December is a hard month for Cory Beyer and Lisa Goodwin. Both women remember it as the time they began to celebrate their first pregnancies, and the first time they had to suffer the isolating grief of a miscarriage.
"It was going to be a big Christmas surprise to our families, but then we found out that it didn't have a heartbeat," said Beyer, of Tulsa, Okla. "It was a total surprise and shock."
To add to her pain, Beyer quickly learned that her sister-in-law was expecting. "As much as we wanted to celebrate her, we felt like we couldn't, and the family didn't understand why," said Beyer, a member of the Tulsa chapter of Mend, Mommies Enduring Neonatal Death.
According to the National Institutes of Health, up to half of all fertilized eggs die before the woman knows she is pregnant. Once a woman knows she is pregnant the miscarriage rate drops to about 15 to 20 percent. Most miscarriages occur during the first seven weeks of pregnancy. Miscarriages are defined as a pregnancy loss before the 20th week.
Although common, research shows that miscarriages fall into a unique category of loss: rarely mentioned, poorly understood and mourned differently by everyone involved. Some women rebound easier than others, but many are pushed into an isolating sense of loss and guilt.
"I heard comments by an older aunt, 'this is just god's way of taking care of someone who's unhealthy.' People don't know how to react," said Renee Henvey, who had a stillborn at 9 months in 2001 and a miscarriage in 2003.
"There is a stigma on miscarriages...not feeling that it is really a baby yet," said Henvey, who now has two boys and lives in the Dallas area. "It is a deep deep loss. My husband and I were definitely affected."
Doctors say women may also feel responsible for a miscarriage as if they didn't take care of themselves, although genetics problems and infections cause most miscarriages.
"Women have this idea that if they eat right, take their vitamins and go to the doctor everything is fine ... but there is this uncontrollable part of the biology," said Dr. F. Sessions Cole, chief medical officer and director of Newborn Medicine at St. Louis Children's Hospital.
Kristen Swanson, dean of Nursing at the University of North Carolina, Chapel Hill has studied couples' reactions to miscarriage and how best to counsel them after a miscarriage. Her latest research was published this October in Journal of Women's Health and Gender-Based Medicine.
Previously, Swanson has found that the pain of a miscarriage is just as intense as the pain of a stillborn, but the emotional pain of a stillborn lasts much longer.
Lisa Goodwin, of Houston, remembers December as the first time she had to go in for a dilation and curettage, a D&C, to remove the remains of her first miscarriage. Her third pregnancy also ended in miscarriage.
"I told all of the downtown medical center," said Goodwin, who was excited that she got pregnant relatively quickly after battling endometriosis -- a condition that often leaves women infertile.
"I had to tell people [about the miscarriage] for a solid year," she said. "If it came up at work I would have to just go and bawl and I'd have to wear waterproof mascara."
Goodwin has two sons now, ages 7 and 3, and each Christmanremembers the two pregnancies that ended in miscarriage.
"Every year, I get the two ornaments for 'baby 1' and 'baby 2' and I hang the ornaments on the tree," said Goodwin, who is also a member of Mend.
Cole says the grief of a miscarriage is often physical and concrete for one parent, and more intellectual for the other.
"Women experience pregnancy, men intellectually acknowledge pregnancy," said Cole, who noted that even after the father feels the baby kicking, it often does not lead to the same thoughts as the mother has.
"They're not the same as feeling the baby move itself ... there's a different emotional chronology between the partner and the pregnant lady," said Cole.
Moreover, research shows men and women often don't discuss this difference. Swanson sites statistics that 85 percent of couples have a limited discussion about a miscarriage, and that the mother-to-be and father-to-be mourn differently.
When asked "just what did you lose," Swanson said, "we frequently find that women would say, 'I lost my baby,' 'my son' or 'my daughter.' Men would talk in more vague terms, like 'I lost my future son' and mostly that they lost a relationship with their wife, their beloved."
She tells married couples the man may have promised to have and to hold in sickness and in health, but "you never said 'and feel the exact same way you do.'" Swanson added she see the difference in reaction is even translated to the pregnant and nonpregnant partner in lesbian couples.
Paula Miltenberger, a clinical psychologist who specializes in treating women in Dallas, said this difference need not impede the couple's healing.
"The biggest thing is to allow the person who's had a miscarriage to talk about it," said Miltenberger. "A lot of these women will suffer in silence, because they feel like no one understands."
If the woman's mourning is not addressed or gets complicated, doctors say she can go on to carry the burden of a miscarriage into their next pregnancy. Researchers such as Joann O'Leary at the University of Minnesota have reportedly also found that untreated grief after a miscarriage can change the way a woman mothers in subsequent pregnancies.
"I actually have seen situations where wonderful, wonderful mothers with great personalities don't see how they are expecting their one child to be more than the child ever could be," said Cole.
In his work, Cole said he has found that women mourn what the baby meant to them as much as the life itself, which can complicate the next pregnancy if the mourning wasn't addressed.
"Every pregnancy represents hope, and every mom when she's told that she's pregnant has a set of ideals that have to do with her upbringing, hope for herself and her future," said Cole. "All of that hope [can] go away when a miscarriage occurs."
Indeed, Goodwin said her subsequent successful pregnancies were fraught with worry rather than elation.
"Until that baby comes out of your body and is breathing, nobody can convince you that it's OK," she said.
Beyer said after her first miscarriage, she stopped trying to bond with her baby in the second pregnancy. While she kept a journal in her first pregnancy, in the second pregnancy she didn't keep one. By the third, she tried the journal again but it sounded curt.
"I wrote 'here it is week 9, this is when I lost your brothers and sisters, and I hope you're holding on OK,'" said Beyer. "I never got anything for the baby until the baby kicked."
Even after she gave birth to her son Hudson, now 5, Beyer said she feels unsure of her time with him.
"I just appreciate him every day. If he wants a hug and I stop what I'm doing and I give him a hug, I don't know how many more days he will be asking for a hug," she said.