When One Twin Baby Lives But The Other Dies

(stitches1975 via compfight)

(stitches1975 via compfight)

By Dr. Karen O’Brien
Guest contributor

Never before in my obstetric practice have I taken care of so many twin pregnancies. What I witness in my own office is part of a nationwide trend: Over the last two decades, the twin birth rate in the United States rose 76 percent, from 19 to 33 per 1,000 births.

And never before have I taken care of so many twin pregnancies with complications.

The specific complication that has given me pause in the last year or two is the loss of one twin, either during or after pregnancy.

This doesn’t happen often, but I have taken care of a number of patients recently who have lost a twin during or shortly after pregnancy. And I’ve learned that though outsiders might see a glass half full, this experience is uniquely devastating, both emotionally and medically.

We must all understand that the life of one twin does not eradicate grief for the sibling who died.

The hope and anticipation of bringing home two healthy babies comes grinding to a halt. The joy of delivery is clouded by sibling loss.

As early as 18 weeks, Melissa’s identical twins showed signs of a complication called twin-to-twin transfusion syndrome, which occurs when one of the twins essentially donates blood to the other.

At 19 weeks, Melissa underwent surgery to try to correct the problem. Unfortunately, two days after the surgery, one of the twins passed away. Melissa remained pregnant for 13 more weeks and ultimately underwent cesarean section at 32 weeks.

She and her husband were able to hold the deceased twin for several hours after delivery. Her live twin did well; she spent a few weeks in the neonatal intensive care unit (NICU) and is now home and thriving.

Samantha’s twins were not identical, and were conceived through in vitro fertilization. At 14 weeks, we found that one of the twins, a boy, had several serious abnormalities. Even at that early gestational age, we knew that he would not live for long after birth, and might pass away during the pregnancy. The other twin, a girl, appeared normal throughout the pregnancy. Continue reading

Help For When Grief Gets ‘Complicated’

Mourner at a funeral for a school shooting victim in Newtown, Conn. (AP Photo/David Goldman)

A mourner leaves a funeral for a school shooting victim in Newtown, Conn. (AP Photo/David Goldman)

Even after all the funerals in Newtown are over, the mourning will long go on. If experience is any guide, the heartbreak there will slowly heal with time. But for some who lost loved ones, the pain of bereavement may remain intense and constant, even years afterward.

Psychiatry calls this ‘complicated grief.’ ‘Complicated’ meaning not complex but that the healing process that normally occurs, after even a sudden and terrible loss, goes somehow awry. It develops a complication, like an infection in a wound. Complicated grief is under consideration to become a new official diagnosis, and psychiatrists have developed specific therapy to help patients who become “stuck” for years in their grief. Carey Goldberg, of WBUR’s CommonHealth blog, explains:

One beautiful July evening, as 62 year-old Gerrit Schuurman was cooking dinner, he told his wife, Cynthia, that he was having some trouble swallowing. Two days later he was dead, killed by an aneurysm his surgeons said was like a ticking time bomb in his brain.

Numb, disbelieving and alone after 37 years of marriage, Cynthia soldiered on. She left Germany, where she and Gerrit had been living, and returned to her native Boston. She found work as a teacher trainer for a non-profit, spent time with her new granddaughter.

Cynthia Leblanc Schuurman found that Complicated Grief therapy helped her. (Carey Goldberg)

Cynthia Leblanc Schuurman found that Complicated Grief therapy helped her. (Carey Goldberg)

On the outside, Cynthia was doing all right. But not inside. Every pleasure was soured by sadness; she obsessed about Gerrit’s death — “Why did this happen? Could I have done something?” — and the parallels with her father’s sudden death when she was just 13. The grief just wasn’t letting up, and it threatened to break her.

“I thought, well, I’m going to feel better in a year. People always say the first year is very difficult,” she recalled. “Other people told me the second year is even worse in the grief process,” she said. “And the second year came and it was worse. So I thought okay, maybe by the third year I’m going to feel better. But I was going through the motions. I was functioning but inside I was a mess. I was very, very upset and crying when nobody was around…About the third year, I was in a class, I was teaching my students and I broke down in the middle of a sentence.”

“The day I had that ‘mini-meltdown,’ I sent up a silent prayer to God and the universe saying, ‘I need help, please help me.’ So on the way home on the train there was a big sign, a big poster, an advertisement poster for ‘complicated grief.’ It said, ‘Are you crying all the time? Are you depressed? Are you stuck in grief?’ And I said, ‘Well, that’s me, it has my name on it.’”

Dr. Naomi Simon, head of the complicated grief program at Massachusetts General Hospital — the program Cynthia noticed in the subway ad — says people can ‘get stuck’ in grief for a wide variety of reasons. Continue reading

Must-Read: Coping With Newtown Begins With Feeling

Flowers, candles and stuffed animals make up a makeshift memorial in Newtown, Conn., on Monday. Much of the initial news coverage of Friday's events was later found to be inaccurate. (Reuters/Landov)

Flowers, candles and stuffed animals make up a makeshift memorial in Newtown, Conn., on Monday. Much of the initial news coverage of Friday’s events was later found to be inaccurate. (Reuters/Landov)

You may have noticed a gesture that many of us feel compelled to use when we talk about the Newtown shooting: You hold your stomach and lean forward, as if punched, as if sick. I’ve seen it several times now, and find myself using it as well, a physical expression of the emotional pain.

I asked a teacher of great Buddhist wisdom the other day: I know compassion and empathy are good, but do they have to hurt this much? I was hoping she’d share ways to lessen the pain with distance or acceptance, but no, she simply confirmed that empathy and compassion can be “very, very painful.” The very etymology of compassion is com — “with” — and passion — “feeling.” You’re feeling with the victims.

A beautiful essay by the author Leah Hager Cohen on WBUR’s Cognoscenti today takes a valuable next step, arguing that feeling is the first step toward coping, in that allowing ourselves to feel then leads to following our feelings to needed action. She concludes:

To feel is good.

It is a kind of intelligence. It’s a first response which may spur us — if we don’t hasten to deaden it — to further response: to action.

If the reason this latest event stands out from the rest has less to do with its uniqueness and more to do with the tender age of the majority of those killed, how shall we make use of our emotional response? How shall we let it — our grief — inform us? Continue reading