Early ultrasounds often detect the presence of two babies, yet as the pregnancy proceeds, one of the embryos dies and slowly disappears, his body absorbed by the placenta, the mother, or his twin. Though more probable as the title of a Nancy Drew mystery, this unnerving process has been named the Vanishing Twin syndrome. The reabsorption process may be accompanied by bleeding or cramping, or it may be completely unnoticeable. A silent death. A quiet loss. The only witness is the other twin.
I did not have any early ultrasounds; a seemingly uneventful first trimester made scans unnecessary. I distinctly recall noticing a teeny spot of blood sometime near the end of the first trimester, but that was all, and certainly within the norm. I didn't bleed at all for the rest of the pregnancy.
About twenty weeks on, I thought I was miscarrying. Lower back pain...cramping...but no bleeding. A quick scan revealed just one baby, our son lying healthy in my womb, his little heart pumping. It even looked like he waved at us. That scan failed to detect the second placental lobe, so despite a 'feeling' early on that perhaps there were twins, these miscarriage symptoms, and some dreams of multiples, there was nothing that occurred during the pregnancy that should have led us to explore the possibility of the existence of a twin.
Wondering if you had another child, but not knowing for certain, is bewildering.
We tend to think that 'bewilderment' is synonymous with 'perplexing', but its etymology means 'to be thoroughly lead into the wilderness'. The wilderness of the human heart. I am lost in the deafening silence of the forest, uncertain whether to fully enter into the valley of the shadow of death, or retreat to the safety of my happy home life. Like the mother of a missing child, I am stuck. There is a time to mourn, says Ecclesiastes, but is it that time? Am I deceiving myself--am I a fool, if I embrace the pain of loss--am I mourning a shadow, an imaginary child? Or do I dishonor a very real baby who is gone by failing to believe, by needing proof before careening heart-first through the remaining trees into the ravine of grief?
An uncertain grief, a tentative grief, feels like I am playing make-believe with my heart, and it will have none of it. Yet with no chance in this world to ever know for certain, it remains a quiet, unresolving pain.
Despite scouring the internet for information on vanishing twins, for information on the grieving process complicated by this syndrome, I have been sorely disappointed. This is a relatively common situation, yet sadly, it appears that very little practical help is available. The few articles I could find concerning grief and vanishing twins seem geared to the loss of a multiple later on in the pregnancy, as if grief is only appropriate when the child you lost is a fetus. Yet despite that, I am grieving my little lost embryo. I am grieving the experience of a twin pregnancy, since I didn't even know there were twins until it was already over. I am grieving the experience of birthing twins. I am grieving the experience of nursing twins. I am grieving the experience of raising twins. My heart has fallen off a wall and shattered and 'all the king's horses and all the king's men' couldn't put it back together again.
I have hesitated to share this part of my story. I have hidden it away. The dramatic circumstances surrounding my surviving son's birth seemed so fantastical that I thought that telling this part of my suffering would be 'too much' for others. But it is hurting so much to keep it in. I believe that I have hidden it away because I just couldn't bear to hear the stupid things people say to grieving parents--especially if there is a survivor. Let me make this clear--the existence of another child cannot replace the one who isn't with you. The love for one child is a unique irreplaceable love. You would never tell someone whose mother died that they should be oh so grateful that their father was still alive, would you?? So please let's retire the ridiculous notion that if a parent has at least one living child, that they should not grieve the death of another.
I have had the strange honor of welcoming five babies in my womb who died in a way that would make each of them especially easy to discount. My first two babies were each a "blighted ovum"--a bizarre name for an equally bizarre condition in which the fertilized ovum implants but the part that is supposed to form into the embryo never develops. Only the placenta grows for a time until the woman's body realizes that something has gone wrong, and begins the process of emptying the womb. My next two losses were "chemical pregnancies"--another odd name--a situation in which an egg is fertilized (...tiny human person created...), begins to produce the hormone hCG (...positive pregnancy test...) but something goes wrong very early in development and the woman has her period (...actually an early miscarriage). And with this recent loss, it isn't clear what happened, but it appears that, assuming that the second lobe and possible remnants of the cord were from my son's twin, there was a little human person who died fairly early on after implantation. And then his / her little body was completely absorbed.
I grieved my first two babies with a pain so intense it was debilitating. My next two losses were much less painful for me. But this one is so very different from the other four. I look at my beautiful son and I see his beauty and his intoxicating little person who draws me into love for him. But I also see a shadow. I see someone who should have been there, with him, but isn't. I look at twins and I wonder what his twin would have been like. Was his twin a boy or a girl? Would they have both had the same color of hair? What color would this baby's eyes have been? Would he or she have snored and snuffled at night, like our son does? How could I possibly have nursed them both? How could I have not? All I know are questions. All I feel is an empty cavern, with the pieces of my heart, my broken heart, cascading ever down.
Yet God touches me with moments of hope. "Lift up your heart," He said to me, through the person of the priest, at Mass. I see myself lifting up my heart, all the shattered pieces, knowing He can melt them back together with His tears. Because He does grieve with me--He authored the words: "Mourn with those who mourn." He was a man 'well acquainted with sorrow'. Jesus wept. He healed with a touch...a word from afar...even with the hem of his garment. And I know His tears can heal.
Please note: this story and accompanying photographs are copyrighted 2014, by Christelle J. K. Hagen. Neither the story nor the photographs may be used in part or in whole in any form without my express written permission.
Blissfully unaware that my son's heart had stopped some minutes earlier, I sank down into the tub, with his little body pressed against my heart. I was not only a veteran mother with five other living children eagerly awaiting their new baby, but an experienced homebirth mom, having given birth at home three times before, with straightforward births and healthy babies. This time would be different.
My dream birth was to have a peaceful waterbirth, at night by candlelight, with my husband at my side, under the watchful eyes of my midwives and supported by my friend, a certified Hypnobabies doula. Since I am also a certified Hypnobabies doula, but had never had my own Hypnobabies birth before, I was planning to use this method to help me stay relaxed during the birth and was hoping for not only a safe birth for me and my baby, but as comfortable a birth as possible. I spent many hours during my pregnancy listening to my Hypnobabies tracks, and one of the most important parts of the birth that I had envisioned was giving birth in the beautiful birthing room that I had carefully decorated. This room I prayerfully named The Heart of the Mystic Rose Room.
I woke up around 5:30 am the morning of his birth. I noticed that my uterus was "exercising" again, but thought little of it. I had always given birth at night, and expected that this time would be the same. I recall spending what I now know was the early part of our birthing time corresponding--with a mom who had very recently miscarried--and with a woman who wanted to become a mother. But after an hour and a half of contractions ("waves" in hypno-speak) which were little different from the ones I had experienced for days, I began to feel a pulling in my back during the waves that felt different. A little before 7 am, when I went to the bathroom, I thought maybe I was leaking a little amniotic fluid and shortly after, my waves got a lot more intense, so I excitedly realized that it was finally THE day! My husband was in the shower, and since I had not told him that I thought it was our birthing time before he got into the shower, I went ahead and called my midwife and my doula and told them both to come on over!
It was really important for me to give birth in my little birthing room, so before my birth got more intense, I put my hair up and grabbed a few things (my glasses, slippers, body pillow, Hypnobabies CD's), told my husband that it was time! and headed to the birth room. Once there, I put on the waterbirth gown that my mom had made for me and settled in. Chris (my husband) soon arrived and began to fill up the birth tub. During the pregnancy, I had imagined my "hypno-anesthesia" as a swirling wave, like sparkly water, and every time I felt a wave passing through me, I used slow breathing and imagined that swirling wave going down through me and washing away any discomfort, and the combination of both was working really well to help me through each wave.
About a half hour later, my midwife arrived and checked my vitals and baby's heart. All was normal. Soon after, my doula also arrived and prayed with me, and not long after, my other midwife arrived.
I decided to get into the birth tub where two of our other children had been born. So far, the birth felt very similar to my other homebirths, with the addition of being able to use the visualization of my swirling hypno-anesthesia during my birthing waves. I also started listening to the "Birthing Day Affirmations" track.
About 9 o'clock, I got out of the tub to use the bathroom and while there, I started feeling pushy. My midwife told me that baby wasn't tolerating me being in a sitting position, so I changed to hands and knees and standing for awhile. I had decided that as soon as I felt really pushy, I would push as hard as possible. That was about an hour later. Being that I was giving birth to my sixth full-term baby, my midwife expected baby to pretty much fall out. I knew better! ;)
Now there are plenty of women who can simply "breathe" their babies out. However, I give birth to babies with...shall we say...larger than average head sizes. The one in utero in this picture had a head that measured 14.5 inches at birth--not ginormous, but no teeny weeny head either. I had already had a birth in which I pushed HARD for 2 hours (and it wasn't my first birth). So there is no gentle "breathing" baby out for this lady..more power to those of you who can.
I was excited to get pushing because I was already experiencing quite a lot of back pain and pushing felt good. To ease the pain in my back, we did counterpressure (a lot of that), leaning over the birthing ball, hip squeezes, as well as compresses. My midwives and doulas did a great job encouraging me that I was birthing well.
As time passed, I began to notice severe pain in my lower abdomen. No amount of visualizing or breathing was making a lick of difference with that. :*( I just had a strong sense that this lower abdominal pain was Not Normal. A crescent shape encircling the very lower part of my abdomen felt like it was in one endless cramp.
After pushing pretty hard for about a half hour (around 10:30 am) my midwife wanted to check to see what the hold-up was. As she performed the exam, I thought, "This birth is doomed." At this point, I just felt that it was time to call a spade a spade. The birth had changed; it just didn't "feel right" to me. Remember I had already given birth five times before, so I knew what normal feels like for me. I have had the whole "self doubt"/transition thing before. But this was different. I had a knowing that the birth had taken an abnormal turn somewhere around the time I started pushing. I asked to be taken to the hospital for a cesarean.
Everybody, including my husband, thought I was just giving up. (Nope.) I said, "I'm serious. I want a cesarean; this pain feels like knives." Not hearing my comment about knives (which was not an exact description of the pain I was feeling--but the best I could do at the time) and convinced that I was still going to give birth any moment, my midwives told me it was too late to attempt a trip to the hospital. I agreed to stay.
Of course, here is where the "what if's" are so tempting. But no one knows what would have happened at the hospital. Maybe my son would have been born by cesarean and would have avoided what would ultimately happen to him at home. Maybe he would have been revived sooner, if it had come to that. ...But with an anterior placenta (placenta at the front of the uterus--lying between your belly and the baby), it is sometimes necessary to cut through the placenta to perform a cesarean. Turns out ours had a velamentous umbilical cord insertion with exposed blood vessels. Those blood vessels may have been cut in the surgery with unknown effects on my son (those vessels were, after all, attached to my son's blood supply). If he had needed to be resuscitated at the hospital, it is possible that efforts to revive him would have been stopped earlier than they were at home; maybe he would not have been revived at all??...
I have decided that you can play the "what if" game all day, but in the end, what happened is what happened. Here is where my faith comes in. Either God prevented us from something worse by keeping us at home OR He redeemed a mistake and allowed our son to live, despite that mistake. Concluding that we were foolish to be (or stay) home OR that we would have been more (or less) safe in the hospital is simply speculation and has more to do with one's beliefs about birth than about facts....
I decided to get back into the tub. Here is where my memory gets fuzzy. Thanks to the birth notes from my doula, I apparently pushed for another one and half hours after requesting to transfer to the hospital.
During those one and a half hours, what I do remember is feeling excruciating pain in my lower abdomen. Meanwhile, my midwife was frequently checking baby's heart. Overall, baby's heart rate was fine, but it seemed that whenever I was in a forward-leaning position (like the one in this photo), baby's heart would show stress.
Around 11:15 am, I was given oxygen and asked to lean back against the side of the tub. Let me say that the LAST thing I wanted to do was lean back, but I wanted to do whatever baby needed, so I leaned back. The "waves" I was experiencing had turned into nothing less than a tremendous violent force that caused me to push as hard as I possibly could from the second they began to the second they ended. I am not exactly a "quiet" birther (ha!) but these train engine-strength forces were taking me to a new level of bellowing that I had never before achieved. Thankfully, Chris was there, and I held onto his hand with a vise-like grip. To my great relief, after about five minutes leaning back like that, baby's heart sounded good, so I chose to stand up, supported by Chris.
What I noticed next was that the birth forces that were possessing my body began to grow closer and closer over roughly the next half hour. Eventually, as soon as one would end, the next would start. I recall both my doula and midwife reminding me to "breathe for my baby" and "take some deep breaths"--but all I was capable of doing was gasping a few times when I was able to stop shouting between each force, and another one would immediately start. I knew that what I was experiencing was not normal, but I did not have enough time to explain what was happening in the short seconds between the birth forces that were pummeling my body. All I could think was, "All for you, Jesus," a prayer that had popped into my head several weeks before his birth, and one I decided at that time that I would pray during the birth. I suddenly noticed that my legs had gone to "sleep" and I shook them, surprised that I had been standing still for so long that both of my legs would go to sleep.
At 11:53 am, something odd occurred that I have yet to fully understand. I felt a teeny painless pop on the side of my belly, about two inches to the right of my navel and maybe one inch up. Immediately, warmth came from that spot and spread downward from the spot. It felt like it was just under my skin and whatever popped felt very small, like the severed end of a blood vessel. I immediately wondered if this spreading warmth were meconium, blood, or amniotic fluid? It was startling, as I have never before (or since) felt anything like that. I tried to quickly explain what had happened and I think I muttered, "Something changed; something changed." Doula's birth notes say, "felt like something released?" Right away, both baby's and my vitals were checked and both were good.
Seven minutes later, I heard a tremendous splash hit the water in the tub. Both Chris and I thought the baby had fallen into the tub! But thankfully it turned out that it was just my waters releasing. (I didn't know at the time, but there was meconium in the amniotic fluid.) A minute later, baby's head was showing.
At this point, I was so tired, and I thought to myself, "Just let my uterus push out the rest of the baby." So I stopped pushing for a little while. But then I strongly felt that I must keep pushing--and hard! In the next two minutes, despite monitoring the baby's heart, the midwife couldn't hear it (not terribly unusual with baby so low). It is possible that the placenta separated at this time, or it is also possible that the baby compressed the exposed blood vessels on the placenta, cutting off his own circulation, or perhaps both. Whatever occurred, this is when his heart stopped.
Four minutes after the baby's head began to show, the rest of the baby's head was out, and a minute later, at 12:06 pm, the baby was born! He was passed between my legs and I held him to my chest. Encouraged by my midwife, I sat down in the tub.
I noticed right away that he was a boy. I held him in my arms and Chris also reached out for him. Meanwhile, my midwives tried to find his pulse. Unbeknownst to me, the midwife who caught him had noticed how floppy he was, and was immediately concerned. I stroked his body and talked with him, encouraging him to breathe, noticing that his hair seemed bloodier than my other babies. However, I was unconcerned that he had not yet started breathing, as it had taken a little while for his biggest big brother to breathe, so I assumed this was the same situation.
Within a minute, to my surprise, he was given oxygen by mask, and almost as quickly, I was up and out of the tub and my midwives helped me to shuffle to the nearby bed where they initiated full CPR. Meanwhile, my doula called 911. His little body laid next to me on the bed. I stroked his little hand and arm, as I slowly watched them turn blue. Fifteen minutes of "One...two...three...(blow)..."--during which I talked with him, pled with him to come back, and begged for the intercession of every known saint--even one whose name I couldn't remember. Chris and I prayed the Lord's Prayer together. Chris ran to tell my mother and our children what had happened and asked them to pray; blessed the baby with a relic of St. Anthony Claret; and at my request, blessed him with holy water. I felt distinctly that this was a spiritual battle. Scattered thoughts: "Do I really have to have first hand experience of stillbirth?" (This was when I was thinking of being a perinatal loss doula.) Meanwhile, my midwives continued giving my son CPR.
When his entire arm had turned blue, I thought he was gone. (Entering into the Heart of the Mystic Rose meant, for me, a willingness to have my own heart pierced with a sword.) Then, suddenly aware that my midwives were still working on him, I thought, "If they haven't given up on him, I can't give up on him." I told him that I claimed him for this world, that he had work to do here.
It was after he was blessed with holy water, 12:19pm, that the EMT's arrived. Two minutes later, they were in the birth room. My midwife declared, "I feel a pulse!" Within a few minutes, an EMT took over the chest compressions, and my midwife began to cut his cord, stopping for a moment to thoughtfully ask if Chris wanted to do it. Soon after, my newborn son was whisked away in the ambulance.
He spent the next fifteen days in the NICU. That is another story, but the short version is, he recovered, he is home now, and as far as we know, doing all the normal things a newborn should do. He is our Christmas miracle! When I look down at his little perfect face, right now, I am struck, almost painfully so, with the beauty that I have been given THIS moment, the fact that he could very easily NOT be here at all, and I feel so unworthy of this miracle. My gratefulness must never end.
Did Hypnobabies give me a pain-free birth? No. But when your placenta tears away from your uterus and almost kills your baby, I don't think anyone would expect to feel no pain.
Did I have my dream birth? No. But I had my most fervent prayer answered--that my son would be returned to us, that he would live. And that is worth far more.
If this story has touched your heart, please consider giving to the Tiny Treasures Love Cupboard, in memory of the babies who won't come back.
I wrote this post for a few reasons. One was to simply tell my version of my son's birth. I needed to do this because his birth was traumatic, and part of the healing process for me has been to write out our story. Secondly, I wanted to describe what a placental abruption feels like (at least what it felt like for me) from the insider's perspective. I hope that this might be helpful for both mothers giving birth, as well as for health care providers and doulas. If reading my story helps even one mother to identify these sensations and get help for herself and her baby immediately, then the effort of writing and the emotional risk of posting this story will be worth it! If any mother fears that she may be feeling similar sensations to what I felt, please do not wait--get to the closest hospital and have them check you and your baby!!
Because I wanted to focus on what this birth felt like from the inside, I left out most of my own speculations about causes, details of the midwifery care I received, various ways my husband and doula supported me, and anyone else's theories of what happened. If this leaves the impression that I was virtually "on my own" during the birth--that is an erroneous conclusion. I believe I was well supported during my birth and believe that my son and I got excellent midwifery care and support from my midwives, my doula, and my husband.
If there are any mothers out there who have also experienced a placental abruption, who have lost a baby, or just feel a desire to reach out to me in order to have someone listen for any other reason, feel free to leave a comment below--and please do not hesitate to contact me.
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