Planning Clinic at the Victoria Street Health Centre. I'd like to speak to you today about the subject of miscarriage.

This refers to the spontaneous delivery of a developing foetus before the 20th week of pregnancy. This can occur as early as the first few weeks into the pregnancy, and, in fact, miscarriages occur most commonly in the second or third month.

It is estimated that about a quarter of all pregnant women have some cramping or bleeding early in pregnancy. Approximately 10-15% actually miscarry. It is to be noted that as much as 60% of the Foetuses which did not survive were proven to have been developing abnormally, and this is often nature's way of rejecting a defective conception. Other causes may be hormonal imbalance, acute infection or disease, physical abnormality of the uterus of cervix, drug abuse or misuse of tobacco or alcohol, and severe emotional shock. Sometimes no cause can be found. Physical injury is not a common cause.

Often emotional distress and physical pain accompany a miscarriage. The mother may experience heavy bleeding, shock, fear and often may require emergency surgery. She may have cramps or pelvis pain even after the miscarriage, and may complain of breast tenderness and fatigue, especially if there was a heavy blood loss.

This may be her first contact with death and there is frequently a great sense of failure and shame. An early miscarriage, perhaps before friends and family were aware of the pregnancy, can lead to feeling of confusion and ambivalence, especially when the parents to-be have just got used to the idea of being pregnant in the first place. A later miscarriage e.g. in the fourth month, when the mother is finally over those feelings of nausea and morning-sickness and is now feeling exhilarated and on top of the world. How devastating it must be for her to then experience the threat and often inevitability of a sudden miscarriage.

Both partners need the opportunity to work through feelings of loss and negative self-image with health professionals, with family and friends or with an independent counsellor. Sometimes an `outsider' can give them more room to express their feeling more openly. Society gives little recognition to the individually of the developing foetus and yet, to the mother, this loss can be as significant as experiencing the death of a new-born baby. The mother might attempt to hide her true feelings to protect her partner, parents or children.

"After all'', she thinks, "this would have been his child too, or their grandchild, or their brother or sister.'' The father-to-be, also, may feel a sense of great loss but, in his pain, cannot give his partner the support and caring which she needs. Their relationship can become strained. Feelings of failure and shame are common after a miscarriage. With no time to prepare emotionally, it is common for the woman to have feelings of great loss, emptiness and anger. Her spiritual faith may be sorely tested and she may have feelings of guilt and blame herself (and others) for what has happened. Until she can express and work through her feelings, often with the help of others, the morning process will continue.

There are certain things which the mother and father can do which will help the healing processes.

1. Stop playing the "what if'' game, tempting though it is.

2. Find out as much as possible from her doctor about why, specifically, the miscarriage occurred. Having an explanation can help a lot to allay the patient's fear that this will happen with every pregnancy or that she may not now be able to become pregnant again.

3. Seek comfort and support form each other, and from family and friends, openly and for as long as the feelings of sadness persist.

4. Do not hide the events from your children. They also need to talk and to express their feelings and to ask questions.

5. Make sure that the mother follows good guidelines regarding nutrition, rest, low-impact exercise and that she has a follow-up examination by her doctor.

6. Try not to rush into another pregnancy too soon. Miscarriage can be a stressful experience both physically and emotionally. Healing needs to take place before another pregnancy.

For friends, family and colleagues it is important to follow there suggestions: 1. Encourage the mother and father to talk and be prepared to listen without judgment.

2. If you have had a similar experience, extend your support to the parents, even if you don't know them that well. You may be the only one prepared to bring up the subject.

3. Don't trivialise the event by saying thing like "you can always have another'', or "you should take comfort in the children you already have'', or "you said yourself that the pregnancy was unplanned. You should be content now'', or "you weren't far on in your pregnancy. So you shouldn't feel so bad.'' 4. Don't ignore the topic or avoid speaking about it if you meet by chance.

You may be afraid that it will make the mother upset or cry. Crying is healthy - feeling ignored or abandoned is unhealthy.

5. Offer to help with household tasks, shopping, cooking or child care.

Despite the fact that many pregnancies end in miscarriage, it is not a subject that is much talked about. I hope that this article can help to fill that void.

Thanks for listening and enjoy the rest of today.

MARY BOORMAN Nurse -- Health Department