When parents learn they are pregnant with twins, it is such a blessed moment in their life. They feel so fortunate and chosen by God to have such a special gift. The parents dream of holding two babies, dressing them the same and watching them grow up together. This is what God intended. God did not make a perfect world though. There is evil in this world and one form of it is a disease called twin to twin transfusion syndrome. It does not care who it hurts, and it always happens to the parents who want and love their babies so very much.
When parents learn that one of their babies has passed away, life will never be the same again. There is deep sorrow and shock. There is confusion about whether or not to deliver the babies. There is no reason to deliver the babies, unless the surviving baby is in major distress. There is a risk that the living baby may bleed blood into his or her twin, through the connecting blood vessels in their placenta that caused the twin to twin transfusion syndrome in the first place. If this happened, it was instantaneous at the time of the loss and already happened by the time you determined the loss. Delivering the babies will not prevent it.
There is a period of about 2 weeks where if there are no signs of distress with the surviving baby then this "bleeding" in laymen's terms, most likely did not happen. The parents should feel confident that their baby should be OK. The mother should also be getting blood work done to make sure that her blood clotting mechanisms are working correctly within her own blood supply. This is a small risk, but one that should not be ignored.
When one of the parent's babies has passed away, they often hear hurtful comments, "They were not meant to be", "You could not have handled both", "God needed him or her more", or "He or she was too sick to survive." All of these statements are not true. Parents need their baby to be recognized throughout the pregnancy as being a beautiful, healthy baby. It is just that the disease took its toll. An important message to tell the parents is that their baby will always be their baby, and that they will always be twins. It is not that they 'were' twins...it is that they 'always will be.' The parents will always be the parents of twins too. The status should never be taken away from them. Ways the status could be taken away is starting to call the pregnancy a singleton pregnancy. Make sure that you communicate with your staff that when the patient comes in for future ultrasounds or nonstress tests, that the nurses should not ask the patient why they are there. The nurses SHOULD KNOW! Parents who have to continually go over and over how one of their babies passed away are tortured by this.
It is also important to understand
that you do not have to tell the mother to be "strong"
for the other baby or that she cannot cry. This is not true.
The mother will be strong without even trying. It is OK
to cry and being given the permission to cry and grieve
for her baby is what will help her most in the end. If the
mother tells you that she can't go on, that she does not
know how to make it through this, of course tell her to
call us. Tell the mom, she does not have to try, her body
will do the work for her. This will be a tremendous load
off of her. We will help her with the emotional devastation,
but let her know she does not have to try.
We are here to talk, listen and cry with your patients. We help them continue their pregnancy after a loss and plan for the compassionate delivery of their babies. Talk with them about the delivery before the delivery day. Encourage the babies to be named and use the names. It is a huge blessing in disguise to have to 'go longer' in a pregnancy with a loss. This time can be used to plan for the compassionate delivery of the babies and the keepsakes the family will treasure for a lifetime. Many doctors scare parents into thinking there will 'be no baby to see'. We have found that rarely to be true even with early losses. Even if the baby has formed to the placenta, work with pathology and have the baby removed. Place the baby, it does not matter how small, in a blanket and put both babies in the mothers arms. She deserved so much more then this, but at least this. Please read 'Compassionate Deliveries' for more specific information. The key is to always keep the status of 'mother and father of twins'.