Sometimes the joys of pregnancy turn to the tears of devastation. A truth that women rarely discuss out loud is how they lost their baby. Some babies are lost to miscarriage, while others are lost in a stillbirth. Indeed, some women become mothers without ever getting to hold their baby in their arms or having to say good-bye in the very moment they are saying hello.
Perhaps, no one talks about it because it's just so cruel, one of nature's harshest realities.
But people should talk about it. They should share what they felt and how they overcame their grief or at least learned to survive it. They should do it as much for themselves and their ever-healing heart as they should for others, who may be facing similar tragedy.
Even if the mother's child was but a tiny seed inside her, when that baby is no longer, she loses a dream of what that life might have been, what that love might have been, what light that child would have shone on the world. From that day on, a darkness - even if it gets smaller as time passes - lives within her.
Mothers' sadness is what miscarriages and stillbirths have in common. While no one wants to demean either loss, there are distinct differences between the two. Each situation is unique from one another as is their causes.
After all, knowing the distinctions can help women better cope and those who love them better able to support them. While this is viewed as a personal tragedy, everyone has something to gain when they learn about this kind of tragedy and what it does to a woman, a couple, and a family.
Learning the definitions of stillbirth and miscarriage is the first step to understanding the differences. In the United States, stillbirth refers to a death of a fetus after 20 weeks of pregnancy, whereas a miscarriage is a loss before 20 weeks of pregnancy, according to the Centers for Disease Control and Prevention.
However, other countries define stillbirth differently, which is why it is sometimes difficult to get reliable statistics on how often it happens across the globe, explains the CDC website. This time difference between the two types of losses is significant. Most miscarriages occur within the first 12 weeks of pregnancy, according to Fit Pregnancy.
This means the fetus is not at all fully formed. The size of the loss is physically smaller in a miscarriage than it is with a stillbirth. In fact, some stillbirths happen after the baby is fully formed and looks exactly as a newborn baby would. Of course, besides seeing and sometimes even holding a dead baby, these moms have spent much more time carrying the fetus in their womb.
They've experienced and shown the signs of pregnancy replete with swollen belly. Usually, they have had more time to anticipate the arrival of a healthy baby, which makes the tragedy all the more devastating.
Often, women wait at least until the end of the first trimester to tell people outside their spouse and maybe a few close friends and family they are pregnant. Few, if any, are showing before then, so they don't have to offer an explanation to anyone. So, if a miscarriage happens, they don't have to go to the trouble of breaking the sad news to too many people.
The story is sadly different for those who have had stillbirths. Many times, in these cases, family and friends of the pregnant woman were as excited as she was for the arrival of the baby. They have to tell the news of the stillbirth to loved ones, and the loss can be almost as hard on them as it is on the parents.
Having to constantly explain what happened can be gut wrenching. That's why some who have been through it suggest moms ask their partner or another close friend or relative to make the initial calls for them, until they are ready to speak about the tragedy.
Funerals help people get closure when they have lost someone close to them. Babies can't be any closer to their mothers. Sometimes, planning and having a funeral can be therapeutic and helpful to mom as she attempts to move on. In some rare instances women might bury fetal tissue after a miscarriage.
(Some Catholics feel compelled to do this because they believe a baby exists upon conception, for instance.) On the other hand, with stillbirths, funerals including either burial or cremation are the rule rather than the exception. In the instance of stillbirths, after all, there is a body.
Some parents have found comfort in having stillbirth photo shoots. Some find it allows them time to say good-bye to their baby ahead of a funeral. And the photos provide documentation of what their child looked like or just provide a release for their emotion.
"I miss who I was before I lost you, I miss being able to close my eyes without reliving that moment again and again, I miss not having to defend myself for being miserable and I miss being able to love someone without being terrified that I'm going to lose them," writes one mother in an Instagram post, according to Huffington Post Canada. "But most of all, I just miss not getting to know you Freddie Bear."
Stillbirths happen less frequently than miscarriages. "Stillbirth effects about 1 percent of all pregnancies, and each year about 24,000 babies are stillborn in the United States," according to the CDC. In contrast, About 50 percent of pregnancies results in miscarriages, according to the March of Dimes.
But the organization explains that many women don't even realize they are pregnant before miscarrying. About 15 to 25 percent of recognized pregnancies end in miscarriage, according to WebMD. Clearly, miscarriages are more common than stillbirths. Both are traumatic, but the stillbirth brings a unique set of circumstances because of the baby's size.
As a result, it is somewhat comforting to know that stillbirths do not happen as often as miscarriages. It can put a pregnant woman's mind at ease because once she gets to the second trimester she is less likely to experience a miscarriage and the odds are that she'll have a healthy baby. Second-trimester miscarriages, in fact, happen in one to five out of 100 pregnancies, according to the March of Dimes.
Miscarriages and stillbirths are completely different when it comes to symptoms. A miscarriage has many symptoms and rarely happens without some warning. For instance, women might feel abdominal and back pain and bad cramping. Mom might feel weak and not the usual exhaustion of pregnancy but something more.
For instance, some women have said they experienced dizziness and feeling faint. Others have had extended diarrhea. Of course, the most obvious sign that an expectant woman is miscarrying is bleeding. Once the miscarriage gets physically underway, the woman will push out hard, golf ball sized blood clots. It can be painful physically and emotionally, of course.
Some women opt to naturally miscarry, whereas others have their doctor perform a procedure, usually dilation and curettage (D&C) to finish the miscarriage. A stillbirth, on the other hand, has few if any symptoms. Sometimes, moms realize that there is less fetal movement and doctors will then perform tests, such as an ultrasound, to see what's happening with the baby. They will also monitor the heartbeat.
Miscarriages and stillbirths also have different causes. To some extent, both are still a bit of a mystery. Medical professionals admit they don't know all the causes. Sometimes, there are unexplained stillbirths. And miscarriages are often unexplained because doctors only study the fetal tissue if a woman has had multiple miscarriages to determine what's happening.
Still, there is some consensus about possible causes of miscarriages. Whenever a woman has a first miscarriage, her doctor will explain that it was likely the result of a chromosome problem.
"Chromosomes are tiny, thread-like structures in cells that carry our genes. Each person has 23 pairs of chromosomes (46 in all)," according to the March of Dimes. "One chromosome in each pair comes from the mother, and the other comes from the father. Most chromosome problems happen when an egg or sperm cell has too many or too few chromosomes."
Other causes of miscarriage include blighted ovum, which means a fertilized egg appears in the uterus but a baby does not form, and mom's health issues, such as diabetes, thyroid disease, lupus, hormone problems, and infections. Mom's health can play a role in stillbirths as well.
Uncontrolled diabetes, high and low blood pressure, previous complications in pregnancy, age over 35, and being pregnant with multiples might be causes of a stillbirth. Other reasons for stillbirths include problems with the umbilical cord or placenta or a genetic problem or birth defect.
For a miscarriage, women can either allow the miscarriage to start and finish on its own, which means suffering through the passage of golfball-sized, hard blood clots and usually comes with abdominal and back pain. And it can be emotionally draining for women, who are experiencing a great loss. Or they can have a medical procedure, usually a D&C, to finish the miscarriage.
The pregnancy hormones may be in a woman for up to two months after the miscarriage. And it usually takes about one month to recover physically. For a stillbirth, moms also usually have the chance to choose whether to naturally go into labor or induce it. Women might also have the option of a C-section or dilation and evacuation (D&E) procedure.
In some cases, labor has to be induced for the sake of mom's health. Mom usually goes into labor within two weeks of her baby's death. If she doesn't, then labor is often induced because she might experience dangerous blood clots, according to the CDC. Every case is different, and doctors can help moms make the best decision based on their situation.
Deciding when to try to conceive again after a stillbirth or miscarriage is a personal decision. Couples must search their own hearts and talk to their doctors to figure out what would be healthy and what just feels right. Some of it depends on mom's health. She might have ailments, such as an infection, that may have contributed to the stillbirth, for instance.
In addition, moms, who deliver stillbirths via C-section, will have a longer healing time. Most doctors recommend waiting at least six months after a C-section before getting pregnant again.
Generally, assuming mom is otherwise healthy, doctors will recommend waiting two to three menstrual cycles after a miscarriage, stillbirth, or full-term delivery, according to Babble, which quoted Ann Douglas and John R. Sussman, MD, authors of the book, Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss.
While parents might be physically able to try again, they may need more time to grieve. Some will decide that trying again isn't for them. Parents need to weigh the physical and emotional risks and make a decision that is right for them and their unique situation.
Humans have this tendency to try and outdo each other, and sometimes our darker angels get the best of us. People want to say one loss is worse than another. A loss is a loss is a loss, and every person experiences loss differently. No one should compare one to another. Miscarriages and stillbirths are ugly, sad, and traumatic.
There's no question that a stillbirth usually brings with it more shock and disappointment because parents get to see their fully formed angel in the flesh, and they've had more time to anticipate joy rather than this sadness. But a miscarriage also brings with it an emptiness and disillusion. In both cases, people expected things to go differently than they did.
Society has made that moment of conception - when one reads the pregnancy test results or hears it from the doctor - as such a joyous occasion. Just watch any such episode of a sitcom. What no one ever says is that a positive pregnancy test does not guarantee a healthy baby will arrive. The truth is that pregnancy is not for the faint of heart.
Often, people don't know how to react when someone shares sad news, such as a stillbirth or miscarriage. But they tend to be more sympathetic and understanding in the case of a stillbirth. They have handled the deaths of loved ones before, and they see this as the same. Of course, it is.
They will send their sympathies, attend a funeral (if that is what the parents want), and send flowers or fruit baskets. They have some practice and socially accepted rituals to which they can turn. They will visit the parents and offer hugs and a shoulder to cry on. Things are often different with a miscarriage.
Usually, mom saw nothing more than a tiny nugget in her womb, which makes it hard for others to recognize the weight of the loss. Most people don't realize the physical reality - passing those blood clots and all the abdominal and back pain - of a miscarriage.
Because miscarriage is the kind of news that makes people uncomfortable and many might not even know the woman had been pregnant, moms keep silent and never share their grief. Sometimes, when they do, they get the wrong kind of reaction. Well-meaning people say insensitive things, such as, "It wasn't a baby yet," or "You'll have another baby, don't worry."
And in both cases they discount dads or partners all together, even though they have experienced a grave loss, too. Regardless of whether parents lost their baby through miscarriage or stillbirth, most really just want a hug and some sympathy.
Some of the same women are at risk for miscarriage as are for stillbirth. For instance, women who smoke, drink, and use drugs are at a higher risk for both than those who don't. Having a healthy lifestyle helps increase the odds of a healthy pregnancy. But it's not a guarantee.
Some of the risks are out of one's control, and moms should not blame themselves if they have a miscarriage or stillbirth. For example, women who are black or unmarried or a teenager have a greater risk of stillbirth, according to the CDC. No one seems to be sure exactly why those groups are more affected.
Women who are obese, have had previous miscarriages or stillbirths, or have chronic diseases, such as diabetes, are more at risk. Being pregnant with multiples also puts a woman at risk for a stillbirth, according to the CDC. Age - being over 35 years old - increases the odds of both miscarriage and stillbirth.
"In fact, 40 year olds are about twice as likely to miscarry as 20 year olds," according to BabyCenter. "Your risk of miscarriage also rises with each child you bear." A history of miscarriages, chronic diseases, uterine and cervical problems, a history of birth defects, environmental factors, medication, diagnostic tests (such as amniocenteses), infections, and even paternal factors have been linked to increasing risk of miscarriage, according to BabyCenter.
Parents want answers after suffering losses, such as miscarriages and stillbirths. They want to know why this happened and whether they can prevent this from happening again. Much of the time, especially in the case of miscarriage, there are few explanations. Unless a woman has had multiple miscarriages, the fetal tissue is rarely examined to try and understand what went wrong.
The majority, however, are known to have happened as a result of a chromosomal abnormality, according to an OB-GYN practice in Paramus, N.J (It's the explanation doctors there gave me when I experienced a miscarriage in 2010.) Stillbirths are different.
Many parents agree to post-mortem testing, including an autopsy, placental exam, genetic testing, and a gathering of an advanced medical history, according to the CDC. The testing takes time, which can be hard on parents, who are trying to overcome their grief and understand exactly what happened.
In the end, even with the testing, many never get a conclusive answer about what went wrong. Sometimes, there is no explanation, which can be frustrating to parents. Still, some say the evaluations help them feel as though they are being proactive and can help ease their fears about trying to conceive again because it can uncover possible risks that can be minimized.
Women who have experienced stillbirths and miscarriages often go on to have healthy babies. "Less than one in 100 women who’ve had a stillbirth in the past (less than 1 percent) go on to have another stillbirth," according to the March of Dimes. Testing, such as an autopsy, sometimes help inform parents about the risk involved.
Waiting to heal physically and emotionally is always wise before jumping into trying to conceive again. If there is a genetic problem uncovered during testing, then seeking help from a genetic counselor is a way to weigh the risks, according to the March of Dimes. Most women who experience miscarriage can go on to have healthy pregnancies.
In fact, only 1 percent of women go onto have a second miscarriage, according to the Mayo Clinic. And the chances of having a miscarriage remains the same with every pregnancy regardless of whether a woman has had one before. Things change a bit for the 1 percent who have multiple miscarriages.
"The predicted risk of miscarriage in a future pregnancy remains about 14 percent after one miscarriage," according to the Mayo Clinic. "After two miscarriages the risk of another miscarriage increases to about 26 percent, and after three miscarriages the risk of another miscarriage is about 28 percent."
Each woman has to decide whether the risk is worth it. Often, the desire to hold a baby in their arms and the fact that the data is in their favor gives people the strength to try again.
Sources: Centers for Disease Control and Prevention, Huffington Post Canada, BabyCenter, Mayo Clinic