical twin and I were born just under 26 weeks. My twin, Jacqueline, was 1 lb 14 oz, and I weighed 1 lb 4 oz at birth (and then was less than 1 lb at a week old). Jacqueline survived 27 hours. I have wondered why I am here and she is not.

At birth, there were many complications and doctors told my parents I would probably not survive and that if I did, I would have serious medical problems; it is amazing I am alive and healthy. Yet, losing my twin has been very difficult for me; half of myself is gone. This is a loss that will be with me forever.

I decided to locate some of the doctors and nurses who fought so hard for the survival of my twin and me. Learning about some of the diseases my twin and I endured has helped me tremendously. Meeting other twinless twins has been amazing because they “understand” me completely and accept me as I am.

As a result of Jacqueline’s death, I am extremely compassionate towards others. I volunteer at UCSF Intensive Care Nursery (ICN), which shared physicians with Mount Zion (where I was born). UCSF and Mt. Zion merged ICNs in recent years. Volunteering at the ICN is important to me because it gives me opportunities to help other premature babies fight for their lives and to step outside myself and share my gift of life and love with others.

Materials

For this project, I used:

  • The Computer
  • Internet
  • Survey Responses
  • Procedure/Method:

I searched online for twinless twins, and when I found names and messages (posted on online guestbook websites), I emailed them. After exchanging emails, I sent them six to nine questions (depending on what ages they lost their twins), including how it is for them to know they are twins and what happened when their twins died.

I was sent numerous emails from twinless twins and I was able to use the 43 surveys and stories I received to complete the study of twinless twins and the impact the loss has on their lives. Using a speadsheet, I categorized all of the data I got from other twinless twins. These categories included: name, male/female, identical/fraternal, age lost twin, circumstance of loss, and present age. I received seven (7) responses from males and thirty-six (36) responses from females. Fourteen (14) twinless twins were fraternal and twenty-nine (29) twinless twins were identical. I grouped the responses by using folders; these folders included: Early loss (in utero to three years), Childhood loss (four to twelve), Teen loss (thirteen to nineteen), and Adult loss (twenty and older).

After I reviewed each response and put the email in the appropriate folder, I found the common ground of the loss (i.e. teen loss). I used the analysis of each category’s loss to come up with common ground for overall twin loss.

Results

I am not an expert, but I do have personal experience in this area of study. I have reviewed each twinless twin’s response and read it carefully and with understanding. Additionally, I found it difficult to graph results and rate each loss on a scale of 1-10. There is information and my findings for each category below.

Early twin loss

I received eleven (11) responses from early loss twins. It is sad for this group of twinless twins to know that they were and are twins – just never having the opportunity to grow up with their twins. As the Early loss twins got older, each twinless twin understood the situation better, but it made some people depressed, sad, and curious about the whole situation. Many wonder about all the things and memories that could have happened. One twin writes, “I miss her every single day and I am constantly curious about how life could have been with her.” Many have numerous questions about why the death of their twins happened so soon. Eight out of eleven twins had parents who did not acknowledge that they were twins and their families were not and are not supportive in any way. For early loss twins, there is a feeling of having an obligation to live on their twins’ behalf. Throughout all of these twins’ lives, they have felt a deep loss. Early loss twins feel like they are searching for best friends but they can never, ever find someone to fill in that “missing puzzle piece.” This loss is difficult because for many, there are no memories or pictures. They were given the gift of being twins, and then it was ripped away so soon after birth. “Survivor’s guilt” is common among Early loss twins. They feel guilty because they survived and their twins did not. According to Dr. Elizabeth A. Pector, “Mirror fascination starting at an early time in infancy has been noted by many parents, especially those with surviving identical twins.” One identical twin expressed that when she looks in the mirror she always has a feeling as if she is looking at two people. Early loss twins have a difficult time talking to their parents about their twins, but they find that their moms do support them. They find comfort in writing poetry or reading, and many talk to their twins. One early loss twin writes, “I think talking about it helps slowly. And emailing other twinless twins who have lost their twins as babies or before birth helps. I think it’s different for the twins who never got to know their twins… the wondering, not knowing can torture you. But I know I’m not alone, and that does help some.” Many have written something similar – “Every evening before I fell asleep I’m talking to him, I can feel him. And most beautiful is to know that I will be together again with my twin after my time is over on earth…”

Childhood twin loss

I received five (5) responses from twins who lost their twins anywhere from the age of four to twelve. These twins feel honored and blessed to be a twin; but they also feel sad because they miss their twins. “It was great been a twin, always had play buddy. It’s like having a friend for life that never lets me down,” one twin writes. Some twinless twins are able to talk to their parents, but others are not able to. A couple twinless twins have cut off all contact with family because of abusive situations. Other twins have supportive family and friends in the sense that they don’t say anything insensitive; however, they really don’t truly understand twinless twins’ lives and the twinships and twinlosses. Twins describe the impact of their loss being they have a feeling of total emptiness. One twin describes, “We were best friends, constant companions, day and night, we were very close. When she died, I became a loner, a deep thinker. At age 16 I had to heal, and it was too young when she died. I had to go back to that day she died and start over in a way.” Childhood loss twins try and remember every detail of each event that happened. They feel a great sense of responsibility and obligation to live life to the fullest. Some twins have great memories of their twins, but when their twins passed away, they were upset. “I was angry for a long time. I have always felt the loss and it still hurts. I have regret because of how different my life might have been if he had lived,” one twin comments. Writing, talking to people about their twins, and spending time talking to their twins are ways they find peace and comfort.

Teenage twin loss

I received five (5) responses from twins who lost their twins in their teenage years. “We were each other in two separate bodies, but one in spirit,” several twins acknowledge. Teen loss twins truly grasp the meaning of being a twin. They understand that their twin was and is a huge part of who they were and are. “I believe that you see true beauty in life through the hardest times. Because I had my twin and then lost her, I have a true sense of what beauty is in life is. Our twin love and the sadness we both felt when we parted makes me appreciate everything I have, even if I am truly sad at times.” They had that one person they loved and trusted and was there for them no matter what. They twins did everything together – “I wouldn’t go anywhere, not even to parties, without her,” one twin comments. They had a truly special and unique bond – their closeness they shared was remarkable and some of them commented that it is hard to describe the closeness they felt with their twins. Their twins taught them love, compassion, truth, and loyalty. Some twins got depressed when their twins died and they cried themselves to sleep. They make scrapbooks using all of the pictures they have; or, they talk to their twins or play their musical instruments – these activities bring them comfort. Family is very supportive – twinless twins say that their families will always be there for them. One twin writes, “I think I took her presence for granted. I always assumed she would be there with me. You go through life and you always forget how precious life is and that it can be gone in an instant. I have read where twins have their own language, and we had our own little language. I miss those quirks. When she was here, I felt complete and now I am half dead.” All of the twinless feel like half of themselves is gone.

Adult twin loss

I received twenty-two (22) responses from adult twinless twins. “I took it for granted in that we were the only two children. She was my sister. She was always there,” one twin comments. Twins said that they did everything together – from elementary school to adulthood. They would call each other for no reason. “We could finish each other’s sentences and thoughts. We would describe stories in the same manner (our family told us this) all details, expressions, mannerisms exactly the same,” a twin writes. Many twins attended the same college and roomed together during those years. They had each other to turn to and the majority of the twins liked all of the same things, which made their lives great. When their twins died, their worlds stopped and they did not know how to go on. They experienced identity crises. Some had panic attacks; the majority of twins suffered (and/or still suffer) from depression and they have gone and/or are still in therapy/counseling. One twin expressed, “When he died, I was absolutely gutted and still am. I felt a small identity crisis when he died. People say that when you lose an identical twin it is like losing an arm. This is true but I also feel that a large part of my soul died with him.” They feel obligated to live their life for their twins. To cope with the losses of their twins, they keep themselves busy, write letters to their twins, and take one day at a time. Some of them turned to alcohol and then realized that was not the best way to cope. A couple of twins talk to their twins and ask them to be with them on special days or when they drive alone in bad weather. Family is extremely compassionate. One twin writes, “I have a very supportive family; I would have committed suicide if not for them.” Twins remarked that it was such a blessing to live life with their twins. “I would say that my greatest joy in life was being a twin but it was also my greatest loss.”

Common Ground Among Early loss, Childhood loss, Teenage loss, and Adult loss

There are several similarities among the twin loss groups. All twinless twins feel that it is a blessing to be a twin; yet they all feel half of themselves is gone. Journaling and writing about or to their twins is something Early loss, Childhood loss, Teenage loss, and Adult loss love doing. For the most part, family is very supportive, although they acknowledge they don’t know what it is like to be twinless because they are not twinless. Twinless twins find comfort in talking to their twins and they believe they will be reunited with them in Heaven.

Conclusion

My hypothesis was correct. No matter when someone’s twin dies, it is an extremely difficult loss; however, because Adult loss twins had the time to develop and nurture their relationships, their losses have a greater impact than Early loss twins’ losses. Early loss twins struggle from the beginning of life – they ask numerous questions and always live with this feeling of incompleteness. They find it difficult to describe the impact the loss has had on their lives and they find it a challenge to communicate their experiences and feelings with people who are not twinless. Yet, because Adult loss twins had a number of years to develop and maintain strong twinships, they are more impacted by the losses. Many go into a deep depression and they question their identities. The results showed exactly what I wanted to test. No mistakes were made because this project involved connecting with other twinless twins and communicating with them. I would not do anything differently – this project was challenging, but having the constant communication with twinless twins and discussing their experiences was amazing for me. The results did not stimulate any new hypotheses. If I had had more fraternal twin responses, I might have been able to compare identical twin losses to fraternal twin losses, but with the results I was given, this was the best hypothesis.

Bibliography

1. Guestbook, Online (Brenda, twinless twin)
http://bradstwin.tripod.com/guestbook.shtml
(found messages and emails from twinless twins and contacted them)
2. Guestbook, Online (Karen, twinless twin)
http://dreamofyou.twinstuff.com/fsguestbook.shtml
(found messages and emails from twinless twins and contacted them)
3. Guestbook, Online (Linda, twinless twin)
http://www.geocities.com/HotSprings/Spa/7546/geobook.shtml
(found messages and emails from twinless twins and contacted them)
4. Pector, Dr. Elizabeth A. family physician
http://www.synspectrum.com/survivors3.doc
(Early loss twins and mirror fascination)

“Two in One: Once a Twin, Always a Twin”

I was inspired to pursue “Two in One: Once a Twin, Always a Twin”, a study on twinless twins, because of a personal experience. Seventeen years ago, my identical twin and I were born just under 26 weeks. My twin, Jacqueline, was 1 lb 14 oz, and I weighed 1 lb 4 oz at birth (and then was less than 1 lb at a week old). My head was smaller than the size of a tennis ball and a wedding ring could slide all the way up to the top of my thigh (see picture below). Jacqueline survived 27 hours. I have wondered why I survived and she did not. At birth, there were many complications and doctors told my parents I would probably not survive and that if I did, I would have serious medical problems; it is amazing I am alive and healthy. Yet, losing my twin has been very difficult for me; half of myself is just gone. This is a loss that will be with me forever.

This past summer, I decided to locate some of the doctors and nurses who fought so hard for the survival of my twin and me. I connected with one of my dear nurses, and she and I spent a day together at the Intensive Care Nursery (ICN) at University California San Francisco (UCSF). I was surprised to meet one of my doctors from 17 years ago while I was there. Since August, when we reunited, we have gone to breakfast. I have been searching endlessly for answers about why things happened the way they did. One of my thoughtful and caring doctors has taught me about some of the diseases my twin and I endured; his assisting me has helped me tremendously.

I would like to give my deepest thanks and appreciation to my Physiology teacher, Mr. Jon Dick. You brought this project to me, talked to me about it, and then you showed an amazing unconditional support and care. This means the world to me. Throughout the entire experience, you were there for me. What a blessing you are in my life.

I volunteer at UCSF ICN, which shared physicians with Mount Zion (where I was born) – UCSF and Mount Zion merged ICNs in recent years. Volunteering at the ICN is important to me because it gives me opportunities to help other premature babies fight for their lives and to step outside myself and share my gift of life and love with others.

Meeting other twinless twins has truly been a blessing. They understand me and it is comforting to know that I am not alone. It is amazing to communicate with other people who have been through and are living with such a similar tragedy.

I would like to acknowledge all twinless twins who assisted me in my project. What a joy it has been to correspond with each of you and to hear your experiences and stories. You have all been so supportive, understanding, and loving and I thank you from the bottom of my heart.

 

Stillbirth and Newborn Death

Posted by on in Bereavement Support, Loss of a baby, infants or childrenLeave a comment

The birth of a child is one of life’s greatest celebrations. Especially during a multiple pregnancy, parents fantasize about their babies, about walking them, showing them off to friends and family, trying out names and how they sound. When the outlook is positive, those close to the couple share in the journey as excitement and anticipation mount.

Yet when one, more or all of the babies dies by miscarriage or stillbirth, parents at times are encouraged to consider a miscarriage or stillbirth as something less than a “real” death. People around you often want to help, but find it difficult to understand the special circumstances of your loss. Information from Multiple Births Canada and other resources mentioned in this article can assist them say and do things that are helpful and avoid those that are hurtful.

If you do lose one, more or all of your babies, you may wish the birth and/or death certificates to reflect the fact that your baby(ies) was part of an appropriate multiple birth set, i.e. loss of one triplet does not make it a “twin birth”, loss of two quadruplets does not make it a “twin birth” and so on. You may need to be vocal about your wishes as some hospitals may record only the surviving baby(ies) and not your accurate multiple birth.

Stillbirth and Newborn Death

For women carrying multiples, prematurity remains the leading cause of death. Approximately 10% of all perinatal deaths are multiple birth children (Multiple Births Canada’s Fact Sheet, Multiple Birth Facts & Figures, 1998).

In spite of our best precautions, premature birth can still occur. There are no guarantees against the early delivery of your babies. Even in spite of appropriate and timely intervention by hospital staff, a loss of one, more or all of the babies may still occur. If such is the case, you will no doubt be:

  • grieving for your baby(ies);
  • grieving the loss of a unique type of parenthood;
  • feeling shocked, empty and alone with disappointment, anger, sadness and grief;
  • wondering how this could happen and fear that you might not have other children.

The loss of one baby from the multiple birth set, can present complicated emotions to deal with:

  • why this baby and not the other?
  • Did I resent or fear the thought of looking after two, three or four babies and thereby cause this to happen?
  • Did I “wish” one or more babies “away” and cause this to happen?
  • Did my preference for one sex cause this baby to die?
  • How will I tell the survivor(s) about her sister and when?

While these thoughts are normal, they also increase the burden of guilt and grief. Don’t leave these feelings bottled up inside of you. Talk to a grief counsellor, good friend, hospital staff, your partner or religious support person, in order to assist you in putting your feelings into perspective.

Losing one, more or all of your babies leaves the parents and those who care about them to deal with complicated issues. Some of these issues are:

  1. Not only have you lost a baby(ies), but you have also lost a unique parenting experience. Seeing other people with their multiples is a painful reminder of your loss, and may trigger feelings of envy, anger, failure or sorrow. In addition, when there is (are) a surviving child(ren), it can be difficult to resolve the conflict between the two extreme emotions that you are feeling – that is, the joy of the birth of a baby(ies) and the sorrow of the death of a baby(ies).
  2. Your feelings may include rage, shock, numbness, guilt, panic, being out of control, powerlessness, confusion, and/or denial. You are adapting to a new reality and it takes time to adjust. In fact, we are never the same after the death of a child(ren). We adapt and go on, but we are not the same. Grief is a journey, not a destination. Expect powerful feelings to resurface at different times as you walk the rocky road. It is healthiest to allow yourself the neeed time to experience them as they arise, rather than suppressing them.
  3. You may not wish to be touched or held for a period of time after your loss because of a fear of losing control of your emotions. At work or in social situations, you may not wish to discuss your children or your loss, afraid that you will break down in tears and be unable to stop the flood. It helps to tell family, friends and co-workers what you do and don’t want to talk about. Every parent is different. While some want and need to talk about their distress with anyone who will listen, others wish to keep their personal pain separate from their social responsibilities. It helps to tell family, friends and co-workers what you do and don’t want to talk about.
  4. You may find that people pay more attention to the live baby rather than the fact that one (or more) died. They may feel that dwelling on the dead baby may make things more uncomfortable for you. Feel free to speak up if you wish to speak of your dead child(ren). Others will be more open about their thoughts if they know you are happy to hear your dead baby’s name and consider him or her to be a special part of your family.
  5. On the other hand, you may wish, yourself, to push all thoughts of the dead baby(ies) out of your mind and concentrate on your surviving baby(ies). You might wish others would stop reminding you of the baby(ies) you have lost. You need not feel guilty about this normal reaction. Parents can only cope with so much at once. With newborns, especially when they are premature or ill, it is common for parents to devote their energy to their living children and delay grief until a later time. In due course, you will find the right way to acknowledge the child who died.
  6. Parents often hear inappropriate comments that are meant to comfort them but in fact, do exactly the opposite. To hear “It’s not the same as losing a baby, this one never drew breath.” or “You are young, you can have other children” is devastating, even if the comment is well intentioned.”At least one survived.” [I am truly grateful, but one crib is still empty.]
    “It’s God’s will. They’ve gone to a better place.” [There is no better place for babies to be than with their parents! ]
    “It’s for the best, she/he would have been disabled. [Death of a child is not “good” and not necessarily easier to handle than disabilities.]
    “You have a healthy baby, just forget the other and get on with your life.” [You have 2 legs. If one was amputated, how would you feel if I said “you have one healthy leg, forget the one you lost and move on?”]
    “You could never have handled quadruplets.” [Death of a child is not easier to handle than mounds of diapers or huge grocery bills!]
  7. Communication is important, and a counselor may help bereaved parents avert losing relationships with family or friends. People often call two surviving triplets or quadruplets “twins”. They need to know what you want to call them. Likewise, one mother reported one of her twin daughters was born very ill and died in the hospital after a short life of two months. Her mother-in-law focused on the surviving, healthy baby, sending the parents a card congratulating them on the “birth of their daughter”. The dead sister was never mentioned, even though she lived for two months, was named and given a funeral. A rift developed between the mother and mother-in-law, with hurt, anger and hostility at the lack of acknowledgement of one grandchild’s birth and death.
  8. Recognize that you will have limits. Your pain may be so intense that you will have nothing to give to the rest of the family or spouse. Be honest and let them know when you need some space for the time being.

Memories

It can be very helpful for parents to see, hold and touch their dead baby or babies. I feel very strongly that we cannot say “Good-bye” until we have said “Hello.” No parents have ever expressed to me their regret at having seen and held their babies, but several have expressed regret that they did not. Sensitive and caring hospital staff can encourage parents to hold their baby(ies), and bathe them if they wish. You can take photos of the deceased babies separately and together, with any surviving babies from the multiple birth, and with other siblings if you desire this. Hospital staff are often exemplary in supporting families at this difficult time, making it as easy as possible for you, although they cannot change the tragic reality of death. Parents are often given specially designed Memory Boxes, one per baby, which may include: the blanket the baby was wrapped in, a lock of hair when possible, plaster hand and foot prints, an outfit the baby wore, hospital bracelets and several photos of each baby. Such special items are cherished as tangible evidence of the reality and value of a baby who did indeed live, even if only in dreams.

There are companies and artists who can create drawings of your babies, or unite separate photos of babies with computer imaging to create a group picture. These tasteful and precious photographs or sketches can provide parents with much comfort. As one Dad put it “.it [the photograph] proved to the world that our son was real.”

This article was written with grateful input and assistance from:
Dr. Elizabeth Pector, Illinois, U.S.A.

Reading Resources

Twins, Triplets and More, Elizabeth M. Bryan, M.D., St. Martin’s Press
Guidelines for Professionals: Bereavement, Bryan, EM; Hallett F, Multiple Births Foundation, London England http://www.multiplebirths.org.uk
Living Without Your Twin, Betty Jean Case, Tibbutt Publishing
Bereavement in Multiple Birth, Part 1: General Considerations, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, November, 2001
Bereavement in Multiple Birth, Part 2: Dual Dilemmas, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, May, 2002
The Worst Loss: How Families Heal from the Death of a Child, by Barbara D. Rosof, Henry Holt
Empty Cradle, Broken Heart: Surviving the Death of Your Baby, Deborah L. Davis, Fulcrum Publishing
Men & Grief, Carol Staudacher, New Harbinger Publications
Trying Again: Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss, Ann Douglas and John R. Sussman, M.D., Taylor Trade Publishing
Empty Arms: Coping with miscarriage, stillbirth and infant death, Sherokee Ilse, Wintergreen Press

Other Organizations