TWINLESS TWINS AND WOMBTWIN SURVIVORS

RESEARCH QUESTIONNAIRE

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Whether you are a wombtwin survivor or a twinless twin, this page is all about your time in the womb and how you feel about yourself today. It may be the first time that you have ever thought about the effect of losing your twin, or admitted your secret feelings of perhaps being a twin. It may be that a therapist or friend has just suggested that you are a wombtwin survivor and you are wondering if it is true or not. There are certain characteristic signs that I am learning to see in wombtwin survivors and I may be able to see things in your story that will help make things clearer to you. There is space for you to supply further details where it's hard to answer a particular question precisely. Tell me as much of your story as you wish: I don't care how long it is!

Please note that your e-mail address will not appear in the header of your submitted form. If you do want me to reply, please write your e-mail address in the box at the bottom of this page. Your secrets are safe with me: I operate by a strict privacy policy.

If you are a parent of a wombtwin survivor, or you are wondering if one (or more) of your children could be a wombtwin survivor, please e-mail me for a separate list of signs and indications. I am now developing a special parents' questionnaire for this site. Your assistance would be much appreciated.

[For more detail on any question, click the question marks to open a small information box.)

Country of origin

Age

Gender  

Male

Female

Mixed gender

DETAILS OF Your mother's pregnancy with you, and any previous pregnancies

Please answer these initial questions as fully as you can before moving on to the research questionnaire. You may not be able to answer all these questions accurately, but please do the best you can, for the data are important to my research into the possibly real nature of the Dream of the Womb. To answer the questions, either write the answer in the boxes provided or check Y for "yes", N for "no" or DK for "don't know."
 

1

Outcome of any pregnancies BEFORE you were conceived (write no. in correct boxes)

Born alive

Died before or at birth

2

Any trauma, illness, accidents, losses, or shocking events during your mother's pregnancy with you: (Give brief details here: you can continue in the box at the end of this form)

3

Indicators during your mothers pregnancy of a possible twin in the womb with you:

Y

N

DK

Mother abnormally large around the waist in the first three months

Bleeding in the first three months

Miscarriage or suspected miscarriage but pregnancy continued

Attempted abortion but pregnancy continued

Mother took Clomid or other drug to stimulate ovulation

Ultrasound evidence of a second gestational sac

More than one embryo implanted after IVF

Mother took oestrogen medication during pregnancy

A doctor, or nurse suspected a twin pregnancy

Another person suspected a twin pregnancy ( if yes, say who)

4

Aspects of your birth:

Y

N

DK

My birth was traumatic

Breech birth

Small for dates

Placenta unusually large

5

Signs of your twin after birth:

Y

N

DK

My twin was born with me but was stillborn

My twin was born alive but died in the first 6 months of life ( inc. neonatal death)

My twin was born alive but died aged more than 6 months. (If "yes" write age at death in box provided)

Additional sacs or cords found attached to placenta after delivery

Fetus papyraceous present

Nodules or thickening of the placennta

Other signs of my twin (if " yes" explain in box provided)

6

Bodily indicators that you may be a wombtwin survivor:

Y

N

DK

Dermoid cyst

Teratoma

Fetus in fetu

Split organs

Congenital abnormality

Left handed

Ambidextrous

Blood chimera

Presence of sex organs (SO) or secondary sexual characteristics (SSC) of opposite sex

Cerebral palsy (indicate severity of disability (0-4)

0

1

2

3

4 severe

Other birth defects (give details in box provided)

7

Other characteristics associated with twinning

Y

N

DK

There are fraternal twins among my blood relations

There are identical twins among my blood relations

I have always had a great interest in twins

All my life I have had the feeling that I may have once been a twin

As a child, I had one or more imaginary friends

8

Identical or fraternal?

I know that I am the survivor of an identical (monozygotic) twin pair

I know that I am the survivor of a fraternal (dizygotic) twin pair

Feelings, beliefs and attitudes

These answers will help me to see if there is any relationship between your feelings, beliefs and attitudes and your experiences in the womb.

Read each statement carefully and decide how true it is for you today.

Then chose a degree response between A (true) and E (untrue) and check the box for that number that express how true the statement is for you. If any statement was once true but no longer applies, check "no longer."
 

A
true

B

C

D

E
untrue

No longer

I suffer from depression

I have a problem with food and eating

I fear abandonment

I fear rejection

I have wanted to commit suicide more than once in my life

I am afraid of being alone in the dark

I have been searching for something all my life but I don’t know what it is

I get very intense and involved at the start of a relationship but then I sabotage it somehow

I am female but I have a strong male side

I am male but I have a strong female side

I frequently feel unable to cope with life

I grieve deeply and for a very long time after someone close to me, or a beloved pet, has died

Deep down, I feel very vulnerable, as it would not take much to totally annihilate me as an individual

I am easily bored

I think a lot about death and dying

I am addicted to substances or behaviours that are potentially damaging to my health, wealth or well being

All my life I have been "putting on a show," pretending to be someone else, and I know its not my authentic self

I feel the pain of others as if it were my own

Deep down, I feel alone, even when I am among friends

I easily get into a love/hate relationship with individuals I want to get close to

It upsets me if I am unable to reduce the suffering of others (please give details in the box below)

I often find it difficult to fall asleep, even when I am very tired

I know I do no rest enough

There are two very different sides to my character

All my life I have felt as if something is missing

I spend a lot of time talking to myself in a mirror

I find disappointment very painful

I think I am psychic

I am a perfectionist

I find it hard to forgive people who have hurt me

I have been in an exploitative relationship with another person

All my life I have felt empty inside

I don't let other people get close to me

I am paranoid

I feel driven by "musts" and "shoulds"

I am dyslexic ( please explain in box below)

I get extremely upset about silly little things(please explain in the box below)

I feel different from other people

I feel guilty about everything

I always feel in some way unsatisfied, but I dont know why

I know I am not realising my true potential

I have strong, inner imaginary life that I use as a coping mechanism

Deep down, I somehow know I experienced death before I was born

I find it hard to let go of unfinished projects: I am always going to finish them one day

I have a strange, irrational feeling that somehow "I don't exist" or "I'm not really here".

I feel very privileged, simply to be alive

There is at least one room (including shed or garage) in my home that is completely full of stuff ( please give details)

I generally lack energy and motivation

I have a problem with expressing anger - either there is too much or too little

I suffer from low self esteem

I often feel torn in two between two decisions

I have suffered for a long time from feeling vaguely unwell, as if I am slowly dying (please give details)

I make a lot of effort to protect my privacy

I am so intuitive and empathetic that it is a problem for me

All my life I have felt restless and unsettled

All my life I have carried deeply felt emotional pain that persists, despite all my efforts to heal myself

I have a deep desire to heal the world and everyone in it

I feel guilty about being alive at all

I compulsively self harm ( please give details in the box below)

I want to succeed in life, but I always end up somehow sabotaging my chances of success

PLEASE USE THE BOX BELOW TO TELL YOUR STORY OR PROVIDE MORE INFORMATION

Story:-

I am willing for anonymous quotes from my story
to be used in Althea's next book: "Wombtwin survivors" Yes No

Name

E-mail address for reply:

Please send me details of how I can become a member or an associate member of Wombtwin.com Ltd. Yes No

Please subscribe me (with the above email address) to the monthly newsletter GEMINI VOICES Yes No

Please note that this form can remain anonymous, if that is what you prefer. I make a personal response to every form where an address is given. If you do not receive a reply within two weeks, this may mean that your email address did not work, so try again or email me with your story

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