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Miscarriage involves a number of potential significant losses and is a complex grief that can involve an additional kind of suffering that is not necessarily present with other types of bereavement. Not only have we lost our baby, we are suffering from the effects of a birth and a death and we usually do not have a baby to bury. A funeral normally gives others their cue of how to behave appropriately and when there isn't one they are often at a loss themselves and may not even realise we are grieving. This adds to our stress as we can then feel we need to explain this, whereas with a still-birth or loss of a child, everyone is aware of the devastation and expects us to grieve. People may not want to talk about what has happened and it's the only thing we can think of.

When our miscarriage has been early in the pregnancy (or even later) it can be minimised and invalidated but for us, it is the strength of the bond with our baby not the length of the pregnancy that determines the depth of our grief.

There are also the other losses that are more difficult to explain unless the person has had a miscarriage themselves, which is why talking to someone who has had one, can offer the most comfort and empathy. This can be a grandmother, mother, sister, friend, medical professional and even sometimes, unexpectedly, a woman who is perhaps only an acquaintance or even a stranger (as on a bulletin board) because they understand the feelings and possible losses involved like -

• the loss of the festivities of a joyous birth and perhaps future ones

• the loss of our dreams for this child and the future our family would have had together - we had made plans for life

• the loss of being able to call ourselves a mother (if no previous pregnancies)

• the loss of access to successful womanhood (in our own or others eyes)

• the loss of trust in the body we feel has betrayed us

• the actual physical loss and the fear that can be felt from the amount of blood passed

• the confusion and dismay when experiencing a 'blighted ovum' when there is only an empty sac

• the loss of innocence for future pregnancies

• the loss of the belief system we didn't even necessarily recognise we held that says "this won't happen to me"

• the loss of our basic trust in life

• the loss of control over our expectations of life

• the loss of the achievement of a goal we had set for ourselves (this may not have been experienced before)

• the loss of self-confidence

• the loss of control of our feelings

• the threat of loss of our identity

• the failure to reproduce when the body is giving monthly signals of fertility

• the illogical shame, guilt or embarrassment

• the worries or fears that this amount of grief (over what is often seen as a minor blip in life) cannot be normal

• the feeling we should hide our loss and not talk about it as others think we are over-reacting

• to be unable to do what other women seem easily able to do as a 'natural part of life' and our jealousy and anger of that

• the loss or change in relationships (sometimes permanently) as we experience others lack of understanding and the isolation and loneliness this causes

• dealing with others' inappropriate comments, some with the best of intentions

• dealing with the thoughtless attitude of others, who have children without experiencing problems, which can be complacent, smug or pitying (perhaps unintentionally)

• dealing with our feelings over others' pregnancies (relatives being even more difficult), especially when they are due around the time we would have been and then later their new babies

• our strong reaction when we observe children being mistreated, feeling how precious they would be to us

• the 'what if's' or 'if only's' that may result from us not even knowing we were pregnant

• the thought that we have somehow killed our baby, or we did something wrong

• the longing for our baby not to be taken away with a D&C even when we know he or she is dead

• the loss of our last chance of having a child because of our age

• the loss of our last chance to conceive because of the inability to pay or be eligible for further IVF treatment

• the feeling we have let our partner/others down

• the guilt and confusion if we have previously had an abortion

• the sometimes harsh judgements we make about ourselves

Living in a world where science has overcome many things, and especially in the health area, she can be shocked and dismayed to find that there are no straight-forward answers to miscarriage from the health professionals. Sometimes their pragmatic attitude to miscarriage can be very hurtful. Referring to the baby as 'clots' or 'tissue' and their use of the medical term 'abortion' in conjunction with a 'miscarriage' seems harsh and judge-mental to us. A miscarriage can be seen as a minor medical occurrence by them and the grief that it can generate is not always understood. We have found that women heal more quickly when they experience an understanding and empathetic attitude from their LMC.

In this century with the expectation of 'instant everything' and 'women can do it!' along with perhaps not experiencing death, there is also not the sense of acceptance and resignation of life's realities, which could help with the acceptance of losses.

As women (certainly in New Zealand) now have their children later, average age 28.5 years, and their genetic signals intensify (the become aware of their biological clock ticking), so their reaction to loss can be stronger. Their chances of a healthy baby lessen with age too. Women are born with about 2 million eggs although only about 400 of these will be released in our lifetime. The perfection of these eggs decreases with a woman's age and from approximately 35 years on, the rate of decline accelerates (something many women are not aware of). This leads to a higher rate of pregnancy loss and can also create problems even if the baby is carried to full term. Women can feel pressured (by themselves or others) to try again quickly, often not taking the time to allow the grief from their miscarriage to pass (3 to 6 months is a guideline). This can have consequences such as partnership stress and/or post-natal depression later following a successful pregnancy.

Women are always looking for answers to 'why' and, although there are reasons, they do not usually find out what they are, so miscarriage grief is not so much about finding the answer they yearn for, as learning how to live without one.

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