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Loss in Multiple Birth

In spite of everyone’s best efforts, there is a chance that you may lose one, more or all of your babies. In an effort to assist you face this difficult time, to guide you when you have to make certain difficult decisions (e.g. whether or not to see or hold your baby(ies), taking pictures, funeral arrangements) and offer ideas on how to deal with others’ remarks, the following has been prepared. May you find some comfort from these suggestions.

Vanishing Twin (occurs by about 12 weeks gestation)

Vanishing Twin occurs when at least one embryo does not develop probably due to the fact the embryo was not able to properly attach itself to the uterine wall to get the maternal nutrition it needed to properly grow and develop.  The embryo dies and is reabsorbed by the placenta or the mother’s body.  Vanishing Twin is not anyone’s fault.

Miscarriage (occurs up to 20 weeks gestation)

If you have lost your babies through miscarriage, you may feel empty or angry with yourself and let down by your body. You may blame yourself, your actions or attitudes or even that glass of wine or cup of coffee. You may find that friends, family or hospital staff don’t acknowledge the pregnancy or the depth of your grief. Remember, this has been a very real pregnancy for both you and your paratner. You have visualized the babies, ‘taken them for a walk’, ‘bathed and dressed them’, amongst other things.

You might wish to try to find out why your miscarriage occurred. Be prepared for the fact that there might be no definite answers. Try not to feel guilty. Talk openly about your feelings and the babies with a caring person. If desired, maintain some contact with the your local twin and triplet support club until you feel ready to let go.

Stillbirth/Infancy (after 20 weeks gestation)

Prematurity is still the leading cause of death in a multiple birth situation. There is no guarantee against the early delivery of your babies. In spite of the best precautions, it can still occur.

Grief can occur on two levels: at one level, the loss of a unique type of parenting experience; and the other the loss of your baby(ies). The emotions experienced can be varied and sometimes not even feel as if they make any sense: “Did I prefer one baby over the other?”, “Did I really only want one?” Be sure and talk about your feelings with a caring person. You may experience inner struggles as you try to deal with the joy of the birth of one baby and the loss of another. You may wish to push all thoughts of the dead baby from your mind and concentrate on your living baby(ies). You may be subjected to thoughtless remarks from family or friends – ‘you couldn’t have handled triplets anyway.’ ‘At least you still have a baby.’ ‘You have some babies who need you, get on with it!’ It is helpful if you take time to grieve your loss. We cannot move forward until we have grieved what we have lost. Children are not interchangeable and we cannot ignore the death of one because others have survived. Don’t be shy about reminding others that you have lost a baby(ies) and have every right to mourn for him (them).

Some important feedback received from bereaved parents:

  • Name your baby(ies)
  • See your baby(ies) if you can. Hold them, touch them, bathe them and dress them. Take all the time you need. Such contact helps with integrating the fact that your baby is dead. We cannot say ‘good-bye’ before we have said ‘hello’. The majority of bereaved parents find solace, comfort and some healing in seeing their baby(ies). Some grieving parents do not want to see their baby(ies). Don’t be talked into anything that you do not wish to do or which does not feel right for you. Whichever works for you is right way to proceed.
  • Take photos. Take pictures of your babies together and alone, as you wish. The photos can be put away until such time as you feel you might like to look at them or, if you feel unable to take the photos yourself, have a hospital staff member or good friend take some.  Over time, some parents report the photos help acknowledge that their baby(ies) really did exist.  These photos can also become very important for the surviving co-multiple(s) in understanding about their beginnings.
  • Ask any questions of your doctor that you might have. Ask until you have answers that you understand. Be prepared, however, for the fact that some questions may have no answers.
  • Plan the funeral or memorial service as you wish.
  • Don’t keep feelings bottled up inside of you. Talk with a caring person whenever you need. Join a local bereavement support group. This is important for both Mom and Dad/Partner.
  • As the parents, try to spend set aside some time to spend together to share your grief and lost dreams.
  • Be prepared to have ‘set backs’ – this is normal. We are not the same people we were before the death. We need to get used to a new reality. The loss of child stays with us forever and we need to learn how to incorporate our grief into our everyday lives so that we can keep on living. Be prepared to have grief feelings triggered for no seemingly apparent reason. Don’t ignore them. It is only by going through these painful feelings that we can eventually begin to feel any peace.
  • You may wish to think about including older children in the funeral in a meaningful way:  draw a picture, pick out the burial outfit, and such.
  • Try to include the grandparents in some meaningful way in either the funeral or memorial service. They too have a lot to deal with. They have lost a grandchild(ren) and in addition, have not been able to protect their own children from such terrible pain.

There are many good books available on grief.  Check your local Library and perhaps the library of your local twin and triplet support Chapter. Many are available on line at Amazon.com  In addition, Multiple Births Canada has written two booklets on loss and they are available from their Business Office. Multiple Births Canada also has a Loss Support Network which issues a monthly e-newsletter (except December), has confidential e-mail connection between the members and can refer you to appropriate support persons. If you already belong to a member Chapter of Multiple Births Canada, there is no charge to join the Loss Support Network although a donation of your choice to help defray printing and web site costs is greatly appreciated.

Please don’t feel alone in your grief. There are many caring people available to assist you.

Other Support Contacts:

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Miscarriage

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

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Bereavement: What Can I Do To Help Myself?

With the loss of one, more or all of your precious babies, you may feel as if you are falling into a deep, dark abyss and being pulled inside out, both at the very same time. The denial is there – this is all a bad dream and when I wake up, I will have my babies. And there is shock – this is not a part of the plan! This can’t be happening to me! It is not easy to go on.

At this very painful and vulnerable time, you will need to take special care. The following are a few tips that have helped others travel this rocky path.

  1. Learn everything you can about grief. There are many good books available on loss, grief and the journey to recovery. Many bookstores carry books on grief, the funeral home can provide a list as can your local library and any grief counselor. It is important to remember that grief is a journey and not a destination. Grief is very personal and there is no right or wrong to grieve and no time frame.
  2. Give yourself permission to grieve. It is okay to grieve, to cry. You have suffered a tremendous loss. Don’t try to block or push away the pain. It doesn’t work that way. It will be necessary to take the time to grieve.
  3. Be patient with the process and with yourself. You are adapting to a new reality. You are not the same person you were before the death. It will take time. Grief is different for each person, including for men and women. In other areas of your life you may expect immediate results, but this is different. Take the time you need, when you need. Be patient and gentle with yourself.
  4. Get plenty of rest and eat nutritiously. When we are grieving, one of the first things “to go” is our appetite. It will be necessary to get proper rest and to eat nutritiously. If you can only manage a snack, that is fine. Make sure it is nutritious.
  5. Treat yourself occasionally. Indulge yourself from time to time. A massage, walk or exercise workout may work wonders.
  6. Find caring people with whom to share your loss. Don’t keep your feelings and pain bottled up inside. There are many caring people to support and assist you: clergy, doctor, counselor, good friend, funeral director. Multiple Births Canada has a Loss Support Network, helpful support literature, a quarterly newsletter Forever Angels and confidential Angel E-Mail Connection between its loss members.
  7. Reflect on your life. It may be helpful to reflect on the relationship you had, however briefly. How will this change you? How will this guide you? So often with loss comes growth. Compassion, understanding, empathy. No matter how brief the life, their impact remains.
  8. Faith can be an important support. Many people find comfort and support from their spiritual or religious roots. Your faith may be an important comfort and cornerstone for you.
  9. Accept help. If someone reaches out to you and wants to help, tell them what you need: a cup of tea, a shoulder, a drive to a doctor’s appointment, quiet company. People want to help so if there is something that will be helpful to you, accept their help.
  10. You may find comfort and solace with your local support Chapter. To find the Chapter nearest you in Canada, check out Multiple Births Canada’s Web Site at http://www.multiplebirthscanada.org

Adapted from a brochure by Ontario Funeral Service Association

Other Resources:

The Lone Twin, Joan Woodward, Free Association Books, 1998
When a Twin or Triplet Dies, Multiple Birth Foundations, London, England, 1997 Living Without Your Twin, Betty Jean Case, Tibbutt Publishing, 1993
The Worst Loss: How Families Heal from the Death of a Child, Barbara D. Rosof, Henry Hold and Co., 1994
Bereavement in Multiple Birth, Part 1: General Considerations, Elizabeth A. Pector, MD; Michelle Smith-Levitan, MD, The Female Patient, Vol. 27, November, 2001
Bereavement in Multiple Birth, Part 2: Dual Dilemmas, Elizabeth Pector, MD; Michelle Smith-Levitan, MD, The Female Patient, Vol. 27, May, 2002

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Grief, How Can I Help?

Question: My neighbours lost one of their triplet sons. I feel helpless and don’t know how to help. How can I effectively support the family at this very sad time?

For several reasons grief is very difficult to deal with: Grief has no time line; Grief is very personal and everyone grieves differently; and there is no telling what may trigger sad and painful feelings. Additionally, grief, for the same individual, becomes different as they walk along its rocky and difficult path. The individuality of grief and where a person in his grief journey, makes it difficult to know exactly how to aid and support someone attempting to heal. Another factor which can impede helping someone is our own inhibitions regarding death and in not knowing how to approach a grieving person. It may be easier for some of us to ignore a grieving person, perhaps with a mumbled “Hello”, no eye contact and then to get on with our own lives.

The following has been prepared in order to assist you when you come into contact with someone who has suffered a loss. I hope that you will find it of assistance.

NOTE: “Loss” is defined as any major loss – e.g. loss of employment, house fire, divorce, as well as bereavement. This article deals with loss by death.

  1. Step forward and approach the bereaved individual. Put out your hand or offer them a hug, if the situation is appropriate. Make eye contact and say, “I am so sorry!” Often that will be enough to allow the person to speak of their pain.
  2. Be a good listener. This rule applies in so many different areas of our lives and is extremely important when listening to a bereaved person. Don’t add to their situation by recounting horror stories of your own. It is not a time for one-upmanship of stories. This is their time and a time for you to listen, to perhaps once again say, “I am so sorry.” Or “It just isn’t fair.” Don’t take up this time with yourself but give freely of your listening skills. Don’t be afraid to use the deceased’s name during the conversation. If you don’t know what they name the baby(ies), ask them. They will appreciate the validation of their baby’s existence. Families need to speak of their lost one(s), including using their names.
  3. Be prepared to make yourself available. Make sure you don’t give them the impression of “hurrying” or speeding them along because you need to be elsewhere or because you feel uncomfortable.
  4. Try to accept the words shared with you. A grieving individual may rail against life, G-d, the doctors, the world. Don’t make harsh judgements. Just accept the words as they come. In an effort to get rid of our pain, it is not unusual to make rash and/or harsh statements.
  5. There are many concrete ways in which you can assist – take care of other children for a while, bring over a meal, send a card, make a donation to an appropriate charity, attend the wake, funeral or memorial service, make a cup of tea for the parents. Ask how you can help.
  6. Don’t minimize the loss – “You can have more children.” “It’s better this way. Your baby was sick.” “She has gone to a better place.” “G-d needed her more than you did.” None of these remarks are helpful to a grieving parent. Children are not interchangeable and “having another one” will not replace what should have been and “a better place” is here with her family. Families who have survivors of multiple birth children are often not given the proper space to grieve their loss. In a bereavement counselling group session, parents of a surviving twin where yelled at by a mother who had lost her singleton child, “Why are you here? You have a baby, I have none!” Minimizing anyone’s loss does not help.
  7. Don’t forget to acknowledge the father’s grief too. Too often the Mom is consoled while Dad is expected to “Hang tough.” Some people ask Dad how Mom is doing and don’t even think of asking him how he is. Dad too, has lost a child and experiences feelings of loss and pain. He has the added burden of society’s expectations that he can “cope.” He may be split between a child(ren) at home, a baby in the NICU, his job, planning a funeral, and his wife recovering from a c-section. He will also need your support.
  8. There are no shortcuts through grieving. Any attempt at a shortcut can only make things worse. Try and allow the bereaved person as long or as short a period as they need. Be patient. Avoid tell the person how they “should” feel or act or what they “should” do to make things easier. Also avoid saying “You are handling it so well” as this puts people into a box. Remember that there is no time limit on grief and several months down the road, these families still do not feel “normal”. They are trying to adapt to a new reality. They have still lost their child(ren) and nothing will ever change that.
  9. Encourage the bereaved person to look after themselves. To eat properly (it is not unusual for a bereaved person to stop eating and drinking), to see to their own needs and not to make important decisions right away. They need time first to grieve and heal.
  10. Remember that you are not responsible for this person’s pain. You didn’t cause it and because your children are alive and healthy, try not to feel guilty about it.
  11. Remember that you cannot take away their pain but you can assist them over the rocky path. You can be supportive and caring. You will not have all of the answers and, often there are not any answers at all. Life happens with no apologies or excuses and sometimes, it can be quite unfair. They did nothing wrong to deserve this.
  12. You may find it prudent to recommend some professional counselling, a physician, religious figure, grief counsellor or therapist. The library has books on death and dying and there are workshops, seminars or support groups that can also be of assistance. Your local funeral home will also be able to guide you in this area.
  13. One way a Chapter can be of assistance is to donate Multiple Births Canada’s Loss Booklets to the funeral homes and neonatal hospital units in your Chapter area. Such a donation will assist the professionals in being aware of the family’s unique needs.

Additional Resources:

  • Empty Cradle, Broken Heart, Deborah L. Davis, Ph.D., Fulcrum Publishing
  • The Worst Loss: How Families Heal from the Death of a Child, Barbara D. Rosof, Henry Holt and Company
  • On Children and Death, Elisabeth Kubler-Ross, Collier Books
  • Life After Loss, Bob Deits, Fisher Books
  • Men & Grief, Carol Staudacher, New Harbinger Publications
Did you do something special by way of support for a bereaved family and would like to share that idea with others? Write and let me know how you helped someone deal with the loss of their precious child(ren).
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Grief and Its Impact on a Marriage

The loss of a baby or babies can and does have an impact on a marriage as each parent attempts to regain their equilibrium and balance after such a devastating loss. The loss of our child(ren) changes us forever. We lose our innocence and the future is forever changed. Add to this the fact that men and women grieve differently, and the impact on a couple’s relationship is not always a positive one.

Generally speaking, women tend to be more open about what they are feeling than men. Women may have one or two girlfriends, a sister or mother with whom they “open up,” express what is on their minds and how they are feeling. Men, on the other hand, don’t usually have close relationships with other men which would include speaking about their emotions or the sharing of feelings and thoughts. Traditionally men have been inundated with messages such as “suck it up”, “crying is for wimps” and “act like a man”. In such an atmosphere, with no safe place to express their emotions, men have not been dealt a fair blow when it comes to expressing those inner emotions.

It is important to note, however, that things are changing. Thankfully there is more dialogue regarding men’s feelings, not only by the men themselves but also by society as a whole. Parenting magazines are offering support articles for men on how to help a partner with breastfeeding, through the pregnancy, dealing with loss of a baby or babies and more. Internet Sites have sprung up providing ample opportunity for men to write about their feelings, express their pain, joy, feelings of insecurity and fears about parenting. Support groups for men and dads are more readily available in many communities. Book stores now carry books for fathers regarding parenting, relationships and grief. Oprah Winfrey has done a couple of shows regarding men and their inner feelings and fears. All of this is important and hopefully, over time, will help bridge the gap between men and women!

It is acknowledged that not all mothers and fathers experience difficulties in connecting while grieving. Some couples are brought closer together, communicate regularly and feel much closer in their time of greatest need. What I would like to explore in this article, however, is the possible negative impact of the loss of one or more of babies on a couple’s marriage. Further, understanding that men and women grieve differently and what some of those differences can be is helpful. We also need to understand a little bit about Grief itself:

  • Grief is a journey, not a destination;
  • Grief has no timeline;
  • Grief is personal. There is no right or wrong way to grieve;
  • Just when you think that you are feeling OK and doing well, Grief will “rear its head” and you may feel overwhelmed all over again. This is normal;
  • Some of the triggers for Grief could be a sentimental song, a beautiful sunset, a singing bird, a garden of flowers blowing in the wind, watching another child play and laugh, or for no apparent reason at all;
  • Grief can leave individuals with a sense of isolation, loneliness, anger, powerlessness, guilt and/or fear. All of these emotions are normal;
  • Grief has been described as an “open wound” which heals over time, but which also leaves a scar.

When we look at Grief from some of these perspectives, it stands to reason that mother and father will not always be on the same time line as each other and or be grieving in the same manner. Initially a couple may cling together and share their pain with tears, embraces and conversation. It isn’t unusual for the father to be the one in charge of making funeral arrangements, talking to the undertaker, hospital staff, choosing a casket, working through the finances and paperwork. He may also have to deal with other children at home, handle his job and the ramifications of his absence, worry about his wife and answer questions from family and friends. One father indicated after the loss of one of their babies, that he was sick and tired of friends calling and asking him how his wife was doing! “What about me? I lost a baby too!” They had skipped right over him and minimized his pain and grief. Juggling all of this and trying to find time to grieve the loss of his baby or babies is a monumental task for a Dad to face.

Mother probably has family and friends whom she can talk to about her baby or babies. She may need to focus on physically getting better in the case of having had a c-section, and may also need to take care of a surviving co-multiple(s).

After the funeral, it may be harder and harder for Mother and Father to “get together” on an emotional level, to speak about what they are feeling: of their fears for the future or the fears each has for the survivors of their multiple birth – “If I get attached to this baby, will she die too?”. One may “blame” the other for the loss, even inadvertently. It may become necessary to seek some bereavement counseling from: a cleric, grief counselor, social worker or psychologist who specializes in grief issues. Your family doctor can assist you in this regard or refer you to an appropriate support individual.

If, as a couple, you already have a child or children, this may add another difficult component to your grieving journey, or not, as each individual family will decide. Sometimes the need to continue to be available for your other children can be a boon. Having to remain mobile, available and responsive, for one or both parents, can sometimes be helpful in spite of mourning for a lost child or children.

Sometimes one or both parents may find the opposite and find it difficult to continue to be an attentive and available parent. One or both may experience feelings of being overwhelmed, pressured, resentful or of wishing to simply withdraw. All of this is normal and doesn’t mean you are a bad parent. Try your best to keep the lines of communication open with your children. Let them know you are feeling very sad at the moment, need some quiet time, or are thinking of their dead brother or sister. Let the child know that they didn’t cause your sadness but you are sad, nevertheless. It will be helpful for him (or them) to know that feeling sad is a part of grieving and your reactions and feelings were not caused by them. By being honest with your child or children about what you are feeling, you will be helping them and yourself, even if it doesn’t feel like it at the time.

It may be helpful to try to keep in tune with whatever your partner may be feeling and to try and distract your other child or children for a time, in order to give your partner some space to him/herself. A role reversal may occur at another time for the other spouse.

Here are some suggestions to aid a marriage in time of grief. You and your spouse may add some others that will work for you.

  1. Don’t expect your spouse to be a tower of strength when he or she is also experiencing grief.
  2. It is very important to keep the lines of communication open.
  3. Be sensitive to your spouse’s personality style. In general, he or she will approach grief with the same personality habits as they approach life. This may be in a private manner or open and sharing, or some place in between.
  4. Talk about your loved one(s) with your spouse. If necessary, set up a daily time period when you both know that it is time to talk about your loved one(s).
  5. Seek professional help of a counselor if depression, grief or problems in your marriage are getting out of hand.
  6. Deal with things as they occur. Do not overlook or ignore anger-causing situation. It is like adding fuel to a fire. Eventually there will be an explosion.
  7. Remember that you loved each other enough to marry. Try to keep your marriage alive: go out for dinner or an ice cream cone; take a walk; go on a vacation.
  8. Be gentle with yourself and with your mate too.
  9. Join a support group for bereaved persons. Attend as a couple, come by yourself or with a friend. Do not pressure your spouse to attend with you if it is not his or her preference.
  10. Join a mutually agreeable community betterment project.
  11. Do not blame yourself or your mate for what you were powerless to prevent. If you feel personally responsible or blame your spouse for your loss, seek immediate counseling for yourself and your marriage.
  12. Remember that there can be a loss of sexual desire or hypersexuality during the grieving process. You can discuss this with your mate.
  13. Be aware of unrealistic expectations for yourself or your mate. Try to remember that your spouse is doing the best that he/she can.
  14. Marital friction is a normal part of any marriage. Don’t blow it out of proportion at this painful time.
  15. Try not to let everyday irritants become major issues. Talk about them and try to be patient.
  16. Be sensitive to the needs and wishes of your spouse as well as yourself. Sometimes it is important to compromise.
  17. Work on your own grief instead of wishing that your spouse would handle his/her grief differently. You will find that you have enough just handling your own grief. Remember, when you help yourself cope with grief, it indirectly helps your spouse.
  18. As one grieving mother stated: “Value your marriage. You have lost enough!”
  19. Hold on to Hope. With time, work and support you will survive. Life will never be the same, but you can learn again to appreciate it and the people in your life.
  20. Allow yourself and your partner to feel whatever it is you are feeling without judging yourself or each other.

Bibliography

Grief and its Impact on a Marriage, Fact Sheet by Bereaved Families of Ontario – Ottawa.
Men & Grief, by Carol Staudacher, 1991, New Harbinger Publications, Inc.
Healing Your Grieving Heart: 100 Practical Ideas, by Alan D. Wolfelt, Ph.D., 2001, Companion Press

Other reading resources:

When a Baby Dies: A Handbook for Healing and Helping, by Rana K. Limbo and Sara Rich Wheeler, 1993, RTS Bereavement Services
The Worst Loss: How Families Heal from the Death of a Child, by Barbara D. Rosof, 1995, Henry Holt and Co.
Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss, by Ann Douglas and John R. Sussman, M.D., 2000, Taylor Publishing Co.
Trying Again After Loss, by Ann Douglas and Lynda P. Haddon

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Talking to Children About Death

How do I explain to my child about death?

Begin by teaching your child that death is a necessary and inevitable part of life – This might include discussing ‘smaller losses’, such as the death of a pet or a plant. Such discussion lays the groundwork for a deeper, more painful loss when it occurs. It also lets your child know that is okay to talk about the painful feelings that death can bring.

Tell your child simply, but honestly, about the death – Depending upon the age of the child, choose words that are simple, age-appropriate but also straightforward. Be ready to honestly answer any questions that your child might have. A child has very keen senses and will sense that something is wrong, if you decide not to tell him and ‘spare’ him the pain. When a child senses your sadness but it has not been explained to him why you are sad, he is most likely to internalize the feelings of ‘something is wrong’. As a result, his anxiety levels will rise and he may see himself or his behaviour as the reason for your sadness. Prepare your child in advance by explaining to him what he will see at the funeral home and/or how the funeral/memorial service will progress.

Grieve with your child – This time gives you both a perfect opportunity to grieve together, to hold and comfort each other and work through some feelings together. It can be very beneficial for both of you. Your child may have feelings of guilt, that he somehow was the cause of the death. You will need to assure your child that this is not so. He did not cause the death nor could he have prevented it.

Avoid clichés or euphemisms when discussing death with your child – If you indicated the person ‘has gone to sleep’, your child may fear going to bed in that the same thing may happen to him. Even using the words ‘lost’ or ‘gone’ can plant the idea that the person who died will eventually be ‘found’ or ‘come back’. This can increase a child’s anxiety levels. It is perfectly all right to use words like ‘died’ or ‘dead’ to describe what has happened.

Questions children may ask – It is not unusual for children to ask the same questions over and over. They are attempting to process the information and to understand the finality of death. Answer your child honestly each time any questions are asked, even if the question is the same one asked again and again.

Children working through their feelings of grief – It may be helpful to put together a memory book together. Include notes, drawings, cards, feelings or other special items. Feelings can be expressed through play and even puppets – anger, guilt, sadness and maybe the realization ‘that all of the toys now belong to me and I don’t have to share them any more’. These are normal emotions that a child may experience. Try not to judge your child for any of these feelings. Like adults, children grieve in their own fashion, even brothers and sisters may grieve differently. Speak to your child again about the loss over the ensuing weeks and months. Don’t be shy about mentioning the deceased’s name and don’t feel your child will not have feelings if he goes several days without mentioning the loved one.

How do I tell my child about the death of his sibling and when is the appropriate time? – If you have a photo of your baby/child who has died, perhaps keep it in a prominent place in your home. You may refer to the photo from time to time and include the deceased child in some conversations. The photo invites conversation when your child/children wish to speak of him. The prompt of the photo encourages your child to speak of her deceased sibling when she wants or needs to and not when the parents may feel it is time to talk.

Some families celebrate special occasions by lighting a candle that will burn all the day long, as a memorial. Make your surviving children a part of these celebrations. Some choose to light a candle on the Birthday of the deceased child, the day he died, as well as meaningful holidays and any other occasion that may be special for your family. In this manner, from the beginning, all of your family is aware of this child and he or she can remain a part of the family. One family found a toy bear who was holding a wooden block with the letter ‘J’ on it, being the first letter in their deceased triplet son Joey’s name. This bear is included in each special photo so that Joey too, can be remain a part of their family.

Some families never speak of their dead child again. In these cases, this denial can cause additional pain and suffering beyond the actual loss. At age five years, twin girls both contracted the same disease. One survived and one did not. The parents removed all clothes, toys, photographs and possessions of the dead twin and she was never spoken of again. At about age 40, the surviving multiple, spoke of her tremendous sense of loss, isolation, confusion and pain as she was not permitted to speak her twin’s name nor was it fully explained to her why her sister had died. She spent many, many years feeling guilty for surviving the disease that killed her sister. She felt that her mother, in particular, blamed her for living while her sister did not. She felt she was less affectionate to her after her sister’s death. She advised she spent so much of her life ‘looking’ for her twin in crowds and on the streets.

Sometimes when we delay, postpone or deny the existence of our dead child, it is because we have not yet faced our own feelings regarding our loss. In such cases, it may be wise to seek some professional assistance in order to help fully address the issue.

Should your child be a part of the funeral arrangements? Depending upon the age of the child, you could ask him if he wishes to be. He may also wish to spend some time alone with his dead sibling or together with you. He may wish to help choose what his sibling will wear or which piece of music will be played at the service. For older multiple birth children, it is not unusual for them to have confided in each other as to what they would like to occur at their funerals. It may assist a co-multiple to be a part of the funeral arrangements and knowing decisions are being made that his co-multiple wanted. Being a part of the arrangements could be very helpful for a co-multiple in coming to terms with the finality of death. It may also be of help to you as you assist and support each other through this most difficult of times.

Be careful not to overdo it – It is good to speak openly and age appropriately with your child(ren) about death and to include them as much as possible in funeral arrangements. On the other hand, be aware of some possible pitfalls of a prolonged focus on the dead sibling within the family. Initially after the death, communication between you and your child(ren) may continue smoothly, but trouble may occur with an extended or continuous ‘over focus’ on the dead child. One family, for example, had shrines to their dead baby in two rooms of their home. The lost daughter’s name was mentioned almost daily as the parents continued to keep her as a current, ‘alive’ part of the family, even one year after her death. An older sibling would constantly bring home pictures of the family with the dead sister included in the drawings.

Although remembrance is important and helps to deal with death, it is also important not to idealize a dead child and make no distinction between them and a living child. There is a risk that siblings may feel that they cannot live up to the image of their dead sibling. While they grow and develop, with the ups and downs that this implies, their dead sibling remains forever ‘perfect’. This is a difficult situation for a child to live with on a day to day basis. They cannot compete with their dead sibling and may forget to get on with their lives through the normal growing stages.

Of course, this doesn’t mean ignoring significant anniversaries as a family, but parents need to be aware of the danger of not providing their living children with space and encouragement to live their own lives to the fullest. Indeed, living in the shadow of a deceased sibling can be a challenge for surviving children at the best of times. All the more difficult, however, if the parents refuse to truly mourn the loss of their child and, instead, establish the child as a permanent, living presence frozen in time.

“Always tell your children as much of the truth as they can understand, if only to establish the most valuable attribute you have as a parent: your credibility.”
– Stan and Jan Berenstain

Article written with input from Dr. Arthur Leonoff, Psychologist/Training Analyst

References

  • Bereaved Families of Ottawa-Carleton
  • St. Mary’s Grief Support Centre, Duluth, Minnesota
  • On Children and Death, by Elisabeth Kubler-Ross, 1983

Additional Resources 

  • Loss of a Multiple: Miscarriage, Stillbirth and Infancy, Multiple Births Canada
  • Loss of a Multiple: Childhood, Teens, Multiple Births Canada
  • Forever Angels, quarterly newsletter of Loss of Multiples Support Network, Multiple Births Canada
  • Loss Series of Fact Sheets covering many topics, Multiple Births Canada
  • Loss of Multiples Support Network, Multiple Births Canada
  • Bereavement Support Kit, Multiple Births Canada

 

0 comments on “Vanishing Twin and Multifetal Pregnancy Reduction: New Reproductive Technologies, New Losses”

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
www.multiplebirthscanada.org

0 comments on “Timely Medical Response When a Baby Dies”

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.

0 comments on “I’m not exactly sure how to start this…Darian and Matthew”

I’m not exactly sure how to start this…Darian and Matthew

I’m not exactly sure how to start this, but the best way I think is to give you a bit of background.  After becoming sexually active at the age of 15, I became pregnant at the age of 21. I had never prevented pregnancy but due to irregular periods, it seemed as though I was not very fertile. I delivered my son prematurely at 8 months gestation. After a brief bout with jaundice my son was sent home from the hospital healthy. I later divorced and remarried when my son turned 3.
My current husband and I have been married now 14 years and we had never used contraceptives with the hope that we might have gotten pregnant. Years went by and it never happened we gave up. Last October I under went gastric bypass due to health problems and a morbid obesity. I lost 88 lbs and became pregnant in March.
This pregnancy took everyone by surprise. Myself 38 and my husband 43, never did we even consider that pregnancy was still a possibility after 14 years. I became pregnant with twins. At 22 weeks of pregnancy at 11:00pm one night I started getting cramps. Thinking it was too early and that it was probably Braxton Hicks, I drank water as recommended and tried to sleep through the night. All night long I was very aware and in tune with my boys. I whispered to them telling them things would be alright. I caressed my belly as if it were them. Come morning, I could not take the pain any longer and I told my husband he needed to take me to the hospital. When I got to the nearest hospital, which was not my normal hospital, I was taken straight up to labor and delivery. There I was told unceremoniously, that I was to have my babies. I knew it was too early and I knew that what she really meant to say was that your babies were going to die. 

I sobbed uncontrollably, my husband looked on in confusion and anguish. I was already dilated 8 centimeters and completely effaced. I begged them to use a cerclage and close the cervix but according to the doctor there was nothing to sew, the cervix had no lip. The amniotic sac was protruding from my cervix. My son could be felt through the sac.

I was also told that due to the age of the boys there would be no life saving measures should they survive. I was in labor for a total of 34 hours. With every contraction I fought not to push. I tried in vain to keep my boys inside of me. They offered medication for pain which I refused for fear of ruining any chance they may have. I fought with every ounce of my being the urge not to push. I prayed and spoke to my boys begging them to fight. For 24 hours I fought. Finally the pain of the contractions were too much to bare and starting to force me to push. I then accepted the epidural the doctor had offered in hopes that calming the contractions would somehow let me keep them longer. 

The epidural did not stop the urge to push. My body wouldn’t listen. No matter how hard I tried not to push my body had a mind of its own and my boys arrived. August 11, 2007 at 6:30 Darian was born weighing 8.5 oz and measuring 9inches. He was perfect and beautiful, he opened one eye and made a small noise waving his arms in the air as the nurse handed him to me. His chest beating strong trying to survive. My husband and I held him and kissed him our tears wetting his tiny forehead. While holding him, the nurse asked me to push the placenta out . When I did as she asked Matthew was born, at 6:40 am. Weighing 9.5oz measuring 9 inches he was slightly larger than his brother. Matthew was as meek as he was in my womb, he laid in my husband’s hand breathing softly with a slight smile on his face. We held our perfect miniature boys bestowing all the kisses we knew we would never have the chance to give them. Darian’s heart beats became slower and slower till they finally stopped 20 minutes after he had come into our lives. Mathew was soon to follow his brother.

What stands out in my mind was the fact that even in birth and death, Darian and Matthew displayed the same personalities as they did in my womb. Darian the fireball came into the world as a lion. Mathew my little lamb.

Overwhelmed with grief I felt no anger then, but it was soon to come. After burying my boys 3 days later anger began to well inside me. A burning primal hatred for what ever force had given us this precious gift after 14 years only to take them away. The anger was consuming me. The tears would not stop. A part of me was dead, as dead as my boys. It’s only been a month and a half, so I still go through anger, but I’m also grateful to have had my boys for the time that I did. They only lived a short time but they were loved a lifetime.

Thank you for your support.

The Mojica Family

0 comments on “Keeping Walker and Losing Willis”

Keeping Walker and Losing Willis

My husband Michael and I found out we were having twins on October 20, 2006 which also just so happened to be the day we were married. I was attending school in Tuscaloosa, Alabama at the University of Alabama and I started to feel so sick I could barely eat. I knew right then that I was pregnant, I just knew.

Michael and I were both excited and we went to the courthouse and got married as soon as we left the doctor’s office that day. We were just glowing and tell everyone down  at the courthouse that we were expecting twins.  Nothing could bring us down that day.

We spent the next few months guessing what sex they would be.  On December 4 we found out they were both boys. We named them Walker and Willis after each of our grandpas. I loved both of those babies with all my heart.

I continued to still be sick even in my fifth month and had trouble keeping food down, but I told God all the time I would suffer through whatever if only he would keep my babies safe. I really believed that he would. I never expected the news we got on January 3 when I went back in for a routine ultra sound.  Twin A no longer had a heart beat and from that moment I just went into complete shock. I started crying right there on the ultrasound table and I just couldn’t believe it. The doctor came in and told me he was sorry, he said we now had to focus on getting Walker here safely.  He sent me to a specialist who said that Walker looked very healthy and that Walker might even go full term.

I was so thankful to still have Walker fighting as he did, but of course I always thought of Willis and wondered what happened to him. I even wondered if it was my fault. I wondered why God would not want me to have both of my babies.  My mother in law told people that I needed to stop talking about Willis and focus on Walker. That really hurt, how dare her. Willis was just as much my baby as Walker, and he was Walker’s brother. I will never stop talking about him.

At home, I began to have anxiety attacks. I would wake up at night and just panic because I would not feel Walker move. Most of the time I would just shake because I was so nervous and scared for Walker. After several late night visits to the hospital and an ultrasound that showed Walker was not doing very good, they sent me to Huntsville where the specialist was to remain in the hospital and be monitored until Walker was born.  The nurses were so wonderful to me in the hospital.  They comforted me and tried to reassure me that Walker looked wonderful on the heart monitor.  And at night when they would hear me crying they came in there to hand me tissues and get me whatever I needed. I don’t know what I would have done without my nurses.

Dr. Bailey, the specialist was heaven sent. I don’t know if Walker would be here if it was not for him. He took such good care of us and he is the one who made the decision to put me in the hospital.

On March 6, 2007, at 11:22 p.m., Walker Joseph was born and Willis’ little body was delivered too by C section. Walker was beautiful and was sent immediately to the neonatal, he was only three pounds.  It sounds weird but I really thought more of Willis those first couple of days, because I knew that now I had to start saying my goodbyes to him. After all those months, he had been with me, even in death he remained in me.  Now I had to give him up. I held him close, and talked to him. I wondered why so many times, but that question will not be answered here on this earth, I know there was a reason.

After losing Willis, I remember the hospital staff that handled the birth certificate came and had me review Walker’s birth certificate. I noticed it said he was a single birth and I started to cry. I asked her why it didn’t say twin. She said it was not considered a twin anymore but she would ask for me.  In the end, they would not change it. It hurt but I tried to understand where they were coming from.

Walker is doing well, he is four months now and twelve pounds. He is a blessing, but of course I will always wish Willis was here with us. But Walker fought so hard even when his brother was gone. I often wonder what he thought when Willis was no longer beside him kicking and was no longer moving.  I thank God everyday for Walker and thank my nurses and my doctor that I now have a precious baby.

I often think about how I used to pray that God would take care of both of my babies and I now see that he has. Walker is here with us and Willis is in heaven where no pain will even touch him. That is what comforts me the most. Thank you so much for this opportunity to share about my babies.

Sincerely,

Brooke (Florence, Alabama)