Mother's Day and Miscarriage: Mother's Day Arithmetic

In these shells, our bodies, we live our mortal lives at the mercy of the biological rules that govern survival. So sometimes bad things happen. One such very bad thing is a miscarriage. Miscarriage occurs in about a fifth of all clinically diagnosed pregnancies. This is a staggering amount of tragedy since most couples never consider this possibility when they choose to have a child. And if one were to include the very early miscarriages that happen around the time of an expected period, the numbers may be much higher.

Miscarriage can happen for a number of reasons. Almost always it is because of some random genetic mismatch incompatible with life. Once again, we're at the mercy of the biological rules. It is nature's way of assuring a continuing healthy species. Miscarriage can also happen due to infection, maternal diseases like lupus, diabetes, and thyroid problems, and abnormalities with the anatomy of a woman's reproductive tract. The sad fact is that it does happen to people who are blind-sided by this loss. Sometimes it happens to the same couple more than once, prompting evaluation for known causes. But it's frustrating that most of the time there is no known cause, and the couple feel they are being sent away with only an invitation to return to the obstetrician for the next try.

This is the illusion, especially in a couple's eyes who feel that the loss is their own private tragedy they can't seem to share enough with others no matter how hard they try. This is because there are no rituals for this type of human loss. There are no funerals or memorial services. Friends and relatives, often misguided into thinking that mentioning the miscarriage will only be upsetting, are instead seen as uncaring in their silence. The grieving couple have only each other, and that may not be enough for the feelings of guilt and self-examining retrospection.

And anger.

After all, this isn't just some tissue that was discarded, like an appendix or a gallbladder. This is just not one of their parts. This was their son or daughter. There were dreams of seeing little league events, helping with homework, attending dance recitals, walking down an aisle. And the whole sense of what might have been is lost to a clinical world of procedures, blood tests, and insurance forms.

As an obstetrician, I can assure any couple that their miscarriage is not just any clinical event. I've been in obstrics long enough to see some of the babies I've delivered wear a mortarboard or start a family. This is professionally thrilling for me, for with conception we start a process that begins a whole, full life for someone--someone we'll miss if that someone goes "away" with the biologicial tragedy called miscarriage. In a way, I grieve with the parents, too, because I know what is being lost in a miscarriage. I'm right there in the middle of it as well. And I put it on a different level than the clinical protocols I employ to deal with it.

A mathematician can count on his fingers, but that in no way reflects the beauty of mathematics. This word processor can lay down words at the direction of certain keystrokes, but that in no way compares to the actual beauty of what is written. I manage the complication of miscarriage, but that doesn't reduce my feelings for what might have been. So I do not merely send them on their way with an invitation to return for the next try. Instead, I applaud them for going back into the world to once again play by the biological rules. They will have that baby not to replace that permanent little hole in the heart left by a miscarriage, but because they want a baby.

On Mother's Day, let's not forget those who also should be mothers. Let us also honor the ones who are determined to be.