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:

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