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contenthead = "If You&#39;re Pregnant Now"
content = "S"+intermediateFormatting+"adly, it is rare that a day goes by here that we don&#39;t hear from a mother who has experienced the death of one of her twins or higher multiples in&#45;utero at some time during pregnancy &#40;and dads too&#41;.  Many whose loss was in the first, second, or early third trimester are having to experience what we call &quot;<a href=index.html?longer>going longer</a>&quot; in the pregnancy with both or all of the babies, for the sake of the survivor or survivors getting as far as possible past prematurity.  We also have known many who are pregnant while &quot;<a href=index.html?knowingahead>knowing ahead</a>&quot; through prenatal diagnosis that one or more of the babies will not live long past birth.  Though it is more rare, we also have known mothers who have given birth to one of their babies, at a time when the baby was too premature to live, and experienced a <a href=index.html?delayedinterval>delayed interval birth</a>, with the remaining baby or babies kept inside for as long as possible.<br><br>If you are visiting this section because you are experiencing one of these losses, we are very sorry and hope that it will be helpful to you in some way as you follow a really unexpected path as person and as a parent, and one that others often do not understand. Though this section is written in a more general way, it is really &quot;you&quot; we are thinking of. <br><br>Our site sections on the loss of a twin, and on higher multiple &#40;supertwin&#41; loss, as well as the section on selective reduction, are of course relevant and include these losses.  In this section, though, we&#39;d like to highlight some of the special needs for information and support of those who are pregnant now with their multiples and know that the birth ahead will involve loss.  We&#39;ve seen that people&#39;s experience of coping and healing over a period of time and enjoying the child or children who does remain from the pregnancy doesn&#39;t come from minimizing or ignoring their loss, or others telling them they have to be happy for the sake of the other baby or babies. It comes through recognition and validation of their loss and needs, in a type of situation that is really a major challenge to anyone&#39;s mental health and emotional and social wellbeing. <br><br>Each part of this section includes some comments and information, some suggestions on resources &ndash; and personal stories of CLIMB members.  Also, be sure to see the <a href=index.html?biblio>Bibliography</a> for the articles and books cited as well as other information that may be of interest.   Please be welcome to check out the part that relates to you and be in touch with us.  We hope that it will be helpful in being your own best advocate for your needs, and in coping and healing over time."
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content = ""+intermediateFormatting+"<b>&quot;The Vanishing Twin</b>&quot;<br><br>Though as with other aspects of multiple birth loss, truly comprehensive statistics are not kept, many researchers agree that there is a very high rate of the loss of one twin or higher multiple in the first trimester of pregnancy.  The article &quot;The Vanishing Twin&quot;, by Drs. Landy and Nies, in Multiple Pregnancy &#40;Keith et.al., see Bibliography&#41; presents a great deal of information on this and what has been known about it over time; and Multifetal Pregnancy &#40;Newman and Luke, see Bibliography&#41; gives information that is quite striking, as do a number of other articles, some of which are listed in our <a href=index.html?biblio>Bibliography</a>. Newman and Luke write that more than one in 8 spontaneous pregnancies begins as twins, and no more than one in 50 natural twin pregnancies survive &#40;both babies&#41; until term;  for every liveborn twin pair, there are 10 to 12 twin pregnancies from which only a single baby is born alive.  They say that it is estimated that 20&#37;&#45;50&#37; of fetuses in multiple pregnancies identified by ultrasound in the first trimester are spontaneously lost. It is the prevalence of ultrasonography which has made the extent of this evident &ndash; and it has come at a time when multiple conceptions are more and more frequent because of fertility technology.<br><br>What this has meant to us is that there are so many who have had early ultrasound, often after in&#45;vitro fertilization or other assisted reproductive technology, and learned at 5 or 6 weeks along that there are two or more embryos. Some have learned at 8 or 9 weeks along that there are two or more heartbeats.  Yet they return for their next ultrasound to learn that one or more of the babies is no longer visible, and has died.  Many of them had not been told, at the amazing time of the diagnosis of two or more, that such a thing was even possible or likely &#40;and those who had been gently advised by their caregiver about early loss, still experience learning that it has happened to them&#41;.<br><br>The emotional adjustment is enormous for many people, and that is often true even if it has been only a few days between the news of multiples and the news that one has died. This seems to be especially true for those who were told that they were having twins, and now have only one baby.  Even though it&#39;s a shock at first, and many parents wonder how they will manage, the whole concept of &quot;TWINS&quot; and &quot;my twins&#33;&quot; is so appealing to most people &ndash; especially those who have been through infertility &ndash; that we are &quot;hooked&quot; in just a few days. Many go ahead and plan their early maternity leave, buy all the books there are on multiple pregnancy and birth, tell their family and friends, and start thinking in &quot;twos&quot; of everything, feeling incredibly lucky and special. Even though originally the news of one was what they hoped for and expected, now it can&#39;t help but feel like a comedown and a huge adjustment emotionally.  They are also left feeling very vulnerable, and worried about the medical and emotional outcome for their survivor.<br><br>This kind of loss also often occurs in higher multiple pregnancies &ndash; according to some of the data mentioned above, even more often.  Many who conceive three, especially,  feel very much the same way.  For some, the news may also be a relief from having to decide about multifetal pregnancy reduction &#40;MFPR&#41;, because they had conceived three, four or more and now have two or three remaining &#40;or for some it means that if they still decide on MFPR it will be less complicated&#41;, or selective termination because of a problem with one or more of the babies.  It may also be a partial relief to their fears about prematurity and other risks and realities of very high multiples.   If parents do lose one or more of the remaining babies later, they may regrieve that earlier loss because that baby or babies now seems even more real to them, and loss seems even more real.  Some who do have the remaining babies safely wonder what could have been and why that baby could not have been here too.<br><br>This kind of loss is something that has also come up quite a lot in our personal experiences with the public, that is, with people who haven&#39;t contacted us but whom we happen to meet in one way or another.  Overall, it seems that each person&#39;s reaction and adjustment is personal and individual &ndash; yet for most people this is a significant event, one that is not forgotten in one&#39;s childbearing history and experiences. Some parents choose to name the baby or babies who died, or refer to them as &quot;Baby B&quot; or &quot;Baby C&quot;,  and include a special symbol of some kind for them in their birth announcement.  Some have memorials of various kinds, and we hope to be able to include some specifics of them in this section. Some plant a special tree or rosebush in their garden. Anything which is loving and honors the baby or babies is appropriate and helpful for the mother and the parents if they wish to do it.   Some instruct their physician to look at birth for any signs of the baby &#40;for example an indention in the placenta is one that people have mentioned&#41; and this may be helpful in saying hello and goodbye to that baby and &quot;my twins&quot; or multiples.   Others have requested a copy of the original ultrasound.<br><br>Beth Pector MD&#39;s article, &quot;Rebuilding a Life After Multiple Birth Loss&quot; &#40;<a href=http://www.thepreemieplace.org/pregnancy.htm>www.thepreemieplace.org/ pregnancy.htm</a>&#41; contains a section on this which lists some resources, and also has some comments on the issue of any potential medical or emotional impacts on the surviving baby or babies.  There are quite a few articles online in one place or another, and it is recommended to compare anything you might to those listed in this section and in our Bibliography before deciding how accurate any of them might be &ndash; the subject of twins and vanishing twins has unfortunately been the subject of some speculation and there is even a &quot;theory&quot; out there involving aliens which should be avoided. Claire Ainsworth&#39;s article in the New Scientist &#40;see <a href=index.html?biblio>Bibliography</a>&#41; attempts to summarize what is and isn&#39;t known at this point.  Our experience here of the outcomes tends to coincide with what is said in most of the available medical articles &ndash; the remainder of the pregnancy is the same as a pregnancy of the remaining number.  For pregnancies that began as two, that means that it is never without the normal risks of any pregnancy, and some of the babies have been premature or had other problems or losses, but seemingly no more so than in singleton pregnancies.  We do not know of any vanishing twin survivors with cerebral palsy.<br><br>The baby and the multiple pregnancy may also symbolize a great deal to people in their lives, as multiples do to so many.  If you find that you are having a difficult time with this loss, it can be very helpful to seek out a counselor who specializes in reproductive issues.  What seems to be the most important is that each person find whatever the meaning and impact of this event is or is not to her, and be open and honest about dealing with whatever it may be.<br><br><b>Loss in&#45;utero in and after the second trimester</b><br><br>While the rate of loss apparently declines after the first and early second trimester, it is still much higher for twins and multiples than for singletons, and some of the conditions that twins are uniquely at risk for &#40;such as Twin to Twin Transfusion Syndrome&#41; play a part here too.  Just the fact that there are two or more babies makes it two or more times as likely that stillbirth will affect a multiple pregnancy.  We cannot even begin to say how many we have known who have lost one of their twins, or one or more of their higher multiples in&#45;utero at any time from 16 or 18 weeks all the way up to 32 or 34 weeks and had to &quot;go longer&quot;. &#40;Many also experience the death of one baby after 36 weeks but they are usually delivered soon after.&#41;<br><br>The article in Multiple Pregnancy &#40;by Dr. Keith et.al., see <a href=index.html?biblio>Bibliography</a>&#41;, &quot;The intrauterine demise of one fetus&quot; by Drs. Lopez&#45;Zeno and Navarro&#45;Pando is a quite an extensive one on the medical aspects of this situation, and there are some others in print since the mid&#45;1980&#39;s. &#40;Helain Landy MD has been researching and writing on these pregnancies for some years, as have Mary D&#39;Alton MD and Kurt Benirschke MD, among others.&#41;   There is also information in Multifetal Pregnancy, by Newman and Luke &#40;see <a href=index.html?biblio>Bibliography</a>&#41;.  Parents often benefit by informing themselves as much as possible, since an individual physician will still only have had a certain number of such cases in his or her practice and experience on which to base his or her approach to this.<br><br>Some of the things especially facing parents who are &quot;going longer&quot; are&#58;<br><br><b>&#183; vulnerability and worry about their surviving baby</b><br>For most parents, no matter how well the survivor seems to be doing, it is very difficult at times to believe that he or she could really be okay.  The safe birth of the baby is a great relief, but the fear may persist after the birth, just as it exists then for parents who have lost a twin at birth, along with the grief.  Finding ways to cope with fear is one major task for parents, especially mothers.  Much is written about this for subsequent pregnancy after loss in a singleton pregnancy &ndash; and parents with the loss of a multiple in&#45;utero are having to deal with it all now, all simultaneously in one experience of &quot;my twins&quot; or multiples.<br><br> Parents make various decisions about how much they want to know or not, and often experience a rollercoaster as to how much they worry or, as some say, &quot;obsess&quot;, or not.  It is very difficult for the mother especially, because everything about the entire pregnancy is physically real to her at all times, there is simply no taking a break.  How the mom experiences and reacts to it all often varies a lot from day to day, along with how she experiences and copes with the fears for the living baby or babies and her relationship with him or her &#40;or them&#41;. <br><br>For those who want to look further at the available information, some of the articles above review the available data on outcomes for surviving babies.  In our experience, the outcome for them has usually been good, if there has been no further loss in the weeks after the loss of the first baby/s, especially with fraternal &#40;dizygotic&#41; twins or multiples.  Some survivors, though, even single survivors of twins, have been born prematurely and with complications, and monitoring for infection and/or premature labor seems to be very important. Some moms were unaware that premature delivery at home was a possibility given the position of their baby who had died, especially if this was their first pregnancy.  The data suggests that monozygotic &#40;&quot;identical&quot;&#41; babies who do share a placenta carry higher risks of various kinds for the survivor, and living with this kind of uncertainty can be very difficult for parents.  The majority of monozygotic survivors we have known have still had a good outcome, it is fair to say. <br><br><b>&#183; planning for the birth, and seeing the baby or babies who died</b><br>In our experience, and in the articles mentioned above, it seems that when a multiple dies in&#45;utero between about 14 and 20 weeks, there are likely to be some small, mummified remains, sometimes called &quot;fetus papyraceous&quot;.   After about 20 weeks, sometimes before, there are usually remains that are identifiable as a baby.  It&#39;s important for parents to know this, and to know that they will be responsible for making arrangements, not the hospital, if the loss occurred past the number of weeks that is considered the difference between a miscarriage and a stillbirth in their states or country &#40;it&#39;s 20 weeks in many U.S. states&#41;. By the same token, if it was at fewer than the legal number of weeks but they would like to see and/or make arrangements for the baby&#39;s remains, parents will need to make that very clear to their caregivers, in advance, because everything is considered the hospital&#39;s right and responsibility.  We continue to hear from quite a few parents with the loss of a multiple in the second or even third trimester who are told that it was a &quot;vanishing twin&quot;, or not given any information &#40;or even the idea that there is information that they should be requesting&#41;.  One mother lost one of her triplets in&#45;utero near the beginning of the third trimester, and her caregiver insisted that there would be no remains. The day after she gave birth to the babies, a nurse arrived in her room to ask, &quot;Well, what are you going to do about funeral plans&#63;&quot;  There are many other examples of this kind, as well as of parents who would have liked to see their baby but did not have the opportunity, or only too briefly and clinically. <br><br>No one can completely plan ahead when it comes to the loss of a child, but parents who do know that their birth will involve loss have an opportunity to do things as much as possible as they would have wanted to.   We have found that with multiples, this is not less important, but even more important in parents later being able to process their very complicated experience as a whole, and be as comfortable as possible raising the survivor or survivors knowing they did everything possible as parents for their multiple who died, while not feeling guilty about something they didn&#39;t do while there was so much going on.   They have a concrete experience to relate to, instead of having it all tend to seem like a strange dream. <br><br>Giving birth to a baby who has died many weeks or months before is sadly another unique aspect of the world of multiple conceptions and births &ndash; it simply wouldn&#39;t happen in a singleton pregnancy.  It is difficult for even experienced caregivers to know what the condition of the baby who has died will be when they are born, and much may depend on specific circumstances.   However, many in our group whose loss was in the second trimester or after have been surprised in a positive way to see how &quot;normal&quot; their baby looked.  &#40;Is it possible that the presence of an ongoing pregnancy makes a difference&#63;&#41;  One mother whose twins were born at 36 weeks after one died in&#45;utero at 17 weeks, wrote in our newsletter&#58; <blockquote><i>&quot;He was intact, complete with all of his fingers and toes, and clearly a boy. As I held Luke, my nurse washed Zach off so we could hold him and take pictures.  We have two very nice pictures that my husband took with our camera, one of Zach in my hands, and another together with Luke in my arms and Zach in my hands.&quot.. </i></blockquote>We think it&#39;s important that parents not expect or be told &#40;as some have been&#41;, &quot;Oh don&#39;t worry, it will look normal&quot; &ndash; and equally important that they not expect or be told that the baby will be something they won&#39;t want to look at. Babies don&#39;t need to be &quot;perfect&quot; for their parents to need and want to see them.  Additionally, people&#39;s imagination about what they don&#39;t see, almost always is worse than what actually was &#40;and from what we&#39;ve been told, photos usually make the baby look worse than he or she really did and are not a good substitute later when the mom feels &quot;ready&quot;&#41;.   One mother whose one twin died at 17 weeks along of congenital problems, wrote&#58;<i><blockquote>&quot;We were still unsure whether we wanted to see Ryan since it had been approximately 18 weeks since his death in&#45;utero.  Our doctor was prepared to take pictures for us with a separate camera regardless of whether we decided to see him.  We had a wonderful relationship with our doctor, who knew us since the beginning of infertility treatment and has an understanding heart.  Although he prepared us for what Ryan might look like, we trusted him to tell us when he was born and help guide us.  I was afraid that a horrible image might be my haunting memory.  We decided to look at Ryan and touch him. I&#39;m glad we made the decision because he looked better than the pictures revealed.&quot;</i></blockquote><br>We think it&#39;s better for parents to expect, and be expected to, see the babies or babies, and if they are not certain, have the help of a trusted friends, relative or caregiver.  We think it&#39;s also very helpful in validating the truth of having had twins or multiples &ndash; it&#39;s difficult to say goodbye to &quot;my twins&quot; or triplets or higher without saying hello, and it&#39;s difficult to feel that you had separate babies, separate experiences, or one big one that is too difficult to deal with. Also it is helpful with the fear as well as the confusion &ndash; one mother, for example, was given her ultrasound photos and advised by her well&#45;meaning caregiver not to see her identical twin son after he died in the early third trimester and was born later. &quot;Just think of your son as a living likeness of him,&quot; she was told. Dressing her survivor for his twin&#39;s funeral was very difficult, she could not stop the feeling that she was dressing him for his own funeral, and then realized she had never separated the two babies in her mind. <br><br>Very few seem to regret having seen their baby or babies while it was possible to do so, though some found it more difficult than they thought it would be.  What we usually hear are the regrets of those who have not done so, now that it is some months later.  All that being said, though, we think it&#39;s completely possible to cope and heal without it, if it is a full and free choice on the part of the mother. Otherwise it&#39;s still possible but there are additional hurdles to overcome. <br><br>Finally, it&#39;s important not to settle for a few foggy moments after delivery, but to see and if possible hold the baby later in a setting that is private, loving and with no time or other pressure &ndash; and more than once if desired.   Parents need to sure also that they receive any possible mementos, foot&#45; and/or handprints, locks of hair, nail clippings, and anything associated with the baby.  The baby who died will not receive a birth certificate but in most states will receive a fetal death certificate if the death occurred at 20 or more weeks&#39; gestation. Some hospitals also offer an unofficial &quot;birth record&quot; with the baby&#39;s name, date and so on &#40;for all babies including those who are stillborn&#41;&#59; several states now do have a Certificate of Birth by Stillbirth.  Parents may wish to make sure that their survivor&#39;s birth certificate correctly identifies it as a twin or triplet pregnancy, if the loss was after the legal limit for miscarriage &#40;usually 20 weeks, in the United States&#41;. <br><br><b>&#183;  testing</b><br>There are certain kinds of testing that may be done as to the cause of death, and it is wise for parents to ask their physician what they may be in their case &#40;and ask him or her to research this if necessary&#41;, and decide what they may wish to do or not &ndash; then make their wishes known in advance as some of them must be done on a timely basis after birth.  It is not always possible to determine a cause if one is not already known, but many parents find it helpful to learn whatever they can.  Also, if the babies are of the same gender, it is possible in some cases to determine whether they are monozygotic &#40;&quot;identical&quot;&#41;, and this may be important to parents both for medical reasons and in knowing how to mentally picture the twins &#40;as well as picture them in a drawing or portrait by an artist, as many have done later&#41;.  The Wisconsin Stillbirth Service Program &#40;see <a href=index.html?otherresources>Other Resources</a>&#41; may have information on testing for the cause of death which may be helpful.  As we understand it, the main possibilities would include  1&#41;  an autopsy  2&#41;  tissue block samples taken soon after delivery, tested for genetic factors 3&#41; a thorough pathology examination of the placenta or placentas and cords, which for example could determine whether the babies were monozygotic or not, and whether they shared a placenta or even the sac, and whether the baby who died had umbilical cord anomalies. <br><br><b>&#183; making arrangements</b><br>Knowing in advance makes it possible to find a funeral director who is experienced in and sensitive in the area of infant loss and will work with parents to make plans that they feel comfortable with.  It is helpful to do some asking around town &#40;and check with a local infant loss support group&#41;, and make sure that it is someone who is supportive of the situation.  Seeing and holding the baby again at the funeral home is an important opportunity for many, even if they were able to spend time with the baby at the hospital. <br><br><b>Birth plan</b><br> All of these things and more may be incorporated into a written birth plan which will serve as a guide to any or all caregivers &ndash; physicians, nurses and others&ndash; involved in the babies&#39; birth.  This may be especially helpful since parents may not be able to know in advance which doctors and nurses and other staff may be the caregivers, depending on when the delivery occurs.  Appendix 3 of Elizabeth Noble&#39;s book, Having Twins &#40;see <a href=index.html?biblio>Bibliography</a>&#41; is a &quot;Birth Plan in the Event of Loss&quot; which may be completed and adapted, even expanded  for everything that parents may wish to be known by their caregivers, and providing for some contingencies &#40;for example, seeing the baby later if general anesthesia becomes necessary at birth&#41;.   Parents should discuss their plan with their primary physician and anyone else possible in the practice and at the hospital, and mothers should have a copy of it with them at all times.  It has also been helpful for many to have a close friend or relative &#40;besides the husband or partner&#41; present at the birth to help ensure that everything goes as much as possible according to the birth plan. Amy Hodge&#39;s article, &quot;<a href=../pdf/doula.pdf>Doula Care and Twin Loss</a>&quot; contains the birth plan which she developed for herself and explains how the care of a doula &#40;birth attendant&#41; was helpful to her when she delivered her babies.  <br><br>In addition to all these, there are many other things unique to parents who are &quot;going longer&quot;.  These include talking and explaining to relatives and friends, and going out in public and being asked about your pregnancy &#40;and &quot;hiding out&quot;&#41;...doctor visits &#40;including ultrasounds, and encounters with other who are pregnant with multiples&#41;...dealing with decisions about a baby shower and preparing the nursery...talking to other children, if any...doing a birth announcement...planning a memorial...breastfeeding...and more. Not to mention marriage, and how the husband or partner is relating to the loss and to the mother&#39;s experience &#40;or experiencing this loss as a single mom, as some have&#41;.  Some of the personal stories here we hope will be helpful in showing how various parents have related to these and other challenges, in their own experience.<br><br>A very special thanks to all those who shared their story in this section. <br><br><a href=./html/article.html?variousjs&exampleofabirthplan>Example of a birth plan</a><br><a href=./html/birthann.html?pregnangjs&glbirthann>Examples of birth announcements</a><br><span class=verdana>Personal stories</span><dl><dd><a href=./html/story.html?pregnangjs&maeve>Maeve &amp; Cecelia</a><dd><a href=./html/story.html?pregnangjs&callahan>Callahan &amp; Sydney</a><dd><a href=./html/story.html?pregnangjs&maxcharley>Max &amp; Charley</a><dd><a href=./html/story.html?pregnangjs&laura>Laura&#39;s Story</a><dd><a href=./html/story.html?pregnangjs&katie>Katie &amp; Jenna</a><dd><a href=./html/story.html?pregnangjs&maxandhistwin>Max &amp; His Twin</a><dd><a href=./html/story.html?pregnangjs&interview>Interview</a><dd><a href=./html/story.html?pregnangjs&ryanrachael>Ryan &amp; Rachael</a><dd><a href=./html/story.html?pregnangjs&memorial>The loss of a twin at 13 weeks</a><dd><a href=./html/story.html?pregnangjs&kathryn>Kathryn Louise &amp; Abigail Rose</a><dd><a href=./html/story.html?pregnangjs&brett>Brett &amp; Jack</a><dd><a href=./html/story.html?pregnangjs&connor>Connor &amp; Sierra</a><dd><a href=./html/story.html?pregnangjs&hailey>Hailey, Timothy III &amp; Dylan</a><dd><a href=./html/story.html?pregnangjs&savanna>Savanna, Ally &amp; Emily</a><dd><a href=./html/story.html?pregnangjs&intervie2>Interview...the loss of a quadruplet</a><dd><a href=./html/story.html?pregnangjs&chrissie>Chrissie&#39;s Story</a></dl>"
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if (knowingahead > -1){
contenthead = "Knowing Ahead"
content = ""+intermediateFormatting+"&quot;<b>Knowing ahead&quot; that a multiple will not or may not survive</b><br><br>With early ultrasound, frequent ultrasound and the kinds of prenatal testing which are now available, sadly many parents expecting twins or higher multiples learn that one of their babies &#40;or sometimes two of triplets or higher&#41; has a problem that will not or may not allow the baby to live after birth.  The conditions which we most often hear of are anencephaly &#40;lack of most upper brain development&#41; and other neural tube conditions; Trisomy 13, Trisomy 18 and Trisomy 21; Hypoplastic Left Heart Syndrome and other congenital heart conditions; problems with lung, kidney or other development, or with the umbilical cord;  and many conditions related to &quot;identical&quot; twinning. It is very possible for the babies to be monozygotic &#40;&quot;identical&quot;&#41; and only one of them be affected by one of these problems or conditions.  In Dr. Keith et.al.&#39;s<i> Multiple pregnancy:  Epidemiology, Gestation and Perinatal Outcome</i>, the article &quot;Congenital anomalies and pregnancy loss&quot; &#40;Meyers et.al.&#41; is very relevant, as is &quot;Selective termination of the malformed fetus&quot; &#40;Grisaru &amp; Lipitz&#41; in <i>Iatrogenic Multiple Pregnancy</i> by Drs. Blickstein and Keith, and the chapter in <i>Multifetal Pregnancy</i> by Newman &amp; Luke &quot;Genetic Diagnosis in Multiple Gestations&quot;&#40;see our <a href=index.html?biblio>Bibliography</a>&#41;.   Again, the fact that there are two or more babies and that multiples may have a higher incidence of some types of problems make adverse prenatal diagnosis an all&#45;too&#45;real possibility, and for many, a reality.  Sometimes it is clear that the baby will not be able to live past birth, at the most, and in other cases it is not as clear what the specific problem is or what the baby&#39;s quality of life might be if he or she survives birth.<br><br>For some parents, selective termination is not an option for medical reasons, or for philosophical ones.  For others, it may be but they choose &#40;in a situation they never would have chosen&#41; to continue the pregnancy as it is because they believe that the benefits don&#39;t outweigh the risks and they would prefer to experience the birth of their babies as the context for saying goodbye to the baby who will die.  Everyone we have known who has opted to continue the pregnancy as it is has given birth to a surviving baby &#40;or survivors of higher multiples&#41; successfully, although some have been premature, in some cases after they were not monitored for the amniotic fluid build&#45;up which can occur with the sick baby.   One mom, who had lost twins to prematurity several years before, successfully battled premature labor and even the urging of her priest, in order to witness the birth and passing of her twin daughter with anencephaly.<br><br>With many thanks to Sandy Lee &ndash; one of our first members who experienced &quot;knowing ahead&quot; with her twin daughter Erin, who was born with her sister near term after 11 years infertility and a diagnosis of Trisomy 13 at 20 weeks &ndash; for her input on some of this, here are some thoughts for those who are now experiencing this.  Special thanks to those who shared their stories in this section.   We hope that being able to plan for the birth will be helpful in coping and healing over time and raising the surviving baby or babies while having a special place in your heart for the one who was not able to be here. <br><br><b>&#183; </b><a href=./html/article.html?pregnanjs&checklist>Checklist</a><br><b>&#183; </b><a href=./html/article.html?pregnanjs&birthplan>Examples of birth plans</a><br><b>&#183; </b><a href=./html/birthann.html?pregnanjs&kabirthann>Examples of birth announcements</a><br><br><span class=verdana>Personal stories</span><dl><dd><a href=./html/story.html?pregnanjs&jonathon>Jonathon</a><dd><a href=./html/story.html?pregnanjs&kendall>Kendall, Trey &amp; Baby C</a><dd><a href=./html/story.html?pregnanjs&kristen>Kristen &amp; Erin</a><dd><a href=./html/story.html?pregnanjs&michael>Michael &amp; Jessica</a><dd><a href=./html/story.html?pregnanjs&christopher>Christopher &amp; Kailee</a><dd><a href=./html/story.html?pregnanjs&intervie3>Interview...</a><dd><a href=./html/story.html?pregnanjs&dylan>Dylan &amp; Cody</a><dd><a href=./html/story.html?pregnanjs&creighton>Creighton &amp; Morgan</a><dd><a href=./html/story.html?pregnanjs&chrissi2>Chrissie&#39s Story &#40;continued&#41;</a><dd><a href=./html/story.html?pregnanjs&thestoryofpeanut>The Story of Peanut</a></dl>"
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if (delayedinterval > -1){
contenthead = "Delayed Interval"
content = "D"+intermediateFormatting+"<b>elayed interval birth after loss</b><br><br>Though it occurs much less often than &quot;going longer&quot;, and probably less often than &quot;knowing ahead&quot;, in recent years it&#39;s become more common for doctors to attempt a delayed interval delivery when one of the twins or multiples is born very prematurely.  After that baby is born, measures are taken to try to keep the remaining baby or babies in for as long as possible, with a better chance to survive and be healthy.  Though there is not a great deal of information in print, other than individual case reports, the <a href=index.html?biblio>Bibliography</a> includes an article in <i>Iatrogenic Multiple Pregnancy</i>, information in Newman &amp; Luke&#39;s book, and an article in <i>Twins</i> Magazine a few years ago.<br><br>It&#39;s important to understand that it is often not even possible to attempt a delayed interval delivery, and even when it is tried, many do not succeed.  We know quite a few who have &#40;for example&#41; given birth to their first triplet at 20 or 21 weeks, kept the others in but gone into labor &#40;or infection&#41; and had to deliver the other babies at 23 weeks, still before they were viable. &#40;On the other side, there are mothers whose twin or multiple born earlier does live, as well as those born later.&#41; We do though have a number of members who have lost one of their twins, triplets or quads after being born very prematurely, then given birth to a healthy survivor or survivors several months later.  One mother who is active in our group gave birth to one of her twins at 18 weeks along, and his healthy sister at 35 weeks &#40;and this experience came after losing both her twins in the same scenario of preterm labor at 18 weeks in her first pregnancy&#41;. <br><br>This situation of being simultaneously pregnant with a baby or babies while experiencing the death of a baby and having to go through all the realities of that &ndash; seeing and saying goodbye to the baby, making arrangements, going through the burial and so on &#40;sometimes after the baby having been alive in the NICU for some time&#41; &ndash; is clearly a really unique and challenging one, and all the more so when the babies are part of a &quot;set&quot;.  In her article, &quot;Rebuilding a Life After Multiple Birth Loss&quot; &#40;<a href=http://www.thepreemieplace.org>www.thepreemieplace.org</a>&#41; Elizabeth Pector, MD has pointed out some of the unique challenges, such as how to experience both of the twins together, and how to have a photo of them together.  The biggest challenge for many has been how to grieve as much as they need to while fearful of being able to keep the other baby or babies in, along with being able to grieve later for the other baby and &quot;my twins&quot; or &quot;my triplets&quot; or more once the survivor is safely home.  We hope that as this site develops, we can develop some further suggestions for parents who are experiencing a delayed interval birth after the death of one of the babies.   Very special thanks to those who have shared their stories here. <br><br><span class=verdana>Personal stories</span><dl><dd><a href=./html/story.html?pregnandjs&mystory>My Story</a><dd><a href=./html/story.html?pregnandjs&isaiah>Isaiah &amp; Gabrielle</a><dd><a href=./html/story.html?pregnandjs&adam>Adam, Alec &amp; Anthony</a><dd><a href=./html/story.html?pregnandjs&intervieq>Interview...a mother of quadruplets</a></dl>"
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if (supertwin > -1){
contenthead = 'Loss of a Supertwin&#40;s&#41;'
content = "I"+intermediateFormatting+"f you are visiting this section because you have experienced the death of one or more of your supertwins &ndash; triplets, quads or more, also called higher order multiples, or HOMs &ndash; with one or more survivors, we are very sorry. You are not alone.  As we&#39;ve mentioned, the time that CLIMB began in response to twin loss was the time that fertility technology dramatically increased not just the number of twins but the number of triplets and other higher order multiple conceptions and births.  So over the years we have known and been in contact with an uncountable number of parents who have conceived &#34;a whole family, at last&#34; and then experienced tragedy in their pregnancy or at or after birth, or in infancy or beyond. Triplet pregnancies, which had been estimated at 1 in 6,400 to 7,910 pregnancies without fertility technology, already by 1990 had become 1 in every 1,341 pregnancies in the U.S., and in 1998, 1 in 570 pregnancies &#40;Luke and Newman, <i>Multifetal Pregnancy</i>, see <a href=index.html?biblio>Bibliography</a>&#41; &ndash; so while the number of twins did double, triplets went from being something quite rare to something that occurred much more often, with not much known yet about the pregnancies, birth and parenting.  Similar things were true of quads, quints and more, which were an extreme rarity before. Though the media and others tend to focus on the &#34;miracles&#34;  and the very rare mega&#45;&#34;successes&#34;  of 6 or 7 &#40;which make it look like triplets or quads are supposed to be easy&#41; and the idea that somehow every mother can do it if she wants to enough, the sad truth is that in having three, four or five &#40;or more&#41; babies at the same time, there are very high risks that can become reality for parents no matter how much they love and want their children and try to do &#40;and do&#41; everything right.<br><br>Whether or not it is after years of trying and fertility technology, it is incredibly difficult to have such a special &#34;gift&#34;, then have to experience everything about the death of a baby or babies while also becoming the parent of and caring for a baby or babies who is part of the same set and often has special care needs and issues because of being very premature. This kind of loss situation been mostly unrecognized and unsupported and we hope that this section will develop over time into something that is truly helpful to parents who are having to travel this road and also to those who are involved in these pregnancies and losses in any way.   The article below describes more of what we have seen over the years, and some of the various loss situations that parents have experienced.<br><br>No matter how many babies have lived and how many have not, loss in supertwins is an incredibly difficult journey into some pretty uncharted territory, and one that parents could never have imagined as being what it would be like to be a parent, or a parent again, and the more so after the kind of bonding that takes place through ultrasounds.   All the things that can be said about the emotional aspects of the loss of one twin, and what parents need to know after they have lost one of their twins, are relevant here &ndash; but we&#39;ve noticed that there are some things that are especially important for supertwin families&#58;<br><br><b>&#183;</b> With so many babies and so much potentially going on with them at the time of the birth&#40;s&#41; and after, parents are even more likely not to have enough opportunity to see and hold their babies or babies who died. Mothers are even more likely to have had a traumatic birth medically, and fathers are even more likely to be separated from the mother and some of the babies because of going with one of the babies to another hospital or some other special care.  Staff may be even less likely to realize how important it is for parents to see and hold their baby or babies who has died, spend time, and have good photographs and other mementos, or to plan and participate in the arrangements for their baby and for a memorial service. Parents, relatives and caregivers all need to know how important these things are and get or arrange support in any way possible. One hospital made arrangements to transport two triplets who were doing well over to the hospital where it was known that their co&#45;triplet was not going to be able to live much longer &ndash; the parents were able to experience having all of their babies together during the time that it was possible, and to have good photographs and mementos of that time, along with their survivors knowing later that they did get to meet and say goodbye to their brother.   Also, mothers who experience the death of more than one baby at separate times need extra support when they have already used many of their coping resources.<br><br><b>&#183;</b> Delayed grief and delayed onset of the active grieving process is really likely, it&#39;s probably the rule more than the exception, since there is some much involved in not only the birth and loss, and everything about having a tiny survivor or survivors.  Homecoming is often the beginning of it &ndash; being out of the world of the hospital and into what is &#34;new normal&#34; at home, with a little more time to even begin to truly experience and process it all while being forced to recognize the reality that <i>that</i> baby or babies didn&#39;t come home, or didn&#39;t stay. Often, it&#39;s later, because of the intense care of tiny babies or a very tiny sole survivor and the expectations of others that mom be grateful and never take any time to grieve.  Sometimes dads are afraid of what would happen if mom would openly grieve.  One mother called because &ndash; with two surviving triplets now doing well, another child before and another baby after the triplets, all under the age of 4 &ndash;her husband was concerned that if she took time to grieve for her triplet son she would become &#34;obsessed&#34; and unable to function.  She herself felt that if she did NOT grieve and do what she needed to for him, that&#39;s exactly how she would become &#34;obsessed&#34; and less able to care for and enjoy her living children as well as feel more peace herself. When parents &ndash; and this does include many fathers too &ndash; do begin the more open grieving process, it can be especially difficult because of the lack of opportunities and mementos at the time of the birth and loss that many have experienced.  We hope that the article below by a CLIMB member, Brenda Noble, who lost one of her quadruplet sons when he was born at 18 weeks along, will be helpful, and we really welcome the development of more features that address these issues and share the experiences of many different people and what was helpful.<br><br><b>&#183;</b> Parents are especially likely to have a survivor or survivors who are medically fragile, have special needs, have longterm disabilities or issues about whether there will be longterm health or other impacts, and in any or all of these ways and more require a great deal of special care and concern for many months and years.  Relating to all of that also involves constant reminders, and having to tell others what happened. This also may create some special aspects of issues about trying again &ndash; some parents would like to also have another pregnancy, with hopefully a nice, normal experience and outcome, some feel that that is not possible because of the needs of their survivor&#40;s&#41; or other factors &#40;and then this becomes also their entire experience of parenting&#41;.<br><br>As mentioned earlier, this is just the beginning, an overview so that something can at last be &#34;out there&#34; on this kind of loss.  We will be involved in and really welcome help in developing more features for this section, and also developing a more interactive portion of the site for members of CLIMB. We also very much hope that an e&#45;mail network, or more than one, will develop that will help to connect parents and generate further ideas and resources. If needed, please be sure to see our site sections on <a href=index.html?selective>Selective Reduction</a> &#40;MFPR and selective termination&#41;, <a href=index.html?pregnant>If You&#39;re Pregnant Now</a> &#40;&#34;going longer&#34; after loss in&#45;utero &ndash; &#34;knowing ahead&#34; that one or more babies will not survive &ndash; &#34;delayed interval&#34; early delivery of one baby&#41;.   &#40;The stories of supertwins in that section are included in this section also.&#41; Sadly, with more supertwins there has also been a steady rate of the loss of a triplet to SIDS;  and an increase in the number of losses  of a young triplet or higher to illness or accident.  Please see our site sections <a href=index.html?sids>SIDS in Multiples</a> and <a href=index.html?older>Loss of an &#34;Older&#34; Multiple</a> if needed. CLIMB has an active parent contact list for supertwin loss which members are welcome to join.<br><br><a href=./html/article.html?supertwijs&seenface>Supertwin loss&#58;  what we have seen, what parents face</a><br><br><a href=./pdf/supertwins.pdf>The Death of Your Higher Multiple Baby</a><br><br><a href=./pdf/supertwinsspanish.pdf>La muerte de un ni&ntilde;o trillizo, cuatrillizo, etc... </a><br><br><a href=./html/article.html?supertwijs&delayedgrief>Dealing with delayed grief and remembering our babies</a><br><br><a href=./html/article.html?supertwijs&labeling>How We Deal with Labeling Our Surviving Children</a><br><br><a href=./html/birthann.html?supertwijs&superbirthann>Examples of birth announcements</a><br><br>Personal Stories<br><dd><a href=./html/story.html?supertwijs&alexbrendancollin>Alex, Brendan &amp; Collin</a><br><dd><a href=./html/story.html?supertwijs&owen>Owen</a><br><dd><a href=./html/story.html?supertwijs&oneonenottwo>Why One Plus One Will Never Equal Two &#40;a dad&#41;</a><br><dd><a href=./html/story.html?supertwijs&tripletkelsey>The loss of a triplet &#8230;our daughter Kelsey</a><br> <dd><a href=./html/story.html?supertwijs&botimcon>Bo, Timaree &amp; Connor</a><br><dd><a href=./html/story.html?supertwijs&niscasca>Nicole, Scott, Ashley &amp; Caitlin</a><br> <dd><a href=./html/story.html?supertwijs&my4>My Quadruplets</a><br><dd><a href=./html/story.html?supertwijs&our4>Our Quads</a><br> <dd><a href=./html/story.html?supertwijs&mayhaveseen>You May Have Seen Me</a><br><dd><a href=./html/story.html?supertwijs&groupsof4>Groups of Four</a><br> <dd><a href=./html/story.html?supertwijs&birthdaythoughts>Birthday thoughts</a><br><dd><a href=./html/story.html?pregnangjs&hailey>Hailey, Timothy III &amp; Dylan</a><br> <dd><a href=./html/story.html?pregnangjs&kathryn>Kathryn Louise &amp; Abigail Rose</a><br> <dd><a href=./html/story.html?pregnangjs&intervie2>Interview&#8230;the loss of a quadruplet</a><br><dd><a href=./html/story.html?pregnangjs&chrissie>Chrissie&#39;s Story</a> &#40;part two is <a href=./html/story.html?pregnanjs&chrissi2>here</a>&#41;<br><dd><a href=./html/story.html?pregnandjs&adam>Adam, Alec &amp; Anthony</a><br><dd><a href=./html/story.html?pregnandjs&intervieq>Interview&#8230;a mother of quadruplets</a><br><dd><a href=./html/story.html?sidjs&breanna>Breanna, Bedford &amp; Brette</a><br> <dd><a href=./html/story.html?oldejs&autumn>Autumn &ndash; a triplet</a><dd><a href=./html/story.html?supertwijs&downtheroaddeb>Down the Road...Deb, mother of Heather, Calli &amp; Micah</a><dd><a href=./html/story.html?supertwijs&kristirobert>Kristi, Robert &amp; Daniel</a><dd><a href=./html/story.html?supertwijs&bobbysstory>Bobby&#39;s Story &#40;a quintuplet&#41;</a>"
main = -1
idstring = "supertwin"
}

if (mfpr > -1){ 
contenthead = 'MFPR'
content = "M"+intermediateFormatting+"any couples we have known have gone from not thinking they would be able to get pregnant at all, to being incredibly pregnant with three, four or more embryos.  After years of fertility struggles, these parents are &#40;as someone once put it&#41; the last ones to take even one tiny viable embryo casually. Parents may spontaneously conceive triplets, quadruplets or even higher multiples and find themselves in the same dilemma, facing their first decision as parents in a way they never could have expected.<br><br>On a semi&#45;practical note, many have found that it is essential to determine whether two of the babies are monozygotic &#40;&quot;identical&quot;&#41; &#151; as many actually are in pregnancies after fertility technology, as well as in spontaneous pregnancies &#151; since most are also monochorionic and share a placenta &#40;more rarely, also a sac&#41; and this will very much affect what the options may be.   The next step for many was to find out as much information as possible about the risks of loss and of severe handicaps, and to find those to whom they can talk freely.  Both of these are difficult, because comprehensive statistics about multiple birth loss and severe disabilities are not kept in the U.S. &#40;and would be difficult to do even if the mandate were there&#41;, so that much that is available is from patient reporting;  and because anything to do with &quot;abortion&quot; has been so politicized in our society.<br><br>At the same time, parents are often caught between two extremes.  They may be urged to make a decision by a medical caregiver who does not address what the emotional impacts may be to them, and considers the procedure a final adjustment in the fertility technology. We&#39;ve talked with some well&#45;meaning caregivers who think that if they don&#39;t make a big deal of it with the parents, then it won&#39;t be a big deal, and that &quot;parents decide to do it and that&#39;s it&quot;.   Thus we have talked with many parents who feel that they had to make a rushed, underinformed decision in an impersonal setting and seem to be at much higher risk for difficult emotional aftermath later, no matter what the outcome of the pregnancy. For many this is intensified by the feeling that they can&#39;t say even a word about any of it to anyone at all when they may occasionally experience emotional aftermath.  Anything that can be done to overcome this isolation and secrecy is very much to the good.  We should add that none of this is made any less difficult by what often seems to be the glorification in the media and elsewhere of very high multiples, often with the implication that only a very few people conceive six or seven and if they really want to they can have them.<br><br>Many parents have commented that a very thorough decision&#45;making process is especially crucial for those who are pregnant with three, or even four, because they will be confronted with living triplets or quads and the reality that it might have been do&#45;able, while those pregnant with 5 or especially 6 or more can pretty much know that the odds are stacked against them and are by the same token far less likely to encounter living sets of that number &#40;other than in the media&#41;.  &#40;Some articles on the medical aspects of whether to reduce from 3 to 2 have been authored by Michelle Smith&#45;Levitin MD, see our <a href=index.html?biblio>Bibliography</a>.&#41;  Those who for various reasons may be needing to decide whether to reduce to one will have some similar issues, as well as the loss of &quot;my multiples&quot;.<br><br>An additional factor for many potential MFPR parents seems to be the extent to which quality of life issues are important.  There is the potential for any babies who &quot;make it&quot; past birth to be handicapped, sometimes very severely, from the effects of prematurity and other things which may occur in a high&#45;order pregnancy and birth &#40;and some may die in infancy or childhood as a result, or of Sudden Infant Death Syndrome, for which prematurity is a known risk factor&#41;.  Some parents feel that it is not right to expect their children to be perfect or to be unwilling to do everything involved in raising a handicapped or multi&#45;handicapped child&#59; others feel that it is their responsibility to their children that they have a life that does not involve more suffering than enjoyment. Although the reality of handicaps in multiples who do &quot;make it&quot; past birth is a major one, often a heartbreaking one, it is poorly addressed anywhere that we are aware of while being a major elephant in the room when it comes to these decisions.   Parents also vary in how they regard quality of life issues for the family&ndash;financial, marital, social issues of raising three, four or more at a time, whether or not they are handicapped.  Some feel that it is selfish to even consider these, as long as the babies live&#59; others feel strongly that they must be considered.<br><br><i>For all these reasons, we really encourage everyone who is having to consider MFPR to take the time and effort to talk with a counselor who is experienced in reproductive issues, for support in sorting through all the information and emotions for each parent and for both parents as a couple &ndash; for support in making the best decision that they can even in a short time &ndash; and to have that person as a trusted resource during the pregnancy and after the birth whenever, and for as long as, needed.  We also encourage everyone to ask questions, seek information, and seek an opinion or second opinion from a perinatologist &#40;maternal&#45;fetal specialist&#41;.</i><br><br>Over the years, CLIMB has included many who have decided on MFPR.  We don&#39;t say &quot;chosen&quot; because they don&#39;t consider it a choice.  Their first choice is to have any and all babies of theirs alive, healthy or with a reasonable quality of life;  now they are trying to take what control they can over a no&#45;win situation that they never would have chosen.  Some have reduced and then lost one or more of the remaining babies either through complications of the procedure, or from risks that are inherent in any pregnancy, especially a multiple one. These parents stress that it is essential for people to know that while it may lessen the overall risk of loss, undergoing MFPR is still not a guarantee, a price to be paid for the assurance of no further problems.  It is also important to note the information about outcomes in relation to starting number that is given in Newman and Luke&#39;s book and in Dr. Smith&#45;Levitin&#39;s article in Drs. Blickstein and Keith&#39;s book &#40;see <a href=index.html?biblio>Bibliography</a>&#41;.  They cite data showing that the higher the starting number &#40;and also the finishing number after MFPR&#41;, the greater the chance that the remaining babies will be premature, though much less so than in an unreduced pregnancy of the same starting number.<br><br>The essence of the situation is that people have to make a decision with no way to know for certain what the outcome will be, and not able to know later what would have happened if they had decided the other way.  So they need to be able to make the decision that is right for them and that they can live with better than the other, no matter what happens.  If they choose not to have MFPR and lose all the babies, would that be better to live with than having had it? If they have it and lose one or more or all of the remaining babies &#45;or not &#45; can they live with that better than having not tried to do what they could&#63; or will they wish they had just tried to have them all&#63; Either way, they may face complete loss of the babies and will need to feel that what they decided was what they could live with better, despite the outcome:  because either way, they can never know what would have happened if they had decided differently.  Parents who do experience loss of one or more of the remaining babies after MFPR tend to feel that their actions have been thrown back in their face, even though they rationally know that the outcome could or would have been even worse had they not undergone the reduction.  Like other parents with multiple birth loss they often undergo a painful period of second&#45;guessing, guilt and &quot;what&#45;if&#39;s&quot; that have to be resolved, and which complicate the grief that they already have.<br><br>Many parents who have given birth to two &#40;or one or three&#41; healthy babies after MFPR have felt their decision has been reinforced &ndash; &quot;This must have been right&#33;&quot;.  However we have known and had as members many who had major emotional aftermath and impacts during pregnancy, at the time of birth, and in and well beyond the first year, or any combination of those, for a variety of reasons.  Sometimes it is a full grief reaction.  We believe that it is possible for parents themselves and for medical caregivers to identify who may be at especially high risk for emotional aftermath, especially of the very severe kind, and offer them special support in various ways. It is crucial that if parents do talk to their medical caregivers about emotional aftermath, they not be told, &quot;Well, everyone else is fine&quot;.  Instead they should be referred or take themselves to a counselor experienced in reproductive issues.<br><br>One mother, now in counseling, who gave birth to three healthy babies who are now 2 years old, after reduction from four &#40;and holding out for three at the last minute&#41;, has commented that for the first six months she was so preoccupied with the babies&#39; health and survival that she suppressed any other thoughts. She also wanted to be positive about her decision and having had a good outcome. After that she was so busy caring for three lively babies that the grief she did feel for her baby who was not there would hit her very suddenly just when she had a spare moment. Now it occurs all the more strongly for seeing the milestones and cute moments of the others, and is all the harder to deal with because of the feeling she cannot talk to anyone about it.  She feels that her fourth baby would probably have survived but had handicaps of some kind.  Her experience is one of the many reasons we feel that a one&#45; or even two&#45;year interval for following up on women who have had MFPR is not a realistic basis for studies, particularly if they are made up only of those who chose to participate, and those who did not experience loss later.<br><br>While we have much less experience with those who do not experience aftermath, or much aftermath, and cannot know what percentage they represent, it seems from what we do hear that many may still wonder from time to time what the other baby or babies would have been like, and what it would have been like, had they all been able to arrive safely.  The parents may have a decision to make about whether or not, or how, to tell their children, as do those who do experience grief later.  As yet there are no surveys or studies of parents with MFPR telling their children (or not) as they get older, though a few parents have told us about their experiences with this.  From our other experience with talking to survivors of multiple birth loss, we think that openness is better than secrecy, if it is something at all important in the family;  but by the same token, parents need to be sure to have enough support for themselves to be comfortable in sharing this with their kids in a way that is based on the kids&#39; needs and understanding, and not parents&#39; own need for support in these sometimes difficult, complicated issues.<br><br>We have also known many who chose not to have MFPR and have experienced complete loss, or loss of one or more with severe disabilities among the survivor or survivors. These parents too may experience second&#45;guessing their decision, along with guilt and grief. A number have decided that if they were to become pregnant with high multiples again, they would &quot;have&quot; to do it, but have taken great efforts not to conceive more than two, three at the most, and have succeeded.  Some who decided not to have MFPR have had some major emotional impact from even having had to consider it &#40;but still preferred the chance to make a decision, to not having that opportunity&#41;.<br><br>Some articles in print on the medical and emotional aspects of MFPR are listed in our <a href=index.html?biblio>Bibliography</a>. Anyone who has been involved in a decision on whether or not to have MFPR is welcome to contribute their story and comments to this site, and to join our Contact Registry &#40;ask us for the form to join&#41;. Several stories which involve MFPR are in the Loss of Both or All section of this site. Also, if you are pregnant now after MFPR, please see our site section <a href=index.html?pregnant>If You Are Pregnant Now</a> on pregnancy after the loss of a multiple/s in&#45;utero.<br><br><b>&#183;</b> <a href=./html/article.html?selectivjs&foodthought>Selective Reduction&#58; Food for Thought</a> <br><b>&#183;</b> <a href=./html/article.html?selectivjs&eaart>Emotional Impacts of Assisted Reproductive Technology</a><br><br><span class=verdana>Personal stories</span><dl><dd><a href=./html/story.html?selectivjs&bonnie>Bonnie&#39;s Story</a><br><a href=./html/story.html?selectivjs&donna>Donna&#39;s Story</a><dd><a href=./html/story.html?selectivjs&vickie>Vickie&#39;s Story</a> &#40;being updated&#41;</dl>"
main = -1 
idstring = "mfpr"
gobacklink = "<p class=smallcenter>&#124; <a href=index.html?selective>&#91; go back to Selective Reduction&#93;</a> &#124;"
}

if (termination > -1){
contenthead = 'Selective Termination'
content = "A"+intermediateFormatting+"nother tragic aspect of the realm of multiple pregnancies and births is that with two or more babies, anything that can come up in a singleton pregnancy is twice or more as likely to do so &ndash; and some problems may be more likely to occur in multiples, or be a special risk of multiples.  Over the years, we have known many parents who have learned during their pregnancy that one of the twins &#40;or one or more of the triplets or quads&#41; has a serious problem.  They have been faced with a decision of whether to undergo selective termination, or whether to continue their pregnancy &quot;knowing ahead&quot; that one or more of the babies will not live long after birth &#40;if it doesn&#39;t die in&#45;utero&#41;, or be severely compromised.  Some of these problems may threaten the life or health of the mother, as well as the healthy baby or babies &#40;and some parents face immediate decisions on experimental or other procedures to try to save the healthy baby, in conditions affecting monozygotic twins&#41;.<br><br>Some parents face receiving an adverse prenatal diagnosis of a condition that is not survivable &ndash; anencephaly, Trisomy 13, and Trisomy 18 are the ones we hear about most often. Others receive diagnosis of a problem that is severe, but whose nature, outcome, and the quality of life for the baby if it lives, are less certain &ndash; Trisomy 21 &#40;Down Syndrome&#41;, hydrocephalus, kidney and heart conditions, and monoamniotic &#40;in the same sac&#41; babies are ones we often hear of, as well as some of the scenarios with Twin to Twin Transfusion Syndrome.    As in Helen&#39;s story below, these parents &ndash; along with the issues of any danger to the healthy baby and possibly the mother &ndash; are having to weigh quality of life issues that may make the decision even more complicated, if there is any possibility that the sick baby might live and be severely handicapped.  Also, in some situations there is the potential for the baby who is healthy now to be severely handicapped as a result of events with the sick baby, if the pregnancy continues as it is.  Although the reality of handicaps in multiples who do &quot;make it&quot; to and past birth is a major one, often a heartbreaking one, it is poorly addressed anywhere that we are aware of while being a major elephant in the room when it comes to these decisions.<br><br>The article by Grisaru and Lipitz in <i>Iatrogenic Multiple Pregnancy</i>, &quot;Selective termination of the malformed fetus&quot;, along with the inserts in it by Virginia Baldwin, MD and Isaac Blickstein, MD, is a current review of the medical and psychological aspects of this&#41;, as is Chapter 4, &quot;Multifetal Pregnancy Reduction and Spontaneous Fetal Death&quot;, of Roger Newman, MD and Barbara Luke&#39;s book <i>Multifetal Pregnancy</i> &#40;see <a href=index.html?biblio>Bibliography</a> for both&#41;.  Both contain many references which may also be of interest. The pamphlet listed in the Bibliography by the Multiple Births Foundation in England, &quot;Selective Fetocide&quot;, has been helpful to many parents.  We plan to develop an article and other resources specifically on parents&#39; experiences with selective termination and the emotional impacts.  For those who have undergone it, our site section <a href=index.html?pregnant>If You&#39;re Pregnant Now</a> is a resource, the part called Going Longer.  For parents who are continuing the pregnancy without selective termination, please see the part of that site section called Knowing Ahead.   Anyone is welcome to share their story, as Helen has, and to join our Contact Registry for MFPR&#47;Selective Termination &#40;ask us for the form to join&#41;.<br><br><i>This is a truly difficult decision and we encourage everyone who is having to make it to take the time and effort to talk with a counselor who is experienced in reproductive issues, for support in sorting through all the facts and emotions and making a decision that they feel they can best live with no matter what the outcome, and to have a trusted resource to talk with during the rest of the pregnancy and after the birth and for as along as needed.  We also encourage everyone to seek the opinion or second opinion of a perinatalogist &#40;maternal&#45;fetal specialist&#41;.  We&#39;ve learned that not all of the information and support groups involved with pregnancy, multiple pregnancy and complications of multiple pregnancy support parents who are having to consider selective termination&#59; you&#39;re welcome to check with us for a listing of those who do.</i><br><br><span class=verdana>Personal stories</span><dl><dd><a href=./html/story.html?selectivjs&helen>Helen&#39;s story</a></dl>"
main = -1
idstring = "termination"
gobacklink = '<p class=smallcenter>&#124; <a href=index.html?selective>&#91; go back to Selective Reduction&#93;</a> &#124;'
}

if (garden > -1){
contenthead = 'Memory Garden'
content = ""+intermediateFormatting+"<a href=./html/story.html?gardejs&mominterviews>Interviews with mothers...how we remember our babies</a><br><br><a href=./html/article.html?gardejs&rememberingholidays>Remembering at the holidays...</a><br><br><a href=./html/article.html?gardejs&newyear>Thoughts on the new year...</a><br><br><a href=./html/articlenoindent.html?gardejs&memorials>Memorials</a>"
main = -1
idstring = "garden"
}

if (espanol > -1){
contenthead = 'En espa&#241;ol'
content = ""+intermediateFormatting+"<a href=../pdf/lamuertemot.pdf>La muerte de su beb&#233; mellizo o trillizo</a><br><br><a href=../pdf/lamuerte.pdf>La muerte de beb&#233;s gemelos, mellizos o trillizos</a><br><br><a href=../pdf/smsl.pdf>SMSL y Nacimientos M&uacute;ltiples</a><br><br><a href=./pdf/supertwinsspanish.pdf>La muerte de un ni&ntilde;o trillizo, cuatrillizo, etc... </a><br><br><a href=../pdf/spanishchildhoodloss.pdf>El fallecimiento de un ni&ntilde;o mellizo o fruto de embarazo m&uacute;ltiple durante la infancia</a><br><br><a href=../pdf/hospitales.pdf>La muerte en nacimientos m&uacute;ltiples y el personal de los hospitales</a><br><br><a href=./html/story.html?espanojs&minombre>Mi nombre es Daniel</a>"
main = -1
idstring = "espanol"
}

if (francais > -1){
contenthead = 'En fran&ccedil;ais'
content = ""+intermediateFormatting+"<a href=../pdf/perdreunjumeau.pdf>Perdre un jumeau ou triplet</a><br><br><a href=../pdf/decesgrossessemultiple.pdf>D&eacute;c&egrave;s lors d&#39;une grossesse multiple, les professionnels de la sant&eacute;&#58; des alli&eacute;s pour les parents</a><br><br><a href=../pdf/smsnfrancais.pdf>Le syndrome de la mort subite du nourrissonet les grossesses multiples</a><br><br><a href=../pdf/lapertedejumeaux.pdf>La perte de jumeaux ou de tripl&eacute;s</a><br><br><a href=./html/article.html?francaijs&jumeauxsurvivants>Jumeaux survivants</a><br><br><br><a href=./html/story.html?francaijs&victoriandluci>Victoria &amp; Lucie</a>"
main = -1
idstring = "francais"
}

if (chinese > -1){
contenthead = '<img src=./images/navigation/inchinesebig.jpg border=0 alt="" width=142 height=55> &frasl; In Chinese'
content = ""+intermediateFormatting+"<a href=../pdf/chineselossofonetwinormultiple.pdf>Loss of One Twin or Multiple</a><br><br><a href=../pdf/chineselossofbothorallmultiples.pdf>Loss of Both or All Multiples</a>"
main = -1
idstring = "chinese"
}

if (russian > -1){
contenthead = '<meta http-equiv="Content-Type" content="text/html; charset=Windows-1251">По-русски &frasl; In Russian'
content = ""+intermediateFormatting+"<a href=./pdf/russianonetwin.pdf>Смерть одного младенца, родившегося в двойне или тройне &#40Loss of a Twin&#41;</a><br><br><a href=./pdf/russianbothorall.pdf>Смерть двойняшек, тройняшек или большего количества детей &#40;Loss of Both or All&#41;</a>"
main = -1
idstring = "russian"
}

if (dads > -1){
contenthead = 'Dads' 
content = "F"+intermediateFormatting+"rom the very beginning of CLIMB, we&#39;ve heard from a great many dads who have suffered the loss of one or more of their multiple birth babies or children.  Though they may be trying to be calm, it&#39;s not hard to hear their own anguish along with their concern for their wife who is devastated.   There are also some dads who have been and kept in touch over the years, and many who have come out to the CLIMB gatherings and talked movingly of their experience of loss and coping &ndash; or not talked, but had their feelings and experience validated along with seeing that their wife&#39;s feelings are normal.<br><br>In this section are some of the things that dads have shared in our newsletter.  We hope that this and some features that we will be adding will be helpful by expressing what some of the emotions and realities are for fathers.  At the same time, not everyone is alike, and not all life situations and loss situations are alike.   No one should feel badly if you &#40;or your babies&#39; dad if you are the mom reading this&#41; don&#39;t feel this way, or don&#39;t seem to &ndash; especially since there is so much pressure put on men not to grieve, as some of these dads so eloquently point out. &#40;Also, we don&#39;t mean to imply that there is always a dad &ndash; there are quite a few single moms out there, and also some families with &quot;two mommies&quot;, and we welcome these experiences too.&#41; <br><br>There are a number of books on pregnancy and infant loss which talk about the grief of fathers.  One of these with an excellent section on fathers is Deborah Davis&#39;s <I>Empty Cradle, Broken Heart, and A Silent Sorrow</I> also has a section.  &#40;see our <a href=index.html?biblio>Bibliography</a>&#41; Everything that is said in these books applies also to fathers who have lost one or more of their multiples.  We think that there are also some additional things about multiple pregnancy that make dads&#39; experiences unique and even more complicated&#58; <br><br><b>&#183;</b> Dads tend to be very involved in the pregnancy &ndash; and for many, even earlier while trying to conceive with fertility technology.  Bedrest, miscarriage of a twin or triplet, difficult decisions about selective reduction, hospitalization and monitoring of the mom, treatment for twin transfusion syndrome &ndash; all these and more can be part of the pregnancy. Frequent ultrasounds and early bonding to both or all the babies are also realities for many dads. <br><br><b>&#183;</b> The last part of the pregnancy and the delivery are likely to be medically traumatic.  Many men watch their wives experience physical suffering, and some see their wives nearly die from blood loss or other complications at delivery. Whatever the outcome with the babies, many are so relieved that their wife lived. <br><br><b>&#183;</b> Situations can be so complicated by the number of babies and conditions.  Some fathers find themselves at another, more specialized hospital with the multiple who is sick and dying &ndash; alone while making medical decisions and being with that baby while mom and the healthier baby are at the original hospital far away.  After the loss of both or all the babies, it is not uncommon for one parent &#40;usually the mom&#41; to be completely involved in grieving for the babies, while the other &#40;usually the dad&#41; is watching out for the mom because she is so devastated, and then he is focused on trying again.  After the loss of one twin or triplet or higher with a survivor &#40;or more&#41;, it is common for one parent &#40;usually the mom&#41; to be focused on the loss, with the other &#40;usually the dad&#41; focuses solely on the survivor.  Maribeth Doerr, founder of PenParents, has commented that multiple birth loss with a survivor creates the unique possibility of denying that a loss happened at all &ndash; &quot;there was the pregnancy, here is the baby&quot;.   Denial is a very tempting thing for any griever, and in our society men tend not to like what they can&#39;t fix, so it can be even more tempting to these dads. Add to that everything involved in the care of a surviving baby or babies who are likely to be preemies.  One dad &ndash; with two surviving triplets and two other children, all age 3 and under &ndash; was very afraid that if his wife went ahead and grieved as she needed to for the triplet who died, she would fall apart and not be able to care for the other children.  So he forbade her to grieve, and justified it by denying that there had been a loss. &#40;The mom, of course, was afraid of what would happen to her and her caring for the other children if she did NOT get to take time to grieve.&#41; <br><br> And then there is just the sheer reality of those babies.  One dad, who had let his wife more or less lead them through the infertility treatment process, experienced seeing his own children for the first time when their twins were born prematurely.  Sick and dying as they were, his first exclamation was how incredibly beautiful they were and how they needed to have many more of these.  Multiples multiply the ways in which dads fall in love with their children. <br><br>Most dads do well over time but there are many pitfalls &ndash; and there are many fathers who later wish that they had asked for and sought more support for themselves than what they did...Relationships are another issue, and we recommend Deborah Davis&#39;s chapter on couples.  We &#40;and others&#41; do think that some of the statistics that people hear out there about a high percentage of marriages ending in divorce after loss are an overestimate&ndash; and many couples become even closer.  But as with grieving itself, there are certainly some pitfalls and some complications that are unique to or accentuated by multiple birth loss. It seems to be really important for couples to pay attention to their relationship and to their respective ways of reacting to the loss from the earliest time and seek counseling, if only as an insurance policy, so that there will not be &quot;fall&#45;out&quot; 4 or 5 years later and they can be unified in raising and enjoying their surviving or subsequent children.<br><br>Special thanks to these fathers.  Please note that there are several items by dads in the SIDS section, too. Before long we will be adding some interviews with dads to this section &ndash; and suggestions for other features are welcome.  Those who have lost a twin are encouraged to see William Woodwell&#39;s <I>Coming to Term&#58;  A Father&#39;s Story</I>  and also <I>Following Foo</I>. &#40;see our <a href=index.html?biblio>Bibliography</a>&#41;<br><dl><dd><a href=./html/story.html?dadjs&somethoughts>Some Thoughts On Loss...<dd><a href=./html/story.html?dadjs&ourbabiesam>OUR BABIES &#40;Adam &amp; Matthew&#41; <dd><a href=./html/story.html?dadjs&morepoemsonthelossoftwins>More Poems on the Loss of Twins <dd><a href=./html/story.html?dadjs&otsandd>Our Twin Son &amp; Daughter <dd><a href=./html/story.html?dadjs&tjatj>To Joe and to John</a><dd><a href=./html/story.html?dadjs&paujotri>Our Triplets <dd><a href=./html/story.html?dadjs&tourd>To Our Dad <dd><a href=./html/story.html?dadjs&ryanatriplet>Ryan &#40;a triplet&#41; <dd><a href=./html/story.html?dadjs&otstanne>Tanner &#40;our triplet son&#41; <dd><a href=./html/story.html?dadjs&otsowe>Owen, our triplet son<dd><a href=./html/story.html?dadjs&rebecceri>Rebecca &amp; Erin<dd><a href=./html/story.html?dadjs&bittersweet>BITTERSWEET ...A Tribute to Three <dd><a href=./html/story.html?dadjs&canyouhearme>To Andrew <dd><a href=./html/story.html?dadjs&waitingforalyssa>Waiting for Alyssa<dd><a href=./html/story.html?dadjs&amberpoem>Amber<dd><a href=./html/story.html?dadjs&erinssecond>Erin&#39;s 2nd birthday<dd><a href=./html/story.html?dadjs&marissa>Marissa<dd><a href=./html/story.html?dadjs&geraldmyson>My Son<dd><a href=./html/story.html?dadjs&robertevan>Robert Evan<dd><a href=./html/story.html?dadjs&owenandspencer>Owen &amp; Spencer</a><dd><a href=./html/story.html?dadjs&mynameisdaniel>My Name is Daniel</a><dd><a href=./html/story.html?pregnangjs&maxcharley>Max &amp; Charley</a></dl>"
main = -1
idstring = "dads"
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if (grandparents > -1){
contenthead = 'Grandparents'
content = "I"+intermediateFormatting+"f you are visiting this section of our site because your child has experienced the loss of one or more of his or her twins or higher multiples<nobr> &ndash; </nobr>your grandchildren<nobr> &ndash; </nobr>we are very sorry.  You are having to suffer the loss of a baby or babies who was precious to you, and at the same time see your own child in pain and sorrow.  If you are here because you are the parent who experienced a multiple birth loss and you are relating to the responses and needs of your own parents, the babies&#39; grandparents, we are very sorry and hope that this section will be helpful to you also. <br><br>In the section, we hope to focus especially on the &quot;twin&quot; and multiple aspects of this loss situation.  There are a number of excellent books on pregnancy and infant loss in general which include the grief of grandparents, such as <i>A Silent Sorrow</i> &#40;Kohn &amp; Moffitt, 2nd ed., Routledge, 2000&#41; and <i>Empty Cradle, Broken Heart</i> &#40;Davis, 2nd ed., Fulcrum, 1995&#41; &#40;see also www.centeringcorporation.org for a variety of resources&#41; and are well worth reading.  What we will talk about here are the complications, the sorrows and sometimes the joys, the potential confusions, and the special needs that come with this pregnancy and birth having been &quot;the babies&quot;, instead of &quot;the baby&quot;. <br><br>We&#39;ll start with a general article about what seems to be helpful or not, thinking of everything that has come up here over the years.  Then in the near future we will be adding some additional links on topics such as&#58;  relating to others in the family... including the baby&#40;s&#41; in the family in an ongoing way...what if there are other multiples in the family...parents relating to a &#40;grand&#41;parent who doesn&#39;t &quot;get it&quot;...relating to other grandparents...and more, including some poems and personal stories.  Your comments, input, suggestions and experiences are very welcome.   This section is written from the point of view of loss in pregnancy, at birth and or early infancy but also much of it is also relevant to the loss of a multiple as a toddler or in childhood.<br><dl><dd><a href=./html/article.html?grandparentjs&bgomwhathelps>Bereaved grandparents of multiples&#58; what helps</a><dd><a href=./html/article.html?grandparentjs&poemsbygrandmothers>Poems by Grandmothers</a></dl>"
main = -1
idstring = "grandparents"
}

if (siblings > -1){
contenthead = 'Siblings'
content = "W"+intermediateFormatting+"e&#39re working on this section.<br><dl><dd><a href=../pdf/talkingtoteachers.pdf>Talking to Teachers About Grief</a><dd><a href=./html/story.html?variousjs&siblinggrief>Sibling Grief</a><dd><a href=./html/story.html?variousjs&mybrothertimm>My Brother Timmy</a>"
main = -1
idstring = "siblings"
}

if (survivors > -1){
contenthead = 'Survivors'
content = "O"+intermediateFormatting+"<script type=text/javascript src=../js/survivor.js></script>ne of the main reasons that CLIMB first came together was the need of those of us who had experienced the death of one of our twins or higher multiples during pregnancy, or at or after birth, to find some support in raising our surviving baby&#40;s&#41;. We were meeting more and more parents who like us were facing this unimaginable and bittersweet challenge &ndash; for many of us, as first&#45;time parents &#40;and some, after many years of infertility&#41;.  Even while we were newly experiencing our loss, we all had so many questions and issues for which there was almost no information or support, such as&#58;<br><br><i> &ndash; Does a baby whose twin died before or at birth miss its twin&#63; Does it make a difference if the babies were identical or fraternal&#63;<br> &ndash;What effects might it have on him or her&#63;  Are surviving twins bound to feel lonely or sad, or always feel like someone is missing&#63;  Do survivors feel &quot;survivor guilt&quot; that they lived and the other baby died&#63;<br> &ndash;Will my own grief affect my baby&#63;  Is it ok to be sad or cry in front of my baby&#63; <br> &ndash;When and how do I tell my surviving child about his or her twin who died, and how do I help my child understand without feeling overshadowed by it&#63;  Why would or wouldn&#39;t I tell him or her in the first place&#63;  If I don&#39;t talk about it, will my child even know&#63; <br> &ndash;How do I explain when we don&#39;t even know why the other baby died&#63; How can I help my child not feel to blame for what happened&#63; <br> &ndash;Is there such a thing as talking about it too much, or being too honest, or telling my child too much&#63; <br> &ndash;Is it ok if my child doesn&#39;t seem to remember or miss his twin&#63; <br> &ndash;How can my child feel that he or she was truly enough for us, when we so much wanted and miss our twins, and our other baby&#63; <br> &ndash;How do I deal with birthdays&#63;  and other landmarks and special days&#63; <br> &ndash;How do I deal with all the daily reminders of what should have been&#63;  looking at my one baby and &quot;seeing&quot; two&#63; <br> &ndash;How do I deal with the terrible fear that something will happen to this baby too &ndash; and still not be too &quot;overprotective&quot;&#63;  What IS overprotective&#63; Does the fear ever end&#63; <br> &ndash;Should I tell others that my child is a surviving multiple&#63;  Do I refer to him or her as a twin&#63; <br> <i>And for some</i> &ndash; How do I deal with my surviving triplets or quads being called twins or triplets&#63;  or &ndash; How do I tell my child there were two, three or more others who didn&#39;t survive&#63;</i> <br><br> Sixteen years later, and after raising our own children, we have what you could call good news and bad news.  The bad news first&#58;  still not enough is really known, and there are no scientific studies that would answer some questions.  Because of how difficult, if not impossible, they would be to do, it&#39;s not likely there will ever be any truly definitive studies, though there is probably some progress that could be made.  The good news is that there are many surviving twins and multiples who are growing up to be happy and emotionally healthy &ndash; and among them, many who know about and love their twin, while not feeling overshadowed or &quot;weird&quot; in any way. <br><br>The other bad news is that there is no one obvious &quot;right&quot; way for parents to relate to all of this, and it IS really so complicated and can be so exhausting.  But the best news is that parents have no reason to fear that their child will have an unhappy or strange life no matter what we do.  We really do all have the possibility of a good life for and with our surviving child or children, even with the loss of our baby and the loss of the babies growing up together.  In many ways &#40;though it sounds strange at first&#41; relating to it is like raising a child who is adopted, and who knows it &ndash; we&#39;ll explore that more in some of the articles below. <br><br>We hope that this section will be helpful to you in finding your and your family&#39;s way among these bittersweet challenges.  These articles and other sections are about some of the aspects of all of this, and we welcome and encourage personal stories and other articles, as well as feedback, experiences and suggestions.  Though it primarily relates to survivors of pregnancy, birth and infancy losses, we are also developing a section below about survivors of &quot;older&quot; loss, the loss of a multiple as toddlers or in childhood.  Be sure to see also the articles about survivors on the website of Elizabeth Pector, MD, <a href=http://www.synspectrum.com/ multiplicity.html>www.synspectrum.com&frasl;multiplicity.html</a>.<br><br><a href=./html/article.html?survivorjs&wheretobeginparentsgrief>Where to begin&#63;<nobr> &ndash; </nobr>Parents&#39; grief</a><br><br><a href=./html/article.html?survivorjs&raisingamy>Raising Amy</a><br><a href=./html/article.html?survivorjs&talkingtosophie>Talking to Sophie</a><br><a href=./html/article.html?survivorjs&jennifersstory>Interview &#45; a surviving twin of SIDS</a><br><a href=./html/article.html?survivorjs&talkingtoberney>Talking to Berney</a><br><a href=./html/article.html?survivorjs&parentstalk>Parents of survivors talk...</a><br><a href=./html/story.html?survivorjs&byabosurvivor>By&frasl;about survivors</a><br><a href=./index.html?biblio#alwaysmytwin>&quot;Always My Twin&quot;</a><br><br> Coming&#58; <ul><li>dealing with others and how to label our survivor&#40;s&#41; <li>the adoption analogy <li>talking to a young survivor, and questions children ask as they grow <li>&quot;telling&quot; an older child <li>special needs and multi&#45;handicapped survivors <li>photos <li>birthdays and other special days <li>survivors of &quot;older&quot; losses <li>personal experiences, stories <li>FAQ&#39;s</ul>"
main = -1
idstring = "survivors"
}

if (friends > -1){
contenthead = 'For Friends &amp; Relatives'
content = "W"+intermediateFormatting+"e&#39re working on this section.<dl><dd><a href=./html/article.html?variousjs&supportingtheparent>Supporting the Parent</a><dd><a href=../pdf/climbflyer.pdf>CLIMB flyer</a></dl>"
main = -1
idstring = "friends"
}

if (multiplesgroups > -1){
contenthead = 'For Multiples Groups'
content = "I"+intermediateFormatting+"f you are visiting this section of our site because your twins and multiples group has encountered a loss among your members or prospective members, our condolences.  If you&#39;re visiting because your group knows that at some point you will have a member or prospective member who experiences a loss and you want to be prepared, we truly appreciate it.   With the rise of fertility technology over the past years, twins and multiples groups all over the United States &ndash; and from what we can see, in other countries too &ndash; have more and more had to relate to loss as part of the &quot;world of multiples&quot; while encountering more and more bereaved families of multiples.  The article in the first link below is about the main ways that this happens, and our suggestions about each of them, keeping in mind what has come up here over the years, and then some additional comments that apply to all of them.  We will be adding much more to this section and really welcome your comments, suggestions and experiences.<dl><dd><a href=./html/articlenoindent.html?multiplesgroupjs&emblwhatyoucando>Encountering Multiple Birth Loss&#58; What You Can Do</a></dl>"
main = -1
idstring = "multiplesgroups"
}

if (professionals > -1){
contenthead = 'For Professionals' 
content = "I"+intermediateFormatting+"n recent years, the number of multiple conceptions has increased so dramatically that many helping professionals are encountering loss in multiple birth much more frequently than ever.  Some have told us, when calling to request our resources, that in the past two weeks they had 4 or 5 families who had suffered a multiple birth loss, &quot;as many as we used to see in a year&quot;.  Not only is there a tremendous need for sensitive and informed care at the time of the loss, but also later from counselors and psychologists, pediatricians, physicians and nurses involved in a subsequent pregnancy, and others who will interact with the family &quot;down the road&quot;.   We hope that the articles in this section, and some others that we would like to add to it, will be helpful, and also encourage you to make our flyer available to those in need.<br><br>It&#39;s important to note that with the increase in multiple births, more professionals have themselves been experiencing loss.  Over the years, our group has included quite a number of physicians and nurses &#40;even obstetricians&#41;, social workers and counselors, psychologists and others who themselves have had to confront the loss of one or more, both or all of their babies.  Most have found that nothing could have completely prepared them for this personal and parenting challenge.  Many have found that their loss experience was itself impacted by this &#40;their caregivers were also their colleagues and it was &quot;their&quot; hospital&#41; &ndash; and many have found it a tremendous personal and professional challenge to return to work which involves birth, death, multiples and so much that relates to their own experience.  Many have found a deeper appreciation of the issues involved in their work and a heightened capacity to relate to others&#39; situations.  We very much welcome input on these issues from parents who are also helping professionals, and we are glad to see the impact that some are hoping to have within their field on awareness of multiple birth loss needs.<br><br>Along these lines, please be sure also to see the website of Elizabeth Pector, MD  <a href=http://www.synspectrum.com/multiplicity.html>www.synspectrum.com&frasl;multiplicity.html</a> with a variety of very relevant articles based on her own experience and prodigious research and activism in the years since.<br><br>We welcome input, questions, comments and other contributions from those who are on the front lines as professionals.<br><br><a href=../pdf/mblnicu.pdf>Multiple Birth Loss and the Hospital Caregiver</a><br><br><a href=../pdf/hospitales.pdf>La muerte en nacimientos m&uacute;ltiples y el personal de los hospitales</a><br><br><a href=../pdf/decesgrossessemultiple.pdf>D&eacute;c&egrave;s lors d&#39;une grossesse multiple, les professionnels de la sant&eacute;&#58; des alli&eacute;s pour les parents</a><br><br><a href=../pdf/doula.pdf>Doula Care and Twin Loss</a><br><br><a href=../pdf/twintriplet.pdf>The Death of Your Twin or Triplet Baby</a> &#40;outreach pamphlet&#41;<br><br><a href=./html/article.html?biblijsdeathofababytwin>The Death of a Baby Twin&#58; Some Comments for Grief Counselors</a><br><br><a href=../pdf/bothall.pdf>The Death of Your Twin or Triplet Babies</a> &#40;outreach pamphlet&#41;<br><br><a href=./html/article.html?griefcounselor&bothoraljs>The Death of Twin Babies: Some Comments for Grief Counselors</a><br><br><a href=./pdf/supertwins.pdf>The Death of Your Higher Multiple Baby</a> &#40;outreach pamphlet&#41;<br><br><a href=../pdf/childhoodloss.pdf>The Loss of a Twin or Multiple in Childhood</a> &#40;outreach pamphlet&#41;<br><br><a href=../pdf/climbflyer.pdf>CLIMB flyer</a>"
main = -1 
idstring = "professionals" 
}

if (otherresources > -1){
contenthead = 'Other Resources'
content = "T"+intermediateFormatting+"here are quite a variety of groups and resources which are relevant to multiple pregnancy, multiple birth loss in general, to specific situations, and to pregnancy, infant and child loss in general.   More, really, than can be listed and kept accurately updated&#33;  These are some of the primary resources which have been of interest to our members.  Most of them include links to many other related sites and sources of information; Dr. Pector&#39;s site, especially, has extensive listings.   The content of each of the sites below is, of course, completely their responsibility.  In pursuing other links which you may find from them, all the usual net cautions apply, about using one&#39;s judgment and critical thinking ability &#40;and please see also our Warning section in regard to online contacts with others&#41;.<br><br>NOTE&#58;  Our <a href=index.html?biblio>Bibliography</a> &#40;which is our bibliography for the site as well as for multiple birth loss generally and contains print as well as online sources&#41; is in the &quot;About CLIMB&quot; section of this site.<br><br><b>eLIMBO &#40;electronicLoss In Multiple Birth Outreach&#41;</b><br><a href=http://www.groups.yahoo.com/group/eLIMBO>www.groups.yahoo.com&frasl;group&frasl;eLIMBO</a> <br>...an e&#45;mail support group of bereaved multiple birth parents, most with the loss of one of their twins or higher multiples in pregnancy or infancy.  Many members are also members of CLIMB and have found it invaluable.<br><br><b>LAMBS &#40;Loss of All in Multiple Birth Support&#41;</b><br><a href=http://www.public.iastate.edu/~cjenks/lambs.html>www.public.iastate .edu&frasl;&#126;cjenks&frasl;lambs.html</a><br>...an e&#45;mail support group of parents who have experienced the death of both twins or all their higher order multiples.  It&#39;s the only one of its kind, started by some of our members over 10 years ago, and it&#39;s been invaluable to many.<br><br><b>Elizabeth A. Pector, MD</b><br><a href=http://www.synspectrum.com/multiplicity.html>www.synspectrum.com&frasl; multiplicity.html</a><br>... includes articles on many aspects of multiple birth loss for parents and caregivers, and an extensive resource listing, by a physician who is also a bereaved multiple birth parent. <br><br><b>Twin and Multiple Birth Loss NZ &#40;Inc.&#41;</b> <br><a href=http://www.twinloss.org.nz>www.twinloss.org.nz</a> <br>e&#45;mail&#58; twinloss&#64;xtra.co.nz, Rosemary Smart and Jan Liddell <br>...peer support network in New Zealand for multiple birth loss at any stage of gestation or age;  it offers a quarterly newsletter &quot;Hearts &amp; Wings&quot; and  assistance to caregivers and multiples organizations.  It helps to distribute &quot;Our Newsletter&quot; and other CLIMB resources in New Zealand.<br><br><b>Lynda Haddon</b><br><a href=http://www.multiplebirthsfamilies.com/bereavement.html>www.multiplebirthsfamilies.com&frasl; bereavement.html</a><br>...a site which includes a large section on bereavement, by a childbirth educator who is also the bereavement coordinator for Multiple Births Canada&frasl;Naissances multiples Canada &#40;loss&#64;multiplebirthscanada.org&#41;<br><br><b>TAMBA BSG &#40;Bereavement Support Group&#41;</b><br><a href=http://www.tamba-bsg.org.uk>www.tamba&#45;bsg.org.uk</a><br>... affiliated with the Twins And Multiple Births Association &#40;England&#41;&#58; peer support for loss in pregnancy and infancy, with the quarterly &quot;Newsletter&quot; and periodic meetings<br><br><b>Multiple Births Foundation</b><br><a href=http://www.multiplebirths.org.uk>www.multiplebirths.org.uk</a><br>...among its publications, booklets for parents and professionals on complications of monochorionic twinning, bereavement, fetal reduction &#40;multifetal pregnancy reduction&#41; and selective fetocide &#40;selective termination&#41;<br><br><i>Also, a number of organizations &ndash; The Triplet Connection, Mothers of Supertwins, the TTTS Foundation, Fetal Hope Foundation and others &ndash; now have discussion forums for some kinds of multiple birth loss.</i><br><br><b>General&#58;</b><br><br><b>National SHARE</b><br><a href=http://www.nationalshare.org>www.nationalshare.org</a> <br>1&#45;800&#45;821&#45;6819<br>...support &#40;since 1977&#41; for bereaved parents and families who have suffered a loss from miscarriage, stillbirth or neonatal death, and assistance to caregivers. The website contains an extensive listing of links to groups and resources related to infant loss, and a listing of local SHARE infant loss support groups across the U.S. &#40;and several in Canada&#41;, as well as information on SHARE&#39;s resources.<br><br><b>The Compassionate Friends &#40;TCF&#41;</b><br><a href=http://www.compassionatefriends.org>www.compassionatefriends.org</a><br> 1&#45;877&#45;969&#45;0010<br>...support &#40;since 1969&#41; for parents and siblings grieving the loss of a child or children at any age from pregnancy through adulthood.  The site contains some related resources and information on locating a local TCF chapter &#40;there are quite a few across the U.S., and in many other countries&#41;.  Some local chapters have additional meetings for parents with pregnancy and infant losses.<br><br><b>MISS Foundation</b><br><a href=http://www.missfoundation.org>www.missfoundation.org</a><br>...another source of local support groups for pregnancy and infant loss, and other resources.<br><br><b>American Self&#45;Help Group Clearinghouse</b><br><a href=http://www.selfhelpgroups.org>www.selfhelpgroups.org</a><br>973&#45;326&#45;6789<br>...as mentioned in our FAQs section, the Clearinghouse publishes <i>The Self&#45;Help Group Sourcebook</i>, a 450&#45;page listing of support&frasl;information groups in existence for many kinds of conditions and situations, including health issues, bereavement and parenting.  It also contains some detailed information on starting a community self&#45;help group, and on researching self&#45;help groups. The listing includes some groups in England and Australia, as well as the U.S. and Canada.<br><br><b>A Place to Remember</b><br><a href=http://www.APlacetoRemember.com>www.APlacetoRemember.com</a><br>1&#45;800&#45;631&#45;0973<br>...many resources for infant loss, including books, memory boxes, and materials for dads, grandparents, siblings and caregivers.  They offer &quot;butterfly&quot; birth announcements for multiples when one has died, which can be customized."
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if (howyoucanhelp > -1){
contenthead = 'How You Can Help'
content = ""+intermediateFormatting+'<ul><li>Donations are always welcome&#33;  We are volunteers and CLIMB is supported completely by voluntary donations.  Postage stamps are always welcome and useful.  We are a 501&#40;c&#41;&#40;3&#41; non&#45;profit organization, IRS &#35; 94&#45;3150067.  A receipt is available on request.  Our mailing address is&#58;  CLIMB, Inc., P.O. Box 91377, Anchorage AK 99509.<br><br><li>PayPal&#58; we can now accept donations through PayPal.<br><br><form action="https://www.paypal.com/cgi-bin/webscr" method="post"> <input type="hidden" name="cmd" value="_s-xclick"> <input type="image" src="https://www.paypal.com/en_US/i/btn/btn_donate_LG.gif" border="0" name="submit" alt="PayPal - The safer, easier way to pay online!"> <img alt="" border="0" src="https://www.paypal.com/en_US/i/scr/pixel.gif" width="1" height="1"> <input type="hidden" name="encrypted" value="-----BEGIN PKCS7----- MIIHXwYJKoZIhvcNAQcEoIIHUDCCB0wCAQExggEwMIIBLAIBADCBlDCBjjELMAkGA1UEBhMC VVMxCzAJBgNVBAgTAkNBMRYwFAYDVQQHEw1Nb3VudGFpbiBWaWV3MRQwEgYDVQQKEwtQYXlQ YWwgSW5jLjETMBEGA1UECxQKbGl2ZV9jZXJ0czERMA8GA1UEAxQIbGl2ZV9hcGkxHDAaBgkq hkiG9w0BCQEWDXJlQHBheXBhbC5jb20CAQAwDQYJKoZIhvcNAQEBBQAEgYBLa19x6BuC43JN jvZtG3ukyv23ysif5hOR5YY0nuEw8yvMrqm8t/NKkSy9I4H6NN+Mq7cfJa83f9jjnV/ 20yWrBOLo/AtDy8JQlQHrPLS+ 1a6ZicmYWWs4aPWTCo6S1GhVW3VCYJLOn25R7XdB5QysGFaNe2ORR2wg8enRSJIgWTELMAkG BSsOAwIaBQAwgdwGCSqGSIb3DQEHATAUBggqhkiG9w0DBwQIq7jz9MphmmOAgbh03LKVSoZh oCXFRW/9MfsIqPpniN8k37xb9ajo0dQk+YRy/S/ uOZqdrKfJeJQK04eAT2O9ogooufaRRkZTietb85vMRHTmdlt8DEK4uTX8XlYNKDk3NNIDApy jWpzHH+em72JAJe0oDGdBjlL+ z3MNQMs21yen3DrcrDTxyDs06esIMPE9M2mxG8aBb6tn8jdDw+ oYXv7IDEWZ495WrFqWKCkJX3p1XG9+w+ sxY7lAIoagJvQqbsyUoIIDhzCCA4MwggLsoAMCAQICAQAwDQYJKoZIhvcNAQEFBQAwgY4xCz AJBgNVBAYTAlVTMQswCQYDVQQIEwJDQTEWMBQGA1UEBxMNTW91bnRhaW4gVmlldzEUMBIGA1 UEChMLUGF5UGFsIEluYy4xEzARBgNVBAsUCmxpdmVfY2VydHMxETAPBgNVBAMUCGxpdmVfYX BpMRwwGgYJKoZIhvcNAQkBFg1yZUBwYXlwYWwuY29tMB4XDTA0MDIxMzEwMTMxNVoXDTM1MD IxMzEwMTMxNVowgY4xCzAJBgNVBAYTAlVTMQswCQYDVQQIEwJDQTEWMBQGA1UEBxMNTW91bn RhaW4gVmlldzEUMBIGA1UEChMLUGF5UGFsIEluYy4xEzARBgNVBAsUCmxpdmVfY2VydHMxET APBgNVBAMUCGxpdmVfYXBpMRwwGgYJKoZIhvcNAQkBFg1yZUBwYXlwYWwuY29tMIGfMA0GCS qGSIb3DQEBAQUAA4GNADCBiQKBgQDBR07d/ETMS1ycjtkpkvjXZe9k+ 6CieLuLsPumsJ7QC1odNz3sJiCbs2wC0nLE0uLGaEtXynIgRqIddYCHx88pb5HTXv4SZeuv0 Rqq4+axW9PLAAATU8w04qqjaSXgbGLP3NmohqM6bV9kZZwZLR/klDaQGo1u9uDb9lr4Yn+ rBQIDAQABo4HuMIHrMB0GA1UdDgQWBBSWn3y7xm8XvVk/UtcKG+ wQ1mSUazCBuwYDVR0jBIGzMIGwgBSWn3y7xm8XvVk/UtcKG+ wQ1mSUa6GBlKSBkTCBjjELMAkGA1UEBhMCVVMxCzAJBgNVBAgTAkNBMRYwFAYDVQQHEw1Nb3 VudGFpbiBWaWV3MRQwEgYDVQQKEwtQYXlQYWwgSW5jLjETMBEGA1UECxQKbGl2ZV9jZXJ0cz ERMA8GA1UEAxQIbGl2ZV9hcGkxHDAaBgkqhkiG9w0BCQEWDXJlQHBheXBhbC5jb22CAQAwDA YDVR0TBAUwAwEB/ zANBgkqhkiG9w0BAQUFAAOBgQCBXzpWmoBa5e9fo6ujionW1hUhPkOBakTr3YCDjbYfvJEiv /2P+IobhOGJr85+XHhN0v4gUkEDI8r2/rNk1m0GA8HKddvTjyGw/XqXa+ LSTlDYkqI8OwR8GEYj4efEtcRpRYBxV8KxAW93YDWzFGvruKnnLbDAF6VR5w/ cCMn5hzGCAZowggGWAgEBMIGUMIGOMQswCQYDVQQGEwJVUzELMAkGA1UECBMCQ0ExFjAUBgN VBAcTDU1vdW50YWluIFZpZXcxFDASBgNVBAoTC1BheVBhbCBJbmMuMRMwEQYDVQQLFApsaXZ lX2NlcnRzMREwDwYDVQQDFAhsaXZlX2FwaTEcMBoGCSqGSIb3DQEJARYNcmVAcGF5cGFsLmN vbQIBADAJBgUrDgMCGgUAoF0wGAYJKoZIhvcNAQkDMQsGCSqGSIb3DQEHATAcBgkqhkiG9w0 BCQUxDxcNMDgwODAzMDE0MjE2WjAjBgkqhkiG9w0BCQQxFgQUdgy7A4Zlhju0ka10ISNGKsH S2JYwDQYJKoZIhvcNAQEBBQAEgYCGJFXqu1RtsSnyfHOBPMIJAQvpknqmhF4utdJSGbKDS4S R2lq1yYI6o8rDlf28yXh4ypulmR2yyKv6UhhFalphEHWL/CajZjMDzEJAhjgiJ1ACWzg/ Ud9V6X8gBgxA7uAW4yct1nR1JOsiu3eliP3JGFydOv/RCJWhXXM2fDeX0Q==-----END PKCS7----- "> </form><li>When you donate, you are welcome to note, or e&#45;mail us, the name of the baby&#40;s&#41; or child&#40;ren&#41; you wish to be included in the &quot;In Memory Of&quot; section of our newsletter and our members&#39; website, along with anything you wish included with their name&#40;s&#41;.  Let us know if you wish to have your name included as a donor or whether you would like an acknowledgement or a receipt.<br><br><li>Make our <a href=../pdf/climbflyer.pdf>CLIMB flyer</a> available to anyone who might be in need of or interested in support for multiple birth loss.<br><br><li>Think about how you might be able to be involved in starting a local group for multiple birth loss support in your area, or to help with that in some way, and be in touch with us about it.  More of these groups are the single largest unfulfilled need at this time.</ul>'
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if (contact > -1){
contenthead = 'Contact us'
content = ""+intermediateFormatting+"Center for Loss in Multiple Birth &#40;CLIMB&#41;, Inc.<br> P.O. Box 91377<br> Anchorage AK 99509<br><br>climb&#64pobox.alaska.net &#40;Jean Kollantai&#41;<br><br> 907&frasl; 222&#45;5321 &#40;M&#45;Th 9&#45;2 or leave a message&#41; &#40;one hour earlier than West Coast time, 4 hours earlier than East Coast time&#41;<br><br>To receive a sample copy of <i>Our Newsletter</i>, please e&#45;mail us with your name and complete postal address, your phone number &#40;for our records only&#41; and your reason for interest. With the newsletter, you will receive the form to mail back to us to join the ongoing mailing list, if you wish.<br><br>We are a non&#45;profit, 501&#40;c&#41;&#40;3&#41; organization, IRS &#35; 94&#45;3150067. Donations may be made payable to CLIMB, Inc. and sent to the above address.<br><br>For any questions, comments or corrections to our site, please contact us at the above e&#45;mail address and include &quot;attn&#58; webmaster&quot; in the subject line.<br>"
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if (about > -1){ 
contenthead = 'About CLIMB' 
content ="W"+intermediateFormatting+"e are a 501&#40;c&#41;&#40;3&#41; non&#45;profit organization based in Anchorage, Alaska, serving families and others throughout the United States, Canada and beyond. Our mission is, and always has been, to provide parent&#45;to&#45;parent support for all of us who have experienced the death of one or more of our twins or higher multiple birth children at any time from conception through birth, infancy and early childhood. It is also to assist extended families, caregivers, twins and multiples organizations and others who are seeking to understand and support the needs of parents with a multiple birth loss.  While it is not officially in our mission, we have come to believe in the importance of greater education of the public on the risks and realities of multiple births, and how often they include tragedy and grief &ndash; and the importance of prevention of multiple birth loss.<br><br>Our founder is Jean Kollantai, whose fraternal twin son Andrew died just before their due date, after a good pregnancy, in April, 1986.  &#40;His surviving brother, Berney, is our webmaster, and their younger brother Alex is now 21.&#41;  In early 1987, Jean began to search for others who had lost a twin and soon was hearing from parents of multiple birth loss from around the country and Canada.  She put together the first issue of <i>Our Newsletter</i> for them in December, 1987, and then heard from many more. Though we didn&#39;t know it then, our group began at the time of the boom in fertility technology,  as well as twins and higher multiples being diagnosed more routinely and earlier through ultrasound.   Jean met Patti Dubler, a local twins club activist and childbirth educator who was deeply concerned with loss and truly able to relate, and they began to develop multiple birth loss support for the Anchorage Parents of Twins &#38; Multiples Club. Jean and Patti soon met Lisa Fleischer, whose twin son Teddy &ndash; born on their due date weighing 8&#35;5 &ndash; died of the effects of a prolapsed cord when he was 10 days old.  &#40;His surviving twin Sophie is 22 soon, and sister Mia is 26 and brother Piers is 18.&#41;  Lisa has been a totally and truly indispensable support to Jean and to CLIMB all these years, and also the coordinator and facilitator of Parents Reaching Out, the Anchorage&#45;based infant loss support group.  Lisa and Jean sadly soon met Becky Crandall, whose twin daughters Julia and Emily were stillborn at 37 weeks along from no known cause in November, 1987. &#40;Like Jean&#39;s, her twins were her first children at 37.&#41; Becky is an artist who provided the hand&#45;drawn graphics for our newsletter, along with thoughtful input on issues about complete loss. &#40;Her subsequent sons  are Timmy, 19, and Alec, 15.&#41;  We were fortunate to locate some professionals around the country and in England who were concerned with multiple birth loss and also encouraged us to form an ongoing organization.<br><br>&#40;Here is a <a href=./images/jeanlisa.jpg>photo</a> of Jean and Lisa at the National Perinatal Bereavement Conference in October, 2004.  Jean is second to the left, and Lisa is on the far right.&#41;<br><br>Over the years CLIMB has served, we estimate, somewhere well over 10,000 families in some way. &#34;Membership&#34; in CLIMB consists of actively choosing to join the ongoing mailing list of <i>Our Newsletter</i>.  At any given time there are 500 on our mailing list &#40;including those in Canada, Australia, New Zealand and Europe&#41;, though it would be several thousand if we didn&#39;t update our mailing list annually.<br><br>Our group includes first&#45;time parents &#40;often, after many years of trying&#41; and some who have many older children&#8230;teenagers and new moms who are over 50&#8230;married and single parents, and some gay and lesbian partners&#8230;company presidents, attorneys and doctors, and people who are on state assistance, and stay&#45;at&#45;home moms&#8230;some who have no living children and others who have many&#8230;some who have deep religious beliefs, including non&#45;Christian ones, and others who are completely secular&#8230;parents whose loss is as many as 40 years ago, and others for whom it is &#34;now&#34;.   We are all here because of our common bond, and the opportunity to share with others in what is now a community for multiple birth loss. Each of us contributes what we can and takes what we need to and that makes sense to us, while coping and trying to heal and face the ongoing challenges &ndash; each of us in our own way, in our own situation, but while knowing we are not alone and that our babies and children matter.<br><br>We have made a number of presentations about multiple birth loss support to conferences and organizations in the U.S. and beyond, such as twins and multiples organizations and organizations related to premature birth, including the conference of the National Association of Perinatal Social Workers in April, 2006 &#40;Jean Kollantai and Elizabeth Pector, MD&#41;. Jean made a presentation on support for multiple birth loss parents at the 9th International Workshop on Multiple Pregnancy in Herzliya, Israel, in 1994, and to the first&#45;ever Bereavement Symposium at the 10th Congress of the International Society for Twin Studies in London in 2001.  Jean and Dr. Pector presented at the 12th International Congress on Twin Studies in Gent, Belgium, in June, 2007. We appreciate networking with many professionals and parents who are involved in multiple births, infant and child loss support, and related areas. Articles by Jean and Lisa have appeared in a number of publications, as well as quotes and other input from CLIMB in many articles about loss in multiple birth.  Jean was recently interviewed in <i>Twins</i> Magazine as a trailblazer in the world of multiples. She is a member of the Advisory Boards of National SHARE Pregnancy and Infant Loss Support, and Multiples Births Canada&#47;NmC, and was a founding board member of the Pregnancy Loss and Infant Death Alliance.  After completing her degree, Lisa is currently a hospice bereavement coordinator in her professional life.<br><br>We are a completely volunteer organization, and all of our staffing and funding comes from voluntary donations by bereaved parents and relatives, caring professionals, and twins and multiples organizations.<dl><dd><a href=#ournewsletter>Our Newsletter</a><dd><a href=#parentcontactlist>Parent contact list</a><dd><a href=#localgroups>What about local groups&#63;</a><dd>&nbsp;<dd><a href=index.html?biblio>BIBLIOGRAPHY</a></dl><hr noshade><b><a name=ournewsletter>Our Newsletter</a></b><br><br><i>Our Newsletter</i> is published usually every three months and usually contains 28 pages of personal stories and updates, poetry, subsequent birth announcements, and any new topical articles and information. At this time, it is available in print by postal mail only. To request a sample copy, please e&#45;mail Jean Kollantai at <a href=mailto:climb@pobox.alaska.net>climb&#64;pobox.alaska.net</a> with:<br><b>&#183;</b>  your full name and complete postal address<br><b>&#183;</b>  your phone number &#40;for our records only&#41;<br><b>&#183;</b>  your reason for interest<br>&#40;This information is confidential.&#41;<br><br>We can&#39;t send the newsletter to anyone not expecting it &ndash; if it&#39;s for a friend or relative, please indicate that you have their permission for us to send it to them, or else request that we mail it to you to pass on to them.  If it seems better, you may request that we mail them our flyer, with a note that says they are welcome to be in touch. The flyer tells about our group and has a coupon they can clip and send to receive a sample copy of the newsletter if or when they wish.<br><br>If you are in <b>Australia</b>, please contact Jenny Stanley <a href=mailto:stanz@bigpond.net.au>stanz&#64;bigpond.net.au</a> with a subject line Our Newsletter in Oz to receive your sample copy. If you are in <b>New Zealand</b>, please contact <a href=mailto:twinloss@xtra.co.nz>twinloss&#64;xtra.co.nz</a>.<br><br> What you will receive is a <u>sample only</u>, and will include a form that you will need to respond with by postal mail to receive any further newsletters.   Responding with the form will place you on our ongoing mailing list, and also if you wish, our monthly e&#45;mail bulletin for parents who are members. &#40;Fyi, when you respond the suggested donation is &#36;20&#47;year for individuals, more if you can afford it or are an organization or institution, and as little as two stamps if that is all that is possible right now.  The suggested donation for Canada is &#36;25, and &#36;30 for overseas mailing, in U.S. funds, please. <br><br>Back issues of the newsletter are generally not available but stories of a particular type of loss may be requested &#40;check with us for more information on that, or if you do need back issues&#41;.<br><br>All members of the mailing list who are bereaved parents, and who wish to receive it, receive our monthly e&#45;mail bulletin with information on what&#39;s up in CLIMB, information about any new resources and events, requests for information or contacts and other items of interest&#59; and may send items for the e&#45;bulletin.<hr noshade> <b><a name=parentcontactlist>Parent Contact List</a></b><br><br>If you are a bereaved parent who joins the mailing list, you&#39;ll receive some sheets of information on CLIMB for new members which include the form you can use &#40;postal&#41; to join our parent contact list. There are really four contact lists &ndash; &#34;Loss of a twin&#34;, &#34;Loss of both or all&#34;, &#34;Loss of an &#39;older&#39; multiple&#34; &#40;those whose loss was after the babies were a year old&#41;, and &#34;Loss of a supertwin&#47;s&#34; &#40;those who have lost one or more but not all of their triplets or other high order multiples&#41;. If you join, you&#39;ll be added to the appropriate listing and then receive a copy of it to be in touch with anyone else on it you wish by mail, phone &#40;if given&#41; or e&#45;mail &#40;if available&#41;. In some circumstances, we can provide several names from the parent contact list to others &ndash; new members who haven&#39;t yet joined the list, or twins clubs, hospital social workers &ndash; who are in need of a local contact.<hr noshade><b><a name=localgroups>What about local groups&#63;</a></b><br><br>We are sorry to say that CLIMB does not have local chapters.  This is because to develop their activities and be legally responsible for them would take up to a full time staff position here that we just don&#39;t have. &#40;But we are happy to hear of and follow up on any leads for funding such a position&#33;&#41;  It is very important to have multiple birth loss support at the local level, and we really encourage our members to try to start something and then support them in any way that we can. Our article <a href=./html/article.html?variousjs&formingalocalgroup>&#34;Forming a Local Multiple Birth Loss Support Group&#34;</a> is posted here with some information and ideas based on what has been done so far.  There are already some local multiple birth loss support groups &ndash; anyone is welcome to check with us.<br><br>Also, some summers we have had some local or regional gatherings organized by CLIMB members. Some of these have been in New Jersey, New York City, Sayre PA&#47;Waverly NY, Maryland, Washington DC, Atlanta&#47;Marietta GA, Minneapolis, Seattle, St. Louis, Phoenix, Salt Lake City, and we welcome more opportunities for local get&#45;togethers.<br><br>Instead of founding a separate support group locally, it&#39;s also possible to create an offshoot of an already&#45;existing group &ndash; such as a local infant loss support group or an NICU group or a twins and multiples club &ndash; by putting together some additional meetings that are for multiple birth loss parents.  We really encourage this as a way to meet the needs without having to completely invent or reinvent the wheel.  Just as with local get&#45;togethers, we can use our e&#45;bulletin and parent contact list to help let others in the area know about it, or help members try to meet others locally and plan something like that.<br><br>Please be sure to see the listings in this site for LAMBS &#40;Loss of All in Multiple Birth Support&#41; and eLIMBO &#40;for all multiple birth loss, including many who have lost one of their twins, triplets or higher&#41; &ndash; these groups have been invaluable in getting people together online, and sometimes as a result, in person also, and are a good place to connect if you don&#39;t have anyone locally, along with our parent contact list."
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if (faqs > -1){
contenthead = 'FAQs'
content = ""+intermediateFormatting+"<a href=./html/article.html?faqjs&faqno1>What about infant&frasl;child loss support groups, and counseling&#63;</a><br><br><a href=./html/article.html?faqjs&faqno2>How do I deal with living twins and multiples&#63;</a><br><br><a href=./html/article.html?faqjs&faqno3>Is my loss rare&#63;</a><br><br><a href=./html/article.html?faqjs&faqno4>What about the medical aspects of my loss&#63;</a><br><br>"
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if (sidsmain > -1){
contenthead = 'Loss to SIDS'
content = "F"+intermediateFormatting+"rom the beginning, CLIMB has included a number of families who did bring both or all of their babies home from the hospital, often healthy and thriving, only to have one of them die weeks or months later from the mysterious killer, SIDS, Sudden Infant Death Syndrome.  One of our first members was a mother who is an identical twin herself, and lost one of her healthy identical twin daughters to SIDS when they were 4 months old; another was Alice Check, whose story of her Patrick along with her poetry and article on SIDS in multiples we are grateful to include in this section. Since then we have been concerned with providing some special support for these parents who suddenly find themselves grieving many losses &ndash; the loss of a precious baby, the loss of the special joy of raising twins or triplets or more, and the loss for the surviving baby, who now must grow up without his twin to share the joys of childhood.   If you are visiting this section because one of your multiples has been the victim of SIDS, recently or no matter how long ago, we are very sorry and hope that it can be helpful in some way.<br><br>Although the overall rate of SIDS has declined in recent years, the cause of SIDS is still unknown, and we continue to hear from families who have lost a twin or triplet baby to SIDS. Twins and multiples are represented disproportionately among SIDS deaths, because prematurity is a known risk factor and twins overall are more premature than singleton babies overall.   As with single babies, SIDS also strikes twins who were not premature &ndash; and whether the babies were premature or not, it&#39;s another situation of anything that can affect a baby being twice as likely to come up in a pair &#40;or three times as often in triplets&#41;.  With the continued boom in fertility technology and the increase in multiple births, especially twins, we are afraid that this may not change &ndash; the numbers of multiple births may rise as much or more than the risk of SIDS declines, with at least the same number of victims among multiple births as there has always been &#40;while being an unrecognized risk of multiple births, often to parents who have undergone years of trying to conceive with fertility technology&#41;.  Alice Check&#39;s research for her article in this section confirms that this is, in fact, the case, at least in the United States.<br><br>This is a major reason why we urge SIDS organizations to provide specific information and support in this area in a variety of ways, and to encourage research on SIDS in multiples as well as on multiples in regards to SIDS.  Multiples, after all, whether &#39;&#39;identical&#39;&#39; or fraternal, share so much of the same genetics and environment from the time they are conceived and are usually each other&#39;s constant companion after birth &ndash; there must be something to be learned about how one could suddenly die and yet the other one or ones continue to live and be healthy.  Nowhere is the mystery of SIDS more evident, as well as the tragedy.  As far as we are aware, nothing specific to triplets  and SIDS and the needs of these parents has yet been done anywhere, another major need.<br><br>As one mother wrote, <i>There are so many stresses:  how to grieve when meeting the demands of a little baby, the loss of so much attention, the constant worry for the surviving twin, and the continuing pain of seeing half of what was once a whole. </i>  While a SIDS death is a crisis for every family who experiences it, when it occurs in a baby in a set of multiples there are many factors that make it extremely stressful which are not always apparent  to other people, even those trying to provide support to the bereaved family.  The article &quot;Coping the loss of a multiple to SIDS&quot; below describes what some of the stresses are for families who have lost a multiple to SIDS. <br><br>Finally, while most of the SIDS losses in our group have occurred from the age of one week to 10 months old, there are 10 or so families we have known over the years who have experienced what some call &quot;older SIDS&quot; with one of their twins, triplets or higher multiples who was past their first birthday, and sometimes between 2 and 3 years old.  The story of one of these families and their son Christopher is included in this section.  There is a website which some have found very helpful for what is called SUDC, Sudden Unexplained Death of a Child, <a href=http://www.sudc.org>www.sudc.org</a>, with further information and support &#40;see also the <a href=index.html?biblio>Bibliography</a>&#41; &#40;and please see also our section <a href=index.html?older>Loss of an Older Multiple</a>&#41;.<br><br>We hope that the items in the <a href=index.html?biblio>Bibliography</a> for this section may be helpful, along with Alice&#39;s article.  Special thanks to those &ndash; including several fathers &ndash; whose story is included in this section &#40;and others are available in back issues of <i>Our Newsletter</i> and our special issues on SIDS in multiples&#41;, and extra to Sophie for sharing her five years of updates and poetry.<br><br><a href=./html/article.html?sid2js&sidsmultipleloss>Coping with the loss of a multiple to SIDS</a><br><br><a href=./html/article.html?sidjs&sidsintwins>SIDS in Twins</a><br><br><a href=../pdf/sids.pdf>SIDS &amp; Multiples</a> &#40;outreach pamphlet&#41;<br><br><a href=../pdf/smsl.pdf>SMSL y Nacimientos M&uacute;ltiples</a><br><br><span class=verdana>Personal Stories</span><br><br><a href=./html/story.html?sid2js&candice>Candice &amp; Patrick</a><br><a href=./html/story.html?sid2js&natasha>Natasha &amp; Vanessa</a><br><a href=./html/story.html?sid2js&december>Difficult December &#40;poem&#41;</a><br><a href=./html/story.html?sid2js&christophe2>Christopher</a><br><a href=./html/story.html?sid2js&kayla>Remembering Kayla</a><br><a href=./html/story.html?sid2js&intervie2s>Interview</a><br><a href=./html/story.html?sid2js&ryash>Ryan &amp; Shannon...and 8 years later</a><br><a href=./html/story.html?sid2js&evan>Evan&#39;s Story</a><br><a href=./html/story.html?sid2js&garrett>Garrett &amp; Gordon</a><br><a href=./html/story.html?sid2js&alexandertraci>Alexander</a><br><a href=./html/story.html?sid2js&breanna>Breanna, Bedford &amp; Brette</a>"
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if (subsequent > -1){
contenthead = 'Subsequent Pregnancy&#63;' 
content = "W"+intermediateFormatting+"hen we were pregnant with our multiples, the last thing on the minds of most of us was another pregnancy.  The death of one or more, both or all of them brings that issue to the forefront in a way that we never could have imagined, and in the most difficult possible way.  Parents who have suffered the loss of both or all their babies find themselves &ndash; even in the midst of the shock and devastation &ndash; thinking intensely about another pregnancy.  If they had their babies after infertility, seeing their own, precious children for the first time adds even more urgency &ndash; and there are practical reasons that they may not be able to wait too long to try again, even though they had not expected to start over. For others who lost both or all their babies, it feels like there is an enormous chasm which must be filled.  For those of us who lost a twin or higher multiple&#40;s&#41;, we find ourselves holding a beautiful newborn baby or babies that we didn&#39;t know we&#39;d ever have &ndash; and at times all we can think about is having another one. Whatever actually does happen later, the issue of another pregnancy is right there from the very beginning, while we go through the very complicated grieving process in multiple birth loss.<br><br>For some, though, there is the knowledge that another pregnancy will not be possible, because they had a tubal ligation at the time of the birth. Some in our group have had to undergo an emergency hysterectomy after the birth of their twins or triplets, in order to save their own life from complications.  For some with the loss of a multiple in childhood, another pregnancy is not possible because of their own age.  These parents all have to deal with the loss being the final event in their childbearing, and not having another pregnancy &ndash; or even fantasizing about another pregnancy &ndash; as one way of dealing with their grief and loss.  Some of our members in these situations have had very good experiences with adoption &#40;as did a family who had lost one of their adopted twins to SIDS&#41;, and some are trying surrogacy as well.  One family surprised themselves by adopting young twins who came to them through foster care.<br><br>Others have barriers to being able to conceive again &ndash; because of divorce, their age, or infertility, it&#39;s not something that they can at all count on happening if they decide they are &quot;ready&quot;.   Some have eventually not been able to conceive again, have suffered miscarriages, or have decided not to try further for medical or emotional reasons, and have had their family through adoption, though there are some who have not been able to do that for medical and financial reasons and do not have a living child.  In families with a survivor, especially if there is another, older child, some parents decide that their family is complete even though they have one child less than what they had expected to have once they were having twins, and the same is true of families who have lost both or all their babies, had a older or subsequent child, and have been unable to conceive again. These stories, as well as stories of adoption, are very welcome in this section, as are comments on everything involved in deciding &ndash; and deciding when and how to decide &ndash; about trying to conceive again, or not, and how people come to terms with what their living family will actually be and when it is complete.  We would also be very glad to include comments and stories on subsequent parenting.  &#40;See also our <a href=index.html?siblings>Siblings</a> section&#41;.<br><br>For parents who do have a subsequent pregnancy, whether it&#39;s a month or two later or three or five years later, and whatever was involved in becoming pregnant again, there are many, many emotions and realities. The kind of fear, vulnerability and related issues that mothers &#40;especially&#41; undergo are addressed in some of the resources that are listed here for subsequent pregnancy after a loss.  For parents who have suffered a multiple birth loss, there are some special, additional issues that can be summed up by the question&ndash; <b><i>Twins again??</b></i>  &#40;see our article below on issues in a subsequent pregnancy&#41;. <br><br>Heartfelt best wishes to all who are looking at subsequent childbearing &#40;including adoption and other options&#41; and parenting after multiple birth loss, and to those who do not know yet that it will be possible, or know that it won&#39;t be.  Heartfelt thanks to all those who shared their comments and stories in this section, and to CLIMB member Junelle Medler for gathering them and the book information at the end.  Anyone is welcome to add to something from your own experience.<br><br><a href=./html/article.html?subsequenjs&twinsagain>Twins again&#63;</a><br><a href=./html/article.html?subsequenjs&qanda>Q &amp; A</a><br><a href=./html/birthann.html?subsequenjs&subseqbirthann>Examples of birth announcements</a><br><a href=./html/story.html?subsequenjs&substories>Personal Stories</a>"
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if (older > -1){
contenthead = 'Loss of an Older Multiple'
content = "W"+intermediateFormatting+"hen CLIMB began, it centered around parents who had experienced the death of one or more of their twins or higher multiples during pregnancy, at birth and infancy. Sadly, it did not take us long to see that there were many twin, triplet &#40;or higher&#41; babies who lived past pregnancy and birth, and even past the higher risk of SIDS, Sudden Infant Death Syndrome, and other risks, but died after their first birthday, as a toddler or young child, from congenital problems, illness, accidents and other causes, leaving behind heartbroken parents and a survivor&#40;s&#41; who had been their companion 24&#47;7 since birth. If you are visiting this section because you are having to cope with this tragedy, we are very sorry&mdash;and it is dedicated to these children and to their surviving siblings.<br><br>Probably the single most prevalent cause that we have seen is accidental drowning, most often with children who are toddlers, as well as accidents in the home and elsewhere.  Many twin or higher multiple birth children have also been lost to sudden illness, to cancer, to congenital problems or the longterm affects of prematurity &#40;now that technology is allowing some children to live longer but yet is not always able to &quot;save&quot; them&#41;.  We have known a number of families who have lost a twin or multiple child to what some call &quot;older SIDS&quot;, the sudden and unexplained death, usually in their sleep, of an otherwise healthy child who is one or two years old. Though statistics do not exist &#40;as far as we know&#41; it is possible that childhood loss is somewhat more prevalent in twins and multiples because of the greater rate of prematurity and of congenital problems &#40;in &quot;identicals&quot;&#41;, and the possibility &#40;some have speculated though we have no statistics&#41; that young multiples are more at risk for some kinds of accidents.  Either way, as with the other kinds of multiple birth loss, there is the sad reality that anything that can come up with a singleton child is twice as likely to affect a set of twins...three times as likely to affect a set of triplets...<br><br>We need to also note that a few losses of both or all multiples in childhood have been known to us, thankfully much more rarely.  Some of these have involved automobile and other accidents, others have been from congenital problems.  One of our members some years ago, had twin sons who were fraternal but both happened to inherit a genetically&#45;linked condition and died around the ages of 6 after being ill most of their lives. More recently we met a father in England whom we&#39;d read of, whose twin sons were murdered by a relative, also when they were 6.<br><br>One of the hallmarks of grief is the feeling of isolation, and the lack of special support has made it more likely for each family to feel &quot;alone&quot; or like &quot;the only one&quot; in the devastation they face.  It also may have made it more likely for others to think that having the twin of the child who died makes it &quot;easier&quot; to cope. We know that it is just the opposite&mdash;parents grieve not only for their precious child, but also for &quot;our twins&quot; and their special status and experience as parents of twins or more.  When the twins were identicals, they face the unique heartbreak of being confronted constantly with the image of their child who died, and seeing exactly what they are also missing. &#40;And as one grandmother wrote, &quot;When twins are identical you can&#39;t just put away the photos and remembrances for a while.&quot;&#41; Parents of fraternals as well as identicals can&#39;t just put away or avoid everything associated with the child who died.<br><br>At the same time parents are confronted with suddenly seeing the survivor as only one child, with half of the pair missing &#40;and sometimes, extreme fear and vulnerability for the survivor&#41;&mdash;and the rather superhuman challenge of dealing with the grief of the surviving twin or multiples, and helping them to &quot;understand&quot;, sometimes also when the child has witnessed the death in an accident.   Many families have benefited very much from counseling for the parents by a sensitive therapist, and  &quot;play therapy&quot; for the young survivor to act out what he or she is experiencing and feeling in a way that can be helped, or therapy for an older survivor.  We have the impression that the initial adjustment period &ndash; the painful time involved for the family and surviving child&#40;ren&#41; to begin to adapt and regroup to the loss and to the changed family and be able to cope with the ongoing challenges &ndash; is something like two to three years.<br><br>With the number of multiples being born rising because of fertility technology, we fear that there will not be any fewer of these tragedies. We have found, though, that there has not been enough special support for families who lose a young twin or multiple.  We hope that this will change, and would like to be able to play a part in it changing.  We have begun a <b>Contact Registry for the Loss of a Multiple in Childhood</b> that is open to anyone &#40;whether they are a member of CLIMB or not&#41; who is a parent or close relative, or a surviving multiple sibling of, a twin or multiple who has died at any time from the age of one through the teens and would like to be in touch with others. &#40;Ask us for the form to join.&#41;  We hope that these contacts will also help to generate some print and other resources, and we very much hope that an e&#45;mail contact and support group will evolve.<br><br>The print resources that we know of are listed in the <a href=index.html?biblio>Bibliography</a> for this section:  an article in TWINS Magazine some years ago which features a family whose 3&#45;year&#45;old twin son was lost to drowning...a pamphlet &#40;originally written by the same author&#41; from the Canadian twins association Multiple Births Canada&frasl;NmC on the loss of a twin in childhood and teens...and some discussion in Eileen Pearlman, PhD&#39;s book, <i>Raising Twins</i>.  A very special thanks to those who shared their stories in this section. There are also others available from back issues of our newsletter, and some articles from the press over the years that feature a family who has lost a young twin. Also there are some items in the Bibliography of the <a href=index.html?survivors>Survivors</a> section of this site which may be of interest.<br><br><a href=../pdf/childhoodloss.pdf>The Loss of a Twin or Multiple in Childhood</a><br><br><a href=../pdf/spanishchildhoodloss.pdf>El fallecimiento de un ni&ntilde;o mellizo o fruto de embarazo m&uacute;ltiple durante la infancia</a><br><br><span class=verdana>Personal Stories</span><dl><dd><a href=./html/story.html?oldejs&ourstory>Our Story</a><dd><a href=./html/story.html?sid2js&christophe2>Christopher</a><dd><a href=./html/story.html?oldejs&kevin>Kevin &amp; Kylee</a><dd><a href=./html/story.html?oldejs&nightmare>A parent&#39;s nightmare</a><dd><a href=./html/story.html?oldejs&jordan>Jordan &amp; Brianna</a><dd><a href=./html/story.html?oldejs&danielemily>Daniel and Emily</a><dd><a href=./html/story.html?oldejs&autumn>Autumn...a triplet</a><dd><a href=./html/story.html?oldejs&mynathan>My Nathan</a></dl>Memorials"
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if (warning > -1){
contenthead = 'Warning'
content = "W"+intermediateFormatting+"e regret having to mention it, but over the years we have seen the importance of letting people know that &ndash; strange but true &ndash; there are actually people out there in &quot;the big world&quot; who would impersonate a parent with multiple birth loss. Not many, but just enough to cause situations that are anywhere from awkward to very painful if people and groups are not aware of this.  Though they have not bothered CLIMB for some time &ndash; partly because we have made our members aware &ndash; there are so many of our members as well as many other bereaved multiple birth parents who are participating in chat rooms, starting or joining e&#45;mail lists, online groups and other contacts of various kinds &#40;as well as newspaper and other articles&#41; that we want to take this opportunity to help you prevent this problem.<br><br>The &quot;hoaxes&quot; that we have known of are mainly women, and seem to have some psychological problems and are looking for new sources of attention and sympathy, or activities of some kind, as well as being attracted to multiples.  We have found it helpful for people to simply use their sixth sense in any contacts with others, and if something makes you feel odd or uncomfortable, check it out a bit before going ahead.  We are all strangers until we meet and &ndash; even though we have multiple birth and loss in common and really need and want to talk with others &ndash; it&#39;s wise to observe all the usual cautions that you would with anyone you&#39;ve just met, and get to know someone before revealing highly personal information, including your location.  Even though these contacts with others are so important, you should never feel that you &quot;must&quot; reveal personal information.<br><br>We also strongly recommend that you never give personal or contact information about anyone else you may happen to know, your loss friends or contacts &ndash; even if it seems like a good idea, or is more convenient, or the person who has gotten in touch with you is insisting.  It&#39;s better to check with your friend or contact and let them be the one to give it if they choose to.<br><br>The other situation is the well&#45;known &quot;Phone Caller&quot;, a man who lives in Southern California and has contacted many thousands of multiple birth mothers around the United States, Canada and beyond since the mid&#45; to late&#45;1980&#39;s.  He does this to talk with women about their unusually large tummies, and is especially interested in those who have had Twin to Twin Transfusion Syndrome, or triplets or higher &#40;or both&#41;. He contacts many bereaved multiple birth parents even though he is well aware of our suffering.   He quickly fools the unsuspecting and people feel victimized afterward when they hear from others who he is. Lately he continues to call people on the phone &#40;after learning their name and general location, then tracking down their phone number&#41;, usually under the guise of his wife needing someone to talk to.  But since the age of e&#45;mail and the net, he is also able to &quot;be&quot; a woman and more easily access various sites and lists.  Sometimes he will phone someone from one of the lists &#40;after learning their last name and location&#41; but more often lately he as a &quot;she&quot; will seek an off&#45;list contact with someone via Instant Messager.  He changes his addy fairly often, and then goes back to lurking on lists.  He also often requests photos.  The best way to spot his contacts is to know that any talk about large tummies, no matter how innocent it may seem, is 99&#37; &#40;or more&#41;  sure to be him.  With some information, he can be spotted ahead of time when he joins lists.<br><br>We strongly encourage everyone who is involved in any way in contacts, groups or publicity of any kind &ndash; and especially those involved with TTTS or supertwins &ndash; to take heed and take a matter&#45;of&#45;fact attitude towards this unfortunate matter.  We feel that anyone starting a group needs to be responsible for knowing about this and for allowing members to know so they can protect themselves and the group.  If you are starting a group of some kind, you are welcome to check with us on some further tips.  By working together we can all do what we need to do, without these problems&#33;"
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if (onetwin > -1){
contenthead = 'Loss of a Twin'
content = ""+intermediateFormatting+"&quot;One twin&quot; &ndash; it seems like a contradiction in terms...It was not something we ever would have imagined at the time of learning that we were expecting twin babies, and everything became &quot;twos&quot;.  Yet for so many of us, because of the high risks in pregnancy and birth, it is the way it turned out:  we have one to care for and raise while missing and mourning for his or her twin.  We experience all the realities of becoming a parent at the very same time as all the realities of becoming a bereaved parent, and all in one package.  Not this year and next year, but all at once now, and &quot;my twins&quot;.   We grieve for our baby and for our twins being together, and we worry about the impacts on our survivor.  It is often a deeply sad, confusing, and physically and emotionally exhausting time.   We&#39;re the last ones who need to be told to be grateful when a baby lives &ndash; yet finding joy in our survivor can be a huge challenge, for so many reasons, even though we need and want to all the more, and want our child to be happy.<br><br>As if this weren&#39;t enough, many of us experience feeling like we don&#39;t fit in anywhere, and that no one understands what we are having to go through and cope with.  We also usually receive comments by others who may mean well but aren&#39;t trying to &quot;get it&quot;, urging us to downplay or even deny our loss.  &#40;Like we want to hurt so much &ndash; but it hurts more to act like this baby was the only one or that our other child didn&#39;t matter.&#41;   With all the attention paid to living multiples, and little shown of the risks and realities, it is also easy to feel that we truly are the only one and are much more unique than &#40;sadly&#41; we actually are.<br><br>Just when others think we are or should be doing fine, is often when we need the most support.   Because of all the realities and pressures of caring for a newborn &#40;and for many, having a tiny survivor who is in the NICU&#41; none of us is in the position of being able to &quot;only&quot; grieve, as painful as that is. Many of us find that the grieving process really begins when we bring our survivor home, and for many of us that means after weeks or months  in the NICU &#40;and just when others might think everything would be &quot;normal&quot; now&#41;. Later also there are pressures from others and from within ourselves to be &quot;fine&quot;, to be coping, to not expect to spend much time thinking about our baby who died or doing what we need to do in relation to him or her.  Sometimes we get used to putting our grief to the side and then it can seem scary to get in touch with it when we do have the opportunity or the need.<br><br>But &ndash; we have the same amount of grief as anyone who loses a baby, plus the grief for &quot;my twins&quot; and the concern for our survivor, and so it gets stretched out over a fairly long period of time &ndash; longer, not shorter because of having a survivor, and complicated, not &quot;easier&quot;. Besides our sheer feelings of losing our baby, we have a great deal to re&#45;live and process emotionally, mentally, spiritually, and even physically about what happened, &quot;why&quot; it happened, and how to somehow integrate it all into our ongoing life. While all that is going on, we are dealing with a birthday which is also the birthday, and then the anniversary, of our twin who died...other landmarks and day&#45;to&#45;day reminders...issues about talking to our survivor and about what they may be feeling, and similar for any older children we may have...and often, issues about another pregnancy.<br><br>All of this is a big order, especially when we think we&#39;re supposed to do it without appearing to be, and without support.  We don&#39;t recommend you try it alone&#33;  and hope that this section and others in this site will be helpful in some way.   This section is focused on the loss of a twin during pregnancy, at birth, or in the days or weeks after birth.  Also in this site are sections on the loss of a twin or multiple to SIDS &#40;which is relevant to other sudden losses in infancy&#41;, and the loss of an &quot;older&quot; twin or multiple &#40;after the age of 1&#41;.  The section If You&#39;re Pregnant Now focuses on the needs of those who learn during pregnancy that one of their multiples has died &#40;&quot;going longer&quot;&#41;, or will not survive past birth &#40;&quot;knowing ahead&quot;&#41;, or who are pregnant after one twin has born born prematurely and died &#40;&quot;delayed interval delivery&quot;&#41;. Also, we are in the process of constructing a section on raising and talking to surviving twins and multiples.<br><br>Here are some of the articles on the loss of a twin which are available now &#40;others are being developed&#41; and please be sure to see everything listed in the <a href=index.html?biblio>Bibliography</a>.  Also, you are welcome to be in touch with eLIMBO, the e&#45;mail support group which was founded by some of our members, by contacting Terry at terryc45&#64;hotmail.com &#40;please include a short intro to yourself and your loss&#41;; or go to <a href=http://groups.yahoo.com/group/eLIMBO/>http:&frasl;&frasl;groups. yahoo.com&frasl;group&frasl; eLIMBO&frasl;</a>.  Most of the members are parents who have lost one of their twins &#40;and the others have had other kinds of multiple birth losses&#41;.<br><br><a href=./html/article.html?onetwijs&lossnow>Loss of a twin&#58;  If your loss is now</a><br><br><a href=../pdf/twintriplet.pdf>The Death of Your Twin or Triplet Baby</a> &#40;outreach pamphlet&#41;<br><br><a href=../pdf/lamuertemot.pdf>La muerte de su beb&#233; mellizo o \</a><br><br><a href=../pdf/perdreunjumeau.pdf>Perdre un jumeau ou triplet</a><br><br><a href=./html/article.html?biblijsdeathofababytwin>The Death of a Baby Twin&#58; Some Comments for Grief Counselors</a><br><br><a href=./html/birthann.html?onetwijs&birthannot>Examples of birth announcements</a><br><br><span class=verdana>Personal Stories</span><dl><dd><a href=./html/story.html?onetwijs&noahalexander>Noah Alexander &amp; James Nicholas</a><dd><a href=./html/story.html?onetwijs&seanaaron>Sean &amp; Aaron</a><dd><a href=./html/story.html?onetwijs&betrayedor>Betrayed or Betrayal&#63;</a><dd><a href=./html/story.html?onetwijs&ryanjohn>Ryan John &amp; Jacob Daniel</a><dd><a href=./html/story.html?onetwijs&rachelmegan>Rachel &amp; Megan</a><dd><a href=./html/story.html?onetwijs&forbrittany>For Brittany</a><dd><a href=./html/story.html?onetwijs&havetwoangels>I have two sons who are angels...</a><dd><a href=./html/story.html?onetwijs&aimeeolivia>Aimee &amp; Olivia</a><dd><a href=./html/story.html?onetwijs&intervieot>Interview</a><dd><a href=./html/story.html?onetwi2js&rachelilana>Rachel Ilana &amp; Marissa Leigh</a><dd><a href=./html/story.html?onetwi2js&davidharrison>David Harrison &amp; Christopher Ryan</a><dd><a href=./html/story.html?onetwi2js&alysonalyssa>Alyson &amp; Alyssa</a><dd><a href=./html/story.html?onetwi2js&meredithabigail>Meredith &amp; Abigail</a><dd><a href=./html/story.html?onetwi2js&coltonkallie>Colton &amp; Kallie</a><dd><a href=./html/story.html?onetwi2js&joshuamaria>Joshua &amp; Maria</a><dd><a href=./html/story.html?onetwi2js&samanthahannah>Samantha &amp; Hannah</a><dd><a href=./html/story.html?onetwi2js&carolyncolin>Carolyn &amp; Colin</a><dd><a href=./html/story.html?onetwi2js&emmalynn>Emma Lynn &amp; Samantha Lloy</a><dd><a href=./html/story.html?onetwi2js&codykyle>Cody &amp; Kyle</a><dd><a href=./html/story.html?onetwi2js&jacobsam>Our Triplets, and Jacob &amp; Sam</a><dd><a href=./html/story.html?onetwijs&ourlisasdeath>Our Lisa&#39;s Death</a><dd><a href=./html/story.html?onetwijs&joshuaandconradjr>Joshua &amp; Conrad, Jr.</a><dd><a href=./html/story.html?onetwijs&amberandnicole>Amber Dawn &amp; Nicole Lynn</a><dd><a href=./html/story.html?onetwijs&juliarose>Julia Rose and Hayden, Stella and Jackson</a><dd>&quot;Going longer&quot;&#58;<dd><a href=./html/story.html?pregnangjs&maeve>Maeve &amp; Cecelia</a><dd><a href=./html/story.html?pregnangjs&callahan>Callahan &amp; Sydney</a><dd><a href=./html/story.html?pregnangjs&maxcharley>Max &amp; Charley</a><dd><a href=./html/story.html?pregnangjs&laura>Laura&#39;s Story</a><dd><a href=./html/story.html?pregnangjs&katie>Katie &amp; Jenna</a><dd><a href=./html/story.html?pregnangjs&maxandhistwin>Max &amp; His Twin</a><dd><a href=./html/story.html?pregnangjs&interview>Interview</a><dd><a href=./html/story.html?pregnangjs&ryan>Ryan &amp; Rachel</a><dd><a href=./html/story.html?pregnangjs&memorial>The loss of a twin at 13 weeks</a><dd><a href=./html/story.html?pregnangjs&kathryn>Kathryn Louise &amp; Abigail Rose</a><dd><a href=./html/story.html?pregnangjs&brett>Brett &amp; Jack</a><dd><a href=./html/story.html?pregnangjs&connor>Connor &amp; Sierra</a><dd>&quot;Knowing ahead&quot;&#58;<dd><a href=./html/story.html?pregnanjs&jonathon>Jonathon</a><dd><a href=./html/story.html?pregnanjs&kendall>Kendall, Trey &amp; Baby C</a><dd><a href=./html/story.html?pregnanjs&kristen>Kristen &amp; Erin</a><dd><a href=./html/story.html?pregnanjs&michael>Michael &amp; Jessica</a><dd><a href=./html/story.html?pregnanjs&christopher>Christopher &amp; Kailee</a><dd><a href=./html/story.html?pregnanjs&intervie3>Interview...</a><dd><a href=./html/story.html?pregnanjs&dylan>Dylan &amp; Cody</a><dd><a href=./html/story.html?pregnanjs&creighton>Creighton &amp; Morgan</a><dd>&quot;Delayed interval&quot;&#58;<dd><a href=./html/story.html?pregnandjs&mystory>My Story</a><dd><a href=./html/story.html?pregnandjs&isaiah>Isaiah &amp; Gabrielle</a></dl>"
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if (privacy > -1){
contenthead = 'Privacy Policy'
content = ""+intermediateFormatting+"CLIMB respects your privacy rights.  CLIMB does not share information with any agencies, companies or organizations.  We have no commercial interests.<br><br>If you e&#45;mail CLIMB to request a newsletter &#40;or for any other purpose&#41; your name, e&#45;mail address and any other information you provide is confidential unless you specify otherwise.<br><br>Our privacy policy does not apply to third party sites that may be accessible through CLIMB&#39;s website.  We encourage you to read the privacy policies of those third parties to learn how they may collect and use information about you.<br><br>Please let us know if you have any questions."
main = -1
idstring = "privacy"
}

if (biblio > -1){
contenthead = 'Bibliography'
content = ''+intermediateFormatting+'This is the Bibliography for this site, and also is a guide to what exists in print and online on many aspects of multiple birth loss.  It is by no means complete &ndash; thankfully many more articles pertaining to multiple births, and directly or indirectly to loss, have appeared in recent years and it&#39;s not possible to list all of them. You are encouraged to seek additional books, articles, and other resources.  Some of the books and articles listed here are not easy to locate, but that is all the more reason to give you the benefit of knowing that they do exist and so the chance to try to locate them if needed.  Any opinions expressed in any of these items &#40;other than those authored by CLIMB&#41; are not necessarily those of CLIMB.<br><br><b>Books &#45; General</b><br><br>Baldwin, Virginia J., MD, <i>Pathology of Multiple Pregnancy</i> &#40;Springer&#45;Verlag, 1994&#45;ISBN 3&#45;540&#45;94011&#45;1&#41;&#58;  400&#43; pages of very detailed and comprehensive clinical information, with illustrations and  some statistics, by a pathologist specializing for many years in the complications of multiple pregnancy.<br><br>Blickstein, Isaac, MD and Louis G. Keith, MD &#40;ed.&#41;, <i>Iatrogenic Multiple Pregnancy&#58; Clinical Implications</i> &#40;Parthenon, 2000&#41;&#58;  300 pages of articles by experts on topics related to multiple pregnancies induced through fertility technology, and their risks.<br><br>Blickstein, Isaac, MD and Louis G. Keith, MD &#40;ed.&#41;, <i>Multiple pregnancy&#58; Epidemiology, Gestation & Perinatal outcome</i> &#40;Taylor &amp; Francis, 2005, second edition&#41;&#58;  976 pages of articles by medical experts worldwide on many aspects of multiple pregnancy and birth. <br><br>Mundy, Liza, <i>Everything Conceivable&#58; How Assisted Reproduction is Changing Men, Women and the World</i> &#40;Alfred A. Knopf, 2007&#41;&#58; several chapters deal in depth with multiple births in relation to fertility technology, discussing the incidence, outcomes, and issues, including selective reduction.<br><br>Newman, Roger B. and Barbara Luke, <i>Multifetal Pregnancy&#58; A Handbook for Care of the Pregnant Patient</i> &#40;Lippincott Williams, 2000&#41;&#58;  written for physicians but readable by others, with comprehensive information and statistics on multiple pregnancy and birth.<br><br><b>Articles &#45; General</b><br><br>Anath, CV, et.al., &quot;The influence of obstetric intervention on trends in twin stillbirths&#58;  United States, 1989&#45;99&quot; &#40;<i>Journal of Maternal&#45;Fetal and Neonatal Medicine</i>, 2004, 14&#41;&#58; concludes that cesarians and induction have produced a large decline in the rate of twin stillbirths.<br><br>Blickstein, Isaac, &quot;When and How to Deliver Twins&#63;&quot; &#40;in the proceedings of the 2<sup>nd</sup> World Congress on Controversies in Obstetrics, Gynecology and Infertility&#41;&#58;  a comprehensive review<br><br>Cheung, Yin Bun et.al., &quot;Mortality of Twins and Singletons by Gestational Age&#58; A Varying Coefficient Approach&quot; &#40;<i>American Journal of Epidemiology</i>, December 15, 2000&#41;&#58;  concludes that &quot;the optimal gestational age for twins appeared to be 37&#45;39 weeks according to neonatal and infant mortality&quot;.<br><br>Coetsier, T. and M. Dhont, &#40;Gent&#41; Embryo transfer and multiple gestation&#58; Avoiding multiple pregnancies in in-vitro fertilization&#58;  who&#39;s afraid of single embryo transfer&#63; <I>Human Reproduction</I> vol. 13 no. 10 pp. 2663&#45;2670, 1998.<br><br>Cooper, Susan L.  and Glazer, Ellen, &#34;Loss in Multiple Pregnancy&#34; &#40;in <i>Beyond Infertility&#58; The New Paths to Parenthood</i>, Lexington, 1994&#41;&#58;  a lengthy section on many aspects of multiple birth loss. <br><br>Derom, R., et.al., &#34;The risk of monozygotic twinning&#34; &#40;in <i>Iatrogenic Multiple Pregnancy</i>&#41; &#40;see Books section&#41;&#58; one of the recent articles documenting the great increase in monozygotic &#40;&#34;identical&#34;&#41; twinning in twin, triplet or higher order multiple sets after in&#45;vitro fertilization and micromanipulation, with sidebars by Drs. Blickstein and Baldwin on some of the risks to monozygotic &#40;and monoamniotic&#41; babies.<br><br>Eberlein, Tamara, &#34;Too Many Babies&#63;  The Dangerous Rise of Multiple Births&#34; &#40;<i>Redbook</i>, August 1996&#41;&#58;  one of the first articles to look comprehensively at the downsides of multiple births, including the realities of loss. <br><br>Hartley, Rebecca, PhD, &#34;Born too late&#58; risky timing&#34; &#40;<i>Twins Magazine</i>, May&#47;June 2002&#41;&#58;  an article for parents based on her study and her personal experience. <br><br>Hartley, Rebecca, PhD, et.al., &#34;Perinatal mortality and neonatal morbidity rates among twin pairs at different gestational ages&#58;  Optimal delivery timing at 37 to 38 weeks&#39; gestation &#40;<i>American Journal of Obstetrics & Gynecology</i>, Vol. 184, No. 3&#41;&#58;  a study based on 10 years&#39; data for Washington State. She devised the &#34;pair method&#34; of looking at mortality, so that &ndash; unlike in other studies &ndash; it can be determined how many losses after 20 weeks are of one twin and how many are of both, and therefore &#40;for example&#41; how many families are actually impacted by loss.<br><br>Hartley, Rebecca, PhD, and Jane Hitti, &quot;Birth order and delivery interval&#58; Analysis of twin pair perinatal outcomes&quot; &#40;<i>The Journal of Maternal&#45;Fetal and Neonatal Medicine</i>, June 2005&#41;&#58; an analysis of 5,138 twin pairs which concludes that if prompt vaginal delivery of twin B does not occur, the benefits of vaginal delivery for Twin A might not outweigh the risks of distress and low Apgar scores in Twin B and vaginal plus cesarean delivery for the mother. <br><br>Kollantai, Jean, &#34;The Context and Impacts of Multiple Birth Loss&#58;  A Peer Support Network Perspective&#34; &#40;in <i>Twin Research</i> special issue June 2002, &#34;Loss of a Twin, Triplet or Higher Multiple &ndash; see below&#41;&#58; an edited version of CLIMB founder&#39;s talk at the ISTS10th Congress Bereavement Symposium.<br><br>Kollantai, Jean, <a href=./html/article.html?biblijs&multirealities>&#34;Multi&#45;realities &#58; coping with the impacts of death in a multiple birth&#34;</a>, reprinted in <i>Iatrogenic Multiple Pregnancy</i> &#40;see Books section&#41;&#58; a summary of the major points.<br><br>Kollantai, Jean and Lisa M. Fleischer, <a href=./html/article.html?biblijs&hospitalcaregiver>&#34;Multiple Birth Loss and the Hospital Caregiver&#34;</a> &#47; <a href=../pdf/decesgrossessemultiple.pdf>D&eacute;c&egrave;s lors d&#39;une grossesse multiple, les professionnels de la sant&eacute;&#58; des alli&eacute;s pour les parents</a> &#47; <a href=../pdf/hospitales.pdf>La muerte en nacimientos m&uacute;ltiples y el personal de los hospitales</a> &#40;1993&#41;&#58; based on the experiences of CLIMB members.<br><br>Kollantai, Jean, <a href=../pdf/reachinganewnormal.pdf>&quot;Reaching a New Normal,&quot;</a> <i>Twins Magazine</i>, March&frasl;April 2004&#58; comments on multiple birth loss and how others can be helpful.<br><br>Machin, Geoffrey, MD, &quot;Boy&frasl;girl twins not identical, but monozygotic,&quot; <i>Twins Magazine</i>, March&frasl;April 2003&#58; a twin specialist explains why so&#45;called identical twins are actually monozygotic &#40;same egg&#41; twins, and how monozygotic twins may be unalike in many possible ways, even including gender.  Dr. Keith and Dr. Blickstein&#39;s book <i>Multiple Pregnancy</i> also contains articles on this topic.<br><br>Pector, Elizabeth, MD, <a href=../pdf/pectorrebuildingalife.pdf> &#34;Rebuilding A Life After Multiple Birth Loss&#34;</a>&#58;  a comprehensive look at grief issues for bereaved parents.<br><br>Pector, Elizabeth, MD and Michelle Smith&#45;Levitin MD, <a href=http://www.femalepatient.com/html/arc/sel/march02/article02.asp>&#34;Bereavement in Multiple Birth Part 1&#58; General Considerations&#34;</a> and <a href=http://www.femalepatient.com/html/arc/sel/april02/article05.asp>&quot;Bereavement in Multiple Birth Part 2&#58; Dual Dilemmas&quot;</a> &#40;<i>Female Patient</i>, November 2001&#41;&#58; another comprehensive look, oriented to caregivers.<br><br>Pector, Elizabeth, MD, &quot;How Bereaved Multiple Birth Parents Cope with Hospitalization, Homecoming, Disposition for Deceased, and Attachment to Survivors&quot; &#40<i>Journal of Perinatology</i>, 2004, 24&#41;<br><br>Pector, Elizabeth, MD and Michelle Smith&#45;Levitin MD, &quot;Mourning and Psychological Issues in Multiple Birth Loss&quot; &#40;<i>Seminars in Neonatology</i>, June 2002&#41;&#58; includes some additional comments and resources.<br><br>Pector, Elizabeth, MD, &quot;Views of the Bereaved Multiple&#45;birth Parents on Life Support Decisions, the Dying Process, and Discussions Surrounding Death&quot; &#40;<i>Journal of Perinatology</i>, 2004&#59; 24&#58;4&#45;10&#41;&#58; based on an e&#45;mail survey of 71 bereaved parents of multiples.<br><br>Pector, Elizabeth, MD, &quot;<a href=./html/story.html?variousjs&whatiwishidknown>What I wish I&#39;d known and what I&#39;m glad I didn&#39;t know</a>&quot; &#40; <i>Our Newsletter</i>, April 2005&#41; reflections 8 years after her own loss experience<br><br>Ramsey, Patrick S. and John T. Repke, &quot;Intrapartum Management of Multifetal Pregnancies&quot; &#40; <i>Seminars in Perinatology</i>, February 2003&#41;&#58;  a review of information and issues related to timing of delivery, labor management, anesthesia options, and choice of type of delivery<br><br>Sairam, Shanthi, MD, et.al., &quot;Prospective Risk of Stillbirth in Multiple&#45;Gestation Pregnancies&#58;  A Population&#45;Based Analysis&quot; &#40;<i>Obstetrics &amp; Gynecology</i>, October 2002&#41;&#58;   concludes that &quot;multiple gestations at 37&#45;38 weeks have a risk of stillbirth equivalent  to that of a postterm singleton pregnancy&quot;. <br><br>Taylor, Holly, &#34;Rolling the dice in the game of life&#34; &#40;Albany <i>Times Union</i>, March 9&#45;12, 1997&#41;&#58; a week&#45;long series which takes a close look at realities of fertility technology, multiple conceptions, selective reduction, and risks of multiple pregnancy, featuring CLIMB members, including a family of 4 survivings quints with special needs.<br><br>TTTS Foundation, Mary Slaman Forsyth, &#34;Compassionate Deliveries&#34; &#40;1994&#41; www.tttsfoundation.org&#58; when one or more of the babies is stillborn. <br><br><i>Twin Research</i>, the bi&#45;monthly journal of the International Society for Twin Studies &#40;www.ists.qimr.edu.au&#41;, is a rich source of current scientific research on many topics related to multiples, including loss&#45;related ones. <br><br><b>Online &#45; General</b><br><br><a href=http://www.synspectrum.com/multiplicity.html>www.synspectrum.com&#47;multiplicity.html</a>, <a href=http://www.synspectrum.com/articles.html>www.synspectrum.com&#47; articles.html</a>&#58; the website of Elizabeth Pector, MD, who is also a mother who lost one of her twin sons at 34 weeks&#39; gestation. She has written extensively on multiple birth loss as well as prematurity and special needs issues for multiples.<br><br><a href=http://www.multiplebirthsfamilies.com/bereavement.html>www. multiplebirthsfamilies.com&#47; bereavement.html</a>&#58;  Lynda Haddon, childbirth educator, and longtime activist in and bereavement coordinator of Multiple Births Canada&#47;NmC, has a website on twin pregnancy, birth and beyond which includes a section on bereavement.<br><br><a href=http://www.ncbi.nlm.nih.gov/PubMed>www.ncbi.nlm.nih.gov&#47;PubMed</a>&#58; &#34;Pub Med&#34;, the National Library of Medicine<br><br><a href=http://fetalmd.hsc.usf.edu>http://fetalmd.hsc.usf.edu</a>&#58; the website of Ruben Quintero and the Florida Institute for Fetal Diagnosis and Therapy, with information on some conditions which may affect monozygotic pregnancies, and their potential treatment<br><br><a href=http://www.fetalhope.org>FetalHope.org</a>&#58; a new organization with information and support for a number of conditions which do or may affect multiples &#40;Twin Transfusion Syndrome, TRAP and others&#41;<br><br><b>Loss of Both or All</b><br><br>CLIMB, Inc., <a href=../pdf/bothall.pdf>&#34;The Death of Your Twin or Triplet Babies&#34;</a> &#47; <a href=../pdf/lamuerte.pdf>La muerte de beb&#233;s gemelos, mellizos o trillizos</a> &#47; <a href=../pdf/lapertedejumeaux.pdf>La perte de jumeaux ou de tripl&eacute;s</a> &#40;1995&#41;<br><br>CLIMB, Inc., &quot;The Loss of Both Twins, All Triplets or Higher&quot; &#40;collections of stories from <i>Our Newsletter</i> through 1995&#41;<br><br>CLIMB, Inc., &#34;The Loss of Twins in the 3rd Trimester&#34; &#40;a collection of stories from <i>Our Newsletter</i>&#41;<br><br>Fifield, Donnali, <i>William &amp; Wendell&#58; a family remembered</i> &#40;Times Two Publishing Co., San Francisco, 2000, www.timestwopublishing.com&#41;&#58; her experience of the deaths of her twin sons at different times from prematurity, in the context of being a twin herself, the suicide of her other brother and death of her father, being a survivor of childhood sexual abuse, and being gay.  She comments on religion &#40;and absence of religious beliefs&#41; and the limitations of conventional psychotherapeutic models in relation to parental grief.<br><br>Howser, Christine, <i>A Different Kind of Mother</i> &#40;1stBooks, 2001&#41; 1stBooks.com &#58; her account of her loss of her twin sons Timothy and Steven from prematurity, a week apart, &#34;...tragedy, intense grief, depression, a supreme test of faith, a glimmer of hope in the darkness...a glimpse of the crawl back from the brink of despair...&#34;&#40;written from a Christian worldview&#41;.<br><br>Kollantai, Jean and CLIMB, Inc., <a href=./html/article.html?bothoraljs&griefcounselors>&#34;The Death of Twin Babies&#58;  Some Comments for Grief Counselors&#34;</a> &#40;1995&#41;&#58; based on the experience of CLIMB members.<br><br>Mieszkowski, Katharine, &quot;Born too soon,&quot; &#40;<i>Salon.com</i>, July 25, 2009&#41;&#58; an interview with Vicki Forman, whose twins were born at 23 weeks gestation.  One of them survived as a super&#45;preemie with severe disabilities, then died suddenly when he was 8.  Ms. Forman is the author of a new book, titled <i>This Lovely Life&#58; A Memoir of Premature Motherhood</i>. <br><br>Moorhead, Susan, &#34;Double vision&#58; Life After Their Death&#34; &#40;<i>Brain Child</i>, Spring 2001&#41;&#58; a short story about the stillbirth of her twins near term.<br><br>Novak, Monica, <i>The Good Grief Club</i>  &#40;Inkwell Productions, 2008&#41; &#58; the story of the members of a SHARE support group over the years since their losses, including the story of a CLIMB member coping with the loss of her triplets <br><br>Pector, Elizabeth, MD, &#34;The Loss of Both Twins&#34; &#40;in <i>Twinsworld</i>&#41; <a href=http://www.synspectrum.com/multiplicity.html>www.synspectrum.com&#47;multiplicity.html</a>&#58; comments for a couple who lost their twins, and suggestions for remembering them. <br><br><b>Loss of a Twin</b><br><br><a name=linkback>Bryan,</a> Elizabeth, MD &ndash; <a href=#bryan>please click here </a> for a listing of her articles and book chapters on the loss of a multiple.   Dr. Bryan was a pediatrician in England deeply involved in multiple births and loss since the early 1980&#39;s until her recent death.<br><br>Centering Corporation, &#34;Death of an Infant Twin&#34; &#40;1984&#41; www.Centering.org&#58; a 2&#45;page pamphlet written by parents and others.<br><br>CLIMB, Inc., <a href=../pdf/twintriplet.pdf>&quot;The Death of Your Twin or Triplet Baby&quot;</a> &frasl; <a href=../pdf/perdreunjumeau.pdf>Perdre un jumeau ou triplet</a> &frasl; <a href=../pdf/lamuertemot.pdf>La muerte de su beb&#233; mellizo o trillizo</a> &#40;1995&#41;, a pamphlet<br><br>Cuisinier, M., M. DeKleine et.al., &#34;Grief following the loss of a newborn twin compared to a singleton&#34; &#40;Scandanavian University Press, 1996&#41;&#58;  a relatively large study based in several hospitals in the Netherlands.<br><br>Davis, Denise, <i>Baby Nathan</i> &#40;Publish America, 2007&#41; &#58;  her account of the loss of one of her identical twin sons, who was stillborn and the survivor in the NICU, by a mom who is also a social worker.<br><br>Doerr, Maribeth Wilder, &#34;A Special Kind of Grief &ndash; The Miscarriage of One Twin&#34; &#40;Shattered Dreams, 1991&#41;&#58;  one mother&#39;s experience, and her comments &#40;see also her website, Parents of Multiples Forever, www.erichad.com&#47;pom&#47; &#41;<br><br>Feldman, Rozlyn, &#34;When You Don&#39;t See Double Anymore&#34; &#40;1983&#41;&#58;  by a mother who lost one of her identical twins to SIDS, it&#39;s still the only thing we&#39;ve seen on the challenges of the loss of a baby who is identical.<br><br>Fleischer, Lisa M., &#34;When One Twin Dies&#34; &#40;in <i>Bittersweet...hellogoodbye</i>, National SHARE&#41;&#58; describes the many things her family did to say goodbye to their twin son who died after birth, including many ways in which the whole family was involved.  <br><br>Fukushima, Rhoda, et.al. &#34;Faith and Grace&#34; &#40;St. Paul <i>Pioneer Press</i>, November 22, 2001&#41;&#58;   a CLIMB family&#39;s experience of the the loss of one twin daughter in&#45;utero from Twin to Twin Transfusion Syndrome, along the birth of the twins and the homecoming of their survivor.<br><br>Hander, Jennifer, <i>A Place of Peace</i> &#40;iUniverse, 2007&#41; &#58;  her account of the loss of one of her identical twin daughters and their premature birth, along with her search for meaning, written from a Christian perspective. <br><br>Kollantai, Jean, <a href=./html/article.html?biblijs&deathofababytwin>&#34; The Death of a Baby Twin&#58;  Some Comments for Grief Counselors&#34;</a> &#40;1995&#41; <br><br>Lewis, Dr. Emanuel, &#34;Coping with the Death of a Twin&#34; &#40;<i>Health Visitor and Community Nurse</i>, 1987, England&#41;&#58; by a psychotherapist with a longtime interest in this and related issues, including the psychological realities of stillbirth. <br><br>Limbo, Rana and Sarah Wheeler, &#34;Loss in a Multiple Pregnancy&#58;  Grieving and Loving at the Same Time&#34; &#40;in <i>When a Baby Dies&#58;  a Handbook for Healing and Helping</i>, 1986&#41;&#58; a chapter on a mother&#39;s experience, the first such in the U.S., by the founders of RTS Bereavement Services.<br><br>Multiple Births Foundation &#40;London, 1998&#41;&#58;  &#34;When a Twin or Triplet Dies&#58;  A booklet for bereaved parents and twins&#34; www.multiplebirths.org.uk&#47;<br><br>Miller, Carol Sjostrom, &#34;When a Multiple Dies&#58; Coping with the Loss of Your Baby&#34; &#40;<i>Baby Years</i>, 2002&#41; <a href=http://www.pregnancytoday.com/reference/articles/multipleloss.htm> www.pregnancytoday.com&#47;reference&#47;articles&#47;multipleloss.htm</a> &#58;  based on the experiences of Jean Kollantai and another CLIMB mother.<br><br>Multiple Births Canada&#47;NmC, &#34;The Loss of a Multiple&#58; Miscarriage, Stillbirth, Infancy&#34;  &#40;revised 2001&#41;&#58;  a pamphlet for parents &#40;included in the bereavement packet, www.multiplebirthscanada.org&#41;<br><br>Multiple Births Canada&#47;NmC, &#34;The Loss of a Multiple&#58;  The Role of Parents of Multiples Club&#34;&#58; a pamphlet for multiples organizations &#40;in the bereavement packet, www.multiplebirthscanada.org&#41; <br><br>Netzer, Dvorah and Ilan Arad, &#34;Premature singleton versus a twin or triplet infant death&#58;  parental adjustment studied through a personal interview&#34; &#40;<i>Twin Research</i>, 1999&#45;2&#41;&#58; a small sample, done by personal interview 3&#45;4 years later, concluding that the situations are similar &#40;and twin parents often unsupported&#41;.<br><br>Noble, Elizabeth, <i>Having Twins &ndash; and More</i> &#40;3rd edition, Houghton Mifflin, 2003&#41;&#58; includes a chapter on twin loss.<br><br>Ong SS, Zamora J, Khan KS, Kilby MD. Prognosis for co&#45;twin following single&#45;twin demise. BJOG 2006 113&#40;9&#41;&#58; 992&#45;8.<br><br>Pector, Elizabeth, MD, &#34;Twin Death and Mourning Worldwide&#58;  A Review of the Literature&#34; &#40;in <i>Twin Research</i> special issue June 2002, &#34;Loss of a Twin, Triplet or Higher Multiple &ndash; see below&#41;&#58;  a summary of beliefs and practices impacting the death of a twin.  <br><br>Schulz, Lynne, <i>The Diary</i> &#40;Clever&#45;clogs Independent Publishers, 1998, 83 pages&#41; &#40;www.murraylandstwinloss.org.au&#41;&#58; a book written &#40;from a Christian view&#41; by an Australian mother whose twins were born in 1990 at 39 weeks, 7 weeks after her daughter had died in&#45;utero.<br><br>Swanson, Kristen, PhD, RN, &#34;There Should Have Been Two&#58;  Nursing care of parents experiencing the perinatal death of a twin&#34; &#40;<i>Journal of Perinatal and Neonatal Nursing</i>, October 1988&#41;&#58;  one of the first and most comprehensive articles for medical caregivers.<br><br>Swanson, Patricia B., et al., &quot;How Couples Cope With the Death of a Twin or Higher Order Multiple&quot; &#40;<i>Twin Research and Human Genetics</i>, volume 12, number 4, August 2009&#41;&#58; a study by an Australian psychologist of grief in 52 couples who experienced the death of a twin or higher&#45;order multiple.<br><br>Sychowski, Sandra M. Perfect, &#34;Life and Death&#58; In the All at Once&#34; &#40;<i>Mother Baby Journal</i>, January 1998&#41;&#58;  by a long&#45;time NICU nurse, using a phenomenological approach in looking at the experiences of some CLIMB mothers.<br><br>Tracy, Amy, <a href=../pdf/tracyasilentsorrow.pdf>&#34;A Silent Sorrow&#34;</a> &#40;<i>Twins Magazine</i> May&#47;June 2000&#41;&#58;  based on the experiences of Beth Pector, Jean Kollantai, and several other mothers.<br><br>Woodwell, William H., Jr., <i>Coming to Term&#58;  A Father&#39;s Story of Birth, Loss, and Survival</i> &#40;University Press of Mississippi, 2001&#41;&#58;  a straightforward account of his experiences with the birth of their twins at 24 weeks along, and the death of one of them.<br><br>Wong, B.D., <i>Following Foo&#58; &#40;the electronic adventures of the Chestnut Man&#41;</i> &quot;A true story about intensive caring&quot; by the well&#45;known actor.  He and his partner were expecting surrogate twins, identical boys who were born three months early from TTTS and one died after birth.<br><br>&#34;Loss of a Twin, Triplet or Higher Multiple&#34;, a 250&#45;page special issue of <i>Twin Research</i>, the journal of the International Society for Twin Studies &#40;June 2002&#41;&#58; presentations from the first Bereavement Symposium at 10th Congress of the ISTS July 2001 &ndash; plus a literature review, several scientific papers, personal experiences, book reviews, website and organizations listing. &#40;A few remaining copies are available at cost from CLIMB.&#41; <br><br><a href=http://www.murraylandstwinloss.org.au>www.murraylandstwinloss.org. au</a>, the website of Lynne Schulz of Australia, author of <i>The Diary</i> &#40;see above&#41;, containing some additional articles by her on the loss of a twin.<br><br><b>Loss of a Supertwin&#40;s&#41;</b><br><br>Bryan, Elizabeth, MD, &#34;Loss in Higher Multiple Pregnancy and Multifetal Pregnancy Reduction&#34;, in <i>Twin Research</i> &#40;special issue, Loss of a Twin, Triplet or Higher Multiple&#41; June 2002 &#40;see &quot;Loss of a Twin, Triplet or Higher Multiple&quot;, above&#41;<br><br>Chasen, S.T., &#34;The natural history of high&#45;order multiples&#34; &#40;in <i>Iatrogenic Multiple Pregnancy</i>, see Books section&#41;<br><br>CLIMB, Inc., &quot;<a href=./pdf/supertwins.pdf>The Death of Your Higher Multiple Baby</a>&quot; &frasl; <a href=./pdf/supertwinsspanish.pdf>La muerte de un ni&ntilde;o trillizo, cuatrillizo, etc... </a><br><br>Newman, Roger, MD and Barbara Luke<i>,</i> &#34;Perinatal Significance of Multiple Pregnancies&#34; and &#34;Management of Triplet and Other High Order Multiples&#34; &#40;in<i> Multifetal Pregnancy, </i>Chapters 1 and 10, see Books section&#41;<br><br>Pector, Elizabeth, MD,  &quot;<a href=../pdf/ethicalissuesHOMarticle.pdf>Ethical Issues of High&#45;order Multiple Births</a>&quot;&#40;<i>Newborn and Infant Nursing Reviews</i>, June 2005&#41;<br><br>Pons, J.C., &#34;Management of triplet and higher&#45;order pregnancies&#34; &#40;in <i> Multiple pregnancy&#58; Epidemiology, Gestation &amp; Perinatal outcome</i>, see Books section<br><br>Sainsbury, Mary Kay, &#34;Grief in Multifetal Death&#34; &#40;<i>Acta Genet Med Gemellol</i>, 1988&#41;&#58;  by a nurse who lost one of her quads, by a nurse who lost one of her quads&#58; probably the first study of bereaved parents of a &#40;higher&#41; multiple.<br><br>Siladi, Heather, <a href=../pdf/siladihelpingmultiplescope.pdf>&quot;Helping Multiples Cope With Loss, and Lessons My Twins Taught Me Along the Way&quot;</a> &#40;<i>Twins Magazine</i>, March 2006&#41;&#58; by a mother who lost one of her triplets, written two years later.<br><br><i>The Triplet Connection Quarterly</i> &#40;Stockton CA, The Triplet Connection&#41;&#58; contains articles related to complications of supertwin pregnancies, and the Tender Hearts section sometimes includes personal stories of loss.<br><br> <b>Selective Reduction &#40;MFPR and Selective Termination&#41;</b><br><br>Allen, Arthur, &quot;Too Many Babies&quot;&#40;<i>Glamour</i>, November 1998&#41;&#58;  subtitled &quot;when fertility technology works too well&quot;, it goes into the situation in regard to higher order multiples and MFPR, with personal experiences and some statistics.<br><br>Bergh, Christina et.al., &quot;Obstetric outcome and psychological follow&#45;up of pregnancies after embryo reduction&quot; &#40;<i>Human Reproduction</i>, vol. 18 no. 8, 1999&#41;&#58;  a small study in Sweden.<br><br>Berkowitz, Richard L. MD et.al., &quot;The current status of multifetal pregnancy reduction&quot; &#40;<i>Am. J. Obstet.Gynecol.</i>, April 1996&#41;&#58; a comprehensive review which also touches on the issue of major handicaps in surviving premature higher multiples.<br><br>Bryan, Elizabeth MD, &quot;Loss in Higher Multiple Pregnancy and Multifetal Pregnancy Reduction&quot; in <i>Twin Research</i> &#40;special issue, Loss of a Twin, Triplet or Higher Multiple&#41; June 2002 &#40;see Articles section&#41;&#58;  her very comprehensive presentation at the bereavement symposium of the International Society for Twin Studies conference in June, 2001, along with some other presentations touching on MFPR.<br><br>Carton, Barbara, &quot;Multiple Pregnancies Are Often Pared Back in &#39;Fetal Reduction&#39;&quot; &#40;<i>Wall Street Journal</i>, Nov. 21, 1997&#41;&#58; includes comments and experiences of a number of CLIMB members.<br><br>Chitkara, Usha et.al., &quot;Selective Second&#45;Trimester Termination of the Anomalous Fetus in Twin Pregnancies&quot; &#40;<i>Obstetrics &amp; Gynecology</i>, May 1989&#41;&#58; one of the earliest reviews of these pregnancies and their outcomes.<br><br>Cooper, Susan and Ellen Glazer, &quot;Multifetal Reduction&quot; &#40;in &quot;Loss in Multiple Pregnancy&quot;, see Articles section above&#41;&#58; quotes and comments &#40;with CLIMB&#39;s assistance&#41; on the emotional aspects of MFPR in the context of infertility struggles.<br><br>Craigo, Sabrina D., MD, &quot;Triplet pregnancy and multifetal reduction&#58;  a rational review of the data&quot; &#40;<i>Contemporary OB&#47;Gyn</i>, April 1999&#41;&#58; just as the title indicates.<br><br>Davis, Deborah, Ph.D., <a href=./html/article.html?selectivjs&eaart>&quot;The Emotional Aspects of ART&quot;</a> &#40;in <i>Our Newsletter</i>&#41;<br><br><a href=./html/article.html?biblijs&coping>&quot;Coping With Your Feelings About the Septuplets&quot;</a> &#40;in <i>Our Newsletter</i>&#41;<br><br>Evans, M.I. et.al., &quot;Multifetal pregnancy reduction&quot; &#40;in <i>Iatrogenic Multiple Pregnancy</i>, see Books section&#41;&#58; a current review by one of the physicians who developed MFPR.  &#40;Other articles by Dr. Evans are in print also.&#41;<br><br>Finkel, David, &quot;What Kind of a Choice Is That&#63;&quot; &#40;front page <i>Washington Post</i>, March 21, 1999&#41;&#58;  on the dilemma of those who conceive higher order multiples, based on the experience of a CLIMB member who lost her quintuplets.<br><br>Garel, M., et.al., &#34;The Psychological Effects of Multifetal Pregnancy Reduction&#34; &#40;in <i>Multiple Pregnancy</i>, see Books section above&#41;&#58;  a summary of some of the studies which have been done<br><br>Grisaru, D. and S. Lipitz, &quot;Selective termination of the anomalous fetus&quot; &#40;in <i>Iatrogenic Multiple Pregnancy</i>, see Books section&#41;&#58;  as mentioned above.<br><br>Kollantai, Jean, CLIMB, Inc., <a href=index.html?selectivjs&foodthought>&quot;Selective Reduction&#58; Food for Thought&quot;</a> &#40;1995&#45;2001&#41;<br><br>McKinney, Mary, Ph.D., et.al., &quot;The psychological effects of multifetal pregnancy reduction&quot; &#40;<i>Fertility and Sterility</i>, July 1995&#41;&#58;  a study of 42 patients, one year later &#40;by telephone interviews&#41;.<br><br>Minnick, Molly et.al., &quot;Selective Fetal Reduction&quot; &#40;in <i>A Time to Decide, A Time to Heal</i>, Pineapple Press 4th edition, 1994&#41;&#58;  stories parents &#40;including some CLIMB members&#41; who decided on MFPR or selective termination.<br><br>Multiple Births Foundation, &quot;Fetal Reduction&quot; &#40;London, 1997&#41; www.multiplebirths.org.uk&#58; a booklet for those making a decision about MFPR.<br><br>Multiple Births Foundation, &quot;Selective Fetocide&quot; &#40;London, 1997&#41;&#58; a booklet for parents having to decide about selective termination.<br><br>Mundy, Liza, &quot;Too Much to Carry&#63;&quot; <i>Washington Post</i> May 15, 18, 20, 2007 on some MFPR experiences and the procedure  in the practice of an MD in New York.<br><br>Newman, Roger, MD and Barbara Luke, &quot;Multifetal Pregnancy Reduction and Spontaneous Fetal Death&quot; &#40;in <i>Multifetal Pregnancy</i>, Chapter 4, see Books section&#41;&#58;  as mentioned above, current information on both MFPR and selective termination.<br><br>Owens, Anne Marie, &quot;The Selective Reduction Debate&quot; &#40;<i>Multiple Moments</i>, Multiple Births Canada, issue 4, 2004&#41;<br><br>Pector, Elizabeth, MD,  &quot;<a href=../pdf/ethicalissuesHOMarticle.pdf>Ethical Issues of High&#45;order Multiple Births</a>&quot;&#40;<i>Newborn and Infant Nursing Reviews</i>, June 2005&#41;&#58; includes an impartial review of some of the information about higher multiple risks and reduction.<br><br>Rapoport, Tal, Psy.D., <i>The Dilemma Within a Miracle</i> &#40;self&#45;published 2000&#41;&#58; based on her doctoral project, it is a supportive booklet for those having to consider MFPR. <a href=mailto:empathy4me@yahoo.com>empathy4me@yahoo.com</a> <br><br>Redwine , Fay O. and Patricia M. Hays, &quot;Selective Birth&quot; &#40;<i>Seminars in Perinatology</i> January 1986&#41;&#58; one of the first articles on the facts and issues surrounding selective termination.<br><br>Roberts, Martha, <a href=../pdf/robertshavingatwin.pdf>&quot;Having a twin is a bittersweet experience&quot;</a> &#40;<i>The Daily Mail</i>, Feb. 2, 2009&#41;&#58; the experience of a mother who conceived twins after IVF and learned that one of that had a very serious problem.<br><br>Smith&#45;Levitin, M., &quot;Reduced and non&#45;reduced twin pregnancies&#58; are they the same&#63;&quot; &#40;in <i>Iatrogenic Multiple Pregnancy</i>, see Books section&#41;&#58; a current review of MFPR and the outcomes of pregnancies after MFPR.<br><br>Smith&#45;Levitin,M., et.al., &quot;Selective reduction of multifetal pregnancies to twins improves outcome over nonreduced triplet gestations&quot; &#40;<i>Am.J. Obstet.Gynecol.</i> 1993, 60&#40;3&#41; &#41;&#58; based on her review of available data.<br><br>Scheiner&#45;Engel, Patricia, PhD, et al., &quot;First&#45;trimester multifetal pregnancy reduction&#58; Acute and persistent psychologic reactions&quot; &#40;<i>Am. J. Obstet. Gynecol,</i> February 1995&#41;&#58; a study of the first 100 to undergo MFPR at one institution where it was pioneered in 1986.<br><br>Wegner&#45;Hay, Martha, <i>Embracing Laura</i> &#40;Centering Corporation, 1998&#41;&#58;  the experience and thoughts of a mom who underwent selective termination after prenatal diagnosis of Trisomy 21.<br><br>&quot;Selective Reduction,&quot; a fact sheet by Multiple Births Canada&frasl;NmC<br><br>There is currently a forum and an e&#45;group for parents involved in reduction pre&#45; and post&#45;decision &ndash; contact us for further information.<br><br><b>If You&#39;re Pregnant Now</b><br><br><b>Loss In&#45;utero</b><br><br>Ainsworth, Claire, &quot;And Then There Was One&quot; &#40; <i>New Scientist</i>, London, 20 October 2001&#41; and www.newscientist.com&#58;  on the current state of knowledge regarding &quot;the vanishing twin&quot;.<br><br>Boklage, C.E., &quot;The frequency and survival probability of natural twin conceptions&quot; &#40;in <i>Multiple pregnancy&ndash; Epidemiology, Gestation and Perinatal outcome</i>, see Books section&#41; <br><br>Hodge, Amy, &quot;Doula care and twin loss,&quot; <i>International Doula</i>, vol. 2 issue 3&#58; the experience of one family, it includes their birth plan. <br><br>Kollantai, Jean, &quot;The Emotional Impact of Stillbirth in a Multiple Pregnancy&quot; &#40;<i>WiSSPERS</i> newsletter, Vol. 1 No.3, Spring 1994&#41; <a href=http://www.wisc.edu/wissp/wisspers/spring97.htm>www.wisc.edu&frasl; wissp&frasl;wisspers&frasl;spring97.htm</a><br><br>Landy, H.J. and B.M. Nies, &quot;The Vanishing Twin&quot; &#40;in <i>Multiple pregnancy&ndash; Epidemiology, Gestation and Perinatal outcome</i>, see Books section&#41; <br><br>Lopez&#45;Zeno, J.A. and Navarro&#45;Pando, J., &quot;The intrauterine demise of one fetus&quot; &#40;in Multiple pregnancy&ndash; <i>Epidemiology, Gestation and Perinatal outcome</i>, see Books section&#41;<br><br>Malinowski,  Witold, et.al., &quot;The Case of Monochorionic Twin Gestation Complicated by Intrauterine Demise of One Fetus in the First Trimester&quot; &#40; <i>Twin Research and Human Genetics</i>, June 2005&#41;&#58;  some statistics and information on the loss of a twin in the first trimester, with babies who share a placenta at higher risk<br><br>Newman, Roger, MD and Barbara Luke, &quot;Multifetal Pregnancy Reduction and Spontaneous Fetal Death&quot; and &quot;Obstetrical Complications Unique to Multiple Gestations&quot; &#40; <i>Multifetal Pregnancy</i>, Chapters 4 and 8, see Books section&#41;&#58; some aspects of in&#45;utero death in multiples.<br><br>Pauli, Richard MD, &quot;Causes of stillbirth in twins&quot; &#40;<i>WiSSPERS</i> newsletter, Vol. 1 No. 3, Spring 1994&#41; www.wisc.edu&frasl;wissp&frasl;wisspers&frasl;&#58; about monozygotic &#40;&quot;identical&quot;&#41; twins.<br><br>Schulz, Lynne, <i>The Diary</i> &#40;Clever&#45;clogs Independent Publishers, Murray Bridge, South Australia, contact www.murraylandstwinloss.org.au&#41;&#58; the story &#40;from a Christian worldview&#41; of a mother in Australia whose twins were born in 1990 at 39 weeks, seven weeks after her daughter died in &#45;utero.<br><br>Woo, HHN, et.al., &quot;Single foetal death in twin pregnancies&#58; review of the maternal and neonatal outcomes and management&quot; &#40; <i>Hong Kong Medical Journal</i>, September 2000&#41;&#58;  a comprehensive review of available information<br><br>Yoshida, K., &quot;Documenting the vanishing twin&quot; &#40;in <i>Multiple pregnancy&ndash; Epidemiology, Gestation and Perinatal outcome</i>, see Books section&#41;<br><br><b>Knowing Ahead</b><br><br>Grisaru, D. and S. Lipitz, &quot;Selective termination of the malformed fetus&quot; &#40;in <i>Iatrogenic Multiple Pregnancy</i>, see Books section&#41;&#58; some information on congenital anomalies being more frequent in twins and higher multiples. <br><br>Meyers, C., S Elias and P. Arrabal, &quot;Congenital anomalies and pregnancy loss&quot; &#40;in <i>Multiple pregnancy &ndash; Epidemiology, Gestation and Perinatal outcome</i>, see Books section&#41;&#58;  a review of the nature and incidence of congenital anomalies in multiples.<br><br>Newman, Roger, MD and Barbara Luke, &quot;Genetic Diagnosis in Multiple Gestations&quot; &#40; <i>Multifetal Pregnancy</i>, Chapter 3, see Books section&#41;<br><br><b>Delayed Interval Birth</b><br><br>Newman, Roger, MD and Barbara Luke, &quot;Delayed Interval Delivery&quot; &#40;pages 201 and 237&#45;38 in Chapters 10 and 11 of <i>Multifetal Pregnancy</i>, see Books section&#41; <br><br>Van Eyck, Jim and Birgit Arabin, &quot;Delayed&#45;interval delivery in multiple pregnancy&quot; &#40;in <i>Iatrogenic Multiple Pregnancy</i>, pages 280&#45;81, see Books sectionf&#41; <br><br>Cacciopoli, Vera, &quot;Buying Time&#58;  A look at delayed interval birth&quot; &#40;<i>Twins Magazine</i>, May&frasl;June 1997&#41;&#58; includes a CLIMB family who lost one of their triplets.<br><br><b>Loss of a Multiple to SIDS</b><br><br>Check, Alice, <a href=./article.html?sidjs&sidsintwins>&quot;SIDS in Twins&quot;</a>&#58; summarizes the information available on the incidence of SIDS in multiples, with attention to the relative risk for survivors; bibliography of key studies.<br><br>Check, Alice, &quot;SIDS in Twins&quot;, <i>Twins Magazine</i>, April 2005<br><br>CLIMB, Inc., <a href=../pdf/sids.pdf>&quot;SIDS &amp; Multiples&quot;</a> &frasl; <a href=../pdf/smsl.pdf>SMSL y Nacimientos M&uacute;ltiples</a> &frasl; <a href=../pdf/smsnfrancais.pdf>Le syndrome de la mort subite du nourrissonet les grossesses multiples</a> &#40;1995, 2004, 2004&#41;<br><br>CLIMB, Inc., &quot;The Loss of a Multiple to SIDS&quot; &#40;collections of stories in <i>Our Newsletter</i> through 1997&#41;<br><br>Getahun, Darios, MD, et.al., &quot;Sudden Infant Death Syndrome among Twin Births&#58; United States, 1995&#45;1998&quot; &#40;<i>Journal of Perinatology</i>, 2004, 24&#41;<br><br>Malloy, Michael H., MD, Daniel H. Freeman, PhD, &quot;Sudden Infant Death Syndrome Among Twins&quot; &#40;<i>Arch Pediatr Adolesc Med</i>, July 1999&#41;&#58; a comprehensive study.<br><br>Koehler, Steven A., PhD, et al., &quot;Simultaneous Sudden Infant Death Syndrome,&quot; <i>Am. Journal of Forensic Medicine and Pathology</i>, 2001&#58; an analysis of the available data which concludes that SSIDS is extremely rare<br><br> &quot;When Crib Death Happens to a Twin&quot;, a booklet of poems and quotes by parents and other relatives &#40;SIDS Resources Inc., not dated but we think late 1980&#39;s&#41;<br><br> &quot;When a Twin Dies of SIDS&quot;, a handout on the emotional and social impacts &#40;Maryland SIDS Information and Counseling Program, 1994, prepared by C. Hosford, LCSW&#45;C&#41;<br><br>www.sidscenter.org, a major source of information on SIDS in general; a Google search for &quot;SIDS&quot; will also show a number of other sources, such as the SIDS Alliance&frasl;First Candle.<br><br> www.sudc.org , a website on Sudden Unexplained Death of a Child; see also www.sids&#45;network.org&#47;experts&#47;older.htm , and www.cjsids.com&#47;research.<br><br><b>Loss of an Older Multiple</b><br><br>CLIMB, Inc., &quot;The Loss of an Older Multiple&quot; &#40;collections of stories in <i>Our Newsletter</i> through 1998&#41;<br><br>Kollantai, Jean, <a href=../pdf/childhoodloss.pdf>&quot;The Loss of a Twin or Multiple in Childhood&quot;</a> &#40;CLIMB, 2007&#41;<br><br>Kollantai, Jean, <a href=../pdf/spanishchildhoodloss.pdf>&quot;El fallecimiento de un ni&ntilde;o mellizo o fruto de embarazo m&uacute;ltiple durante la infancia&quot;</a> &#40;CLIMB, 2007&#41;<br><br>McInnes, Sheryl, &quot;Death of a Twin&quot;, TWINS Magazine, March&frasl;April 1985&#58; on the loss of a twin generally, and includes the articles &quot;A Special Relationship&quot; by Gus Boyle and &quot;My Son Charles&quot; by Grace Dibble Boyle, parents of identical twin sons one of whom drowned when they were 3.<br><br>Multiple Births Canada&frasl;NmC, &quot;The Loss of a Multiple&#58;  Childhood, Teens&quot;&#58; &#40;from Multiple Births Canada&frasl;NmC, formerly POMBA, also written by the late Sheryl McInnes, who was the bereavement coordinator for some years&#41;.<br><br>Pearlman, Eileen, PhD and Jill Alison Ganon, <i>Raising Twins</i> &#40;HarperResource, 2000&#41;&#58; Chapter 12, &quot;When A Twin Dies&quot;&#58; some basic points, by a psychologist who has been active in the area of twin loss.<br><br>Redfern, Suzanne and Susan K. Gilbert, <i>The Grieving Garden, Living with the Death of a Child</i> &#40;Hampton Roads, 2008&#41; &#58;  stories and comments of parents who have experienced the death of a child in childhood or young adulthood, including those of a family who lost one of their identical twins to SUDC, Sudden Unexplained Death in Childhood, when they were 2&#45;1&frasl;2 <br><br><b>Survivors</b><br><br>Barron, D.S. &#34;Once There Were Two...Stories from the Lone Twin Network&#34; &#40;<i>Health</i>, September 1996&#41;&#58;  a surviving twin whose brother died when they were 12 describes a trip to England to meet Joan Woodward and members of the network she founded. <br><br>Bennett&#45;Santoro, Michael and Pamela, <a href=../pdf/talkingtoteachers.pdf>&quot;Talking to Teachers About Grief&quot;</a> &#40;<i>We Need Not Walk Alone</i>, the magazine of the National Compassionate Friends, Spring 2004&#41;&#58; a thirteen&#45;year&#45;old boy deals with the third anniversary of his twin sister&#39;s death.<br><br>Davis, Deborah, PhD, &#34;Multiple Birth Survivors&#34;  &#40;in <i>Empty Cradle, Broken Heart</i>, Fulcrum, rev. 1995&#41;&#58;  a psychologist&#39;s comments and suggestions on relating to young survivors.<br><br>Hanrahan &#40;Medler&#41;, Junelle, &#34;Breastfeeding after the Loss of a Multiple&#34; &#40;Leaven, October&#45;November 2000&#41;, and &#34;Grieving While Lactating&#34; &#40;<i>Clinical Issues in Lactation</i>, November 1999&#41; http&#58;&#47;&#47;lalecheleague.org&#47;llleaderweb&#47;LV&#47; LVOctoNov00p102.html&#58;  for professionals but also helpful for parents.<br><br>Medler &#40;Hanrahan&#41;, Junelle, <a href=./html/article.html?biblijs&breastfeeding>&#34;Breastfeeding and Multiple Birth Loss&#34;</a>&#58; based on her own experience. <br><br>Pector, Elizabeth, MD, &#34;Thoughts on Parenting a Twinless Child&#34; &#40;<i>Twinsworld</i>, Winter 1998&#41; <a href=http://www.synspectrum.com/articles.html>www.synspectrum.com&#47; articles.html</a><br><br> Pector, Elizabeth, MD, <a href=./html/article.html?biblijs&raisingsurvivors>&#34;Raising survivors of multiple birth loss&#58;  What can parents expect&#63;&#34;</a>&#58; a summary of available information.<br><br>Piontelli, Alessandra MD, <i>Twins From Fetus to Child </i> &#40;Routledge, 2002&#41;&#58; from her many years of experience, information on twinning, maternal&#45;fetal complications, and intrauterine behavior and development of twins<br><br><a name="alwaysmytwin"></a>Samuels, Valerie, <i>Always My Twin</i>&#58; a last, a storybook for young surviving multiples and their parents&#33; ISBN 1&#45;4120&#45;6036&#45;2  <a href=http://www.trafford.com/05-0937>Trafford.com&frasl;05&#45;0937</a>. &#40;The author may be contacted through CLIMB for larger orders or questions.&#41;<br><br>Withrow, Rebecca and Valerie L. Schwiebert. &quot;Twin Loss&#58; Implications for Counselors Working With Surviving Twins&quot; &#40;<i>Journal of Counseling &amp; Development</i>, Winter 2005&#41;&#58; a comprehensive article.  A statement in it &#40;about substance abuse in bereaved parents of a young twin&#41; which was not cited was later formally corrected.  &#40;So delete that sentence in the second&#45;to&#45;last paragraph&#33;<br><br>Woodward, Joan, PhD, The Lone Twin&#58;  <i>Understanding Twin Bereavement and Loss</i> &#40;Free Association Books, 1998&#41;&#58;  by a psychotherapist who lost her own twin sister at age 3, and has worked professionally with surviving twins as well as founding the first &#34;lone twin&#34; group, in England. She believes that the lack of support for the parents of the surviving twins of birth loss &#40;Chapter 2, and very evident in most of the accounts&#41; is a major factor in the survivors&#39; reactions.<br><br><b><a name=bryan>Elizabeth Bryan &#45; Bereavement Articles and Book Chapters</a></b><br><br>Death of a twin.  E M Bryan. <i>Maternal and Child Health</i>.  1983, 8&#58; 201&#45;6.<br><br>The death of a newborn twin&#58; how can support for the parents be improved&#63; E M Bryan.  <i>Acta Genetica Medica Gemellologicae</i> &#40;Roma&#41; 1986, 35&#58; 115 8.<br><br>The intrauterine hazards of twins. E M Bryan.  <i>Archives of Disease in Childhood</i>.  1986, 61&#58; 1044&#45;5.<br><br>Management of perinatal loss of a twin. E Lewis & E M Bryan.  <i>British Medical Journal</i> 1988, 297&#58; 1321 3.<br><br>No longer a twin. E M Bryan.  <i>Journal of Obstetrics &amp; Gynaecology</i>, 1987, 8&#58; 70&#45;86.<br><br>The response of mothers to selective fetocide. EM Bryan <i>Ethical Problems in Reproductive Medicine</i> 1989;1&#58; 28 30.<br><br>The death of a twin.  E M Bryan. <i>World Pediatrics & Child Care</i>  1991, 5&#58; 1&#45;3.<br><br>Some Ethical Dilemmas. E M Bryan, R Higgins, D Harvey In&#58; <i>Stress of Multiple Births</i>.  eds D Harvey & E M Bryan. London. Multiple Births Foundation.  1991.<br><br>But there should have been Two.  E M Bryan In&#58; <i>Stress of Multiple Births</i>. eds D Harvey & E M Bryan. London.  Multiple Births Foundation. 1991<br><br>The Death of a Twin.  E M Bryan.  In&#58; <i>Caring for Dying Children and their Families</i>. ed  L Hill. London.   Chapman and Hall.  1994 <br><br>Problems Surrounding Selective Fetocide. E.M Bryan In&#58; <i>The Human Side of Prenatal Diagnosis</i>. eds L Abramsky, J Chappel. Blackwells. 1994<br><br>Perinatal Bereavement after the loss of a twin.  E M Bryan. In <i>Multiple Pregnancy</i>.  eds 	R H Ward, M Whittle.  RCOG Press 1995<br><br>The death of a twin. E M Bryan.  <i>Palliative Medicine</i> 1995; 9&#58; 187&#45;92<br><br>Ethical Dilemmas.  R Rowson & E M Bryan. In&#58; <i>Infertility&#58; Nursing and Caring</i>.  eds L Meerabeau, J Denton.  Scutari Press 1995<br><br>The Death of a Twin.  In&#58; <i>The Psychology of Twinship</i>.  ed A Sandbank. Routledge 1999<br><br>Loss in Higher Multiple Pregnancy. E Bryan, J Denton <i>Triplets and Higher Order Pregnancies</i>. Eds I Blickstein, L Keith Parthenon Press 2001<br><br>Yoruba customs and beliefs pertaining to twins. F Leroy, Taiwo Olaleye&#45;Oruene, G Koeppen&#45;Schomerus, E Bryan. <i>Twin Research</i> 2002;<br><br>Loss in higher multiple pregnancy and multifetal pregnancy reduction. E Bryan.<i>Twin Research</i> 2002;5&#58;169&#45;174<br><br>Also chapters in the following books&#58;<br><i>The Nature and Nurture of Twins</i>.  Eastbourne. Bailliere Tindall 1983.<br><br><i>Twins in the Family</i>. London. Constable 1984.<br><br><i>Twins, Triplets and More</i>.  London. Penguin 1992 &#40;updated edition 1995&#41; and New York St Martin&#39;s Press 1992. &#40;also translated into Japanese, Danish, German, Dutch and Portuguese&#41;<br><br><i>Twins & Higher Multiple Births&#58; A guide to their Nature & Nurture</i>.  Sevenoaks.  	Edward Arnold 1992<br><br><i>Infertility&#58; New Choices New Dilemmas</i>. E M Bryan, R T Higgins. London. Penguin 	1995 &#40;also translated into Portuguese and Japanese&#41;<br><br><i>Multiple Births and their Impact on Families.  Guidelines for Professionals</i>.  E Bryan, J Denton, F Hallett. MBF.<dl><dd>1.	Facts 1997<dd>2.	Multiple Pregnancy 1997<dd>3.	Bereavement 1997<dd>4.	Special Needs 1999<dd> 5.	The First Five Years and Beyond 2001</b></dl><i>Loss of a Twin, Triplet or Higher Multiple. Special Issue of Twin Research 2002</i>;5&#40;3&#41;Eds E Bryan and R Higgins<br><br><a href=#linkback>&#91; back to &quot;Loss of a Twin&quot; Bibliography section &#93;</a>'
main = -1 
idstring = "biblio" 
}

if (bothorall > -1){
contenthead = 'Loss of Both or All' 
content = "I"+intermediateFormatting+"f you are visiting this section because you have experienced the death of both your twins or all of your triplets, quads or even higher multiples, we are very sorry for your loss.   There are simply no words to express the devastation, or fill what Becky Crandall here first called &quot;the deafening silence.&quot; We know it seems impossible that you could be &quot;so&quot; pregnant with two or more babies and yet not be able to bring a child home. Many of you are also facing this tragedy as first&#45;time parents, sometimes after years of infertility struggles; for others, it is after successfully having a child or children and never imagining that this could be the outcome of your next and very special pregnancy.<br><br>The first thing that we wish you to know is that you are not alone.  Sadly, since the very beginning of CLIMB, we have heard from parents on a daily basis who have suffered total loss in multiple birth.  About one&#45;third of our members have lost both or all of their babies. While statistics seem not to be kept, we think that total loss is not much less common than the loss of one twin, or loss of one or more but not all triplets or higher. There seems to be a high rate of miscarriage in the first trimester, and many more parents are aware of it now because of the prevalence of early ultrasound. Besides miscarriage, the most common cause of the death of both or all of the babies seems to be prematurity, often between 20 and 24 weeks in what had been good pregnancies, from a variety of causes or no known cause.   For some, it came after the difficult decision earlier to undergo &quot;selective reduction&quot; &#40;multifetal pregnancy reduction&#41; in order to give the remaining babies a better chance; and for others, after the decision not to have reduction. Another cause of total loss which we hear about so terribly often is Twin Transfusion Syndrome, causing prematurity or death in&#45;utero, as well as other problems of &quot;identical&quot; &#40;monozygotic&#41; twins including birth defects or being monoamniotic &#40;in the same sac&#41;. Some were conjoined twins, or twins who shared a heart. Over the years, we have known many, many families who have lost both their twins in the third trimester, sometimes near full term, when everyone including their caregivers believed that nothing could happen because they were safely past prematurity.  Most of them, from what we were told, were &quot;identical&quot; and shared a placenta.  More rarely, both twins live past birth but are lost later to illness or accident, SIDS, or problems not evident at birth.<br><br>We have also known many parents who have lost their twins or triplets at different times, and in some cases from different causes as well &ndash; another unique aspect of multiple pregnancy and birth. The death of a child or children is more than enough to go through once in a lifetime, and no one should have to go through it again in a period of weeks, months, or years.   We have known families who lost twins from a miscarriage and a stillbirth, a stillbirth and SIDS, or a stillbirth and long&#45;term brain damage from Twin to Twin Transfusion Syndrome.  Others have lost each of their triplets to prematurity at different times over a period of months. Also, some parents have lost twins after the loss of a single baby in a previous pregnancy &ndash; and some others have experienced the loss of more than one set of twins or triplets.<br><br>Many books are written about how difficult it is to cope with the loss of one &#40;single&#41; baby.  Ironically &#40;especially considering how many people there are&#41;, the loss of two or more babies and losing &quot;my twins&quot;, &quot;my triplets&quot; or more, has received less attention.  We hope that this is changing, and that this section &#40;which includes much of what there is&#41; will be helpful in breaking the silence that surrounds so many of you in your loss.  It includes a few of the many hundreds of stories and poems that parents have written and shared, and some of the birth&#47;memorial announcements that parents have created for their babies.  You are welcome to be in touch about receiving our newsletter &#40;see <a href=index.html?contactus>Contact us</a>&#41;, which always includes stories and updates which touch on topics such as ways to remember the babies, trying again, and what it&#39;s like 3 or 5 or more years later. If you join the mailing list, you&#39;re welcome to also join the parent contact list.<br><br><b>Specific Resources</b><br><br>You are encouraged to be in touch with the e&#45;mail support group LAMBS, Loss of All in Multiple Birth Support, at <a href=http://www.public.iastate.edu/~cjenks/lambs.html> http:&#47;&#47;www.public.iastate.edu&#47;&#126;cjenks&#47;lambs.html</a>. It&#39;s a very supportive group which is the only one of its kind and was founded by some of our members &#40;see also our <a href=index.html?otherresources>Other Resources</a> section&#41;.<br><br>You may also want to check out two books written by CLIMB members&#58; <i>A Different Kind of Mother</i>, by Christine Howser, about the birth and deaths &#40;at different times&#41; of her twin sons Timothy &amp; Steven, from prematurity, and Donnali Fifield&#39;s <i>William &amp; Wendell&#58; a family remembered</i> about the premature births and deaths of her twin sons.  Both are listed in our <a href=index.html?biblio>Bibliography</a>, which also includes other items of interest.<br><br>Caregivers are also encouraged to refer to our article &quot;Multiple Birth Loss and the Hospital Caregiver&quot; &#40;in <a href=index.html?professionals>For Professionals</a>&#41;, as well as the article for counselors and others below.<br><br><a href=../pdf/bothall.pdf>The Death of Your Twin or Triplet Babies</a> &#40;outreach pamphlet&#41;<br><br><a href=../pdf/lamuerte.pdf>La muerte de beb&#233;s gemelos, mellizos o trillizos</a><br><br><a href=./html/article.html?occurred&bothoraljs>If Your Loss Has Just Occurred</a><br><br><a href=./html/birthann.html?bothoral2js&birthanngl>Examples of birth announcements</a><br><br><a href=./html/article.html?griefcounselor&bothoraljs>The Death of Twin Babies: Some Comments for Grief Counselors</a><br><br><span class=verdana>Personal Stories</span> <dl><dd>Prematurity&#58;<dd><a href=./html/story.html?bothoraljs&stolen>Stolen Moments &#40;a poem&#41;</a> <dd><a href=./html/story.html?bothoraljs&devin>Devin &amp; Kayla</a> <dd><a href=./html/story.html?bothoraljs&dallas>Dallas &amp; Dalton</a> <dd><a href=./html/story.html?bothoraljs&natalie>Natalie &amp; Zachary</a> <dd><a href=./html/story.html?bothoraljs&tribute>Tribute &#40;poems&#41;</a> <dd><a href=./html/story.html?bothoraljs&matthewethan>Matthew Ethan &amp; Michael Evan</a> <dd><a href=./html/story.html?bothoraljs&george>George &amp; Lucinda</a> <dd><a href=./html/story.html?bothoraljs&mystorb>My Story</a> <dd><a href=./html/story.html?bothoraljs&christophemichae>Christopher &amp; Michael</a> <dd><a href=./html/story.html?bothoraljs&derrik>Derrik &amp; Bryan</a> <dd><a href=./html/story.html?bothoraljs&matthewmason>Matthew &amp; Mason</a> <dd><a href=./html/story.html?bothoraljs&spencer>Spencer &amp; Conner</a> <dd><a href=./html/story.html?bothoraljs&cade>Cade &amp; Carson &ndash; Going on 4 Years</a> <dd><a href=./html/story.html?bothoraljs&alexandreva>Down the Road...Alexandra and Evan</a> <dd><a href=./html/story.html?bothoraljs&briamar>Brian &amp; Marc, and Jessica</a> <dd><a href=./html/story.html?bothoraljs&miscarpoe>Poems on Miscarriage</a> <dd><a href=./html/story.html?bothoraljs&ourtwib>Our Twins</a> <dd><a href=./html/story.html?bothoraljs&mdti>Interview...a Mom and Dad of Twins</a><dd><a href=./html/story.html?bothoral2js&kevincharlie>Kevin &amp; Charlie</a><dd>Difficult decisions&#58;<dd><a href=./html/story.html?bothoral2js&myconjoinedtwins>My Conjoined Twins</a><dd>Loss in the third trimester&#58;<dd><a href=./html/story.html?bothoraljs&erikierste>Erin &amp; Kiersten</a> <dd><a href=./html/story.html?bothoraljs&mia>Mia &amp; Grace</a> <dd><a href=./html/story.html?bothoraljs&wesley>Wesley &amp; Bradley</a> <dd><a href=./html/story.html?bothoraljs&adamatthe>Adam &amp; Matthew &#40;poems&#41;</a> <dd><a href=./html/story.html?bothoraljs&brynn>Brynn &amp; Tyler</a> <dd><a href=./html/story.html?bothoral2js&jennifejessic>Jennifer &amp; Jessica &#40;stillbirth and SIDS&#41;</a><dd>Supertwins&#58; <dd><a href=./html/story.html?bothoral2js&brendan>Brendan, Kyle &amp; Erik</a> <dd><a href=./html/story.html?bothoral2js&samuel>Samuel, Melia &amp; Elijah</a> <dd><a href=./html/story.html?bothoral2js&katlyn>Katlyn, Amanda &amp; Christopher</a> <dd><a href=./html/story.html?bothoral2js&paupatric>Paul, Patrick &amp; Phillip</a> <dd><a href=./html/story.html?bothoral2js&clairisabell>Claire, Isabelle &amp; Colette</a> <dd><a href=./html/story.html?bothoral2js&nevercried>Our Children Never Cried</a> <dd><a href=./html/story.html?bothoral2js&our3our2>Our Triplets &amp; Our Twins</a> <dd><a href=./html/story.html?bothoral2js&formyquint>For My Children &#40;Quintuplets&#41;</a> <dd><a href=./html/story.html?bothoral2js&mystor10>My Story: 10 years down the road</a> <dd><a href=./html/story.html?bothoral2js&trevoandre>Trevor, Andrew &amp; Joelle &#40;poems&#41;</a> <dd><a href=./html/story.html?bothoral2js&mynameisbrina>My name is Brina</a> <dd><a href=./html/story.html?bothoral2js&aaronmaria>Aaron, Maria &amp; Jon</a>"
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content = "B"+intermediateFormatting+"y coincidence, CLIMB began around the time of the &quot;boom&quot; in fertility technology. The increase in multiple pregnancies, births and losses coming from it has meant that we have been in contact with many who are facing, or have faced, a decision about selective reduction.  What most people refer to as &quot;selective reduction&quot; is actually one of two things:  <a href=index.html?mfpr>Multifetal Pregnancy Reduction &#40;MFPR&#41;</a>, because of the high number conceived;  or <a href=index.html?termination>Selective Termination</a>, because one or more of the twins or higher multiples has a congenital or other problem. Some parents we&#39;ve known have faced a combination of those situations, for example conceiving quadruplets and two are diagnosed as being in the same sac and having a condition such as anencephaly. Still others have had to make a decision about terminating the entire pregnancy because both babies have a lethal congenital problem, or because of a condition or situation that is hopeless for the babies and may threaten the life of the mother.<br><br>Decisions about MFPR or selective termination are another very unique aspect of the realm of multiple conceptions and multiple births.   The lives and welfare of other babies who are equally wanted and loved are directly and immediately involved.  We believe it is of utmost importance for parents and others to realize and remember this &ndash; and that parents find themselves in these situations exactly because of how much they do want children.  While MFPR should not be a permanent substitute for continuing to refine the use of fertility technology, both it and selective termination procedures were developed to enable the many parents who might or would have otherwise terminated or lost the entire pregnancy to try to bring home a living, relatively healthy baby or babies from it instead.<br><br>Some articles in print on the medical and emotional aspects of MFPR and selective termination are listed in our <a href=index.html?biblio>Bibliography</a>.  Anyone who has been involved in a decision on whether or not to have MFPR or selective termination is welcome to contribute their story and comments to this site.  Several stories involving them are in the Loss of Both or All section of this site.   Also, if you are pregnant now after a difficult decision, please see our site section <a href=index.html?pregnant>If You Are Pregnant Now</a> on pregnancy after the loss of a multiple&frasl;s in&#45;utero.<br><br>"
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titlestuff = "<meta http-equiv=Content-Type content=text/html;charset=iso-8859-5><img src=./images/navigation/name.jpg border=0 alt='Center for Loss in Multiple Birth' width=512 height=98></td><td align=right><img src=./images/navigation/bigcolorlogo.gif alt=Logo width=58 height=115 align=right></td></tr></table>"

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document.getElementById("morestatistics").innerHTML="&quot;In 2004, the infant mortality rate for twin &#40;28.70&#41; &#91;per 1000 live births&#93; was nearly five times the rate for single births &#40;5.94&#41;.  The rate for triplets &#40;55.53&#41; was nine times and the rate for quadruplets &#40;166.74&#41; was 28 times higher...Multiple births are much more likely to be born preterm and at low birthweight than single births.  The higher risk profile of multiple births has a substantial impact on overall infant mortality.  For example, in 2004 multiples accounted for 3&#37; of all live births, but 15 percent of all infant deaths in the United States. &quot;<br><br> &ndash; National Vital Statistics Reports Vol. 55, No. 14, Centers for Disease Control and Prevention &#40;U.S. &#41;, May 2, 2007&#40;<I>these numbers are for babies who were alive at birth</I>&#41;<br><br>&quot;In 2003, 9&#37; of fetal deaths &#91;after 20 weeks&#39; gestation&#93; occurred in multiple deliveries, as compared to 3&#37; of live births... &#91;&#93; a given multiple pregnancy may include any combination of fetal deaths or live births.  The fetal mortality rate for twins &#40;16.52&#41; was nearly three times that for singletons &#40;5.86&#41;.  The fetal mortality rate for triplet or higher order deliveries &#40;22.31&#41; was almost 4 times that for singletons. &quot;<br><br> &ndash; National Vital Statistics Reports Vol. 55, No. 6, Centers for Disease Control and Prevention &#40;U.S. &#41;, Feb. 21, 2007<br><br>&quot;48&#37; observed decline in twin stillbirth rate between 1989&#45;91 and 1997&#45;99 &#40;17.3&frasl;1000 to 9.0&frasl;1000&#41; &ndash; almost half of this decline was attributed to increased cesarian section and labor induction.   37&#37; decline in neonatal mortality rate over the same period&#58; 21.5&frasl;1000 down to 13.6&frasl;1000.  The 100&#37; increase in multiple deliveries over the same time period outweighs the decline in losses.  Simply put&#58; if you double the births, half the losses still means you end up with the same number of losses.  We've learned that this is likely true with SIDS in twins, and now we can see it is also true for stillbirth and neonatal loss in general in multiples.  So we can make that statement that at least as many, or more, multiples are dying now and the intact sets will suffer loss in the future.&quot; <br><br> &ndash; Elizabeth Pector, MD, with reference to Ananth CV, Joseph KS. &quot;Impact of obstetric intervention on trends in perinatal mortality,&quot; in Blickstein I and LG Keith, eds. <I>Multiple Pregnancy&#58; Epidemiology Gestation and Perinatal outcome</I> 2nd edition, Taylor & Frances, London, 2005, p. 651&#45;659.  <br><br><I>A note in July, 2008&#58;</I>  The fully tabulated U.S. vital statistics for 2005 have now been released.  As always, because of the high rate of in&#45;utero loss of multiples in all trimesters, and the tabulation methods used or not in regard to sets, it is difficult to know who is being counted.   However, by this data, twin births continued to rise, this time by 1&#37; &#40;and at this point they had doubled since 1980&#41;&#59;   triplet and higher births continued to decrease, since their peak in 1998.  One of every 18 pregnancies in mothers over 35 was multiples, and one of every 5 in women over 45.  Prematurity rose&#58; 60&#37; of twins were delivered before 36 weeks, with large increases since 1990 in the percent born preterm or very preterm&#59;  some of the cause of this may have been medical interventions of one kind or another.  While the report does not at all tabulate loss, it states that twins are 5 times and triplets nearly 15 times more likely than singletons to die within a month of birth. http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf"; 
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document.getElementById("moreresearch").innerHTML="1&#41; to know how many actual families each year are affected by loss in multiple birth &#40;when looking at the total number of babies who have died&#41; 2&#41;  for those attempting to conceive with the help of fertility technology to know whether &ndash; if they conceive multiples, and if they do experience a loss, they are more likely to still bring home a baby, or more likely to bring home no one.<br><br>Medical topics which have not received much attention include the most prevalent timing of the loss of both or all the babies, the causes of it in addition to prematurity and/or Twin Transfusion Syndrome, and whether these have any implications for standard prenatal care.   Loss of both babies in the third trimester tragically occurs on a regular basis and as yet has received little or no specific attention.<br><br>Most of all, from the point of view of CLIMB&#39;s mission, nothing at all has been done to study the grief needs of the parents and families who experience the death of two, three or more babies from the same pregnancy and birth, sometimes all at once, sometimes over a period of days, weeks or months&#58;  what are the most effective interventions at the time, and what are the most effective forms of support over what period of time, especially given that most parents also face the imperative to try again for another pregnancy as soon as possible, for a number of reasons. Not only CLIMB but groups such as the e&#45;group LAMBS, Loss of All in Multiple Birth Support, offer researchers potential access, at least retrospectively, to people who are willing to give their input on these issues and we encourage qualified people in search of important but unexplored topics to consider these." 
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content = "W"+intermediateFormatting+'elcome to the website of CLIMB, the Center for Loss in Multiple Birth, Inc.  We are parents throughout the United States, Canada, Australia, New Zealand and beyond who have experienced the death of one or more, both or all of our twins or higher multiples at any time from conception through birth, infancy and childhood.  We originated in 1987, when a mother whose twin son died very suddenly at birth believed that she was truly the only one &ndash; then began to search for &quot;a few&quot; others.  Soon, she was hearing from families everywhere who were struggling to cope and heal from the devastating loss of their twin or twins, their triplet or triplets or other higher multiples, in a wide variety of circumstances &ndash; in sad contrast to the happy images of multiples portrayed in the media and elsewhere.<br><br>At a time when the number of multiple pregnancies has increased dramatically, our mission is and has always been to ensure that none of us who have found ourselves on the tragic side of the higher risks for twins and higher multiples needs to feel truly alone or like the only one, no matter what the loss or the circumstances.  We do this by ensuring that bereaved multiple birth parents have the same opportunities other bereaved parents need and want:  to read materials that relate to what we are going through &ndash; to talk to others who we know truly do understand &ndash; and to gain information that in some way relates to our loss and the challenges we are facing as people and as parents. <br><br>In the process, we&#146;ve found that by speaking up about our experiences and their immediate and long&#45;term impacts on us, it helps the public to learn the real extent of twin loss and higher multiple loss, and the importance of making all possible efforts toward prevention of them. It also helps relatives and friends, and caring others such as health care professionals, twins and multiples clubs and loss support groups learn how they can offer the most meaningful support.<br><br>We hope you will benefit from our site, and you are welcome to be in touch with us.<br><br><nobr><img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0> <img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0> <img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0> <img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0> <img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0> <img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0></nobr><br><br>We are currently completing the remaining sections of this site.<br><br><nobr><img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0> <img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0> <img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0> <img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0> <img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0> <img src=./images/navigation/greydot.gif alt="" height=7 width=7 border=0></nobr><blockquote border=1><br><table border=1><tr><td><br><p align=center><b>Significance of multiple birth loss</b><p align=center>&quot;Between 1990 and 2002 the multiple birth rate climbed 42 percent...in 2002 nearly one&#45;fourth of all low birth weight &#40;LBW&#41; infants were born in a multiple delivery.&quot;  Kochanek KD, Martin JA, Centers for Disease Control &#40;US&#41;, 2007.</p><p align=right><a href=javascript:showmorestatistics()>more...</a><div id="morestatistics"></div></td></tr></table><br><br><table border=1><tr><td><br><p align=center><b>Researchers needed</b><p align=center>Over the years here, it&#39;s been obvious how much research is needed on almost every aspect of loss in multiple birth. But if there is one area where research is most painfully lacking, it is that of the death of both or all of the babies, or what some call complete multiple birth loss.  35&#37; of CLIMB&#39;s membership is parents who have experienced the loss of their two, three or more babies, with no survivors, and almost not a day goes by without hearing from someone new with this tragedy &ndash; yet to the best of our knowledge, no statistics even exist that show what percentage of the time this is the outcome of a multiple pregnancy and birth.  This is important in several ways&#58; </p><p align=right><a href=javascript:showmoreresearch()>more...</a><div id="moreresearch"></div></td></tr></table></blockquote>'

disclaimer = "<span class=disclaimer>This web site is the official web site of the Center for Loss in Multiple Birth (CLIMB), Inc., whose name and associated logo are the service marks of the Center for Loss in Multiple Birth, Inc., and may not be reproduced without permission.  All personal stories are included by permission of the author.  The contents of this site may not be quoted, excerpted, reprinted or used in any way without the written permission of CLIMB and of the individual author.  To do so will result in legal action.<br><br><a name=disclaimer><b>Disclaimer</b></a> This site, as with CLIMB&#146;s newsletter and other materials and activities, is not intended as counseling or as medical or legal advice, nor as a substitute for participation in a bereavement support group, professional counseling, or any other activity appropriate for bereaved parents.  Instead it is a parent&#45;to&#45;parent effort to share our experiences and offer each other understanding of the special &quot;twin&quot;/multiple aspects of our losses, and help caring others to learn how the needs of bereaved multiple birth parents may be supported.  This site is for general use and we urge you to consult a physician, counselor or other professional with any questions you may have about your individual situation.  CLIMB has no responsibility for the content of any internet sites which may include a link to CLIMB&#39;s site;  and CLIMB has no responsibility for the content of the sites which are linked from this site.</span>"

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