Its late summer, as you walk through your favorite department store you can’t help but notice the school supplies and warmer school clothes for children. It causes your mind to wander, thinking back to when you could walk through and imagine these on your child. It pains you so badly that you have to turn and walk in another direction. Inevitably every section you seem to walk into has something that could be related to your missing child. Diapers, shoes, cold medicine, photo albums, books, clothes, toys, even children videos are intermittently mixed in with your favorite comedies. Everything makes that pain deep inside swell. It wasn’t your choice, you didn’t have a choice. If it were up to you, it wouldn’t have happened at all. That child, your baby, it would be here with you.

            Now, you leave the store and walking through the parking lot you notice children that don’t really look like the adult they are with. Pictures and scenarios flash through your mind. Is that child your missing child? Is that six-year-old the child that you gave up all those years ago? Had it really been that long already? What would my child look like now? When would his or her birthday be? These are the thoughts that haunt you incessantly. Dining out an infant cries, you ache to be the one to comfort them. When attending miscellaneous celebrations, you wish it was your rugrat that was stumbling around everything or your baby being fawned over by all the other shower attendees.

            Missing children can be from anything: abortion, adoption, miscarriages, still births, or post-birth deaths, basically anything that makes you no-longer active with that child. No matter the circumstance it doesn’t make the pain any less, or the child missed any less. There are many things that will be discussed in this article. These will include abortion, adoption, still births or miscarriages, and the aftermath of these events.

You are in a relationship where you think things are going to change. He’ll get better, he won’t hurt you anymore. The bruises are hidden, not necessarily on your body but on your self esteem. There is a good day, a day when you are reminded as to why you got with him in the first place, the kind of day you wish would last forever. A few weeks later you find out you are expecting; there haven’t been too many good days since that one, and there definitely won’t be any good ones once he finds out. It was your job to prevent this; you were the one who was supposed to make sure this didn’t happen. You are going to be the one to pay for this, and if this child is born he or she will pay for it. You are going to be their only parent. That child shouldn’t have to deal with what you deal with. What if he hurts your child? How could you live with that? You can’t bear the thought. You know it will be difficult, a decision you don’t really like but if you don’t end it, he will. You choose to abort it before that child can learn of the true pain in the world; the pain of loving someone who loves you with fists and slander.

Abortion is the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo. Not all abortions are planned; they can occur spontaneously or be induced.  An abortion can occur spontaneously because of complications during pregnancy. A therapeutic abortion is an induced abortion to preserve the health of the pregnant female, if it is not in the female’s best interest it is then considered an elective abortion. Therapeutic abortions often occur when the life of the mother is at risk, preservation of the mother’s physical or mental health is necessary; child is to be born with a congenital disorder that would be fatal or result in significant morbidity; or to selectively reduce the number of fetuses to lessen health risks typically associated with multiple birth situations. Most often, when referring to abortions it is the induced kind that is being discussed.  The spontaneous sort typically referred to as miscarriages, will be discussed later on.

As it is associated universally with abortion, the court case Roe v. Wade shall be discussed first. Roe v. Wade was about a woman (called Jane Roe, although her real name was Norma McCorvey) who became pregnant while working at a carnival. In order to obtain a legal abortion, she was convinced to claim she had been raped. Henry Wade, the DallasCounty district attorney representing the state of Texas, and Roe were brought to trial in December of 1971 and then reargued the case in October of 1972. The following January a decision was made. The courts decided that a woman may abort her pregnancy for any reason up until the point at which the fetus is viable, or able to survive outside the mother’s womb even with the use of artificial aid. Viability is typically engaged at about seven months, approximately twenty-eight weeks into the pregnancy, but can start earlier. It was also decided that after viability, an abortion must be available when needed to protect a female’s health as ruled in the case of Doe v. Bolton. These decisions are also vested upon the right to privacy clause of the Fourteenth Amendment. This court case is a pivotal debate item for current politics, as it has reshaped where religious and ethical views fall.  Roe v. Wade was taken from the United States District Court of Texas to the Supreme Court on appeal. While the final verdict was not an entirely unanimous decision, it was a 7 to 2 victory for the plaintiffs, Roe.

There are mainly two different kinds of clinically induced abortion; medical and surgical. Medical abortions are carried out with the use of pharmaceutical drugs, so that surgery is not necessary. The pharmaceutical drugs, typically methotrexate, misoprostol or mifepristone and followed up with a prostaglandin, are only effective during the first trimester. Medical abortion in a pill-form, brand name Mifeprex, is a relatively new concept. For Mifeprex usage, pregnancy should be less than forty-nine days for highest success rate, after which the success rates decrease. This procedure is usually done during two doctor visits, the first of the pill regimen is a mifepristone taken on day one, and then within the next three days the misoprostol pill is consumed by allowing it to dissolve in the mouth instead of being swallowed. With medical abortion it generally takes several hours for the abortion to occur and is finished with a follow-up appointment typically scheduled two weeks after the original appointment. If a medical abortion fails it is necessary to follow-up with surgical abortion.

A surgical abortion is carried out exactly how it is named, an abortion involving the insertion of clinical instruments. The most common method of surgical abortion is suction-aspiration, typically called vacuum abortion. Manually performed, it involves a manual syringe that removes the fetus and its other vital components. It is electrically performed an electric pump is used. Another method, the second most common, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining. The name, dilation and curettage, means the cleaning of the uterus walls. Typically this method is only used when manual vacuum aspiration is unavailable. There are other techniques that are used once the pregnancy has entered the second trimester; often these involve some sort of premature delivery. Surgical abortion can be performed further into a pregnancy than medical abortion, by an entire month. There are advantages and disadvantages to both types of abortion. Both have a similar amount of physical pain (mild to very strong cramping) while the timeframe varies. With medical abortion the cramping will intermittently continue, on average, for a three hour period; surgical abortions are typically paired with an approximate ten minute episode of cramping. While the pain length differs, so do the personal reasons for which procedure people chose. Some women chose the medical procedure to avoid the surgery and the higher costs of the surgical option, whereas medical abortions can be performed in the privacy of ones’ home. Often after a woman goes through with an induced abortion there are mental symptoms that are generally associated with Post-Abortion Syndrome. The actual presence of such syndrome is highly debatable, as some feel if this disease were to exist it would be immediately apparent. The truth is that often symptoms of PAS don’t appear until several years later. Many women have severe psychological issues later in life when they attempt to conceive again, when guilt is typically resurrected in the woman’s life. Such guilt is not felt until later on because the patient is usually overwhelmed with relief, but it resurfaces when a child is conceived.   

Adoption is another way to lose a child. Some believe it to be a more difficult way to lose a child. With adoption, the child does physically exist but is most often unknown to the parent. Most adoptions are considered private domestic adoptions and are typically carried out through intermediaries (churches, charities, or other for-profit organizations). The birth parent(s) may get to decide on which family they would like to give their child to, sometimes already having a family in mind or going through a lawyer, social services or adoption agency. In some jurisdictions, adoptions that are privately arranged are considered illegal. There are two kinds of adoption: open and closed. Open adoptions are far rarer than closed, as they involve actual interaction between the biological parent and the adopted kin. Closed adoptions seal all identifying information, therefore maintaining secrecy and barring the identities of the adoptive parents, adoptee, and the biological kin. Occasionally closed adoptions may allow non-identifying information to be passed. This information includes ethnicity, medical history and religious backgrounds.

You just got out of a relatively difficult relationship. You’ve got your five year plan: attend nursing school, get a decent job, and get your life back on track. You find out that that relationship that just ended has resulted in a new life, not yours but a new little boy’s. You know that you cannot take care of him, hell you can barely take care of yourself. Somebody out there should get him, somebody who can give him the life he deserves. He deserves to be better off; he shouldn’t have to struggle along side of you. A perfect home for him has been found, now the hard part: going through with it. He’s discharged from the hospital, gets to go home to his room at somebody else’s house. You return to your room, with an empty bassinet. You know he’s gone. They said they’d keep it an open adoption, promised to keep you informed, involved, and updated; yet somehow you know it won’t happen. You know that you will never forget him, despite knowing he will never remember you.

Stillbirths are another rather difficult situation to lose your child. Still births are fetuses that die after reaching approximately the middle of the second trimester, as compared to miscarriages which happen prior to twenty weeks of gestation. The cause of still births is still unknown although there are a number of things that can contribute to the likeliness of it. Some of these things are bacterial infections or radiation poisoning, birth and chromosome defects, physical trauma and umbilical cord or placental accidents, and diseases or addictions of the mother (including but not limited to nicotine, alcohol and recreational or pharmaceutical drugs). Stillbirths are relatively common, yet equally random with the average rate being one in 115 births, equating to approximately twenty-six thousand a year. Still births, also known as fetal mortalities, can be divided into two categories: antenatal/ante-partum death and intranatal/intra-partum death. Antenatal deaths occur prior to labor, while intranatal deaths occur during labor.

You’ve done everything you were supposed to. You took all of those vitamins, watched your caffeine intake, monitored your exercising, and made it to all the doctor appointments. You’ve even hit some major benchmarks, at eight weeks that little berry is, according to the doctor, moving around and his or her heart is beating well over a hundred beats per minute; at fourteen weeks they’ve grown some hair and eyebrows; at the eighteenth week you can finally feel all that movement the doctor said was going on; two weeks later, you find out that it’s the little boy you’ve always dreamed of. Just as you are hitting your twenty-eighth week and your nursery is filling with all the clothes and blankets you could ever need, everything goes still. At first you feel that maybe, just maybe, your little boy is sleeping; maybe he is worn out from keeping you up all night this past week. Deep down though, you know something is not right. You go to your doctor, she tells you your little peanut has died. You feel so… so…. Lost. How can he be there one day, kicking like the next David Beckham and be gone the next? Your body is still in shock, yet your mind is shutting down; you don’t quite comprehend what the doctor is saying. Catching every other word: “inducing” “mortality” “autopsy”…. You look to your partner, hoping he understands more than you at the current point and time. One look at his face and you are further crushed. He was just as excited as you. You go through the delivery of your baby boy, except you don’t get to hear that all-important wail as he is delivered. The doctor asks if you want to hold him, and the truth is as unsure as you are, you really do want to meet your son. The two of you name him, knowing you will never tell him to pick up his toys or give heart-to-heart talks about dating. His picture is taken, as you and your partner realize that this will be the only way others will remember him. Death certificates are issued. Your son was merely an event now, not a person who existed. A person who squished your bladder right in the best parts of every movie, your child who refused to let you eat a salad but instead wanted only the greasiest of burgers. No one will remember those things; no one except you, as his parents.

Post birth deaths are also a gut-wrenching event. Post birth deaths, or neo natal mortality, can be separated into three phases. Early neonatal refers to the first seven days of life, late neonatal referring to the time period after that first seven days until the infant reaches twenty-eight days, and post-neonatal which is the remaining eleven months of the infants first year of life. The most common cause of neonatal death, at thirty percent, is a premature birth, or a birth prior to 37 weeks of gestation. Premature birth equates to under developed intestines, brain, and respiratory systems. Birth defects are the second most common reason for neonatal mortality at twenty-one percent. Birth defects can occasionally be detected on ultrasounds, amniocentesis, and other prenatal tests. Other causes of neonatal death include: Sudden Infant Death Syndrome (SIDS), complications from labor, neonatal hemorrhaging of the brain, and other unintentional injuries.

Your baby girl, she’s your pride and joy. She gazes at you adoringly, knowing exactly who you are and what protection you provide. She has finally made it home after an extensive stay in the neonatal intensive care unit. The incubators, ventilators, tubes, everything that made her look less human; they are all figments of the past. The doctors told you about typical problems to look for in premature children: eyesight problems, breathing problems, et cetera. They said nothing about waking up to find her motionless in her crib. “Sudden Infant Death Syndrome” they said when you took her to the emergency room. That sounded familiar, perhaps it was mentioned. You were probably too busy swooning over your newborn that was just so excited to come meet you. Your baby girl had an elevated risk of it because she was born early, therefore resulting in her lower birth weight. Just when you were getting to know how often she liked to nap during the day, and learning the wonderful faces she made, this happens. The doctor had said you had made it through the danger zone. “You can take her home”, yet here you were planning her funeral. Her gravestone wouldn’t even take a span of six months; a mother isn’t supposed to bury her child.

The final ways a child can go missing, hypothetically speaking, are through miscarriages, Ectopic pregnancies, and molar pregnancies.

A miscarriage is a spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving outside of the womb, generally about 20 weeks of gestation. Early pregnancy losses, or chemical pregnancies, are spontaneous expulsions that occur prior to the sixth week of pregnancy, after that point they are considered clinical spontaneous abortions. There are many forms of miscarriage: anembryonic pregnancy, inevitable, complete, incomplete, missed, septic, and habitual. Anembryonic pregnancy, also known as blighted ovum or empty sac, is a condition where, other than the actual embryonic part, the gestational sac develops normally. The embryo part of the sac is said to either stop growing early or is entirely absent. Inevitable miscarriage is where the fetus’s heart has stopped, but the fetus has yet to be expelled from the mother’s body. This will generally progress into a complete abortion. Complete abortions are when all parts of the gestational sac are expelled, while incomplete has parts of the sac remaining. Incomplete abortions are more likely if the pregnancy was further than thirteen weeks into gestation, as it is likely for the mother to not pass all parts of the gestational sac. A missed miscarriage, or delayed abortion, occurs when one where the embryo or fetus has died but a miscarriage has yet to occur. Septic miscarriage occurs when the tissue from a missed or incomplete abortion becomes infected, running the risk of the infection spreading and therefore becoming a fatal situation for the mother. Habitual miscarriage is the occurrence of at least three consecutive miscarriages. It is rare for this to occur; the probability a woman having of three consecutive miscarriages is 0.34%.  Miscarriages are more likely if the pregnancy is a multiple birth situation. Other risk factors include: uncontrolled diabetes, polycystic ovary syndrome, high blood pressure, hypothyroidism, some illnesses, smoking, cocaine usage, physical trauma, environmental toxin exposure, and usage of intrauterine device at time of conception. The risk of miscarriage decreases after the tenth week, but dramatically decreases after the first trimester is complete. After week twenty, it is then considered a stillbirth.

It’s early April, you are late. You didn’t even realize it right away. You take the test, it says positive. You call the doctor to schedule your first appointment; they require a blood test before scheduling the appointment. That Friday you go in and receive another positive. They schedule that first appointment the following week. The night before your appointment you are experiencing some nausea and pain at work. Others comment about how you should get used to the nausea because you still have some time to deal with that. After work you are still experiencing that gut-wrenching pain where you can’t sit or lay down. You are in so much pain you are in tears. You try a hot bath, your mom used to always tell you to do that when you hurt. It helps. It’s late so you decide to go to bed, now that you’ve numbed a majority of the pain. You wake up the next morning, the day of your first doctor appointment, in some pain. Going to the bathroom, you see some spotting. You have a feeling something’s not right. You start to cry, you were just getting so excited, had even decided how you were going to paint the baby’s room. You finally call the doctor when the pain gets so excruciatingly bad that you can’t sit, lay, or even use the restroom without screaming. The doctor listens to your concerns and sends you down to the ultrasound technician. They can’t find anything with the gel and wand, so they are forced to use the internal one. It hurts; you didn’t think the pain could get worse but it does. You squirm, and the technician pushes harder. She questions if you were sure that one was there. You respond and she says to head back to the doctor and he will explain the results. Back in his office he explains that no fetus could be seen, but what the technician did see was lots of internal bleeding. He explains that this usually meant that the embryo has not made it to the uterus and has instead implanted itself in one of your fallopian tubes. He recommends surgery very soon. You don’t know much about what he’s getting at, thinking you will be needing surgery within the next week. He responds with a no, this afternoon, any longer and it could be fatal. You are devastated. Here you thought you were going to find out how far along you were with your first child, head home and hang out, while your significant other went golfing. Instead you are being admitted to the hospital to undergo emergency surgery, have an eighteen hour hospital stay, be discharged, and stuck with not only a half planned nursery, but scars to remind you about how you lost your little bundle of joy.  You should consider how lucky you are; it could have been much worse. The blood transfusions, perhaps going completely unresponsive, you could have been further along, hearing your child’s heartbeat and then not at all; instead you fret about having more miscarriages, another ectopic pregnancy, or complications from either of these surgeries.

 While miscarriages are by far the most common of these three, ectopic pregnancies result in this same spontaneous abortion. Ectopic pregnancies aren’t extremely common but do occur in approximately one percent of pregnancies. An ectopic pregnancy is when the embryo implants itself outside of the uterus, 98% of all ectopic pregnancies are embryos that have implanted themselves into the fallopian tube. There is no set cause for this condition, although in about one-third of the occurrences, patients were noted with having one of the following risk factors: pelvic inflammatory disease, infertility, use of an intrauterine device (IUD), those who have been exposed to Diethylstilbestrol (DES, a non-steroid version of estrogen), tubal surgery, smoking, advancing age, previous ectopic pregnancy, and tubal ligation.  Another suggested cause is damage to the cilia that carries a fertilized egg to the uterus. The main symptom typically associated with ectopic pregnancies is pain; pain when going to the bathroom, lower abdomen pain, pain on a specific side. Another symptom is bleeding; this bleeding can be either internal hemorrhaging or external due to the decrease in progesterone levels. Severe internal bleeding can result in more brutal back, abdominal or pelvic pain, shoulder pain (from free blood entering the abdominal cavity and irritating the diaphragm), cramping or tenderness on one side of the pelvis. It is important to note that ectopic pregnancy can mimic symptoms of gastrointestinal diseases (such as appendicitis), disorders of the urinary system, or other gynecological problems.  To diagnose such pregnancies, two types of ultrasounds are used: the typical one involving the gel and wand over the abdomen, and a vaginal one that is used internally.

A molar pregnancy is another common complication. A molar pregnancy is an abnormal form of pregnancy where a non-living fertilized egg is implanted into the uterus walls, thus converting a normal pregnancy, and its processes, into a pathological one. Molar pregnancies are categorized into partial and complete moles. A partial mole occurs when a normal egg is fertilized by two spermatozoa, while a complete mole has no identifiable embryonic or fetal tissues and arises when an empty egg, with no nucleus is fertilized by a normal sperm. The hydatidiform moles that are created in these pregnancies often resemble a bunch of grapes and although eighty percent of the time they are benign, can develop into a form of cancer known as choriocarcinoma. Hydatidiform moles are treated by evacuating the uterus through suction or by surgical curettage as soon as possible after diagnosis, in order to avoid the risks of cancer. If moles are cancerous, or invasive, they generally require chemotherapy and respond well to methotrexate. Those patients who suffer from molar pregnancies are advised to not conceive for one year after treatment, although chances of repeated molar pregnancies are approximately one percent.

When a child has gone “missing,” the parents of that child often go through many changes. These changes often include some psychological changes: including, but not limited to, depression, guilt, fear and actual syndromes. Post-Traumatic Stress Disorder (PTSD) is typically associated with soldiers who’ve seen the torment of battle; rarely do people associate it with the loss of a child. And few even acknowledge disorders like Post-Abortion or Post-Adoption Syndrome. Post-Adoption Syndrome concerns the emotional well-being of the birth mother after an adoption has taken place, however there is little sound research. It is imperative that all parents of missing children go through the proper steps of grieving. Depending on the source there are five to seven steps of grieving. They are shock and denial, pain and guilt, anger and bargaining, reflection and loneliness, the upward turn, reconstruction, and finally acceptance and hope. The most difficult thing in this process is having the clarity of mind to do things needed for later stages in the early stages. For instance, later in grieving a person may want something to memorialize their lost child, but at the time when receiving a lock of hair or a picture they might still be in shock. Throughout research, it has been found that there are many services and online support groups for grieving parents. Some of these services include: websites devoted to the lost child, photography for still born or post-birth deaths of children, and blankets for burial services. All of these things require the parents, or grandparents, to be of mental clarity to take care of these things immediately. For those suffering from miscarriages, ectopic or molar pregnancies, none of these services can be used. Their child doesn’t always make a physical presence; some don’t even make it to the ultrasound pictures. Trying to conceive again after any of these occurrences often presents fear, fear of it happening again or something worse happening; or it can bring out guilt, if conception is achieved and there is no issue with the child or if another child is conceived and kept after one was not. Working through these issues, a couple can once again achieve their star family they desire; its getting there that leaves a wounded soul.

The true purpose of this article is to put you, as the reader, in each of these situations. It is important to note that the author has not experienced all of these situations but has gotten stories from people who have for all of them. Of all the stories that were heard, all suggested that parents of the missing grieve in their own way, and several suggested receiving some sort of counseling if it will help in the process. If psychiatrists aren’t exactly the cup of tea being searched for, find your own way. It can be online or local support groups, researching the reason the child went missing, or getting a new hobby, like writing.

As the author, and a mother of a missing child, I hope you were touched by this article and would highly recommend just lending an ear when someone wants to talk about it. The person will be much more grateful for your open ears than for your “I understand/know what are going through” advice when you may not know.

Post Abortion Syndrome - http://www.abortionfacts.com/PAS/PAS.asp

Wikipedia - http://en.wikipedia.org/wiki/
(Abortion, Adoption, Guardianship, Ectopic Pregnancy, Complications of Pregnancy, Stillbirth, Roe v. Wade)

What To Expect - www.whattoexpect.com
(Coping with Miscarriage, Grief & Loss Message Boards)

All About Abortion - http://www.fwhc.org/abortion/compare-medical-surgical.htm