Bev experienced multiple miscarriages in her early thirties. She longed desperately for a child, and each pregnancy loss left her feeling hopeless and despairing. Her husband didn't share her fierce yearning for a child, and while he felt saddened and empathic to her pain, he couldn't understand her single-minded pursuit and why their relationship was not enough for her.

As childless months turned into years, their marriage became strained to a breaking point. Once a religious person, Bev lost faith in what she perceived as a cruel God. She had trouble eating and slept fitfully. A bright and accomplished woman, she lost passion for her work and struggled with a sense of meaningless.

In central Tokyo, there is a Buddhist temple called Zojoji, where women like Bev can go to grieve the loss of their pregnancies and infants. The Japanese call these children mizuko, or "water children," and consider them to exist in the liminal space between life and death. Women and couples can make offerings of flowers, candy and toys to Jizo, the bodhisattva (an enlightened and compassionate being) who watches over dead children. There, they can feel the depths of their grief in a culturally sanctioned way, pray for the passage of their mizuko into a new life and be supported by the company of other visitors.

In the Jewish tradition, bereaved parents may chant the traditional mourning prayer for a week after the death of the infant and at every anniversary of the death thereafter, and be comforted by the traditional structures of ritual observance of loss. In mainstream American culture, we have no formal means of commemoration and public grieving for infant loss, despite the fact that at least 25 percent of pregnancies result in miscarriage (the figure may be as high as 33 percent) and 1 million of the 4.4 million confirmed pregnancies per year in the United States end in loss. This kind of grief is known as "disenfranchised." Pregnancy and Infant Loss Remembrance Day on Oct. 15 may be a step toward correcting this ritual void.

There is a growing movement across the world to make this day an international day of remembrance. To this end, the International Wave of Light project invites and encourages bereaved parents and compassionate folks from around the world to light a candle at 7pm in remembrance of a lost pregnancy or deceased infant and to leave the candle burning for an hour, so that the flickering lights shine across the globe, connecting us in our grief and vulnerability. This seems to me a beautiful symbol of how we might share a sense of support and caring with citizens across the world, in mutual recognition of the impermanence and fragility of life.

As a marriage and family therapist, I have brushed against this type of loss both personally and professionally. After a miscarriage, women, in shock, often believe they feel their babies moving inside of them. They are convinced that their baby will still be born alive. It is with unbearable grief that they experience the arrival of their due date. Women and couples may feel angry at God, believing irrationally that they have been punished for past sins or mistakes. They may feel anger every time they hear of a relative or friend who has conceived or given birth, see mothers stroll with babies in parks or catch images of parents with infants in TV commercials.

The sudden drop of pregnancy hormones may make a woman susceptible to post-partum depression, even if her pregnancy was not full-term. This is in addition to any grief-related depression. The engorgement of women's breasts with milk is a constant physical reminder of the loss. Women often experience aching in their arms, a physical pain of not being able to hold their babies. They may hallucinate that they actually hear their baby's cries or smell their newborn scent. They experience enormous guilt that they should have been able to protect them from harm.

With compassionate support and therapy, women and couples can be helped, if not to "accept" the trauma they have experienced, at least to go forward and to reach resolution, whatever that looks like for them.

Bev eventually sought counseling, individually and with her husband. In a compassionate therapeutic environment, she was able to sink into the depths of her grief and share the tears she tried to hide from her husband and friends. Once able to voice her feelings of despair, hopelessness and anger, she was slowly helped to see all of the areas in her life that did still hold meaning for her.

After being helped to communicate with her husband, they gradually rediscovered their feelings of love for each other. She began to pour her passion back into her work and her friendships, and to nurture these areas of her life, as well as herself and her marriage, as she would have nurtured an infant. As she regained her physical and emotional health, she felt ready to attempt to conceive again. Today, she is the proud parent of a kindergartner.

Alissa Hirshfeld-Flores, MFT, practices at PsychStrategies (659 Cherry St., Santa Rosa; 707.303.3257). Having practiced marriage and family therapy for 12 years, she treats most common disorders, with a specialty in grief and loss, life transitions, fertility issues and post-partum mood disorders.

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