Twins again? – dealing with trying again…

Here are some of the special issues for parents looking at childbearing after a multiple birth loss:

· Twins and multiples are so special. Unlike bereaved parents of singleton babies, none of us can say, “Well, I think I’ll go ahead and have my next set of twins or triplets” (and this time “make” it come out right and have the same as what we lost), even if fertility technology is involved. We have to face the multiples being a once-in-a-lifetime event, and knowing that everything about the next pregnancy and its outcome is likely to be very different (and if the multiples were the first babies, unfamiliar) after being accustomed to all the extra attention and other things involved with a multiple one.

· Those of us whose multiples were our first children, perhaps after fertility technology, have to deal with not knowing what a normal, singleton pregnancy would be like for us, (or if we were pregnant with twins or more again, would there be a way to prevent what happened last time). We have to ask ourselves whether the complications of the multiple pregnancy were the exception or the rule for us, with no way yet of knowing for sure. To our memory, with one exception, we haven’t had any members who had lost one or more multiples to prematurity, later lose a subsequent single baby to prematurity, though some pregnancies have still been complicated (and the majority of those who have conceived multiples again have made it at least just far enough this time, see below).

· At some point or another, most of us are pretty obsessed with having twins or multiples again, even though we know we’d be very scared if it actually happened. It’s a fantasy that can actually help us cope. For those of us who are not involved in fertility technology, it means wondering what our chances would be of conceiving twins again, especially if we know that there are twins in our family. That is an article in itself…and in fact one was once written on that topic by a member who lost twins in her first pregnancy, lost one of twins in her second one, and had living twins in a third one – all without fertility treatment. Her experience was by far the exception. Almost all of us end up having to realize that – even though we have had twins once, and there may be a history of fraternals on our mother’s side of the family – 1 out of 50 instead of 1 out of 80 still means a 49 out of 50 chance that we won’t have them again next time. Some have told themselves (and their husbands) that they get “X” number more pregnancies to try to get their twins again! and others of us have told ourselves that while our pregnancy now is a singleton, we can always try again and have our twins “next” time, even though we don’t actually try again later (it can be nice to keep the fantasy going a bit). Others, especially those who have lost both their twins, have found themselves having subsequent children very close in age, sometimes exactly a year apart, and telling themselves that if they can’t have their twins, this is the next best thing! There are also some special issues about this in regard to identical twins, which are even less likely than twins in general and do not have a link to family history, and so are both special AND less likely to happen again. But especially for those with a very premature surviving twin, and even more so for those with more than one surviving higher order multiples who were very premature, having a nice, normal singleton pregnancy and getting to enjoy the perks of the third trimester and a “typical” birth and homecoming has much to be said for it, as it does to any of us.

· Some parents know definitely that they will need fertility technology to become pregnant again, and need to decide about when to begin again physically, emotionally and financially. Others know that there is a chance to conceive spontaneously, and choose to try that at least for a while. Some undergo fertility treatments but do not conceive, then have to give up but then conceive spontaneously. All in all there have been really a lot of members whose twin, triplets or more were conceived through fertility technology but had subsequent children who were conceived spontaneously.

Among parents who do conceive again through fertility technology, there are quite an amazing number in our group who have had subsequent multiples successfully. The number of people with multiple multiple pregnancies and births has risen dramatically, and many would-be parents are having combinations of experiences and outcomes that would have been out of the question even 20 years ago, and seem off the map. The most prevalent has been parents who have lost both twins, or all triplets or quads, having subsequent living twins (and one such family has now had two sets, both born at term, another has subsequent and older twins, one mom has conceived triplets three times, others have conceived twins four times), but there are also quite a few among families who have lost one of their twins or higher multiples as well. Some families, perhaps ten that we’ve known, have had subsequent triplets successfully. After everything we have all learned the hard way about the risks of even twin pregnancies, as well as the difficulties of selective reduction, everyone has been extremely careful not to conceive more than they thought they could safely carry. With one exception when the third egg split, no one has conceived more than three again. Some have lost subsequent multiples and had success with “single-embryo IVF” knowing then they could not carry multiples again; others have lost one of subsequent multiples to risks that were not preventable. (Some stories of these experiences are in several sections in this site.) Some of the pregnancies, including that of Darcie in this section, have been uncomplicated medically – though still very carefully monitored and conservatively treated – and others anything but. Mothers like Emily, whose story is in this section, have spent many months on bedrest and in the hospital on medication in order to make it just far enough to make the difference, then gone on to experience life in the NICU.

It’s safe to say that parents who do bring home subsequent twins or triplets are very grateful indeed for the chance to have them, to raise living multiples, and to be recognized in society as the parent of multiples. At the same time, many find – similarly to the experience of parents who lose a twin – they are seeing what they are also missing in ways that they could not have truly imagined before…and that truly no one replaces anyone, and nothing makes us like it never happened or didn’t matter. When “the twins” are commented on, it raises the issue of whether to say they have had two (or more) sets of twins or multiples; and if they have a surviving twin, there is how to relate to that child about what he or she can see he is missing.

· Parents who have a surviving twin or higher multiples also have some special issues about the timing of another pregnancy, if it is possible and desired. Many have a survivor(s) who was premature and whose care is very demanding, and they and even parents whose baby is completely healthy are often pretty flat-out physically and emotionally caring for the babies or babies, grieving for the one or ones who died and also dealing with the strong fear that we often have for our survivors. Add to that any uncertainties about becoming pregnant again, along with getting through the pregnancy and birth and the outcome of it, and many of us have found it helpful to wait at least a year or more to have the physical and emotional strength for it all and to enjoy the pregnancy and new baby as much as possible, as well as meet any challenges. (Meanwhile, that practice in coping with fear can come in really handy later, and the fantasy can linger a little longer!). Also…some parents who had an older child, then lost a twin, find themselves deciding to have another child through birth or adoption even though before the twins they had completely expected to have a family of two children, especially if there are gender issues involved. It’s very hard to lose “my son” or “my daughter” in addition to “my twins”, and it’s difficult to end one’s childbearing with a tragedy instead of the joyful occasion we all need and deserve it to be.

It’s really helpful for parents to look at all their thoughts and feelings, and get all the support they can for their new journey, to help make it the most joyful that it can be.