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Although 50% of pregnancies end in miscarriage, it's rarely talked about and society tends to neglect the devastating psychological effects it has on both partners, writes GLYNIS HORNING. after an easy first pregnancy that produced a perfect son, I was breezing through my second until a 12-week checkup. "I'm sorry," said the gynae softly, after a pause in our usual banter, "I can't detect a heartbeat." A scan confirmed I had miscarried. In a trance, I heard the nurse book a D and C (dilation and curettage) for the following day. Driving home to tell my husband, anguish poured from me in wracking sobs that frightened me and passing motorists. Miscarriage is a complicated kind of loss. It's easy for those who haven't experienced it to underestimate it, especially in the first trimester, when the being you are carrying is barely bigger than a plum, and losing it is common (see box "causes of miscarriage"). But with today's advanced detection of pregnancy, an unborn baby can become part of our consciousness soon after conception, and the repository of our love, hopes and dreams. "With technology we can see ultrasound pictures and hear the baby's heartbeat very early, so attachment to the unborn baby begins early," says Joburg psychologist and bereavement counsellor Illeana Cocotos. Our bodies feed into this. As Rochelle Friedman and Bonnie Gradstein explain in Surviving Pregnancy Loss (Little, Brown & Co), the physiological and psychological processes of pregnancy start soon after conception. The levels of reproductive hormones in our system rise dramatically, our uterine lining thickens to sustain the new life, our breasts swell in preparation for feeding and our emotions change gear. A sense of attachment and "oneness" with the foetus can form even when the pregnancy is unplanned. Unless we're set against the pregnancy, and considering abortion or adoption, we can be left feeling empty and incomplete when a miscarriage ends it. "You need time to grieve your lost dreams, the psychological impact of miscarriage and the physical trauma of it," says Cocotos. "It's been found that even women whose pregnancies were unwanted were shocked by the physical process of miscarriage." Coping with miscarriage, she concludes, may be one of the most difficult processes a woman ever has to face. Yet levels of grief can range widely. "All loss follows the stages of denial, shock, bargaining, anger and depression, which We should not prescribe how a mother should mourn based on which stage of pregnancy she lost the baby, but rather allow her to mourn in the manner she feels is right for her. '45 you can cycle in and out of before acceptance begins and you can move on," says Dr Colinda Linde, another Joburg psychologist and author of Get the Balance Right (Metz Press). Cape Town teacher Nicole Masureik, 35, went into labour at 37 weeks, but was not worried as her firstborn, Janel, had arrived at 33 weeks. Besides, a scan the previous day had shown the baby was fine. By the following morning, however, labour had stopped and the baby was not moving. An ultrasound showed no heartbeat. "I was in such shock and denial that I couldn't accept that this meant she was dead until they brought in a paediatric specialist who confirmed it." Nicole was induced the following day. "(The) staff were wonderful, but there's no way to get your head around giving birth in circumstances like that." Afterwards, she and Graeme were encouraged to hold their daughter, take a lock of her hair, ink a footprint, and hold a brief naming ceremony. They called her Zoe, and the grief counsellor advised Graeme to bring in Janel, who was 18 months old, to see her sister. "They said to tell her straight that Zoe was dead, or she'd see how upset we were and think she was the cause. Janel gave Zoe a teddy, and when they wheeled her away she started crying. She knew Zoe was not going home with us. She completely got it. Children understand death in a way we don't." An autopsy and a battery of blood tests showed Nicole had a rare autoimmune blood disorder, APS, which produced too many clotting factors, and had blocked blood flow in the placenta. In the weeks that followed, Nicole retreated to her bed. "I fell apart - I couldn't make a decision about anything, even if I wanted a cup of tea. Graeme was forced to put his grief aside to cope with work, care for me, and get Janel to preschool each day. I couldn't bear to be with people, especially her, it was too painful. I lay with my nose in a book, unable to face reality." Next came anger and frustration. "I knew the medical staff had done what they should, but I was frustrated my APS wasn't picked up earlier, and hugely angry with God. It's only recently I've been able to say it wasn't his fault." A major help in getting there has been the birth of a third child, Nathan. "I got pregnant within 18 months of losing Zoe, but I was convinced we'd lose this baby too, even though doctors had me injecting myself daily to counter the APS and reduce the chances of another stillbirth. We bought our own foetal heart monitor and I used it constantly. I kept telling myself not to bond with ) how to support a friend who miscarries: Never underestimate the impact of miscarriage, however early. Don't be afraid to talk about the baby or her loss. Be there for her - simply hold her and listen. Encourage her to express her pain and anger. Don't try to minimise her loss ("you were just three months"). Don't offer platitudes ("it's for the best"). Don't offer your own war stories, except fleetingly to show you care. Don't say you know how she feels unless you too have had a miscarriage. Don't hurry her healing, but if it persists and tips into depression, suggest going with her to get help. Remember that the anniversary of her loss can awaken emotions - call or send a card of remembrance.