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How Bereaved Multiple-Birth Parents Cope with Hospitalization, Homecoming, Disposition for Deceased, and Attachment to Survivors

Journal of Perinatology volume 24, pages 714–722 (2004)Cite this article

Abstract

OBJECTIVE: To elicit bereaved multiple-birth parents' perceptions regarding support, disposition decisions, attachment to surviving multiples, discharge, and later coping.

STUDY DESIGN: Narrative email survey of 70 bereaved parents with quantitative and qualitative analysis.

RESULTS: Bereaved parents of multiples find neonatal hospitalization stressful. Not all caregivers acknowledged loss, although most parents would welcome brief loss discussions during survivors' hospitalization. Half of respondents felt social workers could help coordinate support or mental health care. Most participants recalled hospital support for loss, but only 43% recalled support for neonatal hospitalization. Respondents praised peer support and written materials. Parents felt ambivalent about disposition for deceased babies while comultiples were ill; most made prompt arrangements. Attachment to survivors was difficult for half. Breastfeeding and discharge planning were important, and 31% had difficulty coping at home.

CONCLUSIONS: Caregivers must communicate better with bereaved multiple-birth parents, whose desires for support, loss discussions, disposition, and discharge vary considerably.

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References

  1. Martin JA, Hamilton BE, Sutton PD, et al. Births: Final Data for 2002. National Vital Statistics Report, Vol. 52, No. 10. Hyattsville, Maryland: National Center for Health Statistics; 2003. p. 1–114.

  2. Newman RB, Luke B . Multifetal Pregnancy: A Handbook for Care of the Pregnant Patient. Philadelphia, PA: Lippincott Williams & Wilkins; 2000. p. 53–73.

  3. Hartley RS, Emanuel I, Hitti J . Perinatal mortality and neonatal morbidity rates among twin pairs at different gestational ages: optimal delivery timing at 37 to 38 weeks' gestation. Am J Obstet Gynecol 2001;184(3):451–458.

    Article  CAS  Google Scholar 

  4. Goldberg S, Perrotta M, Minde K, Corter C . Maternal behavior and attachment in low-birth-weight twins and singletons. Child Dev 1986;57(1):34–46.

    Article  CAS  Google Scholar 

  5. Zanardo V, Freato F, Cereda C . Level of anxiety in parents of high-risk premature twins. Acta Genet Med Gemellol (Roma) 1998;47(1):13–18.

    Article  CAS  Google Scholar 

  6. Ostfeld BM, Smith RH, Hiatt M, Hegyi T . Maternal behavior toward premature twins: implications for development. Twin Res 2000;3(4):234–241.

    Article  CAS  Google Scholar 

  7. Yokoyama Y . Comparison of child-rearing problems between mothers with multiple children who conceived after infertility treatment and mothers with multiple children who conceived spontaneously. Twin Res 2003;6(2):89–96.

    Article  Google Scholar 

  8. Cook R, Bradley S, Golombok S . A preliminary study of parental stress and child behaviour in families with twins conceived by in-vitro fertilization. Hum Reprod 1998;13(11):3244–3246.

    Article  CAS  Google Scholar 

  9. Thorpe K, Golding J, MacGillivray I, Greenwood R . Comparison of prevalence of depression in mothers of twins and mothers of singletons. BMJ 1991;302(6781):875–878.

    Article  CAS  Google Scholar 

  10. Pector EA, Smith-Levitin M . Mourning and psychological issues in multiple birth loss. Semin Neonatol 2002;7(3):247–256.

    Article  Google Scholar 

  11. Cuisinier M, deKleine M, Kollee L, Bethlehem G, deGraauw C . Grief following the loss of a newborn twin compared to a singleton. Acta Paediatr 1996;85:339–343.

    Article  CAS  Google Scholar 

  12. Netzer D, Arad I . Premature singleton versus a twin or triplet infant death: parental adjustment studied through a personal interview. Twin Res 1999;2(4):258–263.

    Article  CAS  Google Scholar 

  13. Bryan EM . The death of a twin In: Sandbank AC, editor. Twin and Triplet Psychology. London: Routledge; 1999. p. 186–200.

    Google Scholar 

  14. Bryan E . Loss in higher multiple pregnancy and multifetal reduction. Twin Res 2002;5(3):169–174.

    Article  Google Scholar 

  15. Swanson PB, Pearsall-Jones JG, Hay DA . How mothers cope with the death of a twin or higher multiple. Twin Res 2002;5(3):156–164.

    Article  Google Scholar 

  16. Pector EA . Views of bereaved multiple birth parents on life support decisions, the dying process, and discussions surrounding death. J Perinatol 2004;24(1):4–10.

    Article  Google Scholar 

  17. Eaves YD . A synthesis technique for grounded theory data analysis. J Adv Nurs 2001;35(5):654–663.

    Article  CAS  Google Scholar 

  18. Howser C . A Different Kind of Mother Bloomington, IN: 1stbooks.com; 2001.

  19. Fifield D . William & Wendell: A Family Remembered. San Francisco, CA: Times Two Publishing Company; 2000.

    Google Scholar 

  20. Im EO, Chee W . Issues in Internet research. Nurs Outlook 2003;51(1):6–12.

    Article  Google Scholar 

  21. Frankel MS, Siang S . Ethical and legal aspects of human subjects research on the Internet AAAS workshop 1999 June; Washington DC; 1999 November. http://www.aaas.org/spp/dspp/sfrl/projects/intres/main.htm (accessed 11 January 2004).

  22. Kraut R, Olson J, Banaji M, Bruckman A, Cohen J, Couper M . Psychological research online: report of board of scientific affairs' advisory group on the conduct of research on the Internet. Am Psychol 2004;59(2):105–117.

    Article  Google Scholar 

  23. Little GA . Parents of multiples and decision-making. J Perinatol 2004;24(1):2–3.

    Article  Google Scholar 

  24. Gosling SD, Vazire S, Srivastava S, John OP . Should we trust web-based studies* A comparative analysis of six preconceptions about Internet questionnaires. Am Psychol 2004;59(2):93–104.

    Article  Google Scholar 

  25. Han HR, Belcher AE . Computer-mediated support group use among parents of children with cancer — an exploratory study. Comput Nurs 2001;19(1):27–33.

    CAS  PubMed  Google Scholar 

  26. Epstein YM, Rosenberg HS, Grant TV, Hemenway BAN . Use of the Internet as the only outlet for talking about infertility. Fertil Steril 2002;78(3):507–514.

    Article  Google Scholar 

  27. Klemm P, Hardie T . Depression in Internet and face-to-face cancer support groups: a pilot study. Oncol Nurs Forum 2002;29(4):E45–E51.

    Article  Google Scholar 

  28. Kraut R, Kiesler S, Boneva B, Cummings J, Helgeson V, Crawford A . Internet paradox revisited. J Soc Issues 2002;58(1):49–74.

    Article  Google Scholar 

  29. Miles MS . Sources of support reported by mothers and gathers of infants hospitalized in a neonatal intensive care unit. Neonatal Netw 1996;15(3):45–52.

    CAS  PubMed  Google Scholar 

  30. Harrigan R, Naber MM, Jensen KA, Tse A, Perez D . Perinatal grief: response to the loss of an infant. Neonatal Netw 1993;12(5):25–31.

    CAS  PubMed  Google Scholar 

  31. Bedell SE, Cadenhead K, Graboys TB . The doctor's letter of condolence. N Engl J Med 2001;344(15):1162–1164.

    Article  CAS  Google Scholar 

  32. Davis D, Tesler-Stein M . Parenting your premature baby and child: the emotional journey. Golden, CO: Fulcrum Publishing, 2004, Appendix A, 817–34.

  33. Miles MS, Holditch-Davis D . Parenting the prematurely born child: pathways of influence. Semin Perinatol 1997;21(3):254–266.

    Article  CAS  Google Scholar 

  34. Britt DW, Mans M, Risinger ST, Evans MI . Bonding and coping with loss: examining the construction of an intervention for multifetal pregnancy reduction procedures. Fetal Diag Ther 2001;16(3):158–165.

    Article  CAS  Google Scholar 

  35. Collopy KS . We didn't deserve this: bereavement associated with multifetal reduction. Twin Res 2002;5(3):231–235.

    Article  Google Scholar 

  36. Bergh C, Moller A, Nilsson L, Wikland M . Obstetric outcome and psychological follow-up of pregnancies after embryo reduction. Hum Reprod 1999;14(8):2170–2175.

    Article  CAS  Google Scholar 

  37. Maifeld M, Hahn S, Titler MG, Mullen M . Decision making regarding multifetal reduction. J Obstet Gynecol Neonatal Nurs 2003;32(3):357–369.

    Article  Google Scholar 

  38. Sychowski SMP . Life and death: in the all at once. Mother Baby J 1998;3(1):33–39.

    Google Scholar 

  39. VanderZalm, JE . The perinatal death of a twin: Karla's story of attaching and detaching. J Nurse Midwif 1995;40:335–341.

    Article  CAS  Google Scholar 

  40. Hanrahan J . Breastfeeding after the loss of a multiple. Leaven 2000;36(5):102.

    Google Scholar 

  41. Pector EA, Green J, Ehlers M, et al. Personal experiences of bereaved twins, parents of twins, and their carers. Twin Res 2002;5(3):236–244.

    Article  Google Scholar 

Download references

Acknowledgements

I am deeply grateful to the parents who generously shared insights from their most unfortunate experiences. I also thank Donnali Fifield for editorial advice, and Dr. George Little for comments on an early draft of this manuscript.

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  1. Spectrum Family Medicine, Naperville, IL, USA

    Elizabeth A Pector MD

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  1. Elizabeth A Pector MD
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Conflicts: Current or former member of several networks and organizations surveyed. No income derived from any institutions, networks or organizations mentioned.

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Pector, E. How Bereaved Multiple-Birth Parents Cope with Hospitalization, Homecoming, Disposition for Deceased, and Attachment to Survivors. J Perinatol 24, 714–722 (2004). https://doi.org/10.1038/sj.jp.7211170

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