Loss in the womb
December, 2014; July, 2009
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.
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!”
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.
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. 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.
 A Study on Twins Before and After Birth, Alessandra Piontelli, The International Review of Psycho-Analysis, 1989, Vol. 16, Part 4, Page 413