Loss of Your Twin or Triplet Baby

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

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

Many prospective parents who learn that they are carrying twins, triplets, or even higher multiples naturally also have some 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 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 how many--and get to know each baby very well long before their due date, through sonograms and other testing, becoming thoroughly bonded to each one and to the reality of being the parent of multiples. It's not uncommon for babies to have each have their names from the early part of pregnancy. For those whose twins were not diagnosed until birth, the news carries the same emotional impact.

The Loss

The death of one of the babies is a tragedy that nothing could have prepared us for, even if we knew that it could happen. Being pregnant with two babies--"my twins"--and having only one of them to raise does not make any sense physically, mentally or emotionally…and looking at a tiny surviving baby and seeing the reality of his or her twin and the reality of their death is a parenting challenge that no one should have to face. Yet it is happening to many families throughout the world each year.

The number of multiple pregnancies has mushroomed because of fertility technology--yet the risks of twin pregnancy (estimated at 3 to 15 times those for singleton pregnancies and births, with identicals at the higher end) have not decreased as much, and the risks for triplets and higher are of course even greater, despite some advances. All the images we see on television and elsewhere don't reflect the families whose twin or multiple has died in-utero at any time during pregnancy, even near term…whose twins or triplets or more were born prematurely and struggled for days, weeks or months in neonatal intensive care with only one or not all coming home…whose twin or triplet died from the effects of a prolapsed cord, twin transfusion syndrome, a mismanaged delivery, maternal conditions, congenital problems, SIDS or a sudden illness in infancy--or other things which occur only in multiples, are more likely to occur in multiples, or are more likely to come up given that there are two or more babies. Many families "go longer" in a pregnancy knowing that one baby has died in-utero, and many others 'know ahead' that one of their multiples will not live long past birth because of a condition such as anencephaly.

For some, the loss occurs in a pregnancy that began as 3, 4 or more and the parents made the difficult, painful decision to undergo--or not to undergo--selective reduction for the sake of the remaining babies; or after the decision to undergo the selective termination of one baby who has congenital problems and will not live, for the sake ofthe other. For all of us, it was the shattering of a dream…and the beginning of a rollercoaster ride of grieving and healing which takes a great deal of time and support.

After the Loss

The circumstances around the death of a multiple are likely to be complicated and hectic, because there is more than one baby, the timing of the death before or after birth, and the fact that the other baby or babies may be in the neonatal intensive care unit. Mothers may be ill after a traumatic pregnancy or delivery; and babies may even be in different hospitals, with the mother and father separated so that one could be with each. But no matter what, there are some things that are very important to do and they are even more important to do because these are multiples, and because there is a surviving baby or babies, so that over time the family can begin to process their entire experience and begin to cope, heal and relate to their survivor about their twin who died in a healthy way.

• Seeing, touching, holding the baby who died, even when the baby died in-utero before birth. This validates the reality that there really were twins (or triplets or more), and makes it possible to begin the grieving process for that baby while creating memories that will be appreciated later. There is no reason to settle for a few foggy moments in the delivery room--parents need and should have as much time as they desire over the coming days to spend with the baby(s) who died, as many times as they wish, as well as later at the funeral home. Though it is difficult, many parents have deeply appreciated being able to see and hold both twins or all triplets together, even if it meant transporting a healthier survivor from another hospital, or putting isolettes together in the NICU before or after one has died. Some of these decisions may be difficult when the baby who has died does not look "normal", but it's important to remember that babies do not have to be perfect for their parents to need to see and honor them--and that parents tend to imagine worse than what the reality is and then focus on the beauty of what they do see. It's also very important for grandparents, siblings of any age, and other relatives and friends to have an opportunity to say hello and goodbye. One mother said, "After an entire twin pregnancy and loving and wanting both of them so much, there was no way I was going to miss what was now my only chance to hold both of them together, and I'm so grateful I did. My twins and my son who died are real to my family, also, because they met him too."
  
  
• Photos of the baby who died, and the babies together. A photo of the baby who died, and one of the twins together, and the parents holding the twins or triplets together are treasured mementoes later, and also "worth a thousand words" when talking to a young survivor about his birth and twinship. It's preferable that parents bring their own camera (35 mm film) and have it processed in a shop that does it on-site, or a digital camera; and if the hospital offers to take photos, claim them promptly as these are sometimes lost. Videotaping can also provide some precious mementos, as well as obtaining copies of ultrasound videos.
  
  
• If the babies are the same gender, they may be 'identical' (monozygotic) even if they don't look alike (and even if they were conceived through fertility technology). Many parents have found it important for medical and emotional reasons to definitely know whether their babies were identical or fraternal. This can be determined in a number of ways, and it is important for parents to discuss this with their physician as soon as possible.
• Many parents have combined a baptism for the survivor(s) with a memorial for the baby(s) who died, or honored both of them in another ceremony or ritual. This can still be done weeks or months later, as can sending birth announcements that include both or all babies--CLIMB has examples available of announcements that parents have done. For parents who have lost a multiple(s) to miscarriage or reduction, these are opportunities to name and honor that baby(s).
  
  
• The surviving twin is still a twin, surviving triplets are still triplets. It's important for parents' wishes about how their surviving child or children are referred to by hospital staff, relatives and friends be known and respected. It's difficult for parents who have lost a twin to have their survivor treated as if he was a single baby--and parents of two surviving triplets or quads almost always say that their #1 difficult issue is their babies being called twins.

Homecoming

Joy and deep sadness…loving and grieving…bonding and letting go…all the realities of being a parent--and all the realities of being a bereaved parent: these and more fill the first days, weeks and months after the death of a twin baby. Some very opposite experiences, which are difficult enough done separately, are all wrapped up in one package right now, 'my twins'. Parents still have two babies--but now what is involved in caring for each of them is so very different. Along with that, we are grieving not only for our baby(s) but also for "my twins" or higher multiples and the experience of being the parent of living multiples of that number. Hearing about or seeing multiples of the same number is usually painful, often for years to come; and many of us find ourselves longing to have multiples again. Many parents are intensely involved in the care of a tiny survivor(s)--and even those with fully healthy survivors often feel fearful and vulnerable, as well as needing to be with them at all times.

The grief, and the intense need to process everything about what happened, tend to surface once things get a little more "normal" with the survivor(s). Yet it is often around that time that others think we are, or are supposed to be, ok--and we often get a lot of pressure to just act like it didn't happen or didn't matter. Most of us have received insensitive remarks which usually begin with 'At least…' or, 'It's easier…', 'You should…'. The best friends and relatives are those who know that they don't know what it is like but understand that it is very bittersweet and difficult for you, and are willing to be there and to care.

It's truly essential to finds ways to talk about your baby who died, and to make the time and space to do whatever it is that you need to do for him or her, and for yourself. Many of us have found that allowing ourselvcs to ride this rollercoaster, complicated as it is, really increases the joy we can take in our surviving baby--without "trying"--and decreases anxiety and depression later. It also lays the groundwork for being able to relate to our surviving baby about the loss, and being able to be open about it from the earliest times in a way that is based on the child's needs. Not much is known about whether a survivor of pregnancy or birth loss inherently misses his twin, and it may never be since it this is a subject that can't be studied scientifically. But we know that parents do grieve intensely--and that the more parents can experience their own emotions, address some of the issues they may have, and over time begin to get a little more comfortable with something that is so uncomfortable, the better everything will go for the survivor. Many of us now have teenage or older survivors who have always known about their twin, and have this as something sad but also something special--something that is important but something that does not overshadow their life--and who appreciate being here and being happy.

Remembering Our Baby

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 mom…mounted photos (which can be professionally retouched) or 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 local or other 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 and many more. 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 baby's 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

Useful links:

https://tcfa.org.au/