She didn’t even tell her husband at first. After two definite miscarriages and month after month of disappointment, Kathi Johnson of Gainesville, Va. still finds it hard to accept that this pregnancy will hold. "I always wanted a large family," she says. "But at 31, the clock is ticking." Only when blood-work confirmed the pregnancy did she tell her husband. A few days later, however, she began spotting. "I was frantic, thinking ‘here we go again!’" But after a week of light spotting, repeated blood-work and ultrasound confirmed she was still pregnant and everything was fine. "I was overjoyed, but didn’t want to tell anyone yet." Another two months went by before she finally announced the news.

Pregnancy is an emotional experience for many reasons, but when a woman has experienced miscarriage, these emotions can be overwhelmingly difficult. Instead of joy and hope, there is fear, guilt, sadness and, for many women, isolation. In spite of the fact that an estimated one in four pregnancies ends in miscarriage, it is not talked about openly.

Mel Angel of Hastings, England, understands this, but feels that communicating her feelings to supportive friends was very helpful. A mother of three sons, she lost a fourth son at 19 weeks gestation. When she became pregnant again 10 weeks later, she had a flood of mixed feelings. "I found it very hard at first to talk about my impending baby," she says. "That in some way I was being disrespectful to the one I lost, for conceiving again so soon." In spite of her worries, she announced this pregnancy as soon as she was certain. "If the same thing happens again, then the more people that know, the more help we’ll get."

Mel was fortunate to have friends who understood what she was going through, but even with a good network of support, some women cannot find their way through the maze of loss without professional guidance.

Dr. Cindy Wahler is a clinical psychologist in Toronto, Ontario, who sees several cases each year relating to infertility and pregnancy loss. "There is a definite gender split in the grieving process," she says. "Both men and women experience extensive grief over the loss, but women establish a more intimate bond with the pregnancy, because of the physical changes they go through." So much occurs before the pregnancy is obvious, that an early miscarriage can result in a lot of insensitive reactions. "People expected us to get back to normal," says Mel, who anticipated greater support. "Someone actually asked me ‘Has it really hit you that hard?’ It’s not something you can get over, like a cold."

Kathi miscarried before her pregnancy had been made public, so no one "knew" to sympathize with her. "I really became discouraged at that point," she recalls sadly.

Complicated emotions require time to sort out. "The loss of pregnancy revolves around the potentialities of a child," says Dr. Wahler. "Therefore, the grieving process may involve detailed images of what the baby may have been like." Because these images are all that’s left, they are difficult to let go of, deeply personal and shared by no one else.

For many women, underlying issues that pre-date the pregnancy may come to the fore at this time. The biggest issue is self-blame. "Pronounced guilt may be felt," says Dr. Wahler. "Specifically, thinking they must have done something wrong, whether it was diet, rest, exercise."

Mel knew that there was no reason for her miscarriage. "Still, I thought I would be safe because we were past the risky period. I thought in some way I had done something wrong."

It’s typical for women to be extra cautious as they enter a pregnancy after a miscarriage, highly aware of its tentative and precarious nature. "The second pregnancy may at times not be filled with hope, but rather pessimism as the women have determined that this too shall end in miscarriage," says Dr. Wahler. "They may overinterpret any physical signs as pathological and rely heavily on the medical profession."

It’s important for women to allow themselves time to grieve. "There is no definitive time period for grief," says Dr. Wahler. "But if the intensity and frequency of emotional episodes do not begin to diminish at some point, professional help is advisable." Ignoring the grief will only prolong it, and can lead to an inability to experience joy, a preoccupation with the past and a growing sense of injustice and anger, all of which are potentially damaging to interpersonal relationships. Dr. Wahler suggests achieving closure through a creative outlet such as poetry or journal-writing or burying trinkets, baby blankets or ultrasound photos in a private ceremony. Participation in hospital or community-based miscarriage support groups can be tremendously valuable also.

Most women who have experienced miscarriage will go on to have normal pregnancies, in spite of their fears. Though the memory of a lost child never disappears, the joys of life and parenting help to dull the pain. And sometimes, when it seems hope is lost forever, life throws in a special surprise. As Dr. Wahler says, "A successful second pregnancy is very celebratory; the child is believed to be a miracle, almost magical." Kathi Johnson agrees. In December, she discovered that her large family might be possible after all. Not only is her pregnancy fine and healthy, but she is carrying twins.