Pregnancy Loss
When the Unexpected Happens

A Silent Grief

Pregnancy loss goes by a number of names, and there are a multitude of causes (See sidebar for examples). Each pregnancy is unique and so too is each loss. We hold life so dear that when an unborn or newborn baby dies, the sense of loss is compounded—loss of life, loss of expectations, loss of dreams, loss of parenting, loss of future generations.

Women and couples that experience pregnancy loss find themselves thrust suddenly and unexpectedly into a world of silent sorrow, of grief unseen. In fact, A Silent Sorrow (2000), by Ingrid Kohn and Perry-Lynn Moffitt, and Grief Unseen (2006), by Laura Seftel (2006), are titles of two important books on pregnancy loss and its emotional aftermath.

According to Kohn and Moffitt, there has been a growing awareness of the emotional needs of families who experience pregnancy loss. Yet, it is still an isolating journey for many:

Too many bereaved parents suffer in silence and alone, fearing that their grief is a weakness rather than an expression of the courage to cry. And too few hospitals and medical staff members are aware of bereavement issues and protocols, leaving parents unsure where to turn for help.

Seftel sees a shift in the social response to pregnancy loss beginning in the early 1980s, a transition away from the "dark ages of perinatal bereavement when little or no words were spoken beyond, ‘I'm so very sorry,' if one was lucky enough to hear that."

Times are changing, but the silence persists. Parents and families are not encouraged to speak about the unborn child as happens when other loved ones die. There are no rituals to mark the loss. In Seftel's words, pregnancy loss may still register with family and friends and co-workers as a "non-event," or a loss that can be replaced—"You can always have another."

Statistics No One Wants to Hear

It seems paradoxical that in a society where pro-life rhetoric takes center stage in political debate, the unintended loss of an unborn child receives so little mention, and this in a society where pregnancy loss is fairly common. For example, about one in five pregnancies end in a miscarriage in the United States.

How does this translate in actual numbers? A 1999 study in the Journal of Epidemiology reported an estimated 67 million pregnancies in the US in the eleven year period from 1981-1991. During this time about two-thirds (42 million) of all pregnancies resulted in live births; about one-fifth (14.8 million) resulted in induced abortions; and the remainder, 16 percent (more than 10 million) resulted in pregnancy loss as a result of miscarriage, ectopic pregnancies, or still birth.

Comparing the annual estimates for the years 1990 and 2000, the statistics reflect the same percentages and large numbers overall for unintended pregnancy loss. Refer to the table below.

Year*	Total Pregnancies		Live Births		Induced Abortions		Pregnancy Loss**
	No	Percent	No	Percent	No	Percent	No	Percent
1990	6.6	100%	4.1	62%	1.4	22%	1.06	16%
2000	6.4	100%	4.1	64%	1.3	20%	1.03	16%

* Figures adapted from: Saraiya, et al (1999). Estimates of the Annual Number of Clinically Recognized Pregnancies in the United States, 1981-1991. American Journal of Epidemiology, Volume 149, Number 11 and Centers for Disease Control and Prevention (2004). Estimated Pregnancy Rates for the United States, 1990-2000: An Update. National Vital Statistics Reports, Volume 52, Number 23

** Miscarriage, ectopic pregnancy, stillbirth

Emotional Fallout

The emotions that accompany pregnancy loss often are complex and can include a mix of deep sadness, bitter resentment and envy, self-doubt and self-blame, and a sense of isolation. These feelings can persist for weeks or months or even years.

In general, the research on the mental health impact of miscarriage on women emphasizes the substantial increase in depressive symptoms in the early weeks after a pregnancy loss. Some women, in fact, are at greater risk for a major depressive disorder after pregnancy loss, requiring mental health counseling or other interventions.

Yearning for the lost baby can further compound a woman's emotional distress. She might find herself walking or patting her belly as though she were still pregnant. She might actually feel the baby insider her. There can be longing to hold the baby or to dream and fantasize about what he or she would have looked like.

To what extent these are normal reactions to loss or an indication of pathological mourning depends upon the individual, the family, and the extent of impairment of life's normal activities and relationships.

Keys to Healing

There is help for the intense distress of pregnancy loss. It is important to remember that moving through the feelings will always take away their power.

Literally hundreds of websites provide medical information, mutual support, bereavement resources, and suggestions for creating your own rituals and commemorative activities, moments in which you can keep the memory of your lost child alive within the family. There is help for fathers as well as mothers, forums for sharing your story, and lists of regular groups, available counselors, and other support services within your own communities.

Each circumstance is unique and each loss is profoundly personal, as is the response to that loss. There are numerous keys to healing that can help both grieving parents and those who desperately want to help. Check the sources mentioned below for additional information.

Editorial provided by Judith Gusky, Counseling Services in Pittsburgh, PA.