The Silent Loss
Support and care are necessary in the wake of miscarriage

By Kristen Laine

Chances are you know a woman who has miscarried—yet she may never have spoken of it. Or you yourself may have lost a child—perhaps without even realizing it. At least one in every five pregnancies ends in the 20 weeks following a woman's last menstrual period. Those are the parameters of the official definition of miscarriage. However, because a large number of miscarriages occur in the weeks immediately following conception, before many women suspect they are pregnant or have visited a doctor for confirmation, the true incidence is probably greater. Some experts think that as many as 40 percent or 50 percent of all pregnancies end in miscarriage.

Miscarriage may be common, but as women—and as spouses, family and friends—we often stumble trying to make our way through the difficult terrain of this loss. Miscarriage involves the death of a never-known child, a presence perhaps felt but never seen. For a woman, the impact of such a loss, and the mourning that frequently ensues, can be overwhelming—emotionally, psychologically and physically. Yet, our culture has no etiquette or rituals for dealing with such a loss.

Recovering from miscarriage can take weeks, months, or even longer. Preparing again for pregnancy after miscarriage can be simple for some, but for others may require years of fertility tests and therapies. Miscarriage occurs for many reasons, not all of them understood. No one knows, after a miscarriage, what the future holds, and that can be scary.

Where To Start
Women who have miscarried need to be sure they're getting medical care, says Morgan Martin, ND, licensed midwife and chair of the naturopathic midwifery program at Bastyr University in Kenmore, Washington. "So many women in this country are without prenatal care when they miscarry," Martin says, "and yet the role of a midwife or any medical professional is to care for a woman throughout a pregnancy," even when that pregnancy ends prematurely. After a miscarriage, it can be emotionally challenging to seek out medical care from those professionals one would ordinarily see for a healthy pregnancy, but it is necessary. Midwives, doctors, or nurses should be consulted so they can provide both medical care and emotional support.

After that first step, walking through the grief becomes crucial, says Martin. (See "Ten Ways to Honor the Grieving Process") Grieving can take months, she says, but gently working through the entire process is essential to a full emotional and physical recovery.

Grief is likely to be compounded by hormone withdrawal, according to Rebecca Wynsome, ND, a Seattle physician specializing in women's health. Progesterone, a hormone essential to pregnancy, drops precipitously during and following miscarriage. The emotional aftereffects may include depression, irritability, fatigue, and insomnia, all of which can deepen the existing grief. Wynsome counsels that a woman needs to take care of herself during this critical time. Adequate rest and sleep, a healthy diet, and reduced stress are all essential.

Restoring Health
Physical recovery should begin with small, specific steps, Wynsome says. B vitamins, found in whole grains, nuts and green leafy vegetables help the liver process the pregnancy hormones still circulating in a woman's body. Zinc also helps speed hormone metabolism and strengthens the body's immune system. If a miscarriage involves bleeding, a woman may need to replenish her body's stores of iron. This can be done with food, by eating raisins, molasses, and green leafy vegetables, or through supplements. Wynsome recommends taking 500 mg of vitamin C with each dose of iron to help absorption of the iron. Two herbal teas also can boost recovery: red clover tea as a blood cleanser and red raspberry tea as a uterine tonic.

Of course, many women hope for a subsequent pregnancy once they have physically and emotionally recovered. Wynsome works with such women to ensure that their bodies are functioning optimally. She gives her patients several tests to confirm that they have recovered physically, including a complete blood count to check iron levels, a calcium level check, and tests of liver enzyme function.

Wynsome also tests for levels of the female sex hormones estradiol and progesterone. If these hormones, as well as others that regulate the menstrual cycle, are deficient or out of balance, a woman may have difficulty conceiving or maintaining a pregnancy. Many of these imbalances can be treated, according to Wynsome, sometimes through diet and lifestyle changes, or sometimes by using customized hormone medication to recalibrate a woman's natural system. Acupuncture is also a recognized tool in balancing hormones and improving pregnancy success, she notes.

Wise Choices
Both Wynsome and Martin stress that preparation for pregnancy, especially following a miscarriage, involves basic healthy lifestyle choices: eating well, sleeping well, exercising, reducing stress, and regaining a sense of joy. "One study showed that women who had a positive attitude when they went to fertility specialists were more likely to conceive than women who were stressed out about it," says Martin.

In Martin's experience, unresolved marital issues compound the stress of pregnancy loss and can severely limit a couple's ability to move forward. "I think it really helps to work on your marriage," she says. "I encourage women to ask themselves why they want to be pregnant, to ask their partners if they welcome a pregnancy, and then to listen carefully to what the other person is saying." The benefits of such an approach, she points out, go beyond simply recovering from miscarriage. "Out of this dialogue comes important self-knowledge. Women can draw on that, whatever happens."

Lesson In Loss
Grief from a miscarriage can transform us, bringing self-knowledge and compassion. A miscarriage can be a wake-up call to the fact that a woman may have medical problems that need attention, or that there are some things in life we cannot control. But that doesn't mean it feels good, and there is no quick fix for grief, only the gentle nature of time itself.