Guidelines for Supporting
Grieving Parents of Multiples
By Barbara J. Panza1
The first night, then, I went to sleep on the sand, a thousand miles from any
human habitation. I was more isolated than a shipwrecked sailor on a raft in the
middle of the ocean.
Antoine Saint Exupery, The Little Prince
When told that parents expecting multiples have lost or are expecting to lose one or all of their
babies, it is difficult to know how to respond because of the many conflicting emotions involved
with this type of loss. Although most of these will seem obvious, the following are some “Dos
and Don'ts” that you may find helpful when trying to support the grieving parents.
IMPORTANT: It is important to realize that grieving parents often do not want people to feel
sorry for them, but to feel sorry with them.2 The grief over the loss of a baby is a different kind
of grief. When we grieve the loss of a loved one, we remember them, miss them, and wish that
they were still with us. When parents grieve the loss of a baby, they are grieving what could
have been—their inability to give their baby all that they had hoped and dreamed of, the loss of
the experiences that they will never share with that child, and the inability to get to know their
baby's personality and seeing the person that he or she would have grown to become.3
When parents lose one or all of their multiples they are also dealing with the loss of watching
their babies grow with the special bond shared by multiples. 4 We live in a society that
glamorizes multiple births.5 As a result, the grieving parents may be dealing with what they
perceive as the loss of a once-in-a-lifetime experience and the extra attention often showered on
the parents of multiples.6 In addition, when one or more of the multiples survive, the parents’
grief is complicated by their love, joy, and concern for the survivors. 7 Finally, parents expecting
the neonatal loss of one of the multiples or who have lost a multiple in utero, but have not yet
delivered, are grieving.
Do Listen, Listen, Listen. Mothers, in particular, often need to tell their story over and over,
and talk about their lost multiple(s).8 Show understanding. Empathy is powerful.
Do Encourage Honesty about Their Emotional and Physical Needs. Because the grieving
parents are vulnerable, it is often difficult for them to articulate exactly what they need or want.9
Grieving parents often worry about upsetting the person trying to help them. 10 Let the grieving
parents know that they will not hurt your feelings. Also, let them know that you will try to help
in the way that they desire. Not, the way that you want to. Remember that emotional support is
just as important as physical support (e.g., meals, etc.).11
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Do Understand That They Are Working Toward a "New Normal." Understand that the
grieving parents are working toward finding their "new normal."12 There is no remedy for their
pain.13 You cannot fix things for them. Grieving parents have to learn to live with their loss and
incorporate it into their lives.14 The grief and sadness over the loss of a multiple do not go away,
but when they find their "new normal," they will have found where and how to carry it in their
hearts.
Do Contact the Grieving Parents. Find out the preferred method of contact, e.g., e-mail, notes,
or phone calls, and contact the grieving parents. Let them know that you are thinking of them
directly. Do not send messages through third parties. However, realize that they may not read
your message immediately or even respond. Even if you do not receive a response, continue to
let them know that you are thinking of them. And, do not gossip. Let the grieving parents decide
what, how, to whom, and when they want to share the details of their loss. Also, even if you
have scheduled to visit them in advance, when possible, it is a good idea to double-check that
they are still up for the visit. Grief comes in waves, so even though it was a good time for a visit
yesterday or several hours ago, that may no longer be the situation. Remember what matters is
that you have let the grieving parents know that you care.15 Further, respect the boundaries set
by the grieving parents—acknowledge their cues. For example, watch for cues as to whether the
parents want you to hug them.
Do Acknowledge the Parents’ Conflicting Emotions. Parents who have lost one multiple have
conflicting emotions, i.e., joy and grief. At one moment, the parents will feel blessed with the
birth of their surviving multiple. However, as these emotions take hold, they may feel guilt or
sadness over the loss of their deceased multiple. Often when they feel grief, they will then feel
guilt for taking away from the joyfulness of their surviving multiple. This cycle is emotionally
exhausting and can be long-lasting.
Do Remember Important Dates. The anniversary of the multiple’s birth and death, and
holidays like Mother's and Father’s Day are significant dates.16 A survey by a grief support
group shows that even though it saddens them, most parents who have lost a baby still want their
parenthood remembered and acknowledged on dates like Mother's and Father’s Day.17 Do not
worry that it will make the parents sad or cause them to cry—they are already sad on those days.
Your thoughtfulness will be appreciated. Also, in cases of in utero death and expected loss, keep
in mind that there may be several anniversaries for the parents as the date they receive the
terminal diagnosis, and the dates of death and delivery may be days, weeks, or months apart. In
addition, “birth and death days may coincide or fall close together.”18 Respect the fact that
parents of multiples may have mixed feelings on those days. 19 Some additional dates to
remember include:
•
•
•
•
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International Bereaved Mother's Day (Sunday in May)20;
National Twins Appreciation Day (August)21;
International Bereaved Father's Day (Sunday in September)22;
Stillbirth Remembrance Day (September 6th);
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•
•
•
Pregnancy and Infant Loss Remembrance Day (October 15th) 23;
International Wave of Light (October 15th)24; and
The Compassionate Friends Worldwide Candle Lighting (December).25
Do Acknowledge the Baby or Babies in the Manner Chosen by the Parents. If the parents
name their deceased baby, be sure to use the baby’s name when talking about him or her.
Naming the lost baby assigns a specific identity to that baby and gives the parents someone to
mourn.26 Also, be sure to acknowledge the babies as multiples.27 For example, if there is only
one surviving multiple, try not to act as if that baby were a singleton because to the parents he or
she may be one of twins, triplets, etc. 28
Do Try to Attend any Announced Mourning Ritual. Although they are sorrowful events, a
funeral or memorial service gives the parents an opportunity to say goodbye to their baby in the
way that they want.29 It creates an opportunity for their loss to be acknowledged and for others
to provide comfort and support.30 Also, it allows others an opportunity to recognize the parents'
loss as significant.31 Grieving parents vary in their desires for a funeral or memorial service.
Some keep it small and private, inviting only a few people. Others want a formal memorial and
invite a lot of people. Try to support their desire to say goodbye to their baby in the way that
they indicate. 32
Do Allow the Parents Time to Grieve. The loss of one or all of their multiples is not something
the parents will get over.33 It is something they will learn to live with.34 However, they still need
to go through the grieving process. Allow the grieving parents to take as long as they need to
grieve. Life will go on. They will find a way to go on; they just might take a little longer or go
through the process more slowly than you would like. If there is a surviving multiple, realize
that the grief process may take even longer because their grieving is often delayed until the
demands of caring for a small child are lessened. 35 In these types of situations, “[i]t is not
unusual to take up to five years after a multiple birth pregnancy [for the parents] to feel as if
[they] are getting back to a new definition of normal.”36 Also, be understanding if the parents
seek grief counseling or decide to try other healing modalities.
Do Allow the Parents to Grieve Differently. The parents may deal with their loss differently.
It may be helpful to acknowledge any differences. For example, the mother may be tearful,
while the father may appear stoic. Do not interpret one parent as more caring and the other as
callous. Also, in the case of in utero or expected neonatal loss, realize that the father may
become focused on protecting the pregnant mother and any surviving multiples. As a result, he
may delay his grief, experiencing his loss more intensely at the time of delivery.
Do Respect How the Parents Want to Handle the Loss with Other Siblings.37 If the grieving
parents already have children, respect the manner in which they want to tell the older children. If
you do not know, ask them. It is better to ask the parents than to proceed in a manner contrary to
the grieving parents’ wishes. Handling the matter in a manner different from the parents’ wishes
will only upset the parents and confuse their other children.
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Do Continue to Include the Grieving Parents in Other Events. Even though it might make
the grieving parents sad to be invited to special events, especially events like baby showers,
continue to invite them. However, acknowledge and respect that they may not feel able to attend
or may change their mind about attending at the last minute. Even though it may have been
well-intended, not being invited is often interpreted by the grieving parents as exclusion. Also,
do not interpret the inability of the grieving parents to attend some special events to mean that
they are not happy for other expectant parents. It simply means that attending brings forth
painful memories for them.
Don't Offer Platitudes. Do not offer platitudes.38 Avoid statements like “It is God's Will,” “It
was not meant to be,” “This was nature's way,” and “Your baby has gone to a better place.”39
Although well-meaning, these statements are not helpful.40 Grieving parents often interpret
platitudes as “cold[,] unsympathetic, belittling their grief[,] [or] discrediting their baby’s life.”41
Don’t Suggest that Other Children Replace the Lost Multiple. Older siblings, surviving
multiples, or subsequent children do not replace the deceased multiple(s).42 In cases where there
are surviving multiples, avoid statements that imply the parents should not be grieving because
there are survivors, such as “Well, at least you have one survivor,” and “Thankfully, you did not
lose all of the babies.” These statements diminish their loss. To the grieving parents, one
multiple does not replace the other.
Don't Make Comparisons.
Do not try to compare the loss to something you have
43
experienced. Every loss is unique; grief is not comparable.44
Don't Set Expectations on How the Parent Should Grieve.
However well-intended,
comments that set an expectation, e.g., "You are so strong," are received by grieving parents as
setting guidelines on how they should act and behave. These types of expectations make
grieving parents feel like they need to wear a mask when in your presence or avoid you
altogether. Instead, let them know that they do not need to try to be strong around you, and it is
okay with you if they are sad or cry.45
Don't Expect Either a Show of Faith or a Lack of Faith. It is normal for grieving parents to
question their faith or belief system.46 For most grieving parents the loss of their baby will
change their views about life, religion, and society.47 Some will turn toward their faith, while
others will turn away. Let the grieving parents set the tone for how they are coping. If they
indicate that they are finding strength in their religious beliefs, then it is okay to mention that you
are praying for them, etc.
Don't Suggest that They “Move On.” Do not imply that there is something the parents can do
to erase or forget the memory of their baby or their loss.48
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Don't Give Away or Withhold Something Special You Might Have for the Baby. Items
purchased in anticipation of the baby can be put away and treasured later. 49 It helps the grieving
parents know that their baby was special to others too.
Don't Anthropomorphize Animals. Although many pet owners view their pets as a member of
the family, anthropomorphism, e.g., references to animals as "your baby," can be upsetting to
grieving parents. While there is usually no intent to hurt the grieving parents, they may find it
unsympathetic or belittling the significance of their loss. Remember that in their grief, the
parents are sensitive to your comments.
ACKNOWLEDGEMENTS:
Special thanks to the following individuals for their input, comments, edits, and support:
Ramen Chmait, M.D., Director of Los Angeles Fetal Therapy, CHLA-USC Institute for Maternal
Fetal Health, Los Angeles, California. More information about Dr. Chmait is available at http://
www.losangelesfetaltherapy.org/.
Kenneth J. Trimmer, M.D., Vice President of Regional Perinatal Development, North Texas
Perinatal Associates, P.A., Medical City Dallas Hospital, Dallas, Texas. More information about
Dr. Trimmer is available at http://www.ntperi.com.
Kyle T. Martin, Ph.D., licensed psychologist, Dallas, Texas. More information about Dr. Martin
is available at www.drkylemartin.com.
Donna Petri, Associate Director, Family and Adult Ministry, St. Joseph Catholic Church,
Richardson, Texas. More information about Ms. Petri is available at www.stjospehcc.net.
1
Barbara J. Panza is the mother of Henry and identical twin boys, Peter† and Thomas. Peter died in utero due to
selective intrauterine growth restriction (sIUGR). Approximately 20 weeks after Peter’s death, Peter was delivered
and Thomas was born full-term. Barbara is an appellate attorney in Dallas, Texas. She is also a research fellow at
the Center for Thomas More Studies at the University of Dallas. However, the information, comments, and opinions
in this article do not reflect nor should they be construed to reflect the opinions of her employer, supervisors, coworkers, or the Center for Thomas More Studies.
2
See DEBORAH L. DAVIS, PH.D., EMPTY CRADLE, BROKEN HEART 137 (1996) (discussing grandparents).
3
DAVIS, supra note 2, at 3.
4
MARIE A. WALTER, M.S., RN, LOSS OF ONE OR MORE MULTIPLES (2005); DAVIS, supra note 2, at 12.
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5
See WALTER, supra note 4 (“People in general are fascinated with multiple births an a great deal of attention is
given to families expecting multiples.”); CONNIE L. AGNEW, M.D., ET AL., TWINS! PREGNANCY, BIRTH, AND THE
FIRST YEAR OF LIFE 2–3 (2d ed. 2005) (“We seem to have a fascination with the miracle of twin birth,” and “Media
coverage of high-order multiple pregnancies is relentless”).
6
7
See WALTER, supra note 4.
See WALTER, supra note 4.
8
Amber Webb McIntyre, “Supporting the Parent,” available at www.climb-support.org.
9
McIntyre, supra note 8.
10
McIntyre, supra note 8.
11
See McIntyre, supra note 8.
12
See McIntyre, supra note 8; WALTER, supra note 4.
13
McIntyre, supra note 8; “Bereaved Grandparents of Multiples: What Helps” available at www.climb-support.org;
see generally, DAVIS, supra note 2; WALTER, supra note 4.
14
McIntyre, supra note 8.
“Bereaved Grandparents of Multiples: What Helps,” supra note 13 (advising grandparents to “just be with your
child and try to do anything you can that [] he or she wishes.”).
15
16
See generally, DAVIS, supra note 2, at 64–65 (section titled “Memorializing Your Baby”).
17
Rebekah Mitchell, “Mother’s Day and Father’s Day Survey,” M.E.N.D. Newsletter (Vol. 16 Issue 3, 2011).
18
DAVIS, supra note 2, at 93.
19
DAVIS, supra note 2, at 93.
20
For more information and the exact Sunday in a given year, go to http://carlymarieprojectheal.com/2012/05/
international-bereaved-mothers-day.html.
21
For more information an the exact dates go to http://www.twinsdays.org. This may be a difficult day for the
grieving parents. The news coverage of twins may serve as a poignant reminder of their loss.
For more information and the exact Sunday in a given year, go to http://carlymarieprojectheal.com/internationaldates/babylost-fathers-day.
22
23
On October 25, 1988, President Ronald Reagan proclaimed October Pregnancy and Infant Loss Awareness Month
“to increase our understanding of the great tragedy involved in the deaths of unborn and newborn babies. [And, to]
enable[] us to consider how, as individuals and communities, we can meet the needs of bereaved parents and family
members and work to prevent causes of these problems.” Proclamation No. 5890, 53 Fed. Reg. 43,417 (1988),
available at http://www.reagan.utexas.edu/archives/speeches/1988/102588b.htm; S.J. Res. 314, 100th Cong. (1988).
Subsequently, in America, the federal government and the states have recognized October 15th as Pregnancy and
Infant Loss Remembrance Day. See e.g., H.R. Con. Res. 222, 109th Cong. (2005); Ill. S.J. Res. 0078, 94th G.S.
(2006)
available
at
http://www.ilga.gov/legislation/fulltext.asp?
GAID=8&SessionID=50&GA=94&DocTypeID=SJR&DocNum=78&LegID=25309&SpecSess=&Session=; Mo.
H.R. Con. Res. 20, 93rd G.A. R.S. (2006), available at http://www.house.mo.gov/content.aspx?info=/bills051/biltxt/
intro/HCR0020I.htm; N.J. S.J. Res. 58, 212th Leg. (2006).
24
More information is available at http://www.babyloss-awareness.org.
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For more information and the exact Sunday in a given year, go to http://www.compassionatefriends.org/
News_Events/Special-Events/Worldwide_Candle_Lighting.aspx.
25
26
DAVIS, supra note 2, at 60.
27
“Bereaved Grandparents of Multiples: What Helps,” supra note 13.
28
See generally, DAVIS, supra note 2, at 159; “Bereaved Grandparents of Multiples: What Helps,” supra note 13.
DAVIS, supra note 2, at 63; “Bereaved Grandparents of Multiples: What Helps,” supra note 13 (noting “they will
always be the parents of multiples.”).
29
30
DAVIS, supra note 2, at 63.
31
DAVIS, supra note 2, at 63.
32
See DAVIS, supra note 2, at 63.
33
WALTER, supra note 4.
34
See McIntyre, supra note 8; WALTER, supra note 4.
35
WALTER, supra note 4.
36
WALTER, supra note 4.
37
See generally, DAVIS, supra note 2; WALTER, supra note 4.
38
McIntyre, supra note 8; DAVIS, supra note 2, at 155–57 (section titled “Unsettling Remarks”).
39
McIntyre, supra note 8.
40
McIntyre, supra note 8.
41
McIntyre, supra note 8.
42
McIntyre, supra note 8; “Bereaved Grandparents of Multiples: What Helps,” supra note 13.
43
McIntyre, supra note 8.
44
McIntyre, supra note 8.
45
See DAVIS, supra note 2 at 161.
46
McIntyre, supra note 8; DAVIS, supra note 2, at 173.
47
McIntyre, supra note 8.
48
“Bereaved Grandparents of Multiples: What Helps,” supra note 13.
49
“Bereaved Grandparents of Multiples: What Helps,” supra note 13.
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