Miscarriage is the unplanned ending of a pregnancy before the 20th week of the pregnancy. 15 to 20% of all pregnancies end with a miscarriage. 75% of miscarriages occur within the first trimester (12 weeks) for several possible reasons: improper attachment to the uterine wall, imperfect fetus either genetically or more usually, by a chance mutation of cells at the time of conception. 25% of miscarriages occur during the 13th to 20th week. Usually the fetus is normal but there may be other problems: improper attachment of the placenta, uterine difficulties or an incompetent cervix. There may be several reasons for a miscarriage as discussed above or a mild virus, more serious disease or infection may be the cause. Environmental facts and malnutrition of the mother are two more possible causes. Many times there are no definite reasons for a miscarriage and we, who prefer answers, may have some difficulty in coming to terms with that fact. If you lost one more or all of your babies through miscarriage, you may feel empty, angry or let down by your body. Even worse, you may find that family and friends don't properly acknowledge the pregnancy or the depth of grief. In fact, society tends not to think of miscarriage as a real loss. People tend to think that because you didn't know the baby, you shouldn't feel too sad. The loss is downplayed and the parents are often advised to "try again." If parents are to have any hope of healing, many of those whom have dealt professionally with pregnancy loss or studied it, agree that parents need to grieve their baby's loss if they are to heal. If it is possible to see your child, ask the hospital staff in this regard. They are best suited to advise you. Even if the baby can't be viewed, it might be wrapped in a blanket and brought to you to hold. The physical sensation of holding your child gives you tangible memories of the baby's real existence as a part of your family. Other mementos, such as copies of early ultrasound photographs of the multiple pregnancy with all fetuses intact, are cherished by many families. If it is not possible to see the baby due to the miscarriage at too early a stage, it still may be possible to arrange formal burial or cremation with the cooperation of the hospital and a funeral home. If this is not an option for you, it is helpful for many families to hold a memorial ceremony, either officially with religious involvement or personally with only family and friends. You might decide to plant a tree(s) in a special location in memory of your child(ren). It is important to find a safe place to grieve your loss. You may join a bereavement support group, see a therapist who specializes in pregnancy loss issues, find a caring friend or relative to share your feelings and emotions. Research has shown that parents who do not talk about a tragedy pregnancy take much longer to resolve their grief. Women usually will grieve longer than men and want to speak of the miscarriage for weeks or months afterwards. Mothers may be receiving adequate care and attention afterwards, but bereaved fathers are sometimes overburdened and overlooked. Not only must they console the mother who just suffered a loss and who may be seriously ill herself, but they must also deal with their child(ren)'s death and memorial arrangements while also juggling household duties and possibly a job as well. This article was written with grateful input and assistance from: Dr. Elizabeth Pector, Illinois, U.S.A. www.synspectrum.com/multiplicity.html Sources: Bereavement in Multiple Birth, Part 1: General Considerations, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, November, 2001 Miscarriage, pamphlet prepared by Canadian Mental Health Association, Windsor, Ontario, Canada At a loss, article by Kimberly Pfaff, printed in The Walking Magazine, September/October, 2001 Reading Resources: Twins, Triplets and More, Elizabeth M. Bryan, M.D., St. Martin's Press Guidelines for Professionals: Bereavement, Bryan, EM; Hallett F, Multiple Births Foundation, London England www.multiplebirths.org.uk Living Without Your Twin, Betty Jean Case, Tibbutt Publishing Bereavement in Multiple Birth, Part 2: Dual Dilemmas, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, May, 2002 The Worst Loss: How Families Heal from the Death of a Child, by Barbara D. Rosof, Henry Holt Empty Cradle, Broken Heart: Surviving the Death of Your Baby, Deborah L. Davis, Fulcrum Publishing Men & Grief, Carol Staudacher, New Harbinger Publications Trying Again: Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss, Ann Douglas and John R. Sussman, M.D., Taylor Trade Publishing Empty Arms: Coping with miscarriage, stillbirth and infant death, Sherokee Ilse, Wintergreen Press Other Organizations: Check out Useful Links on this Web Site Multiple Births Canada's Loss Support Network - www multiplebirthscanada.org Centre for Loss in Multiple Birth (CLIMB) - climb@pobox.alaska.net Twin and Multiple Birth Loss NZ (Inc.) - twinloss@xtra.co.nz Multiplicity: Resources for Loss, Prematurity and Special Needs www.synspectrum.com/multiplicity.html SHARE Pregnancy & Infant Loss Support Inc. www.nationalshareoffice.com Pregnancy and Infant Loss Center www.pilc.org www.aplacetoremember.com www.mendingbrokenhearts.org www.misschildren.org