Early Pregnancy Termination In a Twin Pregnancy — and What I Wish I Had Known
My name is Jessica, and I’d like to share my story. It is one of deep sadness and grief we experienced throughout the process of losing our daughter Maeva, delivering her twin sister Memphis, and being parents to our son Maverick all at the same time.
We are coming up on the one-year anniversary of losing Maeva. Even as we are remembering a lost baby, there still are people in our lives who don’t know the details of our experience. I didn’t share all the details of choosing early pregnancy termination with everyone along the way, mostly because I was scared of being judged for the choice we made.
But, now, after a lot of self-reflection, professional help, and making the choice to lean into my grief, the feeling of being judged — while still present, and a great fear of mine — has diminished. If it takes being judged a few times to help even one family understand informed consent, well then, so be it.
Even when I was expected to be joyful about expecting a healthy baby, I was honest about the fact that I was sad. Honoring and sharing those complex feelings has allowed me to really move through my grief, and be in a place today where I can talk about our loss and share how we might be able to make changes for other families in the future.
Throughout our journey, we shared details with our immediate family, who helped us by supporting us and caring for our son during all of our doctor’s appointments. Most of my motivation to reach out and share so openly now has come from finding the holes that exist in our healthcare system. There was so much information that we weren’t given.
The differences regarding terminology and experiences of loss before and after 20 weeks of pregnancy were not explained to us. Maeva’s pregnancy was ended at 19 weeks and 5 days, just two days shy of 20 weeks’ gestation. That means we chose “early pregnancy termination” without realizing the implications.
It is an injustice that we didn’t know that here in Canada, a baby who passes away in utero is considered a “product of conception” until 20 weeks’ gestation. After 20 weeks’ gestation, a baby who passes is regarded as a stillbirth. Only a stillbirth is registered as a death, and only a stillbirth is given documented proof that the baby existed and entered the world. I cannot explain the heartbreak that comes with not having our baby seen as ours. It can make remembering a lost baby that much harder for parents.
We also weren’t given detailed information about continuing the pregnancy with Maeva. We were not told what Maeva’s life could have and would have looked like if we had chosen to carry her. After asking our healthcare team many difficult questions, we received very little encouragement to continue both pregnancies.
I was made to feel like termination was the only and best option. I truly wish more counseling had been made available to us to enable informed consent. I wish that we knew about other families who had been in these types of situations and decided to carry to term. I made a choice based on the information I was provided by my healthcare team that I trusted, and I cannot change what was done. I feel at peace most days now, but I feel that it should be the duty of healthcare providers to inform families of all options regarding babies who face life-limiting diagnoses.
Being informed would have made a world of difference to my ability to truly consent. I needed to be empowered to make a fully informed choice. I needed access to and support from an organization like Carrying To Term. This is why I’m sharing my story. I’m motivated to change this experience for other families. I want to help other families by ensuring they have all the information possible.
Consider the Support You May Need on Your Unique Pregnancy Journey
From the beginning, my second pregnancy was so different. It took quite some time for us to conceive our first child, our son Maverick because I have endometriosis. So, when we decided to get pregnant again, we thought it would take a while, too. We had only been trying to conceive for a month when we found out that we were expecting again in November of 2017.
I have always been a very self-sufficient person. I value my independence and take pride in that as a military wife. With my first pregnancy, we had only known I was pregnant for a week before my husband had to leave for six weeks for work.
When he was home, his work schedule didn’t allow him to make any of my doctor’s appointments, but that was not an issue for me. I thought, “all women do this; this isn’t that difficult. I just have to do whatever I have to do.” It felt like an extension of my independent personality.
I was hospitalized very early on with hyperemesis gravidarum, or severe nausea and vomiting. It was during that hospital visit that we learned we were expecting not only one but two babies. I had felt in my heart that I would have twins long before we even became pregnant with our girls, so twin pregnancy felt right when we found out.
While we were in the hospital, an ultrasound showed that Twin B, whom we later named Maeva, was measuring about a week behind Twin A, whom we named Memphis. I felt some worry, but my doctor was not able to give me a solid reason why Maeva was measuring behind. The fact that my doctor did not seem too concerned put my husband and me at ease.
So, when I was sent to a larger hospital system two hours away from our home for my anatomy scan with Memphis and Maeva, I didn’t think twice about handling it alone. My husband was able to take some time off that day, but we had never left our son with anyone before. We knew we would be nervous leaving our son for the first time.
It seemed too much to keep a toddler busy for so many hours on the road and then at the hospital. We thought this appointment would be just another one to get through — that it wouldn’t be any different — so we decided it would be better if my husband spent the day at home playing with our son while I went to the appointment alone.
Immediately following the scan, a doctor came into the room to discuss their findings. The doctor told me that Memphis was perfectly fine, but Maeva was missing a part of her brain. I learned that they found some abnormalities with her spinal cord, too. She was also measuring three weeks behind what she should have for her gestational age. At that time, we were not given a diagnosis, but would later learn Maeva had Dandy-Walker malformation.
It was very difficult to be given this news alone. I wanted to cry, but I knew I was responsible for hearing and understanding what the doctor was telling me. I had to stay present and process the details so that I could relay that information to my husband. But, as I sat there, listening to the devastating news, it felt like I went on autopilot. I was just going through the motions. I was alone and devastated, and I still had to face the long drive home.
I called my husband as I left the hospital, but the most I could manage to say was that something was wrong with one of our babies. He was worried about me driving home in the snowy conditions, so he didn’t want to go into details until I got home.
After I spoke with my husband, I called my mom. She, too, was worried about my long drive home, so she didn’t want to ask too many questions. I just felt at a loss. I was all alone, and my family was worried for me and wanted me to focus on the drive. We were just all in shock.
Once I got home, I was able to tell my husband all the details. I knew he was in shock. I was in shock. I knew he was struggling to come to terms with it. I think we were both in denial, especially him. But, through all the confusion, heartache, and difficulty, he was extremely supportive as we tried to process and prepare for the next steps.
Looking back, I really wish that day didn’t happen to just me. It is one of my loneliest memories, and it was very traumatic. When something so major happens, it is hard to be the only one who has gone through it. I wish I had someone to care for me in those moments.
Pregnancy, whether it is a twin pregnancy or not, and whether it is filled with complications or not, is important. We should all be supported in whatever ways possible. Knowing what I know now, I wish I had taken a friend to the appointment, regardless of the results.
Since I did learn the devastating news that our daughter had a health issue, having a friend there would have been so helpful, that person would have been there to share in the difficulties of the day. That person could have helped me listen, take notes, and relay that information to my husband. I could have cried and taken the time to process what I had just heard instead of trying to be strong enough to make it home safely.
Ask for More Time and Support
After learning of the prenatal diagnosis of a life-limiting condition for one of the babies I was carrying during my twin pregnancy, the doctors talked to me about the prognosis and my options. This is a really difficult piece of the story to talk about because I wish there were more to say.
Even though I know it was the doctor’s job to make me informed, I feel a sense of guilt, as if I gave consent without doing my job by asking more questions or just knowing more. I wish I had known then what I know now. I wish I had spoken up and demanded more information.
The first doctor I spoke with following the ultrasound was so cold to me. They all were, to be honest. The way she explained some of the findings was confusing, and it wasn’t until I asked what my options were going forward that I began to understand how bad the situation was.
She told me that the prognosis for Maeva, with what turned out to be Dandy-Walker malformation and other complications, was very poor. She said that I had the option to terminate Maeva and continue the pregnancy with Memphis, but there was no sadness or empathy or care from her. It felt like a business transaction.
It was difficult to get information about Maeva’s life if we continued the pregnancy. They couldn’t tell me her life expectancy. They couldn’t tell me if she would or could make it to term. I was given the option to have an MRI to get more information about why this had happened, but the doctors were quick to allude to the fact that testing wouldn’t change anything.
So, I was given the option for more information but, in a way, deterred from actually pursuing that information. Everything I asked seemed to be shut down, and it felt like they were saying that termination was the best option. The differences between early pregnancy termination and waiting beyond 20 weeks’ gestation were not discussed.
I asked if there would be a risk to Memphis if we did terminate Maeva. I was told that there would be a slight risk of preterm labor, which I did, in fact, experience. Overall, we were ill-informed on all options — and parents need to be fully informed in order to truly consent.
We did not have a clear understanding of how early pregnancy termination or continuing the pregnancy would affect Memphis. What I know now is that termination was not the safest or the best option from a medical standpoint; it was just an option that happened to be presented to me as the only option.
Early pregnancy termination in my twin pregnancy had so many ramifications I did not understand. No one explained to me that if I decided to terminate, I would be considered a high-risk pregnancy, and I would have to travel two hours to the hospital every single week until the end of my pregnancy.
I also would have liked the option to look into organ donation. The extra time carrying my daughter and the possibility of getting to help another family or contribute to medical innovation makes me incredibly emotional to think about. I wish I had had that choice.
I was not counseled on the effects that terminating one baby and having to continue to carry them both would have on my mental health. I don’t feel like Memphis’s well-being was considered, and my well-being was certainly not considered. I was not prepared for the intense feelings of grief and sadness.
When I look back on this experience, it felt like a cold transaction, as if we were with an accountant filling out our taxes. As we met with doctors and talked through everything, it felt like Maeva was seen as her own entity. She, alone, was the issue. I wasn’t also pregnant with another baby girl. I wasn’t a mother who was about to lose her whole world. Or a person who would be remembering a lost baby for the rest of my life.
Losing our daughter Maeva, delivering her twin sister Memphis, and being parents to our son Maverick all at the same time was one of the most difficult journeys of our lives. While we supported each other, my husband and I had to process complex information and intense emotions — and we each had to do so in our own way.
We had a follow-up appointment where an ultrasound of Maeva’s brain was performed. This formally diagnosed Dandy-Walker malformation, tethered cord, and early onset intrauterine growth restriction (IUGR). We then met with a genetic counselor who detailed the chromosomal abnormalities we would be looking for if we underwent an amniocentesis.
Following that ultrasound, my husband shared with me that he hadn’t truly believed that the news that something was wrong with Maeva was true until then. The news was just too overwhelming and devastating for him to process and come to terms with until he heard it himself from the doctors.
For me, getting the formal diagnosis felt like the fact that something was wrong with my baby was being rubbed in my face. The findings were still the same — the only difference now was that we had a name for each issue.
As we sat there, listening to the doctor give us the news, the appointment felt like a cold interaction. I’ve said before that our doctor appointments often felt like we were with an accountant filling out our taxes.
We didn’t feel much empathy from our doctors that day. I think that is what made me realize that I would have to look out for my own heart. That is when and why I sought additional counseling and support on my own.
After receiving the formal diagnosis, I searched the internet high and low for resources or similar stories to mine to see if there was any hope. I wanted to see what the outcome would be if we did not terminate. I wanted to hear from women who were remembering a lost baby. I hoped even just to find someone to connect with.
My hospital provided very little support or information, so I had no luck finding someone in a similar scenario. I did, however, immediately seek the help of a counselor, and I later found a network of pregnancy and infant loss families to connect with.
Informed Consent and Feeling at Peace Requires Holistic Perspective
Having been together for a decade, there aren’t many topics my husband and I hadn’t spoken about at some point or another. Making big decisions together has always been something we do really well. When we were discussing Maeva’s Dandy-Walker malformation diagnosis and what we thought was the best option for our family, it was very layered and nuanced.
But, after talking with medical professionals and knowing that they recommended termination, it felt like we had no choice but to terminate. We knew that pregnancy continuation was somewhat of an option in the sense that we were told that it was possible. We didn’t even know there was a difference between early pregnancy termination and waiting until after 20 weeks gestation. We didn’t feel like we had a choice in the full sense of the word.
Our doctors told us that Maeva could suffer during the twin pregnancy. There could be diagnosis-related and twin-related complications. I could experience preterm labor, or Maeva could die at any moment in utero. I was told that if she passed away during the pregnancy, I wouldn’t know when she died.
When they told me that, the thought of worrying every moment of every day about when she might die felt terrifying and anxiety-inducing. There was no conversation about possible survival or outcomes after birth. The information was framed in a way that made it seem like termination was the only and best option, even despite the risk of preterm labor as a result of the termination procedure.
Additionally, we had no idea how much our baby girl would suffer and for how long if she was born alive. The unknown was too much for our hearts to take in this already scary time. So, my husband and I decided to terminate Maeva’s pregnancy and continue Memphis’s.
While the thought of Maeva passing away without me knowing was awful, the idea that I would actually have to make the decision to end her life felt horrible. I kept thinking about this experience in the context of my son’s pregnancy.
If I had terminated his pregnancy, I wouldn’t have known him or had the close bond that I have with him. Although the situations are entirely different, it was impossible to separate the dreams I had for a future with my son and our girls from the reality of the choice before me.
This would have been an impossible situation with a singleton pregnancy, too. Still, there is no way to fully articulate the nuances and difficulties of making this choice in the context of twin pregnancy when there are two babies to consider. I felt like I was being forced to pick between my children — which one could live and which one couldn’t. I cannot begin to explain how difficult that is as a parent.
My husband reassured me many times that I wasn’t choosing between my children. I didn’t choose this situation. I wouldn’t get the future I dreamed of with my girls because Maeva was sick, and Memphis wasn’t. I wasn’t choosing Memphis over Maeva. I was doing the best I could to handle a diagnosis I never expected and a situation that felt impossible.
We live five hours from any family. We live in a military town, and most of our close, trusted friends had been relocated, leaving us with very little support. We live two hours from the only hospital equipped to treat a high-risk pregnancy, a terminal baby, and possibly a premature but healthy baby as a result of a complex twin pregnancy.
Our son was sixteen months old, just beginning to walk, and he needed so much of our care and attention. We didn’t know how we would manage a terminally ill baby in the NICU, a newborn, a small toddler, no local support, the financial strain, and the grief of remembering a lost baby.
Only after the termination procedure, I found a friend online who continued her pregnancy with her baby, who had a life-limiting diagnosis. I followed her story and learned that her baby lived for about a month. It was not until I learned of her story that I realized this could have been a possibility for us with Maeva.
I saw the decisions she had to make after her baby was born. I saw the memories she got to have with her baby, even though they were difficult and limited. For her, remembering a lost baby was very different than it has been for me. I became painfully aware of what we could have had and what I needed and wanted.
The thing about hindsight is that it is 20/20. Had we considered that our family and friends would have traveled to be with us, cook meals for us, and help in any way they could, things might have been so different.
Had we been informed about what life with Maeva, even in the NICU, would have looked like, things might have been different. Had we known that resources like Ronald McDonald House and neonatal palliative care centers exist, things might have been different. But we didn’t know, and no one told us. That’s why informed consent is so important for parents in situations like the one we faced.
What I didn’t fully understand was that the choice was more nuanced than what was being presented. We were not met with empathy as we tried to process the diagnosis and our options. When we had questions or when the information felt incomplete or unreliable, we were never given straight answers or more clarity.
Informed consent would have been monumental for us. I truly felt, in my heart, that continuing the pregnancy was what I needed and wanted, yet I couldn’t articulate it. I did not know how to discuss what I did not know. Every question that I asked my healthcare team was in an effort to lead to pregnancy continuation, yet I felt very redirected to what turned out to be early pregnancy termination.
When One Twin is Critically Ill, Moms May Experience Unique Pregnancy Trauma
My pregnancy with my twin girls was a very wanted pregnancy. The moment I found out that we were having twins, I was so excited. From the beginning, our girls felt like a unit: twins. I never once thought of how difficult twin pregnancy might be.
Then, one of our girls was diagnosed with the prenatal, life-limiting condition of Dandy-Walker malformation. This is by far the most difficult situation I have ever experienced. Before it happened, I truly couldn’t imagine the reality I lived through was a possibility.
It is so very hard to admit my real feelings the night before the termination procedure. But, I told my husband that if we were terminating Maeva, I felt that I wanted to terminate Memphis as well. It makes me sad to think back on those moments, and I think it really upset my husband to hear that I was considering that.
When I considered terminating Memphis, too, it was because the thought of my daughters being together and Maeva not being alone seemed like a small comfort. My husband didn’t know what to say or how to support me. I didn’t know what the right answer was in those moments.
I was too embarrassed to even mention those thoughts to my doctors or to anyone else. But I wonder if I had been honest about how I was feeling; maybe someone would have told me that I wasn’t the first to think that. Or that these thoughts were normal given what I was facing.
To be honest, before the early pregnancy termination procedure, I’m not even sure I thought about what it would be like to continue to carry Maeva after she had passed. I don’t think it registered before the procedure that I would be carrying and delivering a baby who had passed. No one spoke to me about the feelings that would arise from carrying a terminated baby for months after the procedure.
Looking back, I find it hard to remember being pregnant afterward. It’s very difficult to explain because I know that I still carried Maeva in my belly, but it was almost like I stopped visualizing her in there after she passed away. I cannot remember thinking about how she was positioned or what she may have looked like.
I feel like the trauma of what we had been through and the choice we had to make blocked my mind from going there or is blocking me from remembering what it was like during that time. I do remember that it really bothered me when people would touch my belly, aside from my husband or son. It was deeply disturbing to share that connection with anyone, even if they knew what had happened. It felt too personal and vulnerable.
Nothing prepares you for remembering a lost baby while continuing to be vulnerable and sharing your body with another baby. I felt a deep longing, and I began to miss Maeva immediately after the procedure. It is a very difficult thing to explain, as I still physically carried Maeva’s body, but I felt that her soul was no longer close.
Some of my friends expressed immense empathy and sadness over what it must have been like for me to carry both of my babies until delivery. For me, having them both there physically wasn’t the difficult part; it was the feeling of her soul not being with me that was devastating. Nothing prepares you for that.
Nothing prepares you for the depression, either. I wasn’t sure that my depression and grief would ever end. I don’t know if I could ever explain in words how this decision broke my heart. I don’t think I can fully articulate how confusing it all was.
I couldn’t dive into exercise for a release. I had to continue to eat to sustain and nourish Memphis. I couldn’t drink a glass of wine to relax. I couldn’t escape into work to help me cope because no one would hire me at nearly six months pregnant. I wanted to run away from it all, but it was impossible. I just had to get through it.
We didn’t get to experience parenting Maeva. We didn’t get to make memories with her. The truth is, I still wrestle with complex questions and emotions, and I still struggle with feeling responsible for ending a very, very wanted pregnancy.
As the pregnancy progressed, I became more involved in online support groups. I made connections with moms who had decided to carry to term and those who did not. The more I learned the details — no matter how heartbreaking — the more I learned how absolutely essential in the grieving and healing process it is to have tangible memories to process the loss of a child.
Look For Ways of Remembering a Lost Baby and Validating Your Experience
I was hospitalized in an effort to stop my labor, and I stayed in the hospital until I went into active labor at thirty-three weeks. I delivered my girls by emergency C-section. It was during this experience that I really began to see the realities of the choice we made and how much informed consent might have changed our experience.
Since we terminated Maeva’s pregnancy before twenty weeks, it was an early pregnancy termination. That means she was never recognized as a stillborn baby. She was not given any documentation recognizing that she lived at all; that she was a person. As a result, Memphis is considered a singleton baby, not a twin.
My healthcare team did not recognize Maeva as a baby. She was considered a product of conception, and the assumption was that, as a product of conception and not a baby, I wouldn’t be attached to her. So, I was not asked if I wanted to see her.
It never crossed my mind to ask to see her because of how the health care team handled her at the time of her birth but also because of how the doctors had talked about her and her condition at birth at the time of the termination.
What doctors seem to miss in this situation is that there is some intangible attachment that happens between a mother and a baby, and that attachment was there for me with both of my girls. It was never recognized by my health care team. While it would have been difficult to see her, it would have been my only time with my baby and for remembering my lost baby. It should not have been up to my doctors to make that decision for me.
Six months later, when I spoke with the hospital’s bereavement committee, I learned that I could have seen her. Learning that has been one of the hardest things since her birth because it felt like another experience of not being informed so I could truly consent. It’s another loss. Sometimes, I feel a little bit crazy for mourning and remembering a lost baby that I was never able to see, but she was a person and deserves to be mourned. I wish I had had that option.
We are living in a society that deems anything that makes us uncomfortable as bad and to be avoided at all costs. What my doctors didn’t understand is that I had already lived through the most painful days of my life during my twin pregnancy, and no matter what she looked like, my lost twin child was a baby. Seeing and holding her would’ve helped me know that she was real.
Knowing what I know now, it makes me very sad to think about the fact that I missed my chance to see and hold my baby girl. I think being able to see Maeva might have resolved a lot of “what ifs” for me. It would have given me a priceless memory, allowing me to say hello and goodbye.
Some days, this experience feels like a dream because I don’t have anything tangible to hold on to. I think getting to hold her would have helped this feel more real. I am not the only woman to experience this loss, and it’s something that has to change.
Reflections On My Twin Pregnancy and 3 Takeaways For Carrying To Term Families
We, like all excited, expecting parents, were not prepared for the experience of twin pregnancy with a prenatal diagnosis of a life-limiting condition. Before the diagnosis of Dandy-Walker malformation for one of my babies, I was so excited to have twin girls.
Nobody tells you that these things happen at all, let alone how to deal with these situations when they do happen. No one tells you what questions to ask or how hard to push for a second opinion. No one tells you how to do your own research or how important informed consent is for your mental health and emotional well-being.
We trusted our doctors. We trusted that they were giving us all the information that we needed in an unbiased way. We didn’t think we should push too hard, even when we felt like we weren’t getting the whole picture. We were incredibly vulnerable, scared, and overwhelmed. We thought they would help us and ensure that we were fully informed. We gave consent but didn’t understand all of the ramifications of our choice.
It wasn’t until later that we learned how many other people have gone through this experience. It wasn’t until later that we learned how much information and how many resources are available. It wasn’t until later that I knew our doctors could have sent us for second and third opinions.
Six or seven months after delivering the girls and dealing with some of the birth trauma, I started working to accept our decision to terminate. Then, I learned new information that really upset me. I learned that not only are there pamphlets and resources available to parents who have received a prenatal diagnosis of a life-limiting condition, but there are specific resources for parents like us who have one twin with a diagnosis and one healthy twin during twin pregnancy.
I learned that there are resources to help parents process the grief of losing one twin and bringing home the other. I learned that some surviving twins experience a sense of loneliness and grief over the loss of the twin, even drawing their twin in pictures at school. I didn’t receive any of these resources until six months after delivering my daughters.
I began to really doubt our decision, wondering what else was kept from me. I have since spoken with another maternal-fetal medicine clinic about five hours away from us, and we are considering having a consultation with them to review everything. We have so many questions, and we want some sense of peace. We did the best we could with the information we had, and I have to be okay with that. But I now have less trust in doctors, and I live with questions that I will never be able to answer.
The 3 takeaways
For any mother and family in a similar situation, I think it is important to listen to your heart first and foremost. Second, I want you to know that no matter how isolated you feel or how unique your situation may seem, someone out there knows what you’re going through.
Finally, you will never regret being informed. You can’t truly consent without being fully informed. Ask all the questions and weigh both sides, even if you have already decided. Get second and third opinions. Push back when your instincts tell you to. Do your research. Ask for help and support.
Our family today
Our little family is doing well. Maverick turned out to be the best big brother. Memphis has been such an amazing little blessing to us, and her first birthday is fast approaching. Remembering a lost baby is part of our family story. We honor Maeva and keep her close to us daily. Her ashes rest peacefully beside Memphis’ crib. Our girls are together, and that brings us peace.
My husband and I are about to celebrate our fourth wedding anniversary. I have recently become a volunteer with the Pregnancy and Infant Loss (PAIL) Network, and I’m hoping to host a memorial run for Maeva this year!
Although I am so grateful to be in a positive place in my life, I still have a constant ache in my heart. When my little family is all together, it feels like I’m always missing something. I know that’s Maeva, and that feeling is what motivates me to find the light in myself again and do what I have to do to raise awareness and support for other moms.