Not every pregnancy results in a birth. Many pregnancies end in spontaneous or elec­tive abortion.

Miscarriage and Stillbirth

Even when pregnancy has been confirmed, complications can prevent full-term devel­opment of the fetus. A miscarriage is a spontaneous abortion that occurs in the first 20 weeks of pregnancy; many occur before the woman finds out that she is pregnant. At least one in seven known pregnancies ends in miscarriage (Springen, 2005). ■ Table 11.1 gives the most common causes of miscarriage, but in many cases doctors are unable to determine the specific cause (Kaare, 2009).

Early miscarriages can appear as a heavier than usual menstrual flow; later miscarriages might involve uncomfortable cramping and heavy bleeding. Fortu­nately for women who desire a child, one miscarriage rarely means that a later pregnancy will be unsuccess­ful, although many women and couples worry about the possibility of having another miscarriage in a sub­sequent pregnancy.

When a fetus dies after 20 weeks of pregnancy, it is sometimes referred to as a stillbirth. About 26,000 fetal deaths occur each year in the United States, and rates of fetal death are higher for teenagers and women age 35 and older, and for twin and other multiple births (MacDorman & Kirmeyer, 2009). As with miscar­riage, the causes of stillbirth are often unknown. Prob­lems with the placenta or umbilical cord, the baby’s health or development, and maternal health problems such as diabetes or high blood pressure are some of the known factors.

Miscarriage and stillbirth can be a significant loss for the woman or couple. Couples may need to grieve the loss of this pregnancy and baby for several months

Conceiving Children: Process and Choice

before pursuing another pregnancy. Some parents who lose an unborn child find it meaningful to create a memory book of the pregnancy and baby and hold a memorial ceremony of some kind. With a stillbirth, parents may find it important to have photos and footprints of the baby (Price, 2008).