When it's not a happy ending - a story from Canada

When it's not a happy ending

 (An article from Lynda Haddon, worth reading)

While the prospect of twins, triplets or quadruplets is exciting, it can also come with unique and complex health risks.
A loss can take the form of "vanishing twin syndrome" (the loss of one or more embryos before gestational week 12), twin-to-twin transfusion syndrome (a random abnormality that causes one twin to receive less than normal amounts of blood supply during pregnancy while the other receives too much, possibly harming one or both), miscarriage, stillbirth or prematurity.
"Parents who lose one, more or all of their multiple-birth children not only lose a much wanted child, but also lose a unique parenting experience," says Lynda Haddon, a multiple births educator and chair of the breastfeeding and loss support networks for Multiple Births Canada (MBC).

In other circumstances, anticipated health issues from a multiple pregnancy can prompt a physician to encourage the expectant parents to undergo a "multifetal pregnancy reduction" to give the babies - and Mom - the best chance of survival, explains Haddon.
But even with only two fetuses, there is no guarantee they will have equal access to the same nutrients in the womb. For her own fraternal twins - now 29 - there was about a 60-40 split, she says.
"I remember seeing a fat umbilical cord and then seeing one that was maybe the size of my little finger," she recalls.
Later in the pregnancy - when womb space is at a premium - multiples can inadvertently hurt each other, says Haddon.
"One of my twins had to have a leg brace at the age of three months because her leg was twisted in utero. She also didn't walk until she was about 16 months old."
Another common concern in multiple pregnancies is cord entanglement in the womb. Post-birth complications for multiples can involve hearing and vision. Sometimes one or more children are afflicted with ADHD or mild cerebral palsy. For the expectant mother, gestational diabetes and preeclampsia are two major concerns, says Haddon.
For these and other health-related reasons, a doctor might suggest a multifetal pregnancy reduction. At other times, the parents may request a reduction because they feel overwhelmed at the prospect of so many babies.
Haddon says there is an important distinction between a reduction and an abortion.
"An abortion to me is the complete termination of an entire pregnancy - when the child is not wanted under the circumstances or when it's used as a form of birth control. In the scenario of a multifetal pregnancy reduction, there are no winners."
Parents who must make such a difficult choice are often further burdened by a lack of understanding from others.
"Let's face it - this isn't dinnertime conversation," says Haddon. "Quite often, those who go through it don't tell many people because they fear they'll be judged."
While serving as president of the Multiple Births Families Association (MBFA) from 1987 to 1990, Haddon realized there was no place for bereaved parents of multiples to go for adequate support. "At the MBFA, I took the phone calls and it tore me up," she recalls.
One woman she counselled had been pregnant with quadruplets and had to reduce her pregnancy to three. "She told me that whenever she took her triplets to the playground, she would always see four."
About 25 years ago, to help fill the void, Haddon set about writing appropriate resources, giving talks and taking bereavement courses. Today, she authors a monthly newsletter, Forever Angels, on behalf of MBC. The newsletter, bereavement counselling services and other useful tools for parents are available through her website, www. multiplebirthsfamilies.com.
"Thankfully, things have changed a lot with acknowledgment that children are not interchangeable and each child is wanted and loved, regardless of how many we have."
Parental responsibility to share the story of a lost multiple with the surviving child or children is like the final piece to a complicated, emotional puzzle. "We want to know about our beginnings," says Haddon. "At the same time, I think it would be incredibly traumatic to learn about it."
Haddon recalls counselling one woman who, in her mid-30s, was settling her mother's estate when she stumbled across evidence that she had a stillborn twin. "Her mother never told her about it. She was just filled with rage."
A firm believer that major family secrets need to be on the table, Haddon suggests parents start talking when their children are young.
"I think sooner is better. As a parent, if you start early it almost allows you to 'practise' before having the conversation later, when they're a teenager."
Being open about the past also allows parents to get their own emotions out, says Haddon. Parents who repress the truth can suffer insomnia and ulcers, not to mention mental and emotional anguish.
"If you put it under the rug again and again, eventually you're going to trip on the rug," says Haddon.
She stresses that parents who have lost a child need different things at different stages.
"One idea is to talk to a bereavement group, a religious person or to go for grief counselling. Other people choose to make a donation in their child's name, or to do some volunteer work - like helping a child to learn to read at school."
Most importantly, Haddon encourages parents who have lost a child to release their emotions.
"Life is not fair," she says softly. "If you need to cry, then cry. We aren't supposed to bury our children."
Editor's note: This story was first published in the March 3, 2012 print edition of the Ottawa Citizen.

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