Saturday, Oct. 15, is National Pregnancy and Infant Loss Remembrance Day. It is a day observed each year; a time when family and friends can mourn with those who have suffered a miscarriage or any other pregnancy loss or infant death.

For many, a miscarriage is a silent grief.

There are no photos of a first birthday or a favorite Halloween costume. There are no family stories to be told. Instead, parents are left alone with their grief often not knowing what happened or what to do with their emotional pain.

Saturday, Oct. 15, is National Pregnancy and Infant Loss Remembrance Day. It is a day observed each year; a time when family and friends can mourn with those who have suffered a miscarriage or any other pregnancy loss or infant death. Learn more at www.october15th.com.

The culmination of this day is a candle lighting ceremony called “International Wave of Light.” Grieving parents throughout the world can symbolically unite by lighting a candle at 7 p.m. and letting it burn for an hour.

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One in four confirmed pregnancies end in miscarriage (loss that ends on its own within the first 20 weeks of gestation), but experts believe this number could be even higher if very early miscarriages, unreported ones that happen before or immediately after implantation, were also included.

Research by eight medical facilities, including Brigham and Women's Hospital, and Harvard Medical School in Boston, found a majority of respondents to a national online survey had mistaken beliefs about the causes of miscarriages.

A little over three-quarters of participants believed that stress could trigger a miscarriage and over half felt lifting a heavy object was a factor. Some thought a previous use of an IUD or birth control pills could cause a pregnancy loss, according to results compiled last year in an abstract in the Journal of Obstetrics & Gynecology.

None of those factors, according to the researchers, have been proven to cause a miscarriage.

Adding to these false perceptions was a troubling 55 percent of respondents who believed that miscarriages were rare and occurred in 5 percent or fewer of all pregnancies.

It’s no wonder this survey found that a high number of participants felt alone, guilty and ashamed.

The misperceptions demonstrate the need to talk about pregnancy loss. What are the real causes of a miscarriage? What are the signs and treatment options? How does a couple heal after such a loss?

Local doctors address those questions inside, but first, as the nation remembers losses often not spoken about, four Cape Cod residents share their experiences with pregnancy loss in the hope of helping others.

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Angela Menke Ballou was excited. Christmas Eve service was only five days away, and as pastor of the Cotuit Federated Church, she still had a lot to do for the joyous celebration.

Ballou also had personal reasons to be happy. She was nine weeks pregnant and today was her first routine ultrasound.

Both she and her husband were looking forward to this moment. Similar to many expectant couples, they hoped to hear their baby’s heartbeat and maybe catch a glimpse of the new member of their family growing inside her.

When the technician turned to her and asked if she could have possibly miscalculated her “time,” Angela and her husband knew there was something wrong.

The ultrasound showed there was a baby but it measured a few weeks smaller than it should have. The biggest shock was there was no heartbeat.

Listen to Angela talk about coping with grief from the miscarriage

The technician took them to another room where the midwife explained that their baby had died a couple of weeks earlier, but Angela had not yet miscarried. She was told she had a missed miscarriage, a type of pregnancy loss usually associated with chromosome abnormality.

Instead of leaving the clinic with a standard joyous memento of their ultrasound, she and her husband went home to “wait and see” when the miscarriage would take place.

To make her situation more complex, Ballou had little time and space to grieve and unravel what was happening to her.

Christmas season at her church was the busiest and most sacred time of the year. She had no choice but to continue her role as its leader and to devise a plan that would continue the services no matter what happened to her.

Her plan included letting a handful of her congregants know about her pregnancy and inevitable miscarriage, but other than those few, she was alone in her grief.

She remembers thinking to herself: W, what do you do with a deep loss when no one else knows about it?

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Erin Logan, a Yarmouth Port resident, said her dreams of being a mom started when she was very young.

“When people asked me what I wanted to be when I grew up, I told them I didn’t want to be a doctor, a lawyer or a teacher. I wanted to be a mom.”

Logan wanted to do all those little things that a mother does: rocking and singing her child to sleep, snuggling and giving loving caresses, and even changing diapers. She also dreamed of celebrating her child’s firsts: first tooth, first word, first step, first ice cream.

Logan fell in love, and at 33 years old, she became pregnant. She said she was elated that her dreams were finally going to come true.

But her pregnancy was anything but a beautiful dream and now, at 18 weeks, with the baby too young to survive, her husband was rushing her to Cape Cod Hospital Emergency Center. Fluid was leaking and her cervix was dilating.

She was both in pain and exhausted, but when the doctor said it had been a boy, it was then she needed and asked to hold her deceased son for the first and last time. Logan said she needed closure and felt her son deserved this act of dignity and love.

A nurse tenderly wrapped Logan’s son in a rainbow blanket and placed him in her arms. But she could not hold him for long. The placenta was not delivering and Logan needed a dilation and curettage, commonly known as a D and C. She was quickly wheeled into an operating room and remembers that when she woke up, she was in tears from her loss.

Listen to Erin Logan describe how she was affected by her miscarriage

After being discharged from the hospital, she and her husband, both still in shock, went home and nestled themselves into lawn chairs and cried. “I was never so sad in my life. It was as if someone ripped a hole in my heart.”

The next day, Logan felt she needed one last chance for closure. “I was in so much pain and on medication that I felt loopy and didn’t get the proper goodbye.”

She called the emergency room and talked to a nurse who said she could help her.

They met and the nurse gave Logan the rainbow blanket, a memorial box, photos and the baby’s footprints.Logan tearfully remembers this private and important step towards healing. “She gave me closure. She could have brushed me off, but she didn’t.”

And from this act of kindness, Logan has tangible mementos to remember her son.

She keeps all these items in her son’s memory box right on her bureau.

“That’s my go-to place to remember him,” she said.

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John Terry, pastor of the Federated Church in Hyannis, is surprised he still has such intense feelings about a miscarriage that happened more than two decades ago.

He explained that after years of infertility, he and his wife, Elise, adopted two boys and, like most parents, their lives became filled with the daily routines of raising two active sons they loved and cherished.

But then, contrary to medical evidence that they were unable to conceive, Elise became pregnant - not just once, but twice. Both pregnancies ended in loss. The first was due to an ectopic pregnancy in which the fertilized egg attaches in the tube, not the womb, so the fetus cannot grow. The second one was a miscarriage, and it was this pregnancy that haunts them 22 years later.

Terry referred to the baby that miscarried as their “bonus” child and remembers those small and funny dream-like thoughts he had when he first learned about his blossoming family of five. “Tables in restaurants tend to be for four. Cars tend to be built for four. And suddenly, you’ve got five.” he said half-jokingly.

Listen to John Terry talk about how they dealt with the loss

He said he relished the thoughts of taking his “bonus” child to Little League or ballet or simply holding this little one in his arms. “If it were a girl, we would have named her Grace.”

He and his wife lost the baby at 18 weeks. Elise and John shared similar emotions from the miscarriage. Both were in shock. Both were feeling helpless. And both were distraught over losing their dreams and hopes.

But they grieved differently.

Elise wanted to talk about her experience, but John remembered he dealt with the miscarriage the way many men do. He kept his thoughts and feelings to himself, and plowed through it when all he wanted to do was go in a closet and cry.

He said he has learned a lot since that time. “Letting emotions fester inside is not healthy,” he said. “I think being able to talk about them, especially for men like me who are hesitant to speak in public, is a healthier way to cope.”

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After Samantha Moran of Yarmouth miscarried her second child, she felt as if she hit a brick wall. She said she never cried so hard in her life.

She went on to explain that she wracked her brain about what she could have possibly done to prevent the miscarriage. “I worked out. I ate organic. I took all my vitamins. I did everything I could possibly do.”

She researched every article under the sun trying to find answers, but her raw emotions always pulled her back to this thought: “I was carrying her so it had to be me.”

It took a lot for Moran to let go of those feelings.

She tried to change her thought process by telling herself over and over that she did nothing wrong. She spoke to her obstetrician, who told her that her loss was random and there was nothing she could have done to prevent it.

She made progress, but it was still an emotional rollercoaster ride for her. “One day, I’m OK, and the next day, I’m at it again.”

She found healing by talking to a counselor and comfort by joining a women’s roller derby group, an activity she had done before moving to Cape Cod. She explained, “Roller derby is the only place I go where my mind is clear. I don’t think about anything. I don’t stress about anything.”

Listen to Samantha Moran describe how the miscarriage affected her life

When Moran started Cape Cod Roller Derby, she met several women who had miscarried. Once she told them her story, there was an immediate camaraderie. “I didn’t have to say anything. It’s a bond that moms who have lost their babies have.”

With their love and empathy, Moran moved forward from her dark place.

Then, five months after her miscarriage, Moran became pregnant again.

This pregnancy hasn’t been emotionally easy for Moran. She is excited, but fearful. The innocence and naiveté of being pregnant, she said, has been lost because she now knows anything can happen.

But her recent pregnancy has also helped her to start looking at her past in a more positive light.

She said she will never be over losing her daughter to a miscarriage, but the loss has given her a voice and the confidence to use it. She added that because of her miscarriage, she is a stronger person and knows that she is resilient enough to get through anything.

Moran did not have time to be photographed. She was busy getting ready to deliver her third daughter, by a planned Caesarean section, today.

Maryjo Wheatley is a freelance writer. She may be emailed at: bmsboden@comcast.net

Here are some resources for emotional support

National Pregnancy and Infant Loss Remembrance Day: www.october15th.com

Hand of Cape Cod: Contact Julie Esteves at (508) 420-7234

www.hopefloatswellness.org

www.handonline.org/

www.waquoithealingartscenter.com

www.southshorehospital.org/miscarriageandpregnancyloss

www.nationalshare.org

Empty Arms: Emotional Support for Those Who Have Suffered Miscarriage or Stillbirth

Pamela W. Vredevelt

Miscarriage : A Man's Book by Rick Wheat

When Men Grieve : Why Men Grieve Differently and How You Can Help by Elizabeth Levang

Our Stories of Miscarriage: Healing With Words by Rachel Fadet

Silent Grief : Miscarriage-Finding Your Way Through the Darkness by Clara Hinton

A Silent Sorrow: Pregnancy Loss - Guidance and Support for You and Your Family

by Ingrid Kohn and Perry-Lynn Moffitt

Medical Resources

www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/basics/definition/con-20033827

www.arhp.org/Publications-and-Resources/Patient-Resources/Fact-Sheets/Miscarriage

www.americanpregnancy.org/pregnancy-complications/miscarriage/

www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/faqs.aspx