Når jeg kigger på mennesker tager jeg altid hele deres historie med. Det er vigtigt for mig at forstå hvilke vilkår du har haft i din udvikling - lige siden du blev 'formet' inde i livmoderen - det er dit prænatale (før fødslen) fundament. Det kan have en stor betydning for dit generelle velvære, og kan derfor sætte sine spor i din sundhed og din performance.

Jeg er i gang med at skrive en fagbog herom, og nedenfor har jeg skrevet en introduktion til emnet - med udgangspunkt i prænatalt tvillingetab. Du kan desuden læse mere på min anden hjemmeside www.alenefødt.dk

The Vanishing Twin Syndrome from a neurophysiotherapeutic perspective – An Introduction

By Annika Spanggaard, Physiotherapist and neuro-trainer

INTRODUCTION:

BACKGROUND

When speaking of a vanishing twin, a womb twin survivor, or an alone born twin, we refer to the

surviving foetus after the death of a twin (or more) in the womb. This phenomenon has been thought to

have effects on the development of the human being – sometimes in terms of physical, psychological,

hormonal and/or social ways. It is said that 1 out of 10 people are womb twin survivors. Most people

do however not know they potentially have been affected by this, as it usually occurs before the 12th

week of gestation. As the first ultrasound is usually not always performed by then, most women are

unaware, and this would mean that it in most cases goes unnoticed. Vaginal bleeding is common within

the first trimester, and this could potentially be a sign of the body getting rid of something (dead cells

from a twin). There can be other visible signs present in the placenta or on/in the surviving twin's body.

Even if there aren't always visible signs, it seems that this phenomenon yet has profound ways to affect

us. The cause of losing a twin is mainly unknown but certain aspects of the pregnancy could potentially

play a role such as the age of the pregnant woman, chromosomal abnormalities, uses of ART such as

IVF, abnormalities of the placenta, etc.

What happens to the dead twin? It can either be bled out, reabsorbed or 'crushed' into a 'fetus

papyraceous' (a flattened structure of the remainings of the body).

Althea Hayton is amongst the professionals who has researched this phenomenon the most, and she has

found that alone born twins can be widely affected. They can live with a sense of loneliness, something

missing in their life, feeling different from everyone else, fearing rejection, fearing abandonment,

having different sides to ones personality, flipflopping between decisions and so on. They are also more

likely to suffer from depression, anxiety, PTSD, chronic inflammation, amongst many other signs and

symptoms. Although the notion that something so far back may affect us seems alien to most of us if

we haven't heard about it before, there are some scientific factors we'll discuss. that simply cannot be

ignored. This is starting to emerge around the world.

In the Netherlands, there is the Foundation for Alone Born Twins.

In France several books have been written, from Dr Claude Imbert in 2004 and Alfred and Bettina

Austermann in 2007.

In Germany Alfred and Bettina Austermann have also written books and given psychotherapy sessions,

also through balneo/warm water therapy.

In the UK, Dr Philip Hayton carries on the work of his mother, Althea Hayton has done extensive

psychological work and written several books on the subject (2007, 2008, 2011, 2012).

In Ireland, Olga Waters works as a therapist with this phenomenon.

In the United States, Dr Brent H. Babcock also published a book (2009) and work with it in a clinical

setting as well.

Globally with Canada involved, Maria Kliavkoff works with grief. And Monica Hudson in the USA

used to do extensive work with womb twin survivors.

Many of these professionals have come together through the Womb Twin Organization to create a

consensus about how important it is to notice if this has been a part of your life, and how that can have

had and perhaps still has potentially detrimental effects on your life, your health and overall being.

As I live and work in Denmark I am obviously interested in the growth of this here, and there are also

some amazing professionals who are discovering and promoting the importance of prenatal (before

birth) health such as Ann Jeanett Foldager who is known for her work on foetal consciousness, Henrik

Dybvad Larsen who's an author and a psychologist and has written about prenatal psychology from

conception to birth, Nikolaj Jespersen who works with biodynamic craniosacral therapy to treat

traumas such as birth traumas. But there aren't to my knowledge anyone who digs deep into the

importance of the prenatal twin loss. My approach is also slightly different, as a physiotherapist and

functional neuro-trainer – my focus is primarily neurological, and movement-based.

I am myself affiliated with the Womb Twin Organization and work in close collaboration with Dr Philip

Hayton. Although ideas are still developing, many professionals and experts by experience come

together in that network to share and promote scientifical, clinical and personal experience.

The purpose of this article is to bring light from a neurophysiotherapeutic background in terms of the

development of the brain and the nervous system and how that can affect us in our child and adultlife,

if we are alone born twins. To my knowledge, this approach, is the first of its kind.

MOTHER AND FOETUS

The relation between mother and foetus has been widely researched. Everything the mother

experiences are amongst the things that can affect the foetus. It is for instance broadly accepted that

stress and alcohol consumption can have negative impacts on the development of the foetus. There are

also interesting studies looking at other aspects such as what the mother eats and which music she

listens to. From a neurological point of view, it makes sense that the womb and everything that occurs

there, in addition to what happens within the mother herself, also participates in the shaping of our

nervous system. This is where it gets interesting with relation to having started life in the womb with a

neighbour – a twin. It is said that our first relationship is to our mother, but if you are made from one

cell that splits into 2 – wouldn't surely that be your first relationship? Wouldn't sharing a room with

your ''other half'', growing alongside, experiencing the same things, certainly shape us in some way? Dr

David Chamberlain, even describes the womb as a 'classroom' where we learn. And if there is learning,

there is also evidence of memory – hence, we can remember certain things about our prenatal life.

Because babies cannot speak until a few years after birth, they cannot tell us about their experience,

however young infants have been able to put a few words on their birth, and even if without words,

expression comes throughout their (preverbal) behaviours (drawings, movements, screams,..). If the

womb is a classroom and we learn/are built in there, it would only be natural to think that a twin loss

could also leave a trace in us.

MY APPROACH:

NERVOUS SYSTEM

When talking about the nervous system, I refer to the brain, spinal cord and the nerves in our body. Our

nervous system starts developing in the womb. We can look at the nervous system working as

following : It receives inputs from our internal as well as external environment (all our senses and

receptors), integrates it, interprets it and decides what to do with it, and this then comes out as a

reaction (output). This is basically a template of learning. Learning about the world. This creates

neuroplasticity or changes in the brain that make us develop in specific ways depending on those

stimuli.

An example of the input-interpretation-decision/output function of the brain could be if you play

football or tennis and you SEE (external environment giving you cues) the ball coming at you, your

brain has to DECIDE what to do – for instance to either MOVE aside and let it pass or to kick the ball

back (output/reaction). Another example could be if you are thirsty (internal environment), the

receptors in your mouth sends signals to your brain, and the brain then can decide to reach out for a

glass of water (output/reaction).

Our brain is very malleable (throughout our whole life) and we can very quickly learn and integrate

patterns, consciously or subconsciously. This is unfortunately also possible in detrimental ways –

whether prenatally, in childhood, adolescence or even into adulthood and old age. The brain is plastic.

It changes. To whatever stimuli come, it will change – that's just basic neurology.

Movement is vital for survival. If we look at our anatomy, biomechanics, neurology – we are designed

to move. Movement enable us to fetch food, and to remove ourselves from danger. Therefore it is

primitively of paramount importance to us. Conscious movement comes from the brain – the brain

makes a plan to move and sends signals around the body to create the movement. As we see babies

growing up, or try to learn a new sport or to dance, play an instrument etc., we also realise that

movement is about learning. We also know that the more we practice certain movements, the better we

become at them – also if they are not good for us, i.e. sitting in front of a computer 8 hours a day, over

time, will give us a posture that in most cases isn't quite optimal. Movement is also a very important

part of our development in the womb. We can observe foetuses moving around, and it seems some

movements are more conscious than others. For instance it has been shown that twins in the womb

spent more time touching their sibling than themselves. They are actually 'social before birth'.

Movement also enables our connection to others and our ability to approach and express. On the other

hand, movement can also be inhibited. We learn for instance that if we touch fire, it will hurt, therefore

we avoid to do so when we first learn it. In relation to alone born twins, movement may be affected in a

way that is linked to how movement happened in the womb (activated or potentially inhibited). Inside

of the womb, it's a non-verbal world. What we experience gets stored inside our body. Movement can

later tell that story – just like a soldier's PTSD symptoms and reactions tell what trauma has been

stored/learnt in his nervous system and body.

SENSING IN THE WOMB

Everything we experience shapes us. Our sensory organs need environmental stimuli to develop. As we

are moving around in the womb, floating in the amniotic fluid, and sensing our mother's moving body

as well as our own, we also start developing our vestibular system (a balance and proprioceptive

system that tells us which was is up and which direction we are moving). It starts developing by the 2nd

gestational week. This system is intrinsically linked to hearing as they both are placed in the ear and

share a nerve that sends inputs to the brain (the vestibulocochlear nerve). This is extremely interesting

when we think about that the vestibular system is nearly fully developped by birth. This also means that

the possibility of hearing starts very early in the womb. Neurology also has shown us that the vestibular

system can have an effect on the autonomic system. We start to learn about gravity as we are floating

around in the amniotic fluid in the womb. Movement of the head and body gives stimuli to this system

for it to develop. As stated, the vestibular system shares a nerve with our hearing. Hence they can affect

each other. In my practice I have found it quite common to meet womb twin survivors who have either

vestibular issues or hearing sensitivities as adults. It is possible to train reflexes within the brain and

nervous system to recover some of the lost inputs or inhibit some of the potential overactivation from

trauma.

Yet another interesting discovery is that the vestibular system is very closely linked to our gut via the

gut-brain connection meaning vestibular dysfunction could affect gut issues and vice versa. It is also

closely linked to our emotions and can cause mental health issues. These are all symptoms that often

show up with alone born twins.

Looking at embryology, the science of the development of the embryo/foetus, we see that the heart

starts beating around week 6. So far we have seen that babies respond to sound around 14-8 weeks –

but I wonder if it isn't possible to pick up on certain vibrations even before then. According to Alfred

Austermann, such a thing would be possible (from week 6) – which would potentially mean that we

could hear the heart of our co-twin. When one looks at research it is important to note that just because

something hasn't been ''proven'' or researched yet, it doesn't mean that it isn't plausible. There are also

often barriers such as culture, ethics and funding that may play a role in what gets investigated and

what doesn't.

Research has also found that twins play together as early as 14th weeks, but a consciousness of the other

is possible long before that. Our amygdala, part of our limbic system which is considered the seat of

our emotions also starts developing very early, around week 3. Sensation starts developing within the

first few weeks. In the first trimester the foetus can sense touch certain areas of the skin, it has been

observed already by week 7. This leaves to wonder if that obviously wouldn't make us able to sense

heat and touch from another little body in the womb next to us? And wouldn't we then also detect a

change in those sensations, a mass turning cold and hard and deteriorating? We know research show us

that already around week 11 we react to our twin, maybe even earlier..? We can observe that the foetus

reacts with movements to stimuli – whether they be touch, sound, or visual (dark/light). A lot of the

movements are also just sporadic without any goal intended, however there seems to also be a meaning

to some of the reactions. But even the sporadic movements help start to create a sensorymotor map, and

to start strengthening our tissues such as muscles, tendons, ligaments, cartilage and bones.

Taste buds develop between the 8th and the 14th week – this makes the foetus able to detect changes in

the amniotic fluid. The chemistry of that fluid will change depending on the mother's state, i.e. the

levels of stress hormones in the amniotic fluid will rise if the mother is stressed, or it changes

depending on her diet. If a twin dies in the womb and the cells deteriorate, surely this will affect the

acidity of the fluid too and that must be sensed as a change (and probably a negative/stressful one). The

foetus also learns the swallow reflex by practicing with the amniotic fluid.

Pain is felt already in the first trimester. It is noticable by a change in heartrate and hormones.

By 6 weeks, it is possible to detect electrical impulses that act upon movement which means that the

brain is already functioning.

In the first 12 weeks, the brain makes up half of the foetus' weight, but is only roughly 10% by birth.

In the 2nd trimester the brainstem is almost fully developped and controls movements of lungs and the

diaphragm to start 'practicing breathing'.

Embryology is a very complex corner of science, and we are constantly making new discoveries, but

only with what we know so far, shouldn't it be obvious that the loss of a twin in the womb would have

an impact on us? The sounds, the movements, the space, the pressure, the touch, the temperature, etc. It

all starts there and is encoded into our nervous system. I would like to remind the reader that this is an

introduction on the subject and that there are many more layers to this.

There is more and more research done in the world, on prenatal and perinatal psychology, for instance:

Dr Thomas Verny created the Association for Prenatal and Perinatal Psychology and Health, which now

has 34 years of peer-reviewed research, expanding our knowledge on prenatal and birth memories and

traumas. The foetus does have a memory and can start learning in the womb.

Barbara Findeisen, who's a psychotherapist and author also notes that prenatal memoy is often ''the key

to the person's psychological health''.

Akira Ikegawa, medical doctor and chief director of obstetrics and gynecology at Ikegawa hospital,

founder of the Prenatal Memory Network, has done research on prenatal and perinatal memory.

And many more!

SURVIVAL INSTINCT

It's important to know that our brain's main function is to keep us alive. This means that it is constantly

''looking'' for threats, and trying to predict what is going to happen so that it can keep us safe. It often

happens subconsciously, but our brain is constantly screening our environments (internal as well as

external) for threats. This is because the primitive part of our brain is the one who has the last word.

After all, what is more important than surviving?

Everything that we are and that we do is based on learnt and stored experiences within our system.

From that we have developped endless coping mechanisms – both helpful ones but also ones that may

have served us at a given time when we didn't have any other 'ways out' but that may not be working in

our favour anymore. These patterns may act out cognitively, emotionally, physically...

We are also designed to move. Without movement we cannot survive. As we start moving in the womb,

both reflexively and intentionally, we grow and learn through these movements. They can also become

our defences, as we try to survive potential threats in the womb.

SO...WHEN CAN IT GO WRONG IN RELATION TO A TWIN?

As we react to everything around us, so we do in the womb. This is on a much more complex and

primitive way, and which we still have to discover a lot from.

Looking at it from a prenatal perspective, whatever the mother does and experiences can affect the

foetus. There are however other potential impactful events that can occur and that are sometimes out of

our control.

Some of the ways in which we think it can go wrong with regards to a twin inside the womb, could be

many, some of them mentioned below:

-The fight for space: if anything goes wrong, we may get affected by touch, as well as our movements

and thus our vestibular system, potentially also our muscle tone if we have to tense up due to

stress/threats

-The fight for food may cause stress

-The mix of hormones when one twin deteriorates, especially from the opposite sex

-The ''learning'' of getting abandonned and the future social consequences of that

-Overstimulation from the excess in stimuli especially if threatening

-Depending on where on the body, and which side the threats are this can affect and create an

imbalance in the development of the brain

-Many psychological factors such as always feeling that there's something missing, feeling, lonely,

feeling empty, feeling axious, feeling depressive, feeling self-destructive etc.

Amongst many others!

These factors can create responses to triggers that get embedded in our system, and that create reactive

patterns that can be expressed later on in life.

With regards to losing a twin, we will also subconsciously repeat certain patterns that happened in the

womb. This could for instance relate to choosing unavailable relationships that lead to abandonment, or

not taking up the space that we need in guilt for having survived (unknowingly for most), having

behaviours where we double the intent for instance overworking, overtraining, buying 2 of the same

things, eating for 2, etc, - again sometimes unaware that we are doing so, and usually unaware of the

origin of these patterns, that seem unbreakable to us.

SO WHAT'S THE HEALING ABOUT?

As per usual, healing has different aspects to it. Just like when I see patients in my physiotherapy

practice, I am concerned about various areas of their lives, as it is important to notice potential trouble

from a holistic perspectiv. It is, in my opinion, the same with healing a prenatal twin loss. Conversing

to cognitively understand what happened has its importance, so the psychological part of it cannot be

denied. However, as it was a preverbal world, it is also extremely important to work with the

embodiement of the potential trauma, and the physical patterns and expressions of it. Closely linked to

this, are the potential neurologic aspects.

As a neuro-trainer I train the brain and the nervous system, related to the body and movement. This

could be related to tonus regulation, pain regulation, gut dysfunctions, vestibular dysfunctions such as

dizziness, poor balance, motor (movements) deficits, hyper-or hyposensitivity i.e. with skin/touch,

energy, sound, space, etc. It is about uncovering what parts of the nervous system that have been

affected – what parts are underactive and what parts are overactive – and in relation to our sensations in

the body and our movements. I am the only professional in the world to work with womb twin

survivors from this particular perspective.

I'm based in Denmark but I work internationally.

CONCLUSION:

Why is prenatal twin-loss important?

Considering the fact that is is approximately 1 out of 10 being alone born, and potentially more people

that can be affected by this, it only deserves to get more attention. Also, as we see the number of IVFs

performed increasing, this would mean that the number of alone born twins also would.

As most people are unaware of this, they may live their lives in various types of distress or pain without

knowing the cause of this. We cannot deny the closeness of our physical health to our mental and

emotional health, and it is time that we encompass ALL that is us – from conception to where we stand

today.

Below are relevant references, books, and links that have inspired this article – note that the list is not

exhaustive, there is a lot more knowledge on this subject.

References:

Bock et al. (2015): Stress in utero: Prenatal programming of brain plasticity and cognition. Biol

Psychiatry, 78(5): 315-326

Boklage, C. E. (1990): Survival probability of human concetions from fertilization to term. Int J

Fertil, 35(2): 75-94

Bradley R. M. & Mistretta C. M. (1975): Fetal sensory receptors. Physiological reviews, 55:3

Brandt T. & Dieterich M. (2020): 'Excess anxiety' and 'less anxiety': both depend on vestibular

function. Current opinion, 33:1

Castiello, U. et al. (2010): Wired to be social: The ontogeny of human interaction. PloS One, October

7, 2010

Csaszar-Nagy N. & Bokkon I. (2019): Twin loss in the uterus: Neurodevelopmental impairment and

reduced resilience? Activitas Nervosa Superior, 61(1)

Evans T.H & Schiller L.R (2012): Chronic vestibular dysfunction as an unappreciated cause of chronic

nausea and vomiting. Proc (Bayl Univ Med Cent). 2012 Jul;25(3):214-217

Fagard et. al. (2018): Fetal origin of sensorimotor behavior. Front Neurorobot, 12:23

Gonzalez-Gonzalez N.L et al. (2006): Persistence of fetal memory into neonatal life. Acta Obst et Gyn

Scand. Vol 85-Issue 10

Guerri C. & Pascual M. (2017): Effects of alcohol on embryo/fetal development. Reproductive and

developmental toxicology, 431-445

Gurvich, C. et al. (2013): Vestibular insights into cognition and psychiatry. Brain Research. Nov, Vol

1537:244-259

Gouni et al. (2016): The contribution of prenatal psychology to our understanding about prenatal

dynamics and fetal behaviour. Psychology Research, 6(12): 693-711

Hall, J. G. (2003): Twinning. Lancet, 362: 735-743

Hepper P.G. (1996): Fetal memory: does it exist? What does it do? Acta Paediatr Suppl. Oct;416:16-20

Jamon M. (2014): The development of vestibular system and related functions in mammals: impact of

gravity. Front Integr Neurosci. 2014; 8: 11.

Landy, H.J, Keith L.G. (1998) The vanishing twin: a review. Human Reproduction Update 1998, Vol. 4,

No. 2 pp. 177–183

Larkby C. & Day N. (1997): The effects of prenatal alcohol exposure. Alcohol Health Res

World, 21(3): 192-198

Marca-Ghaemmaghami P.L. Et al. (2017): Second-trimester amniotic fluid corticotropin-releasing

hormone and urocortin in relation to maternal stress and fetal growth in human pregnancy. Stress.

May;20(3):231-240

Menella, J. A. et al. (2001): Prenatal and postnatal flavor learning by human infants. Pediatrics, 2001

Jun; 107(6): E88

McDonnell B. P. & Regan C. (2019): Smoking in pregnancy: pathophysiology of harm and current

evidence for monitoring and cessation. The obstetrician & gynaecologist, 21(3): 169-175

Partanen E, et al. (2013): Prenatal music exposure induces long-term neural effects. PloS One, 2013;

8(10): e78946

Peters et al. (2018): The effect of medical and operative birth interventions on child health outcomes in

the first 28 days and up to 5 years of age: A linked data population-based cohort study. Birth, 45(4):

347-357

Pinborg et al. (2005): Consequences of vanishing twins in IVF/ICSI pregnancies. Human reproduction,

20(10): 2821-2829

Pino, O. (2016): Fetal memory: The effects of prenatal auditory experience on human development.

BAOJ Medical and nursing. 2:42:020

Rajagopalan, et. al. (2017): Understanding the links between vestibular and limbic systems regulating

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assessment of complications during the first trimester of pregnancy. Lancet, 2, 1237–1240

Stoeckel, W. (1945) Lehbuch der Geburtschilfe. Gustav Fischer, Jena.

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Physician, 30: 2115-2118

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transmission electron microscopical study. Anat Rec. Dec;246(4):507-23

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in vitro fertilization and embryo transfer. Eur J Obstet Gyn R B, 203: 35-39

Books:

Austermann A. & B. (2007): Le syndrome du jumeau perdu. Editions Le Souffle d'Or

Babcock, B. H. (2009): My twin vanished: Did yours? The vanishing twin crisis. Tate publishing and

entreprises

Chamberlain, D. (1998): The mind of your newborn baby. North Atlantic Books

Dybvad Larsen, H. (2018): Forstrets og fødslens psykologi. Pregnant press

Gouni et al. (2018): Prenatal Psychology 100 years. A journey in decoding how our prenatal

experiences shape who we become. From Prenatal & Life sicences

Hayton A. (2014): Ripples from the womb. How therapists can help the sole survivor when a twin dies

before birth. Wren publications

Hayton A. (2012): A healing path for womb twin survivors. Wren publications

Hayton A. (2011): Womb twin survivors. Wren publications

Hayton A. (2008): A silent cry. Womb twin survivors tell their stories. Wren publications

Hayton A. (2007): Untwinned. Perspectives on the death of a twin before birth. Wren publications

Janov, A. (1990): The new primal scream. Primal therapy twenty years on. Abacus

Noble, E. (1993): Primal connections. How our experiences from conception to birth influence our

emotions, behavior, and health. Fireside

Woodward, J. (2010): The lone twin. Understanding twin bereavement and loss. Free association books

ltd

Websites:

www.alenefødt.dk

www.vanishingtwin.com

www.wombtwin.com

www.healthymourning.com

www.stichtingatn.nl

The Association for Prenatal and Perinatal Psychology and Health

www.birthpsychology.com