A Meeting Place for Early loss twins

This is really my twin's Enjy's place, not mine. S/He does not have any other place in this world. S/He was miscarried at age four months in the womb. We were twins and made to be together for years and we were torn apart within seconds. This is the place where I go to talk to him/her and about him/her. Anyone who has lost a twin in utero or very early is very welcome here to read and share.

Friday, December 1, 2017

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. 

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