eople who have experienced a miscarriage often wonder how and if they can find the courage to try again. As women are getting pregnant at an older age these days, miscarriages are very common - 20 to 30 percent of all pregnancies - and many doctors agree there is a significant number of miscarriages that don’t get reported, which could bring that figure up to 40 to 50 percent. This may not lessen the emotional trauma, but a single miscarriage is not an indication that it is likely to happen again.

Physical Complications
According to Ob-Gyn Dr. Anthony Chin, miscarriage is extremely common and only “after two and especially three in a row, do you start looking for things that may indicate a predisposition, such as thrombophilia, balanced translocations, or uterine anomalies.” The testing for these conditions is extensive and costly, so most doctors do not call for it unless a woman has miscarried two to three times. Dr. Chin says that 95 percent of miscarriages in the first trimester are due to chromosomal or genetic defects that would indicate an abnormal fetus to begin with.

“Physically, if it's only one miscarriage, then the couple is no more or less likely to miscarry again,” says Nurse Practitioner Barbara Dehn. “They have the same chance as everyone else - 20 percent of pregnancies will miscarry. If the woman is close to 40, then miscarriage rates are a bit higher.

“For most couples, there aren't any physical issues to worry about unless they've been given a medical reason for the miscarriage - lupus, diabetes, hypertension, or a clotting disorder, for example.” Couples who experience recurrent miscarriage due to a physical problem will need to consult with their ob-gyn and may want to consider seeing a reproductive endocrinologist or reproductive immunologist.

Barbara Dehn emphasizes, “There is groundbreaking work being done in the field of reproductive immunology” and in developing ways to prevent recurrent miscarriage.

Emotional Complications
For the majority of couples dealing with this kind of loss, the emotional trauma far outweighs anything physical.

“Many times, couples need at least three months to process the emotions, while others take six to twelve months,” says Dehn. “I've worked with a few who never recover from the trauma.” A grieving period is important because the parents don’t necessarily experience the miscarriage as a loss of a pregnancy. It feels more like the loss of promised joy - cuddling their newborn, seeing their baby learn to walk, or the first day of school.

According to Dr. Pec Indman, a therapist specializing in pre- and post-partum depression, therapists dealing with subsequent pregnancy (after experiencing a loss) is a growing field that has gained some momentum in recent years.

“One big issue is allowing the parents - especially the mom - to grieve the loss at the same time she allows herself to bond with the new pregnancy,” she says. Bonding with the new pregnancy is by no means an act of disloyalty toward the lost pregnancy. Anxiety over the chance of miscarrying again is understandable, but Dr. Indman stresses the importance of a healthy bond with the new pregnancy, as well.

“The parents need to be comfortable with taking a risk again,” she says, “no matter how small the risk is.”

Most women who miscarry go on to have healthy babies, but as Dr. Indman puts it, “The bubble of innocence is gone and it is important to have a good emotional and medical support system in place.”

The bottom line here is to respect yourself enough to grieve in a healthy way while opening up to your future hopes and dreams. Chances are you will realize them.

For more in-depth reading, Dr. Indman recommends the following book: Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss by Ann Douglas.