They say --and it's confirmed by everyone who's ever had to go through it -- that the hardest thing in the world is to bury a child.
What they don't say is that to a woman, at least, having a miscarriage is the same.
Only recently, however, have doctors begun to understand this. Many still do not.
"People," says writer Barbara Berg, "tend to dismiss miscarriage. We have a nickname for it. We call it 'a miss.' People say, 'Oh, you'll be pregnant again before you know it.'
"But whether I would be pregnant again or not is really not the point."
Barbara Berg had a late-pregnancy miscarriage and a baby born dead before she and her husband adopted a child. A few months later, despite a host of threatening complications, they had one of their own.
Berg is a feminist, a professor of history (now part time), and has written of her "quest for motherhood" in Nothing to Cry About (Seaview Books, $12.95). Its name derives from the offhand statement her doctor made to her after her miscarriage at five months.
"Miscarriage is belittled," confirms Dr. Elisabeth Herz of George Washington University Medical Center. Dr. Herz is an obstetrician-gynecologist, and also a fully certified psychiatrist. She is one of a small, but growing, number of specialists in the two fields with especial concern for the areas in which they overlap.
The so-called "spontaneous abortion" is one.
"Women who are pregnant," says Barbara Berg, "form a very intimate bond with their baby." (With use of the sonogram, notes Herz, the bonding can come even earlier now. A fetus even may be seen sucking a thumb in a sonogram, before a mother has felt life.)
Yet, says Berg, even though "we had bought the layette, really made plans, after the miscarriage people said, 'Okay, get back to work as soon as possible,' and my husband took me on a trip. Everyone said, 'Get her away,' as though you forget when you're away. So we went to California and all we saw were other pregnant women with babies . . . ."
Herz speaks with the compassion and wisdom her training and wide experience have brought, Barbara Berg with the impassioned intensity she drew from her own anguish.
"We have," she says, to allow women who lose babies to grieve the same way they'd grieve if they lost a living relative. With the stillbirth I was never asked if I wanted a funeral and later when I said I'd never seen the baby, people would say, 'Oh, that's so morbid, why would you want to see the dead baby?'
"And I said, 'Look, this was my daughter. She was four pounds. If she'd not died in utero she'd have been able to live . . . This was a child of mine . . . .' "
Miscarriage, says Herz, "is not taken in the true aspect that it is a loss and that the woman has to go through a grieving, mourning experience in order to get over it, in order to reintegrate her own personality. The great number of patients constantly suppress, suppress, suppress.
"Where grief is repressed, it comes out either as a delayed grief reaction or as a distorted grief reaction," both of which can require professional therapy.
On the average, some 15 percent of pregnancies end in miscarriage. Sometimes there are specific genetic or physiologic reasons and sometimes these can be treated. Often there are no apparent organic reasons.
A woman who has one miscarriage has no less chance of carrying her next pregnancy to term, but a woman who has, say, three successive miscarriages, has only 16 chances in a 100 of the next pregnancy being successful.
In medical parlance, such a woman is called the "habitual aborter." And a common reason for miscarriages is what the doctors call an "incompetent cervix."
Barbara Berg went through a series of humiliating, demeaning and depressing encounters with doctors, nurses and hospital bureaucracies.
As a highly educated and successful career woman, and, to boot, a specialist in (and author on) feminism, Berg says that "I certainly believe that a woman's ability to bear a child has absolutely nothing to do with her identity or her competence, yet when I went through these things I felt that it did . . . .
"What I have learned is that you don't have to apologize for the wish for children. It's very strong, very profound and if it's not satisfied, I think it is a pain that stays with you . . . maybe forever. There is nothing in the male psyche that approaches it. It is primal, primitive, cosmic."
"Why is it," posits Herz, "that the average American OB-GYN has a hard time giving the emotional support which is needed?"
For one thing, she suggests, "physical death in OB-GYN is not a frequent thing. Perhaps they themselves, are not quite able to deal with death so you have already a specific kind of person going into the specialty.
"Secondly, they are trained in medical school as diagnostician and surgeon, not as counselor or consoler.
"Then, of course, every doctor fights against death so that the moment when you have a death, the doctor may feel a failure."
It is not, however, just the doctors, says Herz. "Our society in general has an unfortunate approach to loss, grief and mourning. We have a great tendency to stick it under the rug."
Berg: "As my OB said, 'Look, many of us choose this profession because it's a happy one.' They want to bring life and everybody loves the doctor. He's the hero. He's God. And if the baby dies, it may not have been his fault, but in some way he perceives it that way, and he'll be angry. I felt my doctors were kind of angry with me.
"One of them said, 'After all, Barbara, you're a difficult obstetrical patient.' Yes, yes I am, but I didn't want to be."
In her role as OB and psychiatrist, Herz spends part of her time in clinical work at GW, part in her own practice and part teaching in the GW Medical School.
"When you are a resident in OB-GYN," she says -- her own residency was done some years ago in her native Vienna -- "you want to get your hands on as many forceps as possible, on as many surgical procedures as possible, because you want to get them under your belt . . . I try to tell them, 'You cannot think only in terms of an ovarian cyst. You have to realize what this means for this woman.' You cannot divide mind and body."
Some things that tend to weaken the cervix are repeated D&C procedures, or repeated abortions. Specific conditions such as diabetes and hypertension may make pregnancies difficult. But there are also myths that can tend to exacerbate a guilt trip that society is determined to lay on the woman whose pregnancy fails. Such as: sexual relations caused the miscarriage, or heavy exercise, hard work or heavy lifting. None of those probably had anything to do with it, unless proscribed specifically for a particular reason.
However, says Herz, studies have indicated that when a woman considered a "habitual aborter" is under psychotherapy, her chances of a successful pregnancy can escalate.
Among other projects, Herz is trying to put together a support-therapy group of women who have had successive miscarriages.
For information, phone 676-4357.