ABSTRACT
The rising incidence of multiple births increases the likelihood that care-givers will encounter death among a set of multiples. Although many advances have occurred in the management of multiple pregnancies and in the care provided to newborns, circumstances such as those listed in Table 103.1 continue to sadden many families each year1,2. Indeed, some parents experience more than one type of bereavement with the same set of multiples, and complicated grief is especially likely with multiple birth loss3,4. This chapter reviews the factors that influence a family’s reactions to a multiple-birth loss, and offers practical strategies to care-givers who strive to ease suffering. Miscarriage of all fetuses
First-trimester loss of some fetuses (‘vanishing twin/triplet’)
Later intrauterine demise of some or all fetuses
Multifetal pregnancy reduction (MFPR)
Selective or complete termination for anomalies (ST)
Expectant management with one or more anomalous fetuses
Delayed-interval delivery
Twin-to-twin transfusion syndrome (TTTS)
Monochorionic complications (monoamniotic, conjoined, other)
Intrapartum demise
Delivery before viability
Delivery at limits of viability
Sudden infant death syndrome (SIDS)
Accidental death
OVERVIEW OF MULTIPLE BIRTH LOSS
Grief characteristics
Each bereaved family of multiples brings a unique perspective to their loss, and parents with similar circumstances often exhibit different reactions, as they lose not only their fetus(es) or child(ren), but also the challenge of raising the original number of multiples2,5. Their responses to loss are influenced by their feelings about having multiples1, as well as ethical, logistical and medical dilemmas that arise, and the need to juggle feelings and decisions for many children at once2.
