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Archive for the ‘Loss in the Womb’ Category

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From “Tim’s Goodbye.”

Right this moment, somewhere in the world a parent is being skewered by the existential questions of a 3-year-old. Do dogs have birthdays? Do all the ants know each other? Why is that lady crying? When my son was 3, he wanted to know where he was when I was that age. I told him he didn’t exist yet. “No,” he said, firmly, “I was just very, very small.”

But the hardest questions to answer are those about death, because death is so very hard for any of us to understand. Every death leaves a gaping hole and a pile of questions. Where did they go? Can they still think? If we talk to them, can they hear us? And what do we do with our grief and confusion and aching hearts?

At 4 years old, my first child, Olive, found a wilting sparrow on the sidewalk, named it Betty and asked if we could take it home to fix it. We tried our best with a shoe box bed, an eyedropper of mush and a blanket from the doll’s house, but we failed. Betty the bird was dead. Having recently read Margaret Wise Brown’s “The Dead Bird” (the original edition had drawings by Remy Charlip, but it has been newly illustrated by Christian Robinson), we knew we must organize a proper funeral. But there was a problem. We lived in a third-floor walk-up without a patch of dirt big enough to bury a sparrow. Our neighbors rose to the occasion, offering their garden and a barbecue wake, and in the end it was quite a send-off. Their 8-year-old son wiped his eyes solemnly and said, in a thick Brooklyn accent, “I’m tearin’ up and I didn’t even know Betty!”

Olive’s first small experience with death was eased with community and a picture book.

We read to our children for the same reasons we read books ourselves: to be entertained, to feel less alone, to find help navigating things we don’t understand. There are picture books about where babies come from and about losing a tooth and about the first day of school. And now and then a brave author gives us a book about the end of life.

For me, the gold standard of picture books about death is “Duck, Death and the Tulip,” by Wolf Erlbruch. Duck meets Death, and she’s horrified to realize he’s been with her all along, waiting. It’s hard to describe how this extraordinarily tender book manages to be both heartbreaking and comforting, but it does.

Continue reading the main story

And now three new books tackle the subject, in very different ways. TIM’S GOODBYE (Farrar, Straus & Giroux, 40 pp., $17.99; ages 4 to 8),written and illustrated by Steven Salerno (“Wild Child”), has retro, Ludwig Bemelmans-inspired illustrations in black crayon line on a flat, digital, yellow background. The main character, Margot, is sad because “Tim is gone.” Salerno rapidly introduces a cast of characters who help Margot give her dead pet turtle, the titular Tim, a send-off. It is a mystery what’s happening for most of the book as the children come and go, one of them floating in on a trio of balloons, until the rock, which has been static on each page, is revealed to be poor Tim. The balloons come into service again to lift the turtle, now in a cardboard box, up to the heavens where he possibly becomes a constellation. This gentle story might be just the introduction some readers seek, but for me, the slow reveal that Tim is a dead pet was so light-handed, it left me feeling detached.

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From “A Stone for Sascha.” Credit

A STONE FOR SASCHA (Candlewick, 48 pp., $17.99; ages 4 to 8), written and illustrated by Aaron Becker (the “Journey” trilogy), is the wordless story of a girl trying to process the death of her dog. Initially, at least. Lushly illustrated in digital pastels, it soon expands to take on time and history and cosmology and the interconnectedness of things. On vacation at the beach with her family, seeing another child with a dog, the girl hurls a stone into the sea. On the next page, a golden meteor plummets toward Earth, is lodged deep underground during the Paleozoic era, erupts in a dinosaur-scattering earthquake, and then across various ancient civilizations is alternately worshiped, sculpted, erected, celebrated, crushed, sold, neglected, discovered, plundered and lost to the bottom of the sea. Where, washed by time to a smooth golden stone, it is found by our girl on the beach, who takes it home to place on the dog’s grave. Everyone’s experience of death is personal and the same might be said of books. Some children might consider the leaps in this book too great, others will return to ponder the cinematic images and puzzle out the connections.

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From “The Funeral.”

Matt James’s THE FUNERAL (Groundwood, 40 pp., $18.95; ages 4 to 8) is an oddly exhilarating story of Norma’s first experience of a funeral. In fact, she approaches it more as a “fun-eral,” as the book’s cover makes clear with the bright acrylic and collaged blossom-laden tree, the exuberant children and the separation of “fun” from “eral” in the title typography. Like Viorst, James (“When the Moon Comes”) has an ear at child level and beautifully and convincingly shows us children who fidget during the service and consider a mourner’s hairy ear perhaps more than they think about the deceased. But they are not completely irreverent, just children, who are full of life.

For most books about death are also about life, and we are lucky to have them to help us through both.

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Some ideas and suggestions which can go into a Memory Box:

  1. Plaster and/or foot prints, if possible.  Sometimes the hospital staff will take them, the funeral home or a local individual who specializes in such work.  They can also be framed into a shadow box as a cherished momento.
  2. Photographs in a variety of poses:  singly, together, dressed, undressed, just hands and/or feet, with parents, siblings, grandparents.
  3. Ultrasound pictures, cards, notes receive.
  4. Photographs from the funeral.
  5. Hospital bracelet(s).
  6. Special ornament for the holidays.
  7. Honorary birth certificate if baby was born still.  Make sure the hospital correctly identifies the multiple-birth.  The loss of one triplet, does not make twins.
  8. Death Certificate.
  9. Some items such as ultrasounds and/or photos can be etched into crystal.  An internet search will provide information regarding such services.

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Linda Leonard has created an amazing, comprehensive resource regarding multiple births in British Columbia, Canada 🇨🇦️ and beyond. This in depth brochure will be of interest to parents expecting twins or more, grandparents, healthcare professionals, researchers, grieving parents, and any one else with an interest in multiple births. Lots of information and resources re breastfeeding of multiples. I am so excited about this valuable brochure. Check it out here: https://nursing.ubc.ca/pdfs/twinstripletsandmore.pdf

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In 2006 I gave birth to fraternal twin boys who were sadly stillborn. I was 34 weeks pregnant. They weighed 5 pounds 4 ounces and 6 pounds 3 ounces.  I am also the mother of 4 living sons.

In August the year before, I had [had]my tubes tied so we would not have anymore children. I started to get sick after the procedure and told the doctor. She said that I might have an infection from the procedure. I also complained of pain, so she sent me for a ultrasound cause she said I most likely had cysts on my ovaries. A week after the ultrasound was done I called to get the results and found out I was pregnant again and this time with twins. My husband and I needless to say were very surprised but extremely happy about the news as we thought we no longer could have children. My first question was if they were OK  because I had the surgery around the time they were conceived. The doctor did not check before I had the surgery to see if I was pregnant.

Everything was fine right up till the end. Two weeks before they passed away, I went to the hospital in extreme pain on the left side of my stomach. I was given Tylenol, hooked up to a fetal heart monitor and then sent home. I was told what ever happened inside my uterus my babies were tolerating it well and that was it. No further tests were done. The next day I saw my doctor and told her what happened. She said if it happened again to go back to the hospital and only to come back to see her in two weeks. I never got to see her again. A week and a half later I had a ultrasound that was booked weeks before anything went wrong. [At that time] I was told they were perfectly healthy little boys. I had noticed that the baby on the left’s heart rate was lower than it normally was and I asked why. She said it was because there was really no more room left to grow, he wasn’t active and probably sleeping at the moment. 

On the Tuesday after my ultrasound I went for a nap before my husband had to go to work. I woke up and started to get supper ready for my four boys. I cleaned and then received a phone call from my sister-in-law that she wanted to take my youngest son for the night. I got him ready. By the time I had a few moments to sit, I [realized] that I did not feel any movement since before I went for my nap. I went to get something to eat and drink because usually that would make them move. When that didn’t work I tried to move them myself and nothing happened. I called my husband at work and told him I was going to the hospital. I told him I would call him because he was not allowed to leave unless I was in labor as I already called him home many times that week. I went to the hospital and they told me that they had one baby’s heartbeat but the other baby was probably hiding so they were going to give me a ultrasound to see and hear them better. That was the moment my heart truly broke. The doctor on call told me that both boys were dead. They said that they picked up my heartbeat earlier.  I asked them to call my husband at work. They couldn’t tell him anything on the phone and just told him that he needed to come. He arrived almost a hour later cause he went home first to change because he thought I was in labor and he gets really dirty at his job. When he arrived I heard the nurse tell him in the hallway just outside my room. I remember feeling so numb, how could this be happening to us? 

My stay in the hospital was very emotionally straining because of rude comments I had to endure from medical staff (which I did make a formal complaint about). It was hard enough to deal with what I had to go through then I had to deal with what these (so called) medical professionals were saying to me.  EXAMPLE:  A lab technician said “You had a baby?” I said “Yes, I had twin boys” she asked “Where are your babies?” I said “They passed away.” She replied “Oh you’re the one they are talking about downstairs.  You don’t want any sick or mal-formed babies anyway.  It’s for the best they died.” My sons were not sick , they were not mal-formed. They were healthy little boys. There were other comments as well.

I was told that Lucas died first and he was the baby on the left, the side I  first had problems on, and the baby whose heart rate was lower than it normally was.  I have yet to receive the results of the autopsy report.  I was told by the doctor who delivered my sons that the test they received back showed no cause. I can’t deal with the fact I am being told I buried two healthy little boys. I delivered my boys by c-section and it was discovered later that I had an infection from the surgery.  L. was born at 2:16pm and weighed 5’4 lbs. R. was born at 2:17pm and weighed 6’3 lbs. I remember returning to my room it was 4:30pm. The nurse brought in my babies and placed them both in my arms. I remember thinking they just look like they were sleeping but I knew they would never wake up from this sleep. I kissed each of their little heads and told them I was sorry and that I loved them. The nurse came and took them to another room.  I later asked for them again because I wanted to hold them individually.

We had two services for them because we live so far away from home. We had a service where we live which was open casket and which was the choice of two of my older children. I’m glad we did that because I was feeling a bit better from the surgery than when I originally saw the babies and this time I got the chance to kiss them good-bye without feeling all groggy from pain meds. We had to transfer their bodies ourselves back home which was a hard, long drive (7 hours).  My aunts put together the service back home which was more than I ever expected. I hadn’t been home in 2 years and it was really something to see how many people cared. My boys were not planned but I wanted them more than anything in this world and as each day goes by, I miss more then I think my heart can handle at some times.

 

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Question:  

I lost one of my twins in the womb.  My daughter is now 16 months old. I’ve been thinking what would be an appropriate age to tell her about her twin?

Suggestions:  

Hello,  I am so sorry to hear of the loss of your baby.  Nothing about losing a much-wanted child is easy.  I suggest to parents that they talk about the sibling as early as possible.  It is easier to begin with a young child then to try and break the news to a say, 14-year old who may be shocked to hear the information for the first time.  Teenagers have growing up issues to deal with and learning the truth about their origins later in life can be mind-boggling.  With a young child, the words are less important than with an older child and the parent gets chances to work through the way to deliver the news. When the truth is shared early on, the lost sibling is part of the fabric of who the survivor is vs them facing a completely different scenario at an older age and realizing that they are not who they thought they were.  Even starting now is not to soon.  “There should have been two of you.  Your Dad and I miss your little brother/sister very much and wish whole-heartedly s/he could be here, with us.” And such.  Short sentences, a few words as you also feel the ground for sharing.  It will no doubt be difficult for you as well.  

When your daughter begins to speak, she will eventually ask you questions.  Use age-appropriate language when answering, be honest, try not to avoid the topic – it may come up when you don’t feel like talking about the subject, and expect the same questions over and over.  This is how small children incorporate the idea of death.  It is hard for them to understand what it means to die.  Repetition helps.  “S/he was too sick to stay with us and be a family on earth”  is a gentle way to help her understand until she is older and better equipped for as much detail as you feel you can share.  Be prepared to cry sometimes and that is OK.  You can tell her you are glad to have her but not to have her brother/sister makes you feel sad.  You are helping her learn that life is not always fair, there are loving people around her nevertheless and she is not to blame because he/she died.  She may ask you at some point if the loss was her fault.  It is not her fault, nor yours or her Dad’s.  It was something sad that happened and you would change it if you could, but you can’t.

I hope these are some helpful ideas.  Please accept my sincere condolences on your loss. Lynda

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Loss in the womb

Womb-Twin Survivors

Within a multiple birth, there are several possible reasons for loss in the womb.  One might think that loss in utero doesn’t have much effect on either the womb-twin survivor(s) or the parents.  Such an assumption would be far from correct.  Parents lose on two levels: their precious child is gone and so is a unique parenting experience; and womb-twin survivors lose their womb mate.  When parents do not tell survivors that they began life as at least twins, it is not uncommon for the survivor to develop fantasies about “being with someone else,” of being unable to achieve or needing to live their lives for two.  There can be survivor’s guilt.  If told later in life, survivors can have feelings of relief at not being “crazy” but sometimes too, anger at the parents for a lack of truthfulness and a wonder at what else may not have shared with them.  A womb-twin survivor shared with me once that she found her birth records when she was cleaning our her mother’s estate and they recorded a twin birth with her twin being born still.  The woman (in her 60s) was furious with her mother for not letting her know the truth about her birth and additionally, with the fact that she had no one to rail at in her anger.

For those wishing more information, here are the situations which can occur within a multiple-birth situation:

Vanishing Twin occurs when a fertilized zygote of a multiple-birth pregnancy fails to properly adhere to the uterine wall to attain the maternal nutrition it needs to grow and develop or the zygote itself is unhealthy.  Early ultrasounds, i.e. 6-8 weeks, will confirm a pregnancy and how many. Yet, by week 12, the uterine situation can dramatically change and one embryo “vanishes.”  This loss can happen within a triplet or more pregnancy as well. Over time, the empty sac Is absorbed by the mother’s body.  There is no harm to the remaining fetus(es) and usually no sign of its existence at birth.

It is the advent of ultrasound that has brought the phenomenon of Vanishing Twin to the fore. Before, parents would not have known they were pregnant with 2 or more. There may or may not have been bleeding which can occur despite pregnancy. Instead, the pregnancy continued to the healthy birth of a ‘singleton’ or ‘twins’ (from triplets) with no one the wiser that one had been lost.  Vanishing Twin seems to be more common than was previously thought.

Multifetal Pregnancy Reduction is the reduction of one or more embryos while still in utero, from usually a triplet or more pregnancy in order to give the surviving embryos, and Mom, the best chance of  being healthy.  It is not an easy decision, as the parents grapple with the pros and cons, usually in isolation from family and friends (who may not understand their dilemma), but in consultation with their doctor and other healthcare professionals. If reduction is chosen, it is recommended that a dizygotic (fraternal) embryo be chosen to be reduced as monozygotic (identical) embryos are closely linked and it has been reported that womb-twin survivors can be affected psychologically by the loss of their genetically similar co-multiple.  It may also be considered to reduce a zygote that is smaller or has identified health issues.

Miscarriage can occur in utero involving one or more fetuses within a multiple birth, and the pregnancy needs to continue for the sake of the remaining baby(ies).  It is very stressful when carrying one alive and one dead as parents worry about the health of the other baby(ies) and at their births, parents simultaneously experience the joy of birth and the pain of loss.

Some parents know ahead of time that one of the babies will not survive birth and can only remain alive while in utero.  This, too, is a very stressful situation as only in utero are both or all babies safe.  It is the outside world where one of the babies cannot live.

Complicated Grief

In-utero losses have complicated grieving processes for parents, particularly the Mother as she has carried the infants and probably felt them move.  This does not mean that the Father or Partner will necessarily be unaffected by an in-uterine loss. Any survivors may also experience their own level of grief.  Family, friends and counsellors don’t always identify or appreciate the depth of feelings around such losses.  Some of their comments show that lack of understanding:  “You are young, you can have more,”  “At least you still have a baby,”  or as one bereaved Mom of triplets was told by her mother-in-law, “You have two babies who need you, just get on with it!”

Parents/Mother

Grieving in-utero losses can be challenging for both parents.  The Father may initially feel sad and/or be worried about his wife.  It can be difficult for some men to mourn early loss. Mom has a different experience as she is the’ baby carrier.’ She may have felt them move and experienced physical changes in her body and emotions as her babies were developing.  Interestingly though, through the rest of a grieving woman’s life more often than not the idea of her lost child remains, even if that loss occurred in utero. The deceased child remains in thought, fantasy, prayer; an unseen member of the family but a member nevertheless.

Womb-Twin Survivor

Feedback received from womb-twin survivors indicates that they were indeed affected by the loss.  One survivor lost her twin just before their births:

“…..I used to feel guilty for being alive. ….I thought my parents hated me because I was not her……I often feel very alone and low.”

Another lost her twin brother 20 weeks after conception:

“[I] always feel alone no matter who I am with.”

Another lost her twin sister before she was born at 26 weeks gestation:

“….I think about her every day…..people’s reactions are hard to take – they don’t see or treat an in-utero loss as significant or as a loss.  Because of the skepticism around this issue, it’s almost impossible to talk about my twin to anyone.”

Still another who lost her twin at birth:

“There are obvious senses of loss, guilt, anger, need for closeness that I can’t explain.  They are worse around my birth day ([which is] her death day).  There is an overwhelming sense of being ‘half’ and I have tried to fill it by being better and more than anyone else.”

We know that multiples are aware of each other early on in utero.[1] It stands to reason that there may be feelings of loneliness, always looking especially in crowds, feeling incomplete, empty, sad for no apparent reason and so much more, as womb-twin survivors who began life so closely connected, attempt to find balance outside of the womb.  Doctors, therapists, counsellors, parents, researchers and pastors need to become aware of the unique grief feelings that can affect womb-twin survivors and recognize that even very early losses can have devastating and life-long effects.


[1] A Study on Twins Before and After Birth, Alessandra Piontelli, The International Review of Psycho-Analysis, 1989, Vol. 16, Part 4, Page 413

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