The healing path. The death of a womb twin

There are many ways in which a twin may die in the womb or around birth.  There are three whole chapters devoted to the death of one twin in my book "Womb Twin Survivors: the lost twin in the Dream of the womb.."

Here is a list

Death around birth

Stillbirth
Neonatal death
Separation of siamese twins
The twins body leaves from the womb during pregnancy

Total miscarriage of one twin
Abortion causing total miscarriage of one twin

What is a womb twin? (1) a full-term, perfect dead baby

If you are  the womb twin survivor, who was your womb twin?  The first step on the healing path is to make your lost twin real, and this series of blogs for this week will look at the various forms that womb twins can take. All this information is there in your Dream of the Womb, and the intention is to help you make sense of it all.

A full term, dead baby
The most obvious form of a womb twin is  a full-term and perfect dead baby - or dead within a few hours or days of birth. (In this case some people also call the survivor an "early loss twinless twin".)  The causes of stillbirth and neonatal death among twins are slightly different from those in a singleton birth,  in that there are two babies to be delivered.   Perhaps the second baby is at risk because of being left in the womb after the delivery of the first,  plus very often being in the breech or transverse presentation , which makes delivery very difficult.  However I have heard stories of womb twin survivors whose twin was born first and still dead at birth, so this does not necessarily follow.

We never knew there were twins!
There are also stories of twins who are delivered unexpectedly because no one realised that there were twins - where the twin hearts beat as one, in the absence of ultrasound there can be no clue - except perhaps the fact that Mum is very large.  In this case, where the first twin is born alive,  it all seems to be over and the baby is here, only for there to suddenly be another baby, born dead but un-looked for and therefore never fully acknowledged.  This little baby may never be named or mentioned again - that is, until the survivor comes asking questions!

If the first baby is born dead, then the second arrives as the unexpected "redeemer", a miracle, a living second twin! 

The twin bond remains
If your twin was there with you and alive until birth, then the bond you have with him or her is as strong as any twin whose twin sibling is still alive.  For a twin, the primary attachment is the twin because that was the first relationship - the first lesson in love.  This is no less the case because the twin died at birth.   You had nine months in the presence of another living, responsive little person and that experience is hard-wired into your memory.  It has become the template for all your relationships in born life, as you seek out your twin, and your sense of twin-ship, in others.

More in this book

Chapter three: The death of a twin around birth

Chapter Three : the death of a twin around birth

This chapter was so sad to write. There are some very sad stories included, sent to me by womb twin survivors, but I can't publish them here because of copyright and privacy issues. They make poignant reading.

Multiple pregnancy is dangerous for both mother and babies. There is a higher incidence of neonatal death, SIDS and stillbirth in a twin pregnancy than in a singleton pregnancy.  If your twin died in the third trimester or around birth, then you can call yourself a womb twin survivor, because you only knew your living twin when you were together in the womb.

Here is a snippet for you:

Stillbirth of one twin
When labour begins, even after careful examination of the mother, it is not always obvious that there are twins.  These days, a twin birth is often induced early or at least monitored with extreme care.  However, before ultrasound scans - and even today in less well-equipped hospitals - it can happen that a second baby is delivered and takes everyone by surprise. Under those circumstances things can go very badly for the second twin, especially if he or she is in a breech presentation (head uppermost.)  With these unexpected twin deliveries, the second baby is often stillborn or lives only for a very short time.  Many do not survive the trauma of birth. The stillbirth rate in twins is double the rate for single births.

Accidental death of one twin
Even shortly before birth, a trauma to the womb or the mother may cause the death of one twin by precipitating a sudden labour when insufficient medical attention is available to prevent disaster.  Sometimes one baby is born dead as a direct result of the trauma.

Umbilical cord complications causing the death of one twin
The average umbilical cord is about 55cm long.  If the cord is much longer it can twist into a knot and the blood supply can no longer reach the baby, in which case the baby asphyxiates and dies.  If it is too short, then when labour begins, the placenta may be torn from the wall of the womb causing a fatal haemorrhage.  When MZ twins share an amniotic sac, the two cords may become entangled and the blood supply to one or both babies may be interrupted, with fatal consequences.  Also a longer cord can become wrapped around the neck of one of the babies, who is at risk of asphyxiation during delivery.  As prenatal ultrasound is becoming  increasingly sophisticated, many of these conditions are being diagnosed before birth.  However, some of these problems are not apparent before delivery, even with the idea of ultrasound.  Where the placentas of DZ twins overlap, this may badly affect the position of the cord of one twin.  Meanwhile, the other twin has a centrally-attached cord, and will thrive and grow rapidly, while the other, with little access to nourishment, will be much smaller and may not survive.

Infection causing the death of one twin
Bacteria entering the vagina can cause an infection and inflammation of the amnion and chorion (the membranes surrounding the baby.)  If an infection develops in the third trimester of an MZ twin pregnancy the inflammation of the shared membranes can trigger premature labour, as a result of which one or both twins may be born dead or die at birth.

More about this book

The death of a twin: the same story, again and again

Some  of the 90% of  the population who have no experience of twin loss claim to know that womb twin survivors "make it all up"; that they are seizing on this idea to "explain all their troubles away." Yet time and again I hear the same story. Here is an example. 

More than half a century has passed since Mary Billingdon’s twin sister was stillborn. Here, Mary talks about the sister she always felt was missing from her life, and the heartache it has caused her.

Mary and her sister Rosemarie were delivered in April 1953 after their mother Elizabeth was rushed into hospital suffering from pre-eclampsia. All three lives were at stake and doctors battled to save mother and both children. They managed to save Elizabeth and deliver Mary safely, at just 3lb 7oz. But Rosemarie was stillborn and weighed a whole pound less than her sister.

Mary recalls: "Mum was 29 and we were to be her first babies. She never really got over losing Rosemarie. In those days, people didn’t like to talk about such things, it was out of sight, out of mind.

"But Mum always introduced me to people as ‘one of the twins’, it was as though she didn’t want to let her go.

"I missed my sister right from the beginning. While other children had imaginary friends, I had Rosemarie. I’d sit on the bus and if someone tried to sit on the seat I’d immediately say: ‘Don’t sit on my twin sister!’ Our nanna, who was with me, would be embarrassed, but I was adamant Rosemarie needed somewhere to sit," she said.

Mary said: "Right from an early age I felt something was missing from my life – it was as though there was a part of me missing that could never be replaced. Mum had never hidden from me that I should have had a twin sister and I grew up knowing about her from the start.

"The bond between twins starts early in the womb. We had shared a placenta and an amniotic sac, and after our birth I still felt there was a bond that would never be broken. I remember playing with twins at school, desperately wishing Rosemarie was still alive so we could all play together.

"I had close friends but I still felt lonely and longed for my twin. I chose twins as friends so I could see what it was really like – what it would have been like if she had been there too. I was envious of those twins, who had each other while I had to pretend," she added.

"As I grew older, guilt crept in – guilt that I had lived and Rosemarie hadn’t. While I was staying with my nanna once I asked why I had survived and not Rosemarie. She joked: ‘you were the greedy one, you were a whole pound heavier’, but I was just seven years old and I took her words literally and blamed myself.

"For years I carried that burden around, feeling guilty that I’d survived and not you. I tried to compensate by being over generous to people, anxious not to be seen as greedy.

"It wasn’t until mum died nine years later that I finally realised it wasn’t my fault. As she lay dying of bowel cancer we talked a lot about you. She reassured me that I wasn’t to blame.

"Every time I look in a mirror I think of her. We were identical twins and I think we would have led identical lives. I think she would have been a nurse, like me.

"I wonder if she’d have looked exactly like me, dressed alike. I remember when I was eighteen, mum and I were shopping when a man stopped us and admired my legs. Mum was horrified but I wondered what he would have thought if Rosemarie had been there too, in an identical skirt. We could have hit the catwalk as twin models," she laughed.

Shortly after her 18th birthday, Mary’s best friend Heather died in a car crash.

"I was devastated at losing Heather. Over the years I’d always tried to compensate for not having Rosemarie by having very close relationships with my friends. In a way they were substitutes for her, and I felt doubly devastated by Heather's death.

"My one regret is that I can only talk to Rosemarie in my head because I have no grave to sit beside. When she was buried in a tiny white coffin. The church decided to put her into a grave that was being dug for another body so that they didn’t need to dig a tiny hole.

"We never knew which one she was in. I have recently trained as a bereavement counsellor and it has finally helped me come to terms with her death. I am helping other people who have lost babies and twins and I feel I am putting my grief to good use.

"I am now at peace with my past and hope one day I will be reunited with my twin after a lifetime apart."

This is her story

Womb twin survivors are not making it up. The twin bond was formed in the womb but broken by death and needs to be grieved normally, freely and publicly.  But first we need to overcome this block that exists in some peoples minds,  that this is nothing but a fantasy.

90% of the population have no experience and do not understand - how dare they claim to know anything about this!  It makes me really angry.

The death of a twin at birth - a new play

Hallo I must be going

A new play for the New York fringe theatre

FringeNYC Festival Review
Martin Denton · August 14, 2010

Hello, I Must Be Going begins with the sound of Groucho Marx singing the song of that title; the paradox of that lyric is at the heart of this drama by Albi Gorn, though not, in general, its fractured sense of humor. The play concerns Harvey, who when we first meet him is just a few days shy of his 50th birthday and also about to be a father, for the first time, of twins. But he's saddled with ambivalence because his father, Maury, has recently suffered a debilitating stroke that has left him unable to speak and paralyzed on his right side. And then very real tragedy strikes when one of the twins is stillborn. (The other, a healthy boy, is named Julius—Julie for short—in honor of Groucho, whose real name was Julius Marx.)

Gorn's play explores how happiness and sorrow co-mingle in the lives of Harvey and his wife, Emma, as they celebrate the birth of their son, mourn the loss of their little girl, and try to come to terms with Maury's fading health. The play is adventurous, in places: Maury is represented by two actors, one of whom speaks his thoughts and also portrays him as a younger man in a series of flashback scenes depicting Harvey's relationship with his Dad over the years. More interestingly, the unborn children are played by adult actors who speak their "thoughts" from inside the womb; and baby Julie also is seen to speak his own, very grown-up thoughts even as he "acts" like the tiny infant that he is.

For me, the most interesting idea raised by the play was how the death of a twin in the womb might affect the survivor: Gorn theorizes that Julie misses his sister rather severely, though he seems hopeful about Julie's ultimate ability to overcome this trauma.    More here

You tube Interview with Albi Gorn

Is this another womb twin survivor, I wonder?  His latest play is about forgiveness,  that's a big issue for womb twin survivors........