Women carrying twins, triplets, or more know from the start that their pregnancies — and each of their babies — are at a considerably higher risk than a single pregnancy. And despite the most careful woman's best efforts — and that of her practitioner — there are situations when one or more fetus simply doesn't survive. Knowing why this happens can make going through it somewhat easier:
Early loss. During the initial stages of pregnancy, many women's bodies simply aren't able to support more than one fetus and nature finds a way of allowing all but one to die, often before anyone even knows. This is not uncommon and typically not distressing, since most women never knew they were carrying more than one fetus in the first place.
Reduction. After week 20, women carrying multiples receive many ultrasounds to ensure that all the fetuses are developing well. Sometimes an ultrasound reveals that one (or more) of the fetuses can't survive, or is so severely malformed that the chance of survival outside the womb is minimal. Worse yet, the ailing fetus may be endangering your other healthy one(s). In such cases, your practitioner may recommend removing it from your uterus so that the other(s) can thrive. This procedure, called pregnancy reduction, is agonizing for parents — it may seem like sacrificing one child to protect another — and can leave them plagued with guilt and confusion. There are no sure answers, but you'll want to do whatever you can to make peace with your decision. Review the situation with your practitioner, and seek a second opinion, or third or fourth, until you're as confident as you can be about your choice. You can also ask your practitioner to put you in touch with someone from the bioethics staff of the hospital (if that's available). If religion plays an important role in your life, discuss the matter with your spiritual leader to help you make peace with whatever you decide.
Loss at birth. In some cases, one or more of the babies dies at or just before birth, causing shock and despair even as you rejoice for the child born alive. The mix of emotions is overpowering, and there is no "right" way for you to feel — more pain than joy, more joy than pain, both equally, or in an emotional frozen state of limbo. There are steps you can take to ease this confusion, now and in the future. (Try these ways to heal after a stillbirth.)
The process of grieving for the loss of one (or more) multiple and the birth of the remaining multiple has its own unique ups and downs. If you've lost one of your babies, giving birth to the one or more that remains may bring on an emotional tidal wave. Your feelings may be baffling, as you simultaneously celebrate a new life and mourn a sudden death. Often women are alarmed by this ambivalence, wishing they were happier about the birth instead of feeling so devastated by the loss. But it's important to acknowledge the grief; you lost a child, and that's heartbreaking. Adjustments take time, and it's normal to feel delight and sadness all at once. You'll also need to take time to grieve. Caring for a newborn can limit your time and energy to properly grieve the loss of another. Perhaps it seems like a blessing to be too busy to feel. But it's crucial to grieve or you'll never come to terms with your loss. So as painful as it is, allow yourself to feel the range of emotions that grief brings about — denial, rage, despair, and, finally, acceptance and the ability to move on.