Loss of twin, triplet or higher multiple babies

For parents and families who have experienced the death of both or all of a set of twins, triplets or higher multiples, during pregnancy, at birth, or in infancy.

For anyone who wants children, twins or more are very special. For many, finding out that you’re expecting twins or more feels like drawing a winning ticket when it comes to parenthood, and is one of the most exciting, memorable day of their lives.

Many prospective parents who learn that they are carrying twins, triplets, or even higher multiples naturally may have mixed feelings because of the realities of birthing, caring for and raising more than one at a time - but sooner or later most become very excited about their "group arrival" of babies and the prospect of such a special kind of parenthood.

Many soon come to enjoy their special status and prestige among their family and community as the parents-to-be of multiples. Whether the pregnancy was planned or unplanned, a result of spontaneous conception or after months or years of fertility treatment, "getting ready" for some extra blessings soon becomes the main goal of life.

Thanks to modern technology many parents get to know early that there are definitely multiples and get to know each baby very well long before their due date. It's not uncommon for babies to have each had their names from the early part of pregnancy, and to have everything ready because of prematurity. For those whose twins were not diagnosed until birth, the news carries the same emotional impact.

The Loss

The death of both or all of the babies is devastating in a way that few others can imagine. Because of the much higher medical risks for twins, triplets or more, many parents experience the death of both or all of their babies due to;

  • A loss in the first 20 weeks of pregnancy in-utero (miscarriage)
  • Premature birth
  • In-utero or after birth from congenital problems
  • Maternal conditions
  • The effects of Twin Transfusion Syndrome and other complications that can occur in identicals
  • Birth trauma
  • Some multiples die in-utero near term for no known reason
  • Occasionally both twins are victims of SIDS (Sudden Infant Death Syndrome), illness, or an accident.

Sometimes the deaths are at the same time; sometimes from different causes and sometimes after weeks or months of hoping that at least one baby would survive. If you haven’t loved two or three or more babies at once and had hopes and dreams for each and all of them, you can’t quite imagine the desolation of the death of two or three or more children over a period of hours, days, weeks or months.

At the Hospital

If both or all the babies die around the same time, parents need to take and if necessary insist on having every opportunity that they might want to see and hold the babies, and to have mementos from them.

Parents should never allow themselves to be rushed into saying goodbye. It is their need and right to hold both the babies, together if possible, for as long as they want and as many times as they want over the coming days, and to invite family members and friends to come see and hold the babies (including siblings, even young ones, if there are any).

Parents have deeply appreciated the preciousness of this time for years to come, even though it was so painful. It's also important for parents not to be rushed into decisions which may seem overwhelming, and to consider asking a trusted family member or friend to help define options and coordinate preliminary arrangements while providing the parents with the opportunity to make the final decisions. Some important things are:

  • Plenty of good photos of the babies, together if possible and being held by the parents, dressed up in an outfit chosen by the parents. Videotaping is highly recommended as well (as well as requesting videotapes of earlier ultrasounds, if they exist).
  • Naming the babies can be very meaningful to many parents, and helpful in being able to grieve for and remember the babies later. Some choose to keep the special names they may have picked out for living children later, others decide to use them for the twins and create variations for children later.
  • Decisions about burying or cremating the babies together. Many have taken comfort in knowing that their twins are together in this way. If one baby has already been buried, this may still be possible and should be discussed with a funeral director. One family's twins were cremated separately but the ashes of each placed on one arm of a beloved grandfather who had died earlier in the year. If one baby died earlier and it was not possible for parents to participate in the burial because of the medical condition of their other baby, or there were no remains of the first baby, or they were handled by the hospital, it's important to find ways for that baby to be included in the memorial service and other aspects of the second burial as well. Burial or memorial services do not have to be at a funeral home - other options are churches, your own home or that of relatives, or a park. One couple who lost their triplets, and were both funeral directors themselves, chose to bring their babies home for a service to which they invited dozens of relatives and friends.
  • Birth/memorial announcements. Many have found these a very beautiful way to honour their babies and to let others know what happened and what their feelings and needs are.
  • Finding out whether the twins or triplets were identical or not. This is very important later in knowing how to "picture" the babies, and also in looking at risks in another pregnancy. Also, it will be important at the time and later to find out exactly what happened medically to cause the deaths, and to find answers to any questions.

Coping with the First Weeks and Months

"The silence was deafening" is the way one mother expressed it, there are truly no words to describe the emptiness and devastation of coming home with no babies at all.

After the first few days or weeks, the shock and denial wear off and there is a great void - yet it is often at that time that others expect you to be "back to normal". Often it is at the time of the mother having to go back to work. While work and other activities can be a temporary distraction, they can also be very stressful; and they do not lessen the grief.

Fathers may have a very difficult time as well, some may try hard not to talk about the babies or show any emotion, hoping that will make it easier.

It is very important for both mothers and fathers to talk to anyone they can who understands and is willing to let them talk about their babies. Infant loss support groups can be very helpful - it's a good idea to call and talk to the group leader in advance to make sure of the group's sensitivity in this area. Finding a friend who has also lost multiples is one of the things that have helped many the very most. It's also very important to talk with relatives and close friends and give them an opportunity to understand and be supportive. Counselling from a trained counsellor is always a good "insurance policy", and no one needs to be "losing it" to go - coping with the deaths of two or more babies is plenty of reason.

If the Babies Were After Infertility

Many have gone through months or years of trying to conceive. They may have had miscarriages or other losses, including multiple birth losses; and may have undergone selective reduction hoping to give the remaining babies the best chance. It was easy to feel that these multiples (and this "instant family") were meant to be after all that. "With loss, it gets somewhat better each month, but with infertility, it gets harder each month,” said one.

Subsequent Pregnancy

Even if the multiples were an unplanned family addition, most parents want another pregnancy, and often have subsequent children as soon as they are able to. It's important to know when the mother is physically and emotionally as ready as is possible - but there is no magic formula, and each situation is unique. For those involved in fertility treatment, there are well-founded fears of conceiving multiples again - and of not conceiving at all. When it is possible to have a successful subsequent birth (after an anxious pregnancy and sometimes months of bed rest and other measures) it is a joyful experience that provides much more "balance" in what it's like to be a parent. There is no pretending that it takes the place of the twins, or the first twins if there are multiples again; and the new baby is both wonderful and a reminder of all the "Why?" questions.

Remembering the Babies

Parents have found many ways to remember their twin, triplet or higher order baby(s) and to include them in their family for the rest of their lives. Some of these are:

  • A ring, necklace, locket or charm which represents both or all the babies
  • Creating an artist's portrait (from photos or memory) of both or all the babies being held by mum
  • Mounted photos (which can be professionally retouched)
  • Needlepoint or other works displayed in the home
  • Talking about the baby to siblings, relatives and friends, and including him or her in some way in birthday celebrations, holidays and family occasions
  • Seeking out a support group, and sometimes, helping to found or lead one, and reaching out to others
  • Planting a tree or a special garden and watching it grow
  • Beginning a career in a helping profession

It is important for each family to find ways that are meaningful to them. Few of us ever forget "our twins" or higher multiples but with time and support, our babies’ memory is part of life.

Written by Jean Kollania and graciously reproduced with permission from CLIMB, the Centre for Loss in Multiple Birth, Inc. © 2003

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