Vanishing Twin and Multifetal Pregnancy Reduction: New Reproductive Technologies, New Losses

There are two types of losses which, in my opinion, are often overlooked, not only by family and friends, but also by many professionals, including medical practitioners, therapists and grief counsellors. Those two losses are Vanishing Twin and Multifetal Pregnancy Reduction.

For reasons which can be understood, although debated, one can see why they might be marginalized (it’s an early loss…, “you hadn’t yet had time to bond with your child(ren)” or “at least you still have one [two]”). However judging by the number of e-mails I receive from families with questions, disbelief, concerns and aching hearts, I think, as a society, we need to take a hard and long look at how we are supporting (or seemingly not supporting) families experiencing such losses.

Vanishing Twin (VT) is a surprisingly common situation, certainly judging by how many questions I receive (it’s the most hit-on article on my site). Even as a young girl, I can remember a couple of my Mom’s women friends saying something like, “It’s the strangest thing;  I’ve been bleeding but the doctor tells me I’m still pregnant.”  In hindsight and prior to the advent of ultrasound, I bet some of these women experienced VT.  Not knowing that they did might indeed be their story, and they continued on with their lives, thankful for their healthy baby.

In the messages I receive, parents narrate their stories, desperately looking for hope regarding the empty sac and asking “over time will there be a baby in it?”  Then there is the worry about the effect of VT on the health of the remaining embryo(s). Because ultrasounds are regularly performed at 5-8 weeks, we learn very early that we are pregnant and with how many.  Hence, to learn by 10-12 weeks the situation has changed dramatically is devastating to many families.  Doctors, ultrasound technicians, grief counsellors, friends, family all need to realize that the loss of these much-wanted children is two-fold:  first there is the loss of a baby, and then there is the loss of unique parenting experience. Passing off an early loss as “at least you still have one” is not the way to comfort anyone and only adds to the confusion and disappointment these parents feel while also depriving them of a right to safely talk about their feelings.

Multifetal Pregnancy Reduction (MFPR) is very complicated and in a recent 10-day period, I was contacted by six families facing reduction or who had just gone through it and were comfortable with their decision, and one who deeply regretted the decision and felt pressured to reduce or chance losing the whole pregnancy.  Here too, anyone coming in contact with families facing reduction needs to be in tune with the emotional strain, possibly lasting a life time, of having to decide to reduce.  Yes, a reduction offers a better chance to having healthy survivors; yes, a reduction improves the physical stress on the mother, and yes the brain tells us a reduction makes rational sense in so many instances.  None of this can be repudiated, but it isn’t just the brain making this decision; the heart is very much involved too and will not be ignored.  The heart is already in love with the babies within and wants desperately to believe that the pregnancy will continue to deliver healthy 3, 4 or 5 infants.

In some cases, it will and things work out, and sometimes things don’t work out so well for one or more of the babies.  There is the emotional strain of the decision:  Am I a killer of my baby(ies)? How will I ever tell the others?  When do I tell them?  Do I tell them?  My babies are already bonded in utero, how will a reduction affect the survivors?  All difficult questions and parents need informed guidance and support in finding solutions which will work for them.

MFPR is not a topic that can be easily discussed with family or friends.  The decision is usually made by the parents in conjunction with professionals and peer strangers who are located on the internet (e.g. other families experiencing or looking at reduction, caring support people and organizations who guide them along the rocky path).  Parents can feel very isolated, frightened and alone in making a decision which bears such significant and life altering impact.  If the discussion to reduce does include family members or friends, then it is no longer a “secret” and telling the kiddies of their origins takes on a new urgency so that parents have control over how and when the children are told.

There are no easy answers but one thing is for sure and that is these grieving families need society’s support, comfort, and understanding in a non-judgmental way.  They are mourning their losses and like any grieving individual, deserve a safe place to do so, with caring people all around them who do not minimize or de-legitimize their loss.  It is the least we can do.

By Lynda P. Haddon, Article copyrighted.

Multiple Births Canada

Multiples are Individuals Too

In 2007 Oprah had a show focusing on multiples. There was a delightful family with sextuplets who shared the challenges of raising six babies at one time. The family was obviously full of love and delight with their family, yet they also provided honest feedback on the difficulties and exhaustion they faced with their unique family. They have two older children to add to the mix.

Oprah also interviewed 28-year old triplet men whom had an interesting background and achievements whose father died unexpectedly when they were 10 years old. They have two older brothers and their mother raised her five sons on a teacher’s salary after their father died. She focused on three places her children should always be: at home, in school or in church. Get this: all five sons are lawyers and achieved top of their class marks, not only in high school but university as well! It is thrilling to hear of the achievements of this special and unique family, under challenging circumstances.

So here’s my but. One cannot take away from this single mother’s love and devotion to her children, especially under extenuating circumstances. And the love of the sons (one older brother and the mother were also present) towards their mother was very evident. So what was bothering me? It took me a little while to figure it out.

Parenting multiples is a challenge. With two or more babies arriving at once and struggling to meet their needs, it is difficult to find time for one-on-one and let alone learn the unique characteristics, desires and interests of each child as an individual. Some of us have other children too, making quality individual time all the more difficult to schedule.

What stood out for me was that at age 28, these young men are a unit. As they explained, they were always in the same class, graduated high school top of the class, two were Valdictorians. They admitted that they were never sports minded.  They went to the same university, all taking Law, in the same classes and graduating top of their class. They were pleased to note that they try to meet three times a week for lunch.  They were dressed in spiffy suits, looking very similar, and while two were wearing black shoes, one was wearing brown. I was excited to see this obvious bit of individuality.  No one spoke of dating, girlfriends or wives.

I’m not trying to tell people how to live or even make a judgment regarding their choices but in this particular case, I was left feeling sad about the lack of any expressed individuality (beyond shoe colour) of these three bright men. I believe that part of a parent’s responsibility, and particularly those of us with multiples, is to honour their birth bond while encouraging and nurturing individuality.  Such balance is essential to a child’s well-being. I was left with the impression that the men and their relationship as it stood, precluded their need or desire to look outside their relationship for any other relationship comfort or connection. In other words, they received all of their connection and safety within their own relationship and hence had no need to look elsewhere. I admit I do not know this family other than what was portrayed on the show.

As can happen with multiples and the media, this “unit” of 3 persons was celebrated and acclaimed, I felt not as much on the merit of their individual achievements, but primarily on their merits as being triplets. This is dicey because what they have each achieved is something any parent would be proud of, yet once again, the public has not appreciated these multiples as individuals but mainly as triplets. Because they have been continually presented as a package to the public, it is their “package” that has been celebrated rather than whom they are as individuals.  I believe they were recognized firstly as triplets rather than bright, capable, highly achieving individuals. I also believe that parents call the shots on how their children are perceived. It is the responsibility of the parents, or parent, to encourage their multiples in every aspect of their lives, including the nurturing of their individuality.

One of the beauties of having multiples is the factor of built-in playmates, something quite different from raising a singleton child when parents actively seek community situations where their singleton can learn to socialize, share and take turns.  The failure to encourage our multiples to reach outside of their unique situation and embrace something else, be it activities, interests or individual friends, robs them of a chance to learn to live and adapt to the world outside of their relationship. Parents needs to be aware and take appropriate steps that each of their multiples is given a chance to shine alone. If not, they can be robbed of an opportunity to grow and develop as individuals, and that would be such a shame.

April, 2007

Timely Medical Response When a Baby Dies

For nearly 20 years, I have provided grief support and resources to parents losing one, more or all their multiple-birth children. On their behalf, I reflect on a situation which warrants some discussion.

There are some healthcare professionals who, while Mom is pregnant and for follow-up after birth, encourage appointments and answer questions; yet, if there is a loss by or at delivery they stop being accessible after the initial one or two postnatal visits; they refuse to provide a timely medical response.

Yet again, I heard from a Mom who, four months after the birth of her twin survivor, has no word on lab test results in spite of several calls to her doctor’s office.  She is afraid to call again because the staff has become cool and abrupt.  Another Mom said, “It’s been a year since the autopsy and I still don’t have any results. I’ve had to hire a social worker to follow up on the results because I’m so overwhelmed with grief and anger, I can’t function.”  And, from another Mom, “I know the office dreads my call.”

Think of the parents. They are trying to deal with a twin (triplet or quadruplet) survivor(s) [and perhaps other children as well], come to terms with and grieve the death of their baby(ies) and hopefully learn why he/she/they died. After repeated attempts to get information, some parents may be perceived as pushy or emotional, however handling the baby’s(ies) death requires getting report results from their doctor’s office and not making them feel side-lined, minimized or ignored.

We know doctors are busy, but why is it that bereaved parents sometimes cannot get timely feedback on autopsies, lab results from blood work/placental examination or other situations where the medical world explores why the baby(ies) died? Sure, some tests take time; however, initiating a call to the parents at least once in a while, until the answers come in, would be sensible, considerate, and an acknowledgement of the families’ grief and pain.

It’s true, some causes of death cannot be explained and parents may never learn why their baby(ies) died. If this is the case, then don’t those parents still deserve to hear, “In spite of all the tests, we don’t know why your baby(ies) died.”? Surely parents have been through enough already!

Even if certain tests take months for results to come back, let the parents know. Often parents fantasize about why their baby(ies) died, sometimes blaming themselves or each other. Such a situation puts an added strain on the marriage and marriages crack and break. As well, a preoccupation with getting results affects availability and parenting abilities for the surviving children.

One would think that being compassionate would be easy, and I suppose most days it is; but when one is too busy (and I strongly suspect that is a big part of the problem for many doctors, nurses and hospital staff), then compassion can fall by the wayside and it is the most vulnerable who suffer as a result.