Woman crying, tears, sad, sadness, depression, grief, depressed.

Suffering in silence ... miscarriage affects up to 25 per cent of pregnant women.

It happens to one in four pregnant women in Australia. But you wouldn't know it because women tend to suffer it in silence.

In fact, silence means the rates of miscarriage are likely to be even higher than what's reported, according to Danielle Herbert, research fellow at the University of Queensland's school of population health.

I didn't realise how common it was because no one talks about it, but as soon as you start talking about it you realise 

"It may happen at home and they may never report it clinically," she says.

Also, because most miscarriages happen within the first 12 weeks, many women don't even realise they were pregnant. If they do, it's likely they haven't shared the news - and this makes it even harder to then share the grief.

"Historically, people don't talk about personal events, and a norm in society is not to announce until after the first trimester," Herbert says. "Also, couples often wish to grieve in private."

As understandable as this is, it means many women feel alone in their ordeal, and are unaware of how prevalent it is.

Pregnant at 42, Sian's risk of miscarriage verged on 50 per cent, but because women so rarely talk about it, she had no idea. "I was oblivious that miscarriage was so common and that there was such a thing," she says.

That was until she experienced it herself. She was left devastated by two miscarriages, the second one only late last year. "I found out at the 12-week ultrasound that the baby had died," she says. "There were no symptoms. It just sort of stopped [growing]."

"It was taking [the nurse] ages to find the heart beat and I still wasn't even worried. Then she said, 'Look, I'm really sorry - the baby has died.'"

Sian says she was overwhelmed by a sense of shame and failure. "I felt that there was something wrong with me - that I couldn't do something so simple. It felt like if you can't do that, what can you do? You've failed."

But Herbert, a researcher on an ongoing study tracking Australian women's fertility, says that miscarriage is part of the biological pregnancy process.

"There are two types of miscarriage," she explains. "In the first trimester, it's often [because of] genetic abnormality. The body self-checks. It can pick up high degrees of genetic abnormality and expel the pregnancy."

"The second trimester is more likely to be some other [inexplicable] factor."

Herbert says there are ways to improve your fertility. "Smoking is associated with miscarriage, obesity is a major problem in regards to pregnancy complications, and poor lifestyle [of the partner] means sperm can have a lot of damage."

Having said this, she stresses that "miscarriages are a random event, and it's important that [women know] they couldn't have done anything about it. Many pregnancies are lost."

Like Sian, Emily*, 31, was surprised to learn just how many are lost. She miscarried at 28, when she was 10 weeks pregnant. An ultrasound after a heavy bleeding episode detected no problem and she was told the baby had a strong heart beat, but she says she knew something was wrong.

"I just didn't want to admit it," she says. "I hung onto [the hope] because I wanted it, but I just kept bleeding."

At the 12-week ultrasound she was told there was "nothing there."

"I spoke to my obstetrician and he said it's very rare for someone to have babies and not have miscarried. I didn't realise how common it was because no one talks about it, but as soon as you start talking about it you realise."

While she understands that it wasn't her fault, she also acknowledges that "nothing makes you feel better ... I just sort of sucked it up and pushed it down. That's the way I coped with it and my husband hated it because he was trying to mourn it. [But] I just wanted to focus on something else."

Similarly, Sian didn't allow herself to feel and says it was "punishing" for her partner.

"We broke up three times," she says.

"But to face it would make it real - a permanent state of mind. And I was worried that I couldn't have a baby at all. My instinct was to retreat. I didn't even want to go there. The emotion is so huge it feels ... like a thread on a jumper - if you pull it, it will unravel."

When the baby is lost can also make a difference to how the loss is treated, which can also impact heavily on the grieving couple.

"In Australia a distinction is made at 20 weeks," says Herbert. "Before 20 weeks it's called a miscarriage. After 20 weeks it's called a stillbirth and you can get a birth certificate and a death certificate, which you can't at 19 weeks."

This lack of a marker complicates the sorrow, says Kate Bourne, chairman of the Australia and New Zealand Infertility Association. "It's a messy grief," she says. "Women often wonder whether they are entitled to grieve because there's no baby to hold or say goodbye to."

Neither Emily or Sian marked the loss. They both just bottled up and tried to block it out. "I just thought 'my life will be my work,'" Sian says. "I had a back-up plan. It's not going to replace the baby, but it's a survival mechanism. It's the hope and fear that breaks you."

The reality is that most women do go on to have babies - only around 3 per cent don't, Herbert says.

As for Emily, she became pregnant again quickly after her miscarriage, and despite her fears gave birth to a healthy baby girl. "I was a lot more scared the whole time but, a lot more thankful too," she says.

Sian has also become pregnant again, but has found the dormant fears much more debilitating. She's consciously taking steps to emotionally engage with the baby, and at five months is finally allowing herself to accept that it might all be OK. She still goes to the toilet "twenty times per day and checks the toilet paper for blood," but she also says she's feeling positive for the first time, and is starting to prepare herself and her home. "I'm even considering opening a bag of baby clothes a friend gave me," she says.

Dealing with the grief of miscarriage or the fears that arise during pregnancy post-miscarriage is hard. Kate Bourne suggests:

  • Living in the moment and practicing mindfulness.
  • Acknowledge that your feelings are normal and it's natural to feel tentative.
  • If you're pregnant and feeling fearful you might try talking to the baby and saying 'hang in there, I'm doing the best I can.'
  • Mark a loss. Donate, plant a rose bush, or buy a piece of jewellery that marks the baby you can always wear.
  • It's worth acknowledging 'I'm feeling stressed about this and that's normal, but I'm going to let it go.' You can't just stop feeling stressed - that's like saying to someone to stop breathing.
  • Guys have a very difficult time of it, as it can be overwhelming to see your partner go through that level of distress. Often they don't feel the loss as much because it wasn't in their body, but they were emotionally involved, too. Offer each other support, with lots of listening and cuddling.

*Name has been changed to protect privacy.

May is National Pregnancy Loss Awareness Month. Through its Light a Candle initiative, the Small Miracles Foundation is raising awareness of fertility issues, miscarriage, neonatal loss, still birth, premature birth and infant loss, giving Australian families that have faced the loss of a child an opportunity to remember their loved ones in a special and lasting way.

You can also seek help and support for Miscarriage and Pregnancy Loss on the EB forums.