I have seen women very upset who miscarry on the day of their vaccine or shortly after. This does NOT mean the two things were connected. Thousands of women lose their babies every day. It’s sad and terrible, and I so wish it didn’t happen. It only makes sense that some of the women who lose their babies will have done something that day that will make it seem connected. Had sex. Worked out. Fallen down. Or gotten a vaccine or other medical procedure.

Right now there is one thing we do know: swine flu is unexpectedly more dangerous to pregnant women and their babies. They are dying. Not all of them, not even a lot of them, but more than was expected. So the flu itself is a risk.

• Are there little children in your house who could bring home swine flu?
• Are they in day care and more likely to get swine flu?
• How do you personally handle illness?
• Have you been prone to illness so far in the pregnancy, are you run down or fighting difficult symptoms?
• What sort of swine flu complications are popping up in your specific part of the world?
• And importantly, have you ever had a flu vaccine? Did it make you sick before?
• Do the benefits of the vaccine outweigh the risk?

Hannah lost two babies to stillbirth in less than a year. I visited her altar at the exhibit, where she had tributes not only to her children, but also let visitors add to chains of bracelets with the names and dates of their own babies.

So many wonderful and proud mamas are doing great work to help get miscarriage out of our secret lives and into the open, where we can talk about it without discomfort.

See more pictures.

I spent today making votives for the people coming to the one here in Austin, Texas. If you are hosting one, and would like to use this label for votives of your own, feel free to right-click and “Save picture as.” It is designed for standard address labels, Avery 8160. It does not have to be printed in color. It looks good in black and white too.

The Austin candle lighting will be at the lighted fountains in Butler Park, which is behind the Parmer Events Center (Long Center.) It’s easiest to park along the street on Riverside. We generally light them by the water’s edge, but you will find us by our candles.

Here are the final votives and how they turned out. You can get little candles like these for about $4 a dozen.

Blessings to all of you who will mark this day for your lost babies.

I have had quite a few of these lately, and I’m talking about them because if you’re here right now, you’re probably either scared or grieving, worrying about a little blood you just found, or having some cramping, or waiting for test results and looking for information on the internet.

I’m here to tell you that even if the worst happens, an overwhelming majority of you (yes, YOU) will go on next time to have a healthy baby. You will never forget this one, and you will always carry a bit of grief in your heart over this loss. But you will go on, and you will find the courage to try again.

One thing about talking to women in the middle of a loss every day, as I do, is that you learn to appreciate the happy endings. So many of us have a very difficult journey into motherhood, full of despair we never knew we’d feel in connection with what was supposed to be the most joyous period of our lives.

But we do find our way. For a few, it might be adoption or recurring miscarriage treatments. But for most of us, we’ll perservere, and that baby we long for will come. And when it happens to you, I’m delighted to hear about it.

I’ve had a four-fold increase in direct emails since the new year began. Heartbreaking stories, difficult moments. Many of you feel so very alone.

I’ve heard women say things that make me so sad that in the ten years since this site began, so little has changed in how we feel about revealing the extent of our grief:

• On Facebook, a woman wrote me thanking me for the private support, but she couldn’t join the Facts about Miscarriage support group because she didn’t want any of her Facebook friends to know she’d lost a baby. (Note that you have to be a member of Facebook–which is free–to see our Facebook group.)
• Via email, another woman felt uncomfortable sharing the name of her baby, as she thought others would think it silly to name her lost child.
• And everywhere, friends tell me how they keep their pregnancies to themselves for months, “just in case.” They don’t want others to know about the baby should they have a miscarriage.

I understand all this. I’ve been in these places, felt these things. But I want, really really want, a world where life CAN be celebrated from the moment it is known to exist. That we CAN tell our friends and family about this devastating loss, and feel loved and supported as we would in any death in the family. That we would NEVER feel guilty or as though we did something wrong, that the miscarriage was our fault.

This year I’m going to work even harder to make this happen. I’m applying for fellowships, trying to find time (and grant money to support me) to finish Baby Dust. I want to get this so visible, so public, so open, that we can change this feeling that we should hide what has happened.

We can’t change the miscarriage rate. This year, like most years, 6 million women (in the US) will get pregnant and almost 1 million of them will lose her baby. We are probably one of the single largest groups that suffers so silently.

I know from your emails, your notes, and your blog posts that you are having a hard time. 2009 isn’t starting off anything like you hoped. But this is a year we will get stronger. We’ll make something out of what has happened to us. And we’ll change things, because our babies, those beautiful little life-lights, live through us.

Before I say anything else, I want to assure you: That’s just fine. You don’t have to feel thankful. You don’t have to count your blessings every single moment. You can, when you need, grieve for the holiday you thought you would have, either glowing and pregnant, enduring jokes about eating for two, or with that new baby, walking into relative’s home to the exclamations over the new family member.

Do not feel you have to save face. Do not feel you have to hide how you feel. And if your family gathering involves pregnant women or new babies, this may be the year to volunteer in the kitchen. I always start cutting onions if I can’t control myself, for the concentration and the excuse for tears.

If you find yourself in a tough situation, look around for a sympathetic relative. Maybe it will be the boys, and you can run off with them to watch a football game rather than fuss over the small children. Maybe it will be a forgotten aunt. Take time to really get to know her this year.

Don’t expect that everyone is going to understand. Your sister-in-law might feel slighted if you don’t want to hold her newborn. Walking out of the room during a discussion of what to name a baby might cause a little stir.

SO WHAT.

Try not to get into any confrontations about it. Just smile and make a simple excuse. Plan ahead so you can bow out of uncomfortable moments gracefully by maybe preparing some complicated dish of your own.

Your years will come.  Have faith in that. And while you’re washing dishes or stuck watching UT beat the Aggies, think ahead to that, to your turn, and even if your family thinks you are being dramatic or over emotional, they are your family. You were born into it, and your future babies will be too. Love them even if they don’t understand.

Hopefully you have a good understanding doctor in your corner (if not, FIND one, ask your friends for recommendations) and a supportive partner.

But still, as the nausea starts to hit and you consider whether or not you can get away with leaving your pants unbuttoned, you wonder–should I tell anyone I am pregnant?

The first impulse is to keep it to yourself. Your conversations about the loss might have been too terrible and painful to consider going through again. Maybe you feel like a failure (though you shouldn’t) or worry you will be judged.

It’s natural for us to want to hunker down with our pain, fight it alone, and try to keep the glossy outside world separate from our grief. Maintaining a zone where you don’t have to think about a loss, where you can escape it for a few hours, is a legitimate reason to keep the information from coworkers or bosses.

But I do think you should reconsider not telling friends and family. Imagine yourself, 25 years down the line, with a daughter in your position. Would you not want to know? To hopefully offer some sort of ear, if not concrete help?

I know some of us have parents who are less than helpful. Our partner’s parents may be worse. But I am a big believer in pain shared being pain halved, and if you don’t let anyone know you are pregnant, then no one can help you in your dark days.

I also want you to consider this: if you knew you only had two weeks to spend with someone you loved–how would you want it to be spent? In secret, in shadow, just between you? It’s possible, and if so, then keeping the knowledge private might be the way to go.

But if you want hope, joy, and happiness to suffuse what time you might have, then let it all out. Greet this new baby into the world with all your heart, make memories, make scrapbook pages, and make a mini-life. You are not going to feel worse because you did this. Your heart cannot hurt any more than it will if you kept it a secret. But you will have had that happiness, and certainly those moments make the pregnancy worth it, no matter how it ends.

I understand the need to hide it. If you read my journal you’ll find I felt exactly the same way the second time around. But in hindsight, and that is what I share with you, I am glad I wasn’t able to contain it and told everyone. Because when the bleeding started, when the tests were abnormal, when I had to be on bedrest, crying, sure another baby would be lost, I had help. I had books, I had phone calls, I had caring. And me and that baby were surrounded with love, and that’s the best way to go out of this world.

I am always glad to find a book that is up to date and comprehensive, the best sort of resource for a woman who is ready to sit down and read, hoping to find a stronghold in what has felt like a freefall so that she can begin the search for answers.

Overall, this book delivered. The section on myths (and why luncheon meat does not cause miscarriage) made me want to leap up and shout, “Finally!” So many women, with their pregnancy manuals in hand, will apply the warnings about tuna and hair dye and hot tubs retroactively, certain that they caused their losses. Young clearly defines the line between a theoretical health risk and a serious miscarriage cause.

The book contains all the classic elements: signs of an impending loss, common causes, treatments, and thoughts on prevention. It has a nicely expanded section on the impact of health conditions that can complicate a pregnancy. Some of the stories were out-and-out riveting, including patient histories where one twin was failing and they had to make a careful decision on when to deliver for the safety of both, and the harrowing case of a woman with kidney disease trying to delay the birth so her baby would survive, even though she was risking death herself.

I would recommend this book, but I have some very sharp criticisms. I almost flung the book across the room in horror the moment I opened the Table of Contents.

I’m not sure who thought glib chapter titles such as “scarred and scared” for scar tissue or “misplaced trust” for ectopic was a good idea, but let me be clear: miscarriage is not and will never be funny. Do not try to be clever or use flip word play to women who are in real pain.

This happened again in the myths section. Young calmly talks about how working out, having sex, and caring for your other children are perfectly safe activities. Then, inexplicably, he gets cute, saying that because of the association between night work and an increased risk of miscarriage, “…You can work very hard, only not at night!”

Is that supposed to be funny? Are all the women who have evening shifts, nurses and factory workers and 911 operators, supposed to read that and think—I killed my baby? Once again I sat the book down and reflected on whether or not I could recommend it.

I am not a fan of the “I’m the doctor know-all” style, nor the way Dr.Young starts off each chapter by describing the physical characteristics (overweight, blonde, tall) of the woman whose case he is about to explain, but this is the most recent book that covers what many of you want to know—the how, the why, and the what next.

Since it does its job efficiently most of the time, I will, with some reservation, say, yes, I can recommend it to you. But don’t read it when you’re upset. Take up this book when you are ready to plod through some of the insensitive writing to get at the heart of the research and information.

More about Miscarriage, Medicine & Miracles

I didn’t find any similar articles in US papers, but it’s easy to see why the new home pregnancy tests could cause a flurry of concern.

Old-style tests, manufactured prior to 2004, typically looked for a pregnancy hormone level of 50-100 mIU/ml and were not effective until the day a woman missed her period, on average, about 14 days post fertilization. This is when the baby is well implanted and the miscarriage rate is expected to be between 8 and 20 percent.

The new tests, however, detect the hormone at 20 mIU/ml. This is within a day or two of implantation, more like 9-10 days after fertilization.

Since the advent of early sonography, we’ve known that a huge number of fertilized eggs either never implant at all, or attempt implantation and fail. This number varies depending on who you ask, but is always frighteningly high — between 50 and 75 percent.

For many moms, working so hard to achieve pregnancy and the family of their dreams, this is a terrible and sad loss. The emotional pain in getting their period after seeing a positive pregnancy test is often strong and frightening.

These early losses, however, almost never indicate a problem that needs treatment. The fusing of the egg and sperm’s genetic material is tricky and often goes awry, either misaligning or dividing improperly in early cell growth. When the egg with chromosomal errors bumps against the uterus, the body will start the implantation process. This sets off the manufacture of pregnancy hormone, but often, the lining rejects the egg. In this case, the woman’s body will register a fleeting rise in pregnancy hormone even though the baby could not implant and grow. The new tests are so sensitive as to catch the temporary rise.

This early chromosomal rejection has no bearing on the health of the mother or her ability to carry children to term. The rush of hospital visits by distressed moms causes extra upset and frustration. They often find they are simply turned away. Others might be subjected to invasive and unnecessary tests. The problem amplifies — moms want their babies to be recognized from conception, and health care providers want to maintain a simplicity in diagnosis and treatment of clinically recognized pregnancy and miscarriage.

As I write what I hope to be the newest book about miscarriage and how to get through it, I will address the issue of the new definition of miscarriage. Do we adjust our statistics and scare women with the real figure — that over half of their pregnancies will be lost before week 5? And how do we decide when a woman actually needs intervention for recurring miscarriages? Do early losses simply “not count” anymore? I do wish sites like this one that advocate super-early testing also include a reminder of how common an early loss can be.

Perhaps we will rewrite the rules based on our early detection of pregnancies, creating a hierarchy of risk based on gestational age. But the rules will be for treatment and clinical relevance only. Our babies are our babies, whether at 16 cells or fully formed in our waiting arms.

Many of you know my younger daughter Elizabeth was once part of a set of twins. I lost one of the babies when my water broke on that sac at 10 weeks. It was a harrowing experience as I was on an airplane, only two hours into a 12-hour flight between Switzerland and the US.

After a tense week, we finally saw Elizabeth’s heart beat, and the other sac collapsed and got out of the way. I had no further complications to her pregnancy, other than the usual stuck position and required c-section.

A few days ago, after taking Elizabeth’s hair out of braids, she said, “I have angel hair!” So we took her picture holding a baby doll, which I later replaced with an image of herself as a baby.

There isn’t a sweeter guardian angel than Emma Hope, Elizabeth’s twin, and no better way to portray them than with a sister who once shared her womb.

This image is available at RedBubble for a keepsake card or a little poster for baby’s room, if you also have a guardian angel who will watch over you or your other children. It includes the very common phrase you will see repeatedly on grief sites, miscarriage tickers, and signatures, “Some people dream of angels…I held one in my arms.”