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Twins and the separation process

Symbiosis in twin pregnancy from conception and the delicate process of mourning when one of the twins passes away.


Image: Sarah Graybeal / Unsplah

The increase in cases of artificial insemination brought a new reality to neonatal ICUs: the fight to save babies born prematurely and difficult reality to face the joy of saving a child and lose the other. To get in touch with the reality of some mothers in this situation made us want to shine a light on the particularity of the grieving process.

The loss of a brother is already in itself a rather delicate issue for parents to deal with their children, because they are also in the middle of a devastating process of pain. But losing a brother who was generated with you and has always shared all the spaces at your side makes this process of grieving very particular, with unique characteristics, no matter how long there was a coexistence between them. And what is it like for those parents who had a dream split in half? Looking at the little one and facing the pain of not seeing the other at his side. Getting to know the personality of one of them and not imagining what the other one would be like?

The psychologist Gabriela Casellato, Institute 4 Seasons founder, explains some important questions about the issue of multiple births in the mourning context and the special attention we must give to it.

What are the main features of the mourning process in the case of twin brothers?

Gabriela – From the parents’ point of view, we must consider some specifics to address the loss in case of twins: the pain of such an unexpected and illogical loss, generates an important uncertainty and a breach of the presumed world of parents, which often results in an overprotective attitude with respect to the surviving baby, either to protect him/her or as a search for possible repair of real or fantasized guilt around the loss of the other child who could not be saved. On the other hand, when a mother feels severely affected by the pain of loss, the result can be a strong sense of devaluation by the surviving son who feels unable to appease the grief of his mother despite his/her intense efforts. Another risk would be contrary to an overprotective reaction, a rejection or an important reaction to avoid connecting to the surviving baby , resulting from a deep sense of incompetence and self-criticism for not having prevented the death of the other baby.

Feelings of guilt are always present in losses, especially in parental loss and in these cases, the guilt can be a strong risk factor for the bond with the surviving baby and the marital relationship and can manifest in many different ways. From the point of view of the surviving twin, the most striking aspect is the identity that he assumed from the start in pairs with his brother, either real, or even fantasies that sustained the parent’s impressions from the interaction observed both during pregnancy and after birth when possible. The experience of multiple births has features like a formation of identity that occurs in comparison to the other … between dominant and dominated, agitated and calm, among other features. In this context, the surviving child will have to live with this “label” and the comparison to a brother whose identity will be perpetuated after death … the comparison between brothers is always very delicate, but the comparison between a twin brother who is alive and another one who is dead is without a doubt, dangerous and perverse. The intimacy between twins becomes therefore a risk for grieving, because the perception of himself has always been “we” and therefore he lost an important pillar of identity that came from the complementarity between the brothers.

What differences do you see in the child who lost his brother in the early days of life, therefore in intrauterine experience, from the child or young person lost after?

Gabriela – This is quite a controversial question, because it raises the issue of what a baby can memorize, or even to what he can react psychologically during intrauterine life or in the first days of life … but many studies on attachment point out that the link of baby with the mother, the father and a twin begins in intrauterine life and already has certain patterns of interaction behavior with the environment. There are many scientific records that prove these statements. Therefore, it is noteworthy that before the passing away of a twin even during pregnancy or shortly after birth, a baby will react to separation and discontinuity of interaction that until that time was constant and intense as part of the reassurance background and protection of the surviving baby. Although we cannot compare and match the background of experiences that were lived and internalized with brothers who lived longer, and we cannot compare the overall development over time that enables better and greater understanding of reality, we cannot trivialize and neglect the grief experienced by newborn babies at the loss of a twin.

How do you prepare parents to deal with this lack, and in some cases to live with the similarity between the two children?

Gabriela – This is not about preparation, but about welcoming all spontaneous initial reactions. From this process, comes a relationship of care, respect and strength to deal with the pain of loss paradox and the love and bond that will be consolidated with the surviving son. A constant feeling of inadequacy and discomfort to the suffering, the need to go on with the living son, the couple will follow a reframing of their own history, ranging from coping with the pain and all related feelings and the need to adapt to life and relationship with his living son, reorganizing a new parenting gradually separated from twin pregnancy. The similarities observed in the surviving son should be seen naturally, without exaltation or inhibition. The surviving child can live with the lack of a real brother, but hardly will be able to deal with the memory of a dead brother or a kind of holy ghost fomented by secrets and unspoken words.

The reactions of very young children will be much more physical and behavioral, it becomes a challenge for parents who are also suffering, because it requires a greater effort in the perception and validation. It is important to tolerate regressions, aggressive behaviors, tricks, somatization and all forms of non-verbal expression of suffering. It is essential to open a space for the child to express doubts, fantasies, feelings such as brother’s anger, parent’s anger, fear, guilt, and not the concern to “solve” these reactions … the expression welcoming is already very beneficial for the child. If questions come up, be honest but take care to provide simple, direct answers. If it is too difficult, seek help from a professional who can help you right away.


Sharing stories has shown us to be an important help tool for those who write them and also for those who are going through the same grieving process and feel that they are not alone in pain. So, we invite three great women to tell us how they and their children faced this process. Read below the testimony of Cristiane Pereira Heal, Ana Paula Moreira da Costa and Tatiane Martins de Barros.

The history of Cristiane

“Mommy, why did God take Luisinha to heaven? How old is she now? I do not like God, he is very selfish? How many days did she stay with me? ”
(Clara, 6, twins with Luisa)

Cristiane Pereira chose to tell her daughter Clara a baby about the existence of Luisa, her sister.
Cristiane Pereira chose to tell her daughter Clara a baby about the existence of Luisa, her sister.

“She spent the last three years wanting to see the photos of Luisa and trying to understand what happened to them. She always wanted to know how much we love her and how much we loved Luisa. And when someone asks if she has a little sister she quickly says she does but that she has become a little star. I never wanted to hide from Clara that she had this little sister. I always thought she had the right to know, as soon as she was able to understand it. I always thought this story was as hers as it was mine. Sometimes I regretted, I thought I was putting too much weight on a small child. But Clara has always been a great companion. It is as if we share this pain. It is as if we could move forward together. But I realize that time is helping us and as it did with my feelings, it is “fixing” the feelings of Clara as well. She is no longer so angry when she sees other little brothers playing. It seems that time, as it did with me, has calmed her little heart too. It seems that time will turn Luisinha, the star, into memories, longing, far away in spite of being so close. Over the years the talk about the little sister has gotten. But once in a while she still lets out a big sigh and says, ‘Mommy, I wanted to go to heaven to play with her. Me too.’

Ana’s history

“Mom, why did you tell me this only now? Why was it Guilherme who died and not me? How many days did he live? This could be his pajamas today right? ”
(Joao 13, twin brother Guilherme and sisters; Gabriela 9 and Manoela 8)

Ana Paula Moreira da Costa, made different. She told her son Joao only when he was 7 years old that he was twins with William who also succumbed to premature labor.
Ana Paula Moreira da Costa, made different. She told her son Joao only when he was 7 years old that he was twins with William who also succumbed to premature labor.

“It was a very difficult phase for us. Even today, after 13 years and having 3 beautiful and healthy children, reliving that moment is very painful for all of us. Joao struggled to survive for 111 days in the Eisntein ICU and when we got him home we decided to spare us from more suffering and protect him too, so small and fragile next to us! We chose not to talk about Guilherme. But deep down I felt that he knew his brother, because he gave several signs that he was not the only child. In drawings and jokes always inserted his brother at his side. On his three year old birthday, when we finished to sing happy birthday, he told us: ‘Now let’s sing for my brother.’ He was always a boy who wanted a friend, called attention for the need of having a partner, not to be alone and clearly asked all the time for the presence of another person next to him. I began to get intrigued and began to research and found that the twin child really has this greater need to share, for having shared the space with someone since conception. At 4 years old my second daughter Gabriela was born. When I got home I asked him to help me to take care of our baby and he very firmly told me, ‘mom this is not our baby, that’s my brother Guilherme.’ I cried desperately, I spent three months crying everyday, it looked like he was becoming aware and solving Guilherme’s grieving at that time. I got so attached to him and didn’t want to separate from him not even to let him go to school. Suddenly everything vanished and I could face this new situation with more joy. When he was 7 years old I felt it was time for him to know. Sitting doing and doing family homework, I told him about everything. He was pretty shaken up the next day and woke me up early bombarding me with questions. The one that broke my heart was why it was his brother who died and not him? Why he had survived? It took a long time to process all this new identity. Nowadays he still goes back at it, but it’s something that we regard as part of our history, after Gabriela came Manuela and this is the family constitution that has been granted to us in order to live happily. ”

The history of Tatiane 

“Mom, since we travel by plane and go to heaven, we will be able to meet Henrique? Mom is it true that everyone who dies is buried? Will Henrique be also seeing how beautiful the Eiffel Tower is? ”
(Deborah eight years, twin of Henrique and Rafael sister about to be born)

Tatiane Martins de Barros lost her 4 years old son Henrique and from the beginning sought psychological help for the family and found comfort in grieving support groups. Nowadays, she is 9 months pregnant with her son Rafael and faces this new family constitution with serenity and joy.
Tatiane Martins de Barros lost her 4 years old son Henrique and from the beginning sought psychological help for the family and found comfort in grieving support groups. Nowadays, she is 9 months pregnant with her son Rafael and faces this new family constitution with serenity and joy.

“How do you tell a 4-year-old child about the death of another child and even more, this being her twin brother who shared all his life with her from the belly? It all seemed very unthinkable, but at the same time real and I had to deal with the situation the less damaging way possible. I did not have much time to work out what I was going to say, then I thought to be the most honest possible within her understanding of reality. We found it important to take her to the viewing to say goodbye her to brother, but she didn’t go to the funeral. The image that remained for her was that her brother was lying on a bed of flowers and thus went to heaven. At the time we looked for help from a grieving expert psychologist, because looking at my daughter without the presence of her brother was like something was missing, it looked like she had been amputated and I did not know how her mind worked. Then the psychologist helped us to talk to her as she was questioning us and her curiosity came up, without anticipating anything because the child reframes her brother’s death until teenage hood. For me it was so hard to know it, until I realize that she would suffer all the time, but every time she resignified loss, she would talk about the subject again to better understand it. At 6 years, she understood that her brother had been buried and asked us how this process was and was sure to be present at the funeral of her grandparents as a way to get back and to be closer to her brother and see the sign with his name. We always respected her processes, with psychological help. Life made her mature earlier in order to get in touch with so much pain and with only eight years old, I feel that she deals with death differently, with resilience and a lot of empathy with people in these times. Last year it was a very difficult year. She was seven years old and felt a great difficulty in dealing with the missing brother. I cannot explain, but it seems that she understood and left first childhood at once. She suddenly got mature and it was a difficult process for her. The twin pregnancy brings a very complicated issue at this time. Our family has started with two, not an only child. So for us, suddenly having an only child and she becoming an only child was very complicated, we felt always incomplete. When people ask me on the street if I have only one daughter, or when she draws her family. She never wanted to draw the brother who lives in heaven and we respect that. In those moments I relive the pain and I feel the hole that we have in our family constitution. When I became pregnant with Rafael, who will arrive in some days, it was as if we had given a different meaning to her life. It looks like she blossomed! She said ‘Mom today is the happiest day of my life.’ No child is able to replace the other, but I know it was important to have a brother and not be the only one. The name Rafael means ‘healed by God’ and I feel that we are all cured. We have a scar that we will never forget, but let’s move on. When Henrique went away I could not do anything for him, but for my daughter I did. She did not deserve to have a crazy mother. My husband and I are relying too much on each other and nowadays my mother says she does not know where one begins and the other ends. Life has completely changed and our values ​​as well. It is impossible to lose a child and not to become someone else. And I am living my life intensely, every moment, because I know the pain is to realize that life can end in a matter of hours! I read a text that says that the baby coming after a dead child is called ‘Rainbow baby’ (rainbow baby) because the rainbow does not deny the devastation caused by the storm, but it brings hope. In the middle of the clouds a beautiful rainbow may emerge and bring hope and a new joy and that is what we are expecting. I believe I can be happy again!