Medical staff and bereavement parents. The story.

"...She was 28 years old, and pregnant of discordant twins.

In 32 weeks of gestation we diagnosed that the small twin as IUGR (intra-uterine growth restriction), but the other twin fine.

After I explained twins status to the parents, I showed the decision to end this pregnancy by Cesarean for rescuing the small twin in34 weeks. Because it was only 32 weeks, we had decided to prolong 2 more weeks for fetal maturation. Also I was obligated to have a business trip for 1 week (during 33rd weeks of her pregnancy), so it was an additional reason to delay the Cesarean.  

Unfortunately, early morning on just 33 weeks of gestation, I got the phone call from hospital with bad news: the small twin had suddenly died. It happened exactly one day before my business trip…I was really shocked.
I apologized for the fact that I could not predict with the mother, father and other relative:  My business trip seemed to them the main reason to delay the Cesarean and, logically, the main reason of one twin’s death. They believed if the Cesarean was done in 32 weeks both of twins baby could have been saved.   

I was worried if I could make the right decision at that time. I evaluated survived twin’s health and I proposed we could wait till 34 weeks from medical point. If it was possible to wait, I did not want to detach the dead baby soon from mother.  but… she was having the dead baby inside and I was obligated to be of city by business. Though, over this discussion we took the risk to wait until 34th weeks for be sure about safe of the alive fetus better.

Furthermore, she stopped to talk.

From that time on, the hospital staff has been keeping to exam regularly the heart beating of only survived twin, then happened unfortunate accident; one of doctor who was not familiar with the situation make an effort to exam the second fetus’s heart beating. It has unpredictable effect; she felt revive and start to communicate. She realize that she is caring on still two her babies inside even on of them is not alive any more.

In contrary to the mother, this accident had made the father very mad. From this moment they went by the different roads.

One week later I was back to the hospital. Surprisingly, spontaneous delivery has begun the day. I felt as if both baby would have waited for me to come back. First came out the healthy baby-boy who had been immediately place in an infant incubator to pediatrician sector. He was fine.

Then it was the time to come out of the dead baby. In the delivery room, there were mother in labor, nurse and me only. It was proper company of people who wanted to meet this baby and share own sad feeling. The mother had enough time with dead baby to hold, to cry and to say goodbye.

The father was keeping his anger and avoided spending time with dead baby. By this reason we had a lot of time to communicate with the bereavement mother.

This kind and supportive treat helped to the mother passed relatively smooth the anger stage of her grief via mostly asking a questions and taking about the event.

But the father escaped to talk in a normal way with us, did not visit the hospital during the mother was staying there and, did not emotionally support her. They lost communication way, so about two year after got divorce. …”

Dr. Masato Takeuchi, MD, PhD, 

Tokyo Humanized Care Center