title: Mothers' perspectives on the perinatal loss of a co-twin: a qualitative study.
abstract: BACKGROUND
  There is a growing body of literature exploring the emotional impact of perinatal loss upon parents but only limited research focussing specifically on the views and experiences of parents who have experienced a loss from a twin or higher order pregnancy. We undertook a qualitative study to provide an in-depth understanding of the experiences of mothers who have had a loss from a twin pregnancy and subsequently continued visiting hospital whilst their surviving twin was cared for.
  
  
  METHODS
  A qualitative study involving semi-structured interviews. Mothers were recruited from a Neonatal Intensive Care Unit and Fetal Medicine department. Fourteen interviews were carried out with mothers who had experienced a loss in pregnancy or the neonatal period and had a surviving twin on the neonatal unit. Data were analysed using a generative thematic approach.
  
  
  RESULTS
  The analysis identified three key themes in the accounts mothers gave of their experiences: the status of 'special'; the importance of trust; and control and empowerment. Where the surviving co-twin remained in hospital for many weeks, mothers described the emotional support of health professionals as crucial to their wellbeing. Few mothers sought formal bereavement support, instead they kept their grief 'on hold' in order to support their surviving baby. Due to the trauma of their loss, mothers reflected that they had been unable to make informed decisions, in particular in relation to the funeral of their deceased baby.
  
  
  CONCLUSIONS
  Our study highlighted that there are a specific set of issues for mothers who have lost a baby from a twin pregnancy. Relatively small changes to practice however, made a significant difference to wellbeing during their time in hospital with a surviving twin. Findings from this research will provide insight into the needs of bereaved mothers, will inform healthcare planning and the development of care packages.
authors.affiliation: Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, England, NE2 4AE, UK. judy.richards@ncl.ac.uk.
authors.forename: Judy
authors.initials: J
authors.lastname: Richards
authors.affiliation: School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, England, NE1 7RU, UK. ruth.graham@ncl.ac.uk.
authors.forename: Ruth
authors.initials: R
authors.lastname: Graham
authors.affiliation: Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, England, NE2 4AE, UK. nicholas.embleton@ncl.ac.uk.|Newcastle Hospitals NHS Foundation Trust, Newcastle Neonatal Service, Newcastle upon Tyne, England, NE2 4AE, UK. nicholas.embleton@ncl.ac.uk.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Embleton
authors.affiliation: Newcastle Hospitals NHS Foundation Trust, Newcastle Neonatal Service, Newcastle upon Tyne, England, NE2 4AE, UK. claire.campbell35@yahoo.com.
authors.forename: Claire
authors.initials: C
authors.lastname: Campbell
authors.affiliation: Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, England, NE2 4AE, UK. judith.rankin@ncl.ac.uk.
authors.forename: Judith
authors.initials: J
authors.lastname: Rankin
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001293:Attitude to Death; D001601:Bereavement; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D009035:Mothers / Q000523:psychology*; D066087:Perinatal Death; D011209:Power, Psychological; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000523:psychology*; D036301:Qualitative Research; D035502:Trust; D014427:Twins