Vanishing twins don't 'vanish'!

The term 'Vanishing Twin Syndrome' (VTS) has gained some popularity over the past ten years. According to Wikipedia it describes "...a fetus in a multi-gestation pregnancy which dies in utero and is then partially or completely reabsorbed. In some instances, the dead twin will be compressed into a flattened, parchment-like state known as fetus papyraceus.

Nice and clean, isn't it? The fetus dies and then is reabsorbed. Or if that doesn't happen, it will be compressed and flattened. Like flowers picked and pressed in a book. Lovely.

Only that's not what happens inside the womb. That's what happens in bits and bytes and on a keyboard.

At least wikipedia mentions that the fetus dies. It dies the same way every human dies. The heart stops beating, blood stops flowing, cells stop growing. Limbs stop moving, eyelids stop opening and closing, fingers stop flexing, toes stop wriggling, lips stop sucking. All these movements are common in a fetus between 8 and 12 weeks, the first three, of course, before. All these things also happen exactly the same way if it is not a vanishing twin but a vanishing singleton. A miscarriage. Because singletons also may vanish within the first trimesters without the mother noticing anything. It's called a "missed abortion" then and unlike in cases of VTS it's mostly treated by a curettage, an abrasion of the uterus. 

When there is a living twin fetus, nature is left to deal with the dead body so as not to risk the other baby. The idea of a corpse in the womb is, of course, unsettling and there are postings to be found in internet forums about pregnancy that warn of poisoning caused by a "rotting corpse" in the womb.
There is a slight risk for the mother and remaining child, but to rot in the full meaning a dead body needs oxygen which isn't present in the womb. 

So the dead twin doesn't rot, it mazerates.

We all know mazerating. We mostly don't know that we know it. Take a hot bath for a reeeally long time. Maybe with a good book and a glass of wine. After about 90 minutes - in my humble experience the necessary time for a good bath - your skin will be slightly swollen, look crumbled and maybe even flakes will come off. That is the uppermost layer of your epidermis, easily scrubbed off with a sponge or pumice.

That's mazerating. The very first step of it. If you stay even longer in the warm water (like John Lennon used to do), your skin will further deteriorate, and if you happen to be a dead fetus in the womb, your skin will finally drift off your body and float in the amniotic fluid.

Depending on the type of twin pregnancy the surviving fetus witnesses this process more or less directly. In a fraternal twin pregnancy the babies may be located within a distance in the womb. That doesn't mean they don't notice each other. Since they are both connected with the maternal organism, the MOTHER, through their umbilical cords and placentae, they, by proxy, witness what happens to the other. The death of one fetus causes a difference in the mother's metabolism. The placenta stops working, blood stops flowing. All these occurences are passed on, albeit diminished, to the surviving fetus. The difference is notable.

If the twins are monochorionic-diamniotic like many identical twins, or if they are dichorionic like some identical and all fraternals, but positioned very close to one another in the womb, they witness their co-twin's death in more detail.They notice the movement stopping, maybe notice that the heartbeat and blood flow stops - these things don't happen in complete silence - in addition to the effects on the mother's metabolism.All in all, for all these twins something changes from normal - movement, sensations, noises made by the co-twin - to absolutely unnormal. 

The most severe effects are felt by the fetus in a monochorionic-monoamniotic pregnancy. This, rare, type of twin-pregnancy is also the most risky. There is still an estimated 50% risk of one or both babies dying before birth in a, so called, MoMo-pregnancy. With two umbilical cords floating in the amnion, entangling, twisting around limbs, the possibility of one or both of them knotting or wraping round one of the babies is always present. Cord accidents are a much feared cause of fetal demise (medicine lingo for a baby dying before birth) in singleton pregnancies, too, in a MoMo-pregnancy they're almost to be expected.

Being with another one in the same amniotic sac is the closest a human being can get to another one. The twins feel each other earlier than other types of twins. Through all the weeks when their bodies develop and their brains accordingly - for every sensation felt, every movement made fires some input into the developing brain and causes new synapses to be built - there is not a single moment when this is not their one and only and the only normal way to exist: in contact with one another. Impuls followed by re-action. I kick you, you kick me. It all belongs together. In a MoMo-pregnancy being in close contact with another one, feeling another one's movements, presence, limbs and skin is the only way of existing the growing fetus is exposed to. This is its normal. This is the only way of existence its brain acknowledges as normal. This is it.

There is, of course, no way to interview a fetus in utero about its experiences, but it is a well known phenomenon among mothers that very young children - and not so young ones, too - have difficulty do distinguish between themselves and what they feel. To realise that me feeling, a thing felt and the feeling itself are three different things is a highly advanced stage of human development. Thus a young child will just cry when it hurts somewhere and not be able to point to his head or tummy for approximately two or three years after birth. It's very likely that a fetus in utero if it experiences anything at all - and we know it does, we have, fortunately, sound scientific proof of that (google Alessandra Piontelli!) - resembles the young child rather than the grown person. What the baby feels it is. The twin baby in close contact with the co-twin IS the two of them. 

When a fetus in a MoMo-pregnancy dies, the surviving twin witnesses directly what happens to the co-twin. Unfortunately, as stated in the title of this entry, the co-twin does not vanish, it mazerates. Its skin comes off in flakes, they touch the co-twin's skin, its lips, it may even swallow them by accident. 

After the skin came off, the organs will fill with liquid, swell and then dissolve. Some of them may get caught in the co-twin's moving limbs. Sounds like a zombie-film? What may it feel like to the baby?!

The skeleton is last to disintegrate. If the pregnancy was advanced into the second or even third trimester, the skeleton may be too hard, already, to completely dissolve and the bones, maybe also some tissue, will form something like a lump in the womb. It will sink to the bottom of the amniotic sac but depending on the mother's movements may also drift up again and touch the surviving twin fetus. 

Not nice. Not clean and easy and certainly not as harmless as "vanishing" indicates. 

Such remains of a "vanished" twin may be found at birth but up to the 1980s doctors and midwives most certainly wouldn't mention it to the mother. They may have expressed the need to to an additional curettage to "clear out the womb" without going into further detail. Nobody will know there ever was a twin.

Nobody but the survivor.

To be in close contact with these weird things emerging from the sudden unnormality certainly overwhelmes the fetus in its abilities to compensate. These moving things create an unexpected and unpleasant sensation in its body. What is this slimy thing clinging to my feet? Why AM I a slimy thing clinging to my feet? What is wrong? Why AM I wrong?

Neurologists track the perception of one's own body back to the time in the womb. Whether a person feels okay with his/her own body is largely due to how they are treated as babies and toddlers by their parents but part of it may origin from experiences in the womb. For when the brain forms, it takes what is given to it as input and info from its environment in utero. The death and mazeration of a co-twin is a totally different experience than a corpse-free pregnancy. It would be highly surprising if these experiences were NOT stored in those parts of the fetal brain which are very active even before birth. Especially the amygdala, the part of the brain that deals with feelings and fears, has been noted to be even more active before birth than after. 

It should be clear from this scenario that a vanishing twin pregnancy MAY result in a severely traumatised newborn infant. 

It is not a necessary outcome. The capacity of the individual to deal with trauma is different even in a fetus. Chance may favour one child more than the other and provide less traumatic experience. Beside the type of pregnacy the emotional situation of the mother, her diet, even the family history, the political situation the family lives in - war or peace - all this may contribute to the way a fetus copes with the death of a co-twin. 

But one thing should be kept in mind by all who have to deal with the possibility or certainty of a person, be it themselves, parents, relatives or friends, subject to VTS -whatwever a vanishing twin does, it doesn't just vanish.

For those who want to check the information given in this entry - I learned the details of what happens when a fetus mazerates from several handbooks for midwives and medical articles on the internet. There are pictures, too. They aren't pretty.

For the development of a fetus in utero and its capacity to experience and react we will be forever indepted to Alessandra Piontelli who did the first long-term ultrasound study in the 1990s. She covered the development of several children, twins among them, from the 8th week of the pregnancy to four years of age. Her books are amazing.

For some pictures of miscarried children to illustrate how these tiny individuals living through this apocalypse may look, go to https://lostinnocentsblog.wordpress.com/photographs/. A very informative site done with love and care unsurpassable.

For the description of how it MAY feel to be in close proximity of a dead co-twin the work of Luc Nicon, French psychotherapist, is of immense value. Early loss surviving twins might benefit greatly from a look at one of his books.

We survived the zombie-apocalypse. And live to tell the tale. 

And don't forget. Before it became a "zombie", it was our twin. Before that upside down we were thrown into there was our normal, our natural exchange with our twins in utero, our feeling each other, our being together, our being t(w)ogether.- 

Our brains and bodies stored that, too. 

Twin mementos

It's difficult to find a memento for someone who never had a name nor a face. Still, I assembled a collection of them over the years and here are some of them:

 This is a silver pendant showing two dolphins. I chose it - and engraved it myself with names for me and my twin - because they jump in different directions and are still connected.

 This is another silver pendant of two little angels kissing.

                                               
 This one is special. It's an ammonite fossil I found at Mainz Christmas Market two years ago. What makes it special is there are two of them. Ammonites are prehistoric marine animals whose shells are often found as fossils. They resemble a very young embryo in the womb. The booth trading in minerals at the Christmas Market had many petrified ammonites that day but only one that had two in one.

 Sometimes, when the unfairness of being a twinless twin hits me hard I take to this pendant. It's a pewter one showing twin skeletons in a fetal position twins often take in the womb, when one twin faces downward and the other upward. It may look a bit morbid but I still wear it sometimes. It's a reminder that not only life before birth is real but so is death. On the old ultrasound it may look as if a twin vanishes, like a soap bubble in the air. In reality the twin DIES and there will be a skeleton however tiny.

 This one is more comforting. It's made from Tibetian yak bone and shows the sun and the moon kissing. I choose it when I feel my twin may, after all, have been a brother, because there is more of a male and female completing one another quality in it.

You can order customised dogtags all over the internet and I have a huge collection of the ordinary US-Army type, but this one is made in the fashion of the German Bundeswehr. I assumed my twin was a girl when I ordered it and it's engraved with the names I chose for me and my (girl)twin and the words "Once a twin - always a twin". It's a bit large to wear it so I have it stored in my treasure shrine.

Here's another find from Mainz Christmas Market. These adorable little bears hugging I embossed with the letters A and B which may just indicate twin A and twin B or the names I chose. The little pendant hanging from them I orderer from a Dutch website where you can find all kinds of things made to order with your own photos. I used the water colour I made at age 4 of two identical girls rope skipping I described before on this blog.

Here is one of my dogtags US-Army style I ordered with the words "Once a twin - always a twin". The other "dogtag" I made from fimo and it bears the words "Surviving twin". I wear it when I'm in the mood to encourage myself. I made it to this life for a reason! One day I will know which one.

Last but not least the most fitting memento for my twin I ever found. It's a bone carving showing two dolphins positioned like embryos in the womb. Sometimes I wonder why I ever take it off.

What if...

...my twin had lived?
Sometimes I try to imagine what life with my twin might have been like.
Then I look at the picture I have posted before (a watercolour I did at age 4) and think of my sister (left) always a bit more outgoing, more adventurous than me.

Would our younger siblings have been born at all? I think so. Our mother conceived so easily our father once said he only had to look at her lovingly and she became pregnant.
But our parents may not have had a divorce. They may have had too much to do with four of us to become hippies and turn our family into a great aquarian experiment. We may have gone to a regular primary school, not the Montessori one I suffered at for four years. We still would have had much the same way to school, though, and we would have argued about which dog we wanted to have.

I would have wanted a Dachshound.
- And I a Whippet.
- Oh, yes, but I also wanted a Saluki.
- Then I would have wanted an Afghan.

Not so much different from how it was.

Our parents would not have sent us to separate classes at school. Too much trouble with parents evenings and all that stuff, but through puberty we would have drifted apart a bit. I would have had riding lessons (I really did) and always be a bit afraid of the horses (I was). You would have done some other sports - maybe handball or gymnastics - but you would have come with me to the stables once or twice and be less afraid of the horses than I. That would have been mean.
I would have been totally into animals and you would have been more popular, but I wouldn't have been lonely because I'd always have had you.

We would have graduated from school together and suddenly discovered we wanted to be together again and go to the same university. Would I still have studied theology? I think I may but probably not Catholic since becoming Catholic was part of my searching for you everywhere without knowing. Our parents may have stayed with the Protestant Church, we would have gone to Confirmation and I may have studied to become a pastor. You would have cancelled your studies - maybe geography - after two years and become a flight attendant. Yes,you would! Always with both feet in the air while I am trying to have one foot on earth and one in heaven.

Would I be married to the same husband? Probably not, but maybe to someone very similar in character. A fellow theologian, perhaps. We would have shared a comgregation.

You would have flown around the world and come to visit us often. You wouldn't have married but you would have felt like my children were yours, too, and you'd have been godmother to all of them (three at least, maybe four like I have now, or even five). They would have adored you.

Your favourite country would have been...

-South-Africa!
-Why South-Africa?
-No idea, it just may have been.

Okay, South-Africa. You would have sent us pictures from Krüger Nationalpark and always dream of finding a South-African husband. I would have been jealous of all your boyfriends.

I would have been worried your plane might crash all the time...

Now, at age 50+, you would have thought about retirement with work conditions at Lufthansa becoming tougher every year. I would have wanted you to settle down near me but been afraid to say so for fear to drive you away. Because, of course, you would have been talking about moving to...

-South-Africa.
-Yeah! I got that. South-Africa.

I would feel a bit abandoned by you, now, because you'd mostly be away and life would be getting more exhausting (it really is) and I would think we should be more together and help one another.

Not so much different from how it is.

We would have talked on WhatsApp daily, sometimes by the hour. You would have said "WhatsApp is really almost like being in the womb together again. We don't talk novels but we're always in touch."

Not so much different from how it is...

Twin-Life before Birth

Lately I have felt the effects of being an early twin-loss survivor more keenly again. I will try to restart this blog and see who picks up or to whom it resonates anew.



When people realise they very probably were conceived a twin there are some things nearly all of us do. We give our twins names and we invent a life together. We imagine what it was like in the womb, how we played together, what we felt and thought and what our life together might have been, and we treat ourselves and our twins as PERSONS. There is no other way. As conscious individuals we cannot speak of other individuals than as persons.
If we, born and grown to think ands feel als persons, want to remember our twins we have to invent their personalities.
I did and I do the same.
Yet, all the time I am very conscious of a flaw in this scenario seemingly healing my twinloss if only in imagination. My twin was not a person when s/he died and neither was I.

That's not a bad thing. I still was I. There is a continuity from the fertilised egg in my mother's womb to the 54-year-old typing these words. But to be a person includes the ability to distinguish between me and another person. We did not do that in the womb.

My twin and I just were. We were there. We had our own blood circuit, our own hearts. We grew differently ( I have reason to believe my twin was much smaller than me), we moved differently. We were not one, we were separate entities, but us being together was the only reality we knew. To be was to be together. I moved, my twin moved. We reached out, we kicked, our movements sent ripples through the amniotic fluid. Impulses received from the other one, responses to impulses sent - all this was what I experienced as presence, as existence. So did my twin. The other's presence was part of our individual presence, part of our individual existence.

So, when my twin was lost I did not lose a person, I lost a presence. And I lost part of my existence.
What had been a daily, normal and substantial part of existence, what had been a decisive part of my very exyistence, the PRESENCE of my twin, was suddenly lost.
And is lost to this very day.
My twin was not taken from my side, s/he was taken from my core.

At the same time psychologists in one country still doubt that prenatal twin-loss can have any effect on the survivor at all, in other countries statistics show that such a loss is experienced the more devastating the earlier it occurs. (http://www.primal-page.com/twiner.htm)
And how could it not be?
There are no words to express the panic when the loss happens. There is no name to cherish and no pictures to keep. There are just feelings, very profound feelings of mortal danger, existential fear, the dire need to curl away from the source of danger... All this is stacked away neatly in my amygdala and gets fired at me in odd situations.
When a WhatsApp message I sent does not receive a reply a chasm opens beneath me.
When my keys are not where they ought to be panic engulfes me.
And sometimes, for no apparent reason, a convulsive pain grips me, as if something was ripped from my midriff.
It's the lack of a presence that should be there to confirm my existence.
When I reach out to that presence and it isn't there, my body flies into panic mode.
The amygdala is a stubborn conservative. Nothing can convince this small gland in my brain responsible for storing emotions, preferrably negative ones, that what happens now isn't connected with what happened then.
To my amygdala I'm a wholesome entity. No difference between embryo-me and university-graduate-me.
And both, the embryo-me and the university-graduate-me, are twin-me.

These things are getting worse the older I get. The pain is getting more piercing. The despair is holding as firmer grip.
The inability to consciously comprehend and articulate what happened then and what is happening now gets more frustrating.
At times I feel like a veteran from a war with a shrapnell shard still embedded in my body somewhere (When I was I child there were many men suffering from that). It can't be operated upon, maybe it won't kill me but it's a constant reminder of a wound I received before I was born.