Elizabeth A. Pector, M.D.



                                                                                             July 5, 1999


Twinless Twins,


I am writing to tell you we have just lost a set of twins. S and T were born on May 15, 1999.  She weighed 13.6 oz. and lived for 2-3/4 hours.  He weighed 12.2 oz. and lived for 1-1/2 hours.  They were born premature at 21 weeks….Everything was fine until 24 hours before delivery.  I started having contractions every 5 minutes apart, that never changed.  Even with all the medication they could give me….


We …would like to receive any information that you may have that would be of some help to us.  …This is our first children.  And the loss has been very hard to handle.  And to go through.  I don't think anyone understands unless they have experienced it personally themselves.  I do think it has been worse losing twins.


Loving parents,


J & B B.


This heartrending letter was forwarded to me by Dr. Brandt for answer and commentary.  I have written to the Blairs with some resource information and suggestions, but the following comments might be helpful to give others some insight into the sorrow faced by parents confronting the loss of all of their multiple-birth children.


My deepest sympathies and prayers go out to J and B at the deaths of S and T, deeply loved children born too soon.  Many among their family and friends may not appreciate some unique aspects of their grief.  They have lost not only two eagerly awaited lives, but the prestige and challenge of raising twins, the joy of watching their children's relationship blossom, and the hopes and dreams of a once-in-a-lifetime parenting privilege.  Jennifer may mourn the loss of the last half of pregnancy, even with all the physical discomforts that can mean for mothers of twins.  Many people may not recognize the B's as parents since they do not have living children.  They may therefore be denied opportunities to share the story of their brief, sad parenting experience and the visions they had for their son and daughter.


Grief is a painful but natural and healing process, and varies quite a bit from person to person.  It is a bumpy road, with good days followed often unexpectedly by extremely sad days.  Mothers and fathers often differ in the depth and length of their mourning, and should respect each other's differences without feeling that the less sorrowful parent loved the children less. It is indeed worse to lose twins; the loss is at least twice as great and the sorrow twice as intense.  In grieving the loss of a baby, initial feelings of shock are followed by anxiety, guilt, depression, anger, and often feelings of failure or isolation ("I don't think anyone understands unless they have experienced it…")  Envy of women with intact sets of twins and pangs at twin encounters may persist for years, although the severity of these feelings decreases over time.  The hardest period after losing a child is usually the first six months.  Resolution of grief--establishing a "new normal" and becoming able to enjoy life again--can take an average of 18 months after both twins die.  Parents are changed by this tragedy and will not be the same as they used to be.  Infant loss or multiple birth loss support organizations, Pen Parents, or Internet e-mail support networks can provide meaningful contact with other parents who have lost one or more children at birth--people who have personally gone through the same experience.  Many people, however, prefer to work through their grief privately.


A strong urge to pursue another pregnancy as soon as possible is common after a twin pregnancy loss.  Twin issues become a factor, with some women praying for repeat multiples "to prove I can do it right next time" and to finally have the opportunity to raise twins. Others deeply fear another loss or maternal health complications if multiples are conceived again.  It's best to allow some time to pass in order to work through the most painful grief feelings first.  Subsequent pregnancies frequently involve much anxiety, and even difficulty attaching to the baby during pregnancy due to fear of another loss.  A living child, or even another set of twins, could never replace S and T, but having a healthy living child does ease the anguish of loss somewhat for many parents.  At the very least, I would recommend the B's avoid a pregnancy with a due date very close to the delivery date or original due date of their twins. 


Since pregnancy loss involves the death of hopes and dreams rather than a recognizable person, recording the events of pregnancy and their visions for their children's future in a journal or scrapbook may be helpful for J and B.  Ultrasound photos, heartbeat monitor strips, and mementos from the hospital can be valuable documentation of the babies' real existence.  I'm happy they have precise measurements of their children.  It is also recommended that hospitals obtain photos of the babies together, and of the parents holding both children together, preferably with hands touching.  I have seen scrapbooks that have moved me to tears, with ultrasound images, photos, birth and death certificates, footprints, copies of obituary notices or a printed guide for the funeral service, Scripture, prayers, meaningful song lyrics and poetry.  I read once about a father who writes a letter annually on each of his children's birthdays, reflecting on their accomplishments and major events during the preceding year.  A similar birthday letter about what the children might have been doing if they had lived, and about how their life has progressed differently without the twins, might be a meaningful tradition for the B's to consider.


Parents have devised creative ways to keep their children's memory alive.  Some of these include planting a tree for each child, buying angel or cherub figurines for the garden, naming a star after their children, or having their names inscribed on a brick, plaque, wall or statue in return for a donation to a meaningful cause.  Some parents buy small personalized items with a deceased child's name, such as refrigerator magnets, keychains, toy license plates or pencils.  Portraits or sketches can be created by an artist experienced in working with bereaved parents, even if there are only poor photographs or none at all of the children at delivery.  Some parents use their own talents to write poetry or songs, make customized urns for their children's ashes, sew memory quilt squares, or establish Internet web pages dedicated to their children.  Jewelry can symbolize enduring love, with angel pins, charm necklaces, birthstone rings or name bracelets popular among bereaved parents. 


Birthdays and holidays are usually very difficult times.  Some parents bring cake, flowers, or small toys to the cemetery, decorate candles to burn on the birthday, or even organize memorial walks to raise funds for a charitable organization to honor their children.  Memorial services can be held anytime, even years after a death.  Some parents have started collections of angel figurines, buying new ones on sad days such as birthdays, Mother's Day or Father's Day, and winter holidays.  For Christmas, parents have made or bought ornaments for their children each year, purchased gifts in their children's names for needy children of similar ages, or donated money to a charitable organization or foundation dedicated with the condition that caused their child's death.


I hope some of these suggestions help the B's as they look for ways to demonstrate their lasting love for their twins.  I do hope that God will grace this loving couple with living children in the future, and that through grieving in healthy ways they will be changed for the better, with the increased sensitivity and compassion toward others which can only come from those who have known great sadness.


Elizabeth A. Pector, M.D.

Family physician and mother of a baby miscarried in 1990, David born in 1991, and Jared and his stillborn twin Bryan born in 1997