How Couples Cope With the Death of a Twin or Higher Order Multiple

Abstract

Fifty-two Australian couples who had experienced the death of at least one member of a multiple birth (twin or higher order), with at least one survivor of that birth, were interviewed about their experiences at the time of the death, and since. This study compared parents' coping after the twins' deaths using the Beck Depression Inventory II, Perinatal Grief Scale, and unstructured interviews with some structured queries. Parents provided information on the influence of family, community and medical staff. According to retrospective reports, mothers experienced significantly more depression and grief than fathers at the time of loss. Both parents found the death of their twins grievous, but fathers, unlike mothers, were not encouraged to express their emotions. Although parents generally agreed about what helped them cope, fathers believed that they should be able to cope regardless of their grief. The strength of parents' spiritual beliefs had increased significantly since their loss, and there was some evidence that depressed and grieving mothers turned to spiritual support. Parents whose children died earlier reported levels of depression similar to those reported by parents whose children died later. To date, this is the largest study of grief in couples who have experienced the death of a twin and who have a surviving twin or higher order multiple.

The experience of parents who lose a baby of a multiple birth during the neonatal period – A literature review

“…Swanson et al (2002) reiterated these findings, by suggesting that mothers avoided attaching to survivors, likening it to a self-defence mechanism to protect against further emotional pain. In contrast to these papers findings, another retrospective comparative survey by Swanson et al (2009) found that as a couple; mothers and fathers favoured and found solace in the presence of a surviving co-multiple.…”

“…Of the bereaved multiple (continued on next page) Experience of parents who lose a baby of a multiple birth birth mothers who took part in Swanson et al (2002) study, 67% recorded that they had experienced a disenfranchised response following their infants' death. Many stated that they were encouraged to feel "fortunate" that they still had one or more living child, and therefore felt that they lacked the permission to grieve following the death (Swanson et al 2002(Swanson et al , 2009). Another bereaved multiple birth parent confirmed this feeling by stating; "it was cruel of people to console us by saying that we still have a baby who survived" (Netzer and Arad, 1999).…”

“…Whilst, within the same cohort of parents, 25% did not wish to be constantly reminded about their loss, although the majority appreciated HCP who cared for the living infant, without forgetting the deceased (Pector, 2004a). 'Hurtful' comments from HCP such as "Just be glad your survivor's alive" (Pector, 2004a), "you are young, you can have another", "but you still have one" (Swanson et al 2002(Swanson et al , 2009, "it happened for a reason" (Pector, 2004b) were documented across several papers. In a study looking at parental attitude following perinatal death, half of the sample stated that they were not given the opportunity to participate in EoL decision making and subsequently felt unsupported by HCP during this time (Einaudi et al 2010).…”

“…Although they required support from their family and friends, they felt that they were inadequate in providing this, because they did not understand or accept the loss (Netzer and Arad, 1999). In spite of this, support from family and friend networks was identified as helpful to both mothers and fathers in aiding long-term coping (Swanson et al 2009). Comments made by other families on the NICU were found to be particularly painful, and given their troubled emotions, parents did not wish to hear about, or be around intact sets of multiples (Pector, 2004a).…”

Recorded Pregnancy Histories of the Mothers of Singletons and the Mothers of Twins: A Longitudinal Comparison

“…Additionally, mothers who experience the death of a multiple are more likely to experience mental health problems such as prolonged anxiety, depression and grief 5 years after the death, than mothers whose singleton died (Swanson et al, 2009). Prior studies have also identified single maternal marital status and extremes of maternal age as risk factors for poor perinatal outcomes in multiples (Salihu, 2005) The risk of adverse outcomes in twin pregnancies may be reduced by careful monitoring of the mother in the antenatal period (Campbell, 2001;di Renzo et al, 2001;Zhang et al, 2002).…”