Women carrying twins and multiples know that their pregnancies are at a higher risk of complications than those of moms expecting only one baby. Though many sets of twins and multiples are born perfectly healthy, there are some cases when one or more fetuses doesn't survive.
Making sense of this kind of loss can be unimaginably difficult, and you may never have all of the answers. But knowing more about why the loss of a twin or multiple happens may help.
Early loss (miscarriage) of a twin or multiple
During the initial stages of pregnancy, some women's bodies aren't able to support more than one baby, which can result in a miscarriage of one or more of the fetuses.
These early losses, often called vanishing twin syndrome, are fairly common, affecting between 10 and 40 percent of multiple pregnancies. Vanishing twin syndrome most often occurs in the first trimester, sometimes before a woman even knows she's carrying twins.
When a woman does experience symptoms of an early twin loss, the symptoms are similar to miscarriage in a singleton pregnancy. These can include mild cramping, vaginal bleeding or spotting, and pelvic pain.
In some cases the only sign of vanishing twin syndrome is no longer detecting a second fetus on an ultrasound, if a second fetus had shown up on a previous sonogram. But if a woman miscarries before she's had her first ultrasound, she may never know that a twin or multiple was lost.
Later loss (stillbirth) of a twin or multiple
When a twin or multiple is lost after 20 weeks of pregnancy, the loss is considered a stillbirth. Stillbirths can result from a number of complications, including placental defects, infections, problems with the umbilical cord, high blood pressure and problems related to it. But in up to a third of cases, the cause of the stillbirth is undetermined.
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A lack of fetal movement or kicks may be the first sign of a stillbirth in a singleton pregnancy. A woman who is pregnant with multiples may notice a decrease in movement after one fetus is lost. The lack of movement may be confined to a specific location, with movement still happening in the part of the womb where the other fetus is.
Less movement or a lack of movement in a certain area doesn't automatically mean a woman has had a stillbirth though. Only a lack of fetal heartbeat, which is usually detected via ultrasound, can confirm a stillbirth.
Medical loss of a twin or multiple
After 20 weeks of pregnancy, women carrying multiples have regular ultrasounds to ensure that all their babies are developing normally. Though many women find that their babies are progressing as they should, in some cases, it turns out that one or more of the fetuses is unlikely to survive in utero or outside the womb. And sometimes the at-risk twin or multiple may be endangering the life of the other healthy baby (or babies) or the life of the mother.
In those cases, your practitioner may recommend medically terminating the fetus or fetuses so that the other one or more can survive, if it is legal where you live. This procedure, called multifetal pregnancy reduction, can be agonizing for parents.
Facing a decision like this can be devastating. While there are no sure answers, having a detailed conversation with your provider is an important first step. Together, you can weigh the risks and benefits of your particular situation until you're as confident as you can be about your choice, the American College of Obstetricians and Gynecologists (ACOG) recommends.
Making your decision may also involve consulting with other experts like maternal-fetal medicine specialists, neonatologists, child development specialists and other clinicians who specialize in multifetal pregnancy reduction.
You can also ask your practitioner to put you in touch with a mental health professional or someone from the bioethics staff of the hospital, if available. And if religion plays an important role in your life, you might discuss the matter with your spiritual counselor to help you further come to terms with whatever you decide to do.
Loss of a twin or multiple at birth or shortly after birth
In some cases, one or more babies are lost during or just before birth. The mix of emotions can be overwhelming, and there is no "right" way to feel. You're in the very difficult position of celebrating the birth of one or more baby while mourning the loss of the other(s).
It's normal to have deeply conflicting emotions, and they could change from minute to minute. You might feel immense joy while holding or feeding your newborn, only to be hit with overwhelming sadness or anger when your mind turns to the other baby who should be with you. In some cases, your baby may automatically remind you of her lost twin, making it hard to enjoy time with your newborn.
You might find yourself feeling intensely guilty or confused too. In addition to mourning your own loss, you may be grieving over your living baby's loss, feeling shameful or remorseful that you weren't able to give her a sibling. You may also wonder why one baby was chosen over another or whether there was something you might have done to cause this to happen.
It's important that you allow yourself to mourn your lost baby (or babies), as challenging as that will be while you're caring for a newborn. Try to be good to yourself as you process your grief. In time, you will recover and heal.
How to cope with the loss of a twin or multiple
There's no right or wrong way to feel after losing one of your babies, and unfortunately, there's no instruction manual for how to move forward. Pregnancy losses are always devastating, and feelings can become infinitely more complicated when twins or multiples are involved. In addition to working through your loss, you're still preparing for taking care of a newborn — and experiencing all of the emotional highs and lows that come with it.
You should take as much time as you need to grieve the loss of your baby, in whatever way that works for you. The intensity of your feelings — and how long it takes before you start to feel "normal" again — can depend on when and how the loss occurred. Seeking support from your partner, family, friends or a mental health professional is always a good first step. Taking some time to rest, if you're able to, is also important.
You might decide to do something to honor the baby that you lost — anything from having a quiet day of reflection, to collecting keepsakes from ultrasound pictures, to planting a tree in your baby's honor, to naming your baby and having a memorial ceremony. Let your emotions be your guide, and think about what might help to provide you with a sense of closure so you can start the work of accepting your loss.
Keep in mind, too, that accepting is different than "moving on" or forgetting. Even though you still have one (or more) babies, they won't replace the one that you lost. You'll always remember the baby that isn't with you, and one day you may come to talk openly about the loss with your child. But as time goes on, the raw shock and pain will start to subside, and you'll grow into your role as a parent.
There's no timeline for how long this might take. But as the weeks and months pass, you should start to feel better instead of worse. If things aren't gradually starting to become easier or you're experiencing signs of depression (like trouble sleeping, lack of appetite, trouble focusing, or feeling isolated) or anxiety, reach out to a mental health professional.
Physical recovery from the loss of a twin or multiple
It's normal to focus on your emotions after a pregnancy loss. However, your body will also be recovering physically. What that entails and how long it takes for you to heal will depend on when the loss occurred.
Miscarriages and early pregnancy losses may cause bleeding or cramping for a few days and spotting for a few weeks. Multiple pregnancy losses that occur later have longer recoveries. Though it can be difficult to think about, the process of vaginal or C-section delivery where one of the fetuses is stillborn is usually the same as for a multiple birth where both of the babies are alive.
Heavy bleeding, cramping, perineal discomfort, fatigue, achiness and breast engorgement are par for the course. The bleeding will slowly taper off over the course of about six weeks, and you'll continue to have some cramping as your uterus shrinks back to its pre-pregnancy size. If you had a C-section, you'll also have to contend with pain from your incision.
Navigating the loss of one twin or multiple may be one of the most difficult things you ever experience. But in time, you will move forward.
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