She knew for sure when the doctor leaned over her and said, "Goodnight, Debbie." Drifting from consciousness, warm tears spilling down her cheeks, she repeated to herself: "When I wake up, I won't be pregnant anymore."
Somewhere deep down and for some time, Debbie Lindner had known she would lose the baby that New Year's Day. The bleeding had been steady and, hour after hour, the cramping had grown more intense.
What she could not know was how alone and achingly empty she would feel for weeks and months after miscarrying this first child she and her husband had dreamed of and anticipated for so long.
"I sat on the sofa mostly, trying to take care of myself," she says. "I was disbelieving that this could have happened to me. I wasn't prepared for miscarriage. I felt I was walking in a dream, all by myself.
"I was going to hear a heartbeat on my next prenatal visit, and here I am a week later, my heart broken. What if I hadn't pruned the roses? What if I had eaten more protein at breakfast?"
Studies indicate that more than 20 percent of pregnancies end in miscarriage or stillbirth. Among women over 35, the risk is significantly higher.
It is not an uncommon experience, and yet it is muted. People clam up, unsure what to say when a child's chance at life is lost.
"It's a lonely loss," said Kathy Nuffer, president of the Empty Nest support group in San Diego. "People don't realize how bonded you are to your child from the day of conception."
For parents, and particularly the mother who has felt the child in her womb, the loss is devastating _ and, often, isolating.
Friends and family may tiptoe around it, afraid of coming too close to so personal a misfortune, or trample over it, bombarding grieving parents with useless, if well-intentioned, observations.
People told Lindner that it was meant to be, as if to explain away her loss. Society's message was simple: Move on. She tried, and she failed, and she tried again until one day the pain finally began to dull.
"People would say, "Aren't you glad you lost the baby? There must have been something horribly wrong,' " said Lindner, who started a support group at Eden Hospital in Castro Valley, Calif. "The loss is undervalued and, later, ignored. It's supposed to be something you can snap out of."
For many women, the grieving goes on for months, long after the obligatory sympathy notes have been sent and the boss says: "Take all the time you need," long after the rest of the world has moved on.
It can be an especially isolating time for couples whose pregnancies end before friends and family know they began.
"Miscarriage is real hush-hush because it's early and often at home," said JoLynn Crouch, a determined Utah woman who endured multiple miscarriages and stillbirths on the way to becoming a mother of seven. ". . . There is no death certificate, no record that a child, a child of yours, ever existed.
"If they are stillborn or die as newborns, you at least have something to bury, somewhere to go to say, "Yes, I really had this baby.' Even if you can't hold it, you know it's someone you love."
For the many women who have delayed childbirth until just the right time and for those who have fought an arduous fertility battle before getting pregnant at all, the despair is particularly acute.
Margaret Hollister speaks to these women. As a woman who has battled infertility, she understands how cold society's comfort can be.
"People mean to be soothing and helpful . . . but they don't understand," said Hollister runs a hot line for RESOLVE, a national infertility and pregnancy organization based in Somerville, Mass. "So often, you hear someone say, "Oh dear, you're so young. This was God's way. You can try again'."
This may be true, but, for the woman who just lost a child she had planned for, prayed for, captured in her mind's eye playing tag or graduating college, there is no thought of what's best _ or of the future.
There is only the loss.
"The problem is that there is no validation for the mother's experience," said Dr. Rochelle Friedman, a psychiatrist at the Massachusetts Institute of Technology and co-author of Surviving Pregnancy Loss.
"The majority of people don't understand why it's so hard. Everybody feels the pain is terrible . . . (but) we live in a culture that has a hard time with loss and death and sadness."
In the days after the stillbirth of her son, Patricia Cane was surprised to hear more from casual acquaintances than from her dearest friends. It added to her isolation. She felt contagious.
"We were very close to one couple and went out with them often," said Cane, who runs a support group in Auburn, Mass, "but (the stillbirth) was never mentioned. It was a topic that was to be avoided at any cost. Maybe they were too close."
It wasn't that her friends didn't care, she said. They just didn't know what to say, how to act.
Cane, in a way, was one of the lucky ones. While her doctor wasn't terribly sensitive, she was at a hospital that provided resources and support and encouraged her to hold her stillborn child and consider a memorial.
Had she known better, Cynthia Gaufin would have asked for the same. She would have spent more time with her baby, held on to him longer before he died. She would have taken photographs, had better sets of foot and handprints made, saved a lock of his hair.
It may sound morbid. To Gaufin, a nurse, and to her husband, a neurosurgeon, it might have sounded morbid a decade ago, but that was before they went through the experience of losing a newborn child.
"People don't understand that it's part of a healthy grieving process," Gaufin said from her home in Provo, Utah. "They give you about two weeks, and then wonder why you haven't gotten back to normal."
It takes time. Some dive right back in and try to get pregnant again, and, statistics indicate, the odds are encouraging: At least 70 percent of women who experience pregnancy loss go on to have healthy children.
But that, too, may be difficult. Gaufin became hypersensitive. What had she done wrong last time? She felt her body had betrayed her, worried about what she ate, suffered guilt if someone beside her happened to sneeze.
"All I could think was, "How can I keep this from happening again?'
" Gaufin recalled. "I kept asking my husband whether it was something I did or didn't do. I think I drove him crazy."
And what of the fathers? They often are left on the sidelines, perhaps not as comfortable grieving openly as women might be. They are supposed to be the strong ones, the stoic ones.
"I had questions continually about "How's your wife. How's she doing?' But never about how are you," said Chuck Lammert, an engineer at a power plant in St. Louis.
"I was offered some consolation when I came back to work, but it was mostly about getting on with business, and I tried. I didn't know of the significance of the events unfolding."
Lammert, with his wife, Cathi, helps run the national support network SHARE.
"A great many of us end up running from it," said Michael Donnen, a therapist who conducts grief workshops in Seattle. "We throw ourselves into work or drink a tad more or go fishing. Society says we're supposed to be strong for our wives, that they can do the crying for both of us."
But it's a setup, because, although the wife might be crying, she often is also seething. Doesn't he care? Doesn't he share this grief? The divorce rate among couples that have lost a child is significantly higher than the norm.
"My husband and I found we needed more support than we were being given," said Cathi Lammert, who coordinates 240 SHARE chapters. "Some people feel the only place they can really speak of this is at a support group. Family and friends may not understand all these feelings."
Those who have been through it say the greatest comfort comes in speaking frankly, letting others in on their grief. They have held funerals or memorials, and openly shared the loss with their living children _ who cannot help but sense the pain.
It must not be hushed up, they say, because the grief, whether spoken or not, is still there.
For Debbie Lindner, it will always be there.
"All my life I'd waited for this," said Lindner, who went on to have three children, but cannot _ does not choose to _ forget those she lost to multiple miscarriages.
"You fall in love. You take care of it. You imagine this life to come, and once that pregnancy registers you are a mother. To have that severed by death is painful."
Silence, these parents say, redoubles the crime.