In Today’s Issue:

🔗 The best resources I found this week
📖 Deep dive: When One Twin Lives and One Dies—What Parents Want Nurses to Understand

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🔗 The Best Resources I Found This Week

Mothers’ perspectives on the perinatal loss of a co-twin — the core paper behind this week’s deep dive, and the best place to start if you want to understand the emotional terrain parents are living in.

Loss of a co-twin at birth and subsequent risk of psychiatric disorders — useful if you want the bigger picture on why surviving twins may need long-term emotional support, not just good NICU care.

This Is Somewhat Us — a thoughtful look at how This Is Us handled twin-loss grief, and why that kind of juxtaposition hits so hard for families who are living it in real life.

📖 Deep Dive

When One Twin Lives and One Dies—What Parents Want Nurses to Understand

There is a particular kind of heartbreak that happens in twin pregnancies when one baby dies and the other lives.

The 2015 study Mothers’ perspectives on the perinatal loss of a co-twin helps us understand why this experience feels so heavy and so hard to name. The mothers in this study were not talking about a single moment of loss; they were describing what it felt like to grieve one baby while continuing to care for the other, often in the NICU, often for weeks, sometimes months.

If you have ever seen This Is Us, you already understand something about the emotional tension here. That show captures the juxtaposition of love and grief living in the same space, and that is exactly what these mothers were living through.

A mother who once felt thrilled to be carrying twins now finds herself moving between incubator checks, funeral decisions, and private tears she cannot afford to cry yet. She is grateful for the surviving baby, but every heartbeat of the living twin also reminds her of the one who is missing.

Now, there’s a ton here we can cover but for today, I want to unpack a qualitative study published in in BMC Pregnancy and Childbirth in 2015, “Mothers’ perspectives on the perinatal loss of a co-twin: a qualitative study”.

The authors interviewed 14 mothers. The sample included mothers whose twin loss happened either during pregnancy or in the neonatal period, and the loss occurred anywhere from six months to two years before the interview. They conducted interviews and a generative thematic analysis, which means they let mothers tell the story in their own words and then looked for repeated patterns across the interviews.

The authors found three main themes: the baby’s special status, trust, and control and empowerment. Those three themes are useful because they explain what parents are carrying emotionally, what helps, and where care can go wrong in very small but memorable ways.

Theme 1: The parents feel they lost the “special status”

This theme starts with identity.

Many mothers described feeling special when they found out they were carrying twins. So when one baby died, they were not only grieving a child — they were grieving the twin experience itself, the idea of two babies, the image they had already built in their mind.

That is why comments like “at least you’ve still got one” landed so badly. The surviving baby is not a replacement, and parents know that immediately. The paper makes that painfully clear.

The other piece of this theme is that the deceased baby does not disappear just because the surviving baby lives. Mothers said birthdays, anniversaries, and milestones could make the absence sharper, not softer. So even something joyful for one baby can carry a second, quieter ache.

What nurses should understand

Parents are trying to hold both babies in their hearts at the same time. If the room only makes space for the surviving baby, the grieving parent feels the other baby vanish all over again.

Theme 2: Trust (or the lack of trust) with the staff

This theme is really about whether parents feel emotionally safe with the team.

The mothers valued staff who acknowledged the death, stayed present, and remembered both babies. They noticed when a nurse sat down and listened, and they noticed when a nurse treated the loss like part of the story instead of an uncomfortable detour.

Continuity mattered a lot. A familiar nurse or midwife could make a hard day feel more manageable because the parent did not have to explain everything from scratch. But the reverse was true too — inaccurate paperwork, wrong names, or staff who kept calling the deceased baby by a label instead of a name damaged trust fast.

The study also shows something nurses already know in their bones: emotional care and medical trust are connected. When a mother felt a nurse was kind, attentive, and emotionally real, she often felt more confident leaving the surviving baby in that nurse’s care.

What nurses should understand

Parents are watching how you care, not just what you do. They are deciding whether they can trust you with both the living baby and the memory of the baby who died.

Theme 3: Control and empowerment

This theme may be the most important one for bedside care.

After a twin loss, parents often feel that almost everything is happening to them. The hospital, the NICU, the follow-up visits, the funeral planning, the discharge process — all of it can feel like one long loss of control.

The study found that location mattered a lot. A private room could feel kind and protective, but it could also feel lonely or abandoned if staff did not check in often enough. Being placed near other families with healthy twins could also feel devastating, because it sharpened the sense of difference.

Then there is the trauma piece. The mothers said grief and shock made it hard to process information or make decisions clearly. Some later regretted choices about funeral arrangements because they felt swept along while still trying to survive the emotional shock.

But there was also something hopeful here. When staff offered choices ahead of time — for example, talking through funeral plans before birth when possible — mothers felt more prepared and less cornered by the moment. That is what empowerment looked like in the study: not control over the outcome, but a little more space to decide.

What nurses should understand

Small choices matter. Clear options matter. Timing matters. A parent who is traumatized cannot always ask for what they need, so if the team waits, too much gets missed.

What we can take away from these three themes

If I were reducing this study down to one bedside takeaway, it would be this:

When one twin dies and the other survives, the parent is living in a constant juxtaposition — love and grief, gratitude and heartbreak, parenting and mourning — and the nurse either makes space for both or accidentally narrows the room.

That is why the little things matter so much:

• Use both babies’ names when appropriate.

• Do not collapse the family into a singleton story.

• Keep information consistent across shifts.

• Offer choices before parents have the strength to ask.

• Treat grief as something that may be on hold, not something that has ended.

Parents are trying to stay attached to a surviving baby while their body and mind are still registering the death of the other.

The study mention parents are keeping grief “on hold” so they could focus on the living baby. Another study found that the surviving twin became a living reminder of the baby who died, which meant the grief kept showing up long after discharge, especially at milestones and family moments.

Moms often hit pause on their grief to focus on the surviving twin in the NICU. They cherished staff who built trust through emotional support, like using both babies' names and offering continuity.

Additional data I found after reading through four published studies on this topic

When one twin dies in a monochorionic pregnancy, the surviving baby is not only grieving from a family perspective — medically, that baby is also at higher risk for death, brain injury, and later neurodevelopmental problems because of the shared placental circulation. Full study here

The 2021 population study found that loss of a co-twin at birth was associated with increased risk of psychiatric disorders in the surviving twin compared with loss of a full sibling. Full study here

The 2025 study found that the surviving twin often remains a living reminder of the baby who died, and that grief continues to return over time rather than ending at discharge. Full study here

Parents in the NICU study described the loss of one twin as especially difficult because they had to combine mourning with caring for the surviving baby at the same time. Full study here

What was the impact of today’s deep dive for you?

(Select one)

⭐️ It was extremely helpful and gave me new insight

👍 Helpful, mostly a good refresher

✅ I didn’t learn anything new, but it validated what I already do

😕 It missed the mark or I have feedback

👋 That’s a Wrap!

Before you go: Here are ways we can help your hospital

Education: Please share our newsletter with your co-workers. Our priority is empowering nurses with the tools to support patients with modern, evidence-based bereavement education.

Bereavement boxes: Our bereavement boxes were designed out of a need for a modern high quality solution for families suffering from miscarriage, stillborn, or infant death.

Reply to this email “Sample” to get a free sample sent to your hospital.

What we prioritize:

1. Tools for hospitals to create a bereavement experience for families to begin their grief journey

2. Educating nurses with modern bereavement standards and continuing education.

3. Helping hospitals build a foundation of trust and support, so bereaved families feel seen and cared for—now and in the years to come.

These boxes were born out of our own personal losses, including Jay’s (CEO) 15 years of experience working in labor and delivery as a CRNA and witnessing time and again how the hospital experience can profoundly shape a family’s grief journey, for better or for worse.

Until next week,

Trina and Jay
Co-founders of Forget Me Not