The early loss of a twin happens when one of the embryos stops developing. Later losses, after 20 weeks or even shortly after birth, may happen because of complications such as infection, maternal health conditions, or problems with the placenta or umbilical cord. Sometimes the reason is unknown. Occasionally, a medical termination of one twin allows the other to survive.
Making sense of this kind of loss can be unimaginably difficult, and you may never have all the answers. But learning more about why the loss of a twin or multiple happens may help.
What causes an early loss (miscarriage) of a twin or multiple?
Sometimes one twin or multiple miscarries early in pregnancy for the same reasons other early miscarriages happen — most often due to chromosomal abnormalities. In this case, the affected twin stops developing while the other twin continues to develop normally.
These early losses, often called vanishing twin syndrome, are fairly common, affecting between 10% and 40% of multiple pregnancies. Vanishing twin syndrome most often occurs in the first trimester, sometimes before a woman even knows she's carrying twins.
When symptoms do occur, they're similar to those of a miscarriage in a singleton pregnancy. These can include:
- Mild cramping
- Vaginal bleeding or spotting
- Pelvic pain
In some cases the only sign is that a second fetus is no longer detected on an ultrasound after previously being seen. But if a woman miscarries before she's had her first ultrasound, she may never know that a twin or multiple was lost.
"I had a vanishing twin when pregnant with my daughter, but it happened early on before both babies had heartbeats," says What to Expect Community mom P247. "It was so upsetting. But my daughter remained healthy and I had no major issues the rest of the pregnancy."
What causes a later loss (stillbirth) of a twin or multiple?
When a twin or multiple is lost after 20 weeks of pregnancy, the loss is considered a stillbirth. Stillbirths can result from a number of complications, including:
- Problems with the placenta
- Infection
- Umbilical cord issues
- Maternal health conditions such as high blood pressure
In up to a third of cases, however, the cause of the stillbirth is undetermined.
A lack of fetal movement or kicks may be the first sign of a stillbirth in a singleton pregnancy. A woman pregnant with multiples may notice a decrease in movement after one fetus is lost. The reduced movement may be limited to one area, with movement still felt where the other fetus is located.
Less movement or a change in movement doesn't automatically mean a stillbirth has occurred. Only a lack of fetal heartbeat, which is usually detected via ultrasound, can confirm a stillbirth.
In some cases, one or more babies are lost during or just after birth. When this happens, the mix of emotions can be overwhelming, and there is no "right" way to feel. You're in the very difficult position of celebrating the birth of one or more baby while mourning the loss of the other(s).
"Children are not interchangeable, and just because you have one baby doesn’t make up for the loss of the other," says Community mom babykeys32, who lost one of her triplets.
Why might a medical loss of a twin or multiple be necessary?
While many pregnancies progress without major issues, in some cases one or more of the fetuses may be unlikely to survive in utero or after birth. And sometimes the at-risk twin or multiple may be endangering the life of the other healthy baby (or babies) or the life of the mother.
In cases like these, your practitioner may recommend medically terminating one or more fetuses so that the other one or more can survive, if it's legal where you live. This procedure, called multifetal pregnancy reduction, can be agonizing for parents.
Facing a decision like this can be devastating. While there are no easy answers, having a detailed conversation with your provider is an important first step. Together, you can weigh the risks and benefits of your specific situation until you're as confident as you can be about your choice, according to the American College of Obstetricians and Gynecologists (ACOG).
There are a number of other supportive specialists you might consult for guidance in making your decision, such as a:
- Maternal-fetal medicine expert (perinatologist)
- Neonatologist
- Child development specialist
- Clinician who specializes in multifetal pregnancy reduction
- Mental health professional
- Bioethics staff member from the hospital, if available
- Spiritual counselor, if religion plays an important role in your life
Connect with other moms who have lost a twin or multiple, get expert advice, and record your memories in the What to Expect app.
How can I cope with the loss of my twin or multiple?
There's no right or wrong way to feel after losing one of your babies, and there's no clear roadmap for how to move forward. Pregnancy loss is always devastating, and feelings can become even more complicated with multiples. In addition to working through your loss, you're still preparing for taking care of a newborn — and experiencing all of the emotional highs and lows that come with it.
It's normal to have deeply conflicting emotions that can shift from moment to moment. You might feel immense joy while holding or feeding your newborn, then be overcome with sadness or anger when thinking about the baby who isn't there. In some cases, your baby may remind you of the twin who was lost, making it harder to fully enjoy time with your newborn.
"The joy of having one is complicated by the pain of losing the other," says Community mom ajeremica. "While it is such a comfort to have my survivor, she is also a constant reminder of her identical twin sister that we lost."
You might also feel guilt or confusion. Along with mourning your own loss, you might grieve over your living child's loss or wonder why one baby survived and the other didn't.
"I struggled with feeling sad for the baby I lost but happy for my surviving baby at the same time. And sometimes I felt guilty for feeling more sad than happy," says Community mom tryingforbabyc.
Take as much time as you need to grieve in whatever way feels right. How long it takes to start feeling "normal" again can depend on when and how the loss occurred. Seeking support from your partner, family, friends, or a mental health professional can help. Taking some time to rest, if you're able to, is also important.
"I find the more I talk about it the easier it is for me to emotionally heal," says Community mom evengeliapolis.
You might decide to do something to honor the baby you lost — anything from having a quiet day of reflection, to collecting keepsakes from ultrasound pictures, to planting a tree in your baby's honor, to naming your baby and having a memorial ceremony. Let your emotions guide you to what feels meaningful and healing.
Keep in mind, too, that acceptance is different from "moving on" or forgetting. Even though you still have a baby (or babies), they won't replace the one that you lost. You'll always remember the baby that isn't with you, and, over time, you may find ways to talk about the loss with your child. As time passes, the initial shock and pain usually begin to soften, and you'll continue growing into your role as a parent.
There's no timeline for healing. But as weeks and months pass, you should gradually start to feel better. If you're not, or if you're experiencing symptoms of anxiety or depression (such as trouble sleeping, lack of appetite, trouble focusing, or feeling isolated), reach out to a mental health professional.
What is physical recovery from the loss of a twin or multiple like?
It's natural to focus on the emotional impact of pregnancy loss, but your body is also recovering physically. What that looks like and how long it takes for you to heal depends on when the loss occurred.
Early losses may cause bleeding or cramping for a few days, followed by spotting for a few weeks. Losses later in pregnancy often involve a longer recovery. Though it can be difficult to think about, C-section or vaginal delivery where one of the fetuses is stillborn is typically similar to that of a multiple birth where all babies are alive. And so is the recovery.
Common postpartum symptoms include:
- Heavy bleeding, which usually tapers off over about six weeks
- Cramping, which may continue as your uterus shrinks back to its pre-pregnancy size
- Perineal discomfort
- Fatigue
- Body aches
- Breast engorgement
If you had a C-section, you'll also be healing from the incision.
Navigating the loss of one twin or multiple may be one of the most difficult experiences you face. Don't hesitate to reach out for support and give yourself time to heal both physically and emotionally.
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