A pregnancy that ends in loss leaves prospective parents on rocky emotional terrain. They leave the hospital with empty arms and hearts breaking from sorrow. There seems to be no relief from oppressive desolation and despair. For some, an overwhelming urge to try again comes with the sorrow. Even as they know they'll never replace the baby they lost, they need to give birth to a baby to once again move forward with their lives.

"Grief needs to be given it's own place in your heart after a loss," says Dr. Carista Luminare-Rosen Ph.D., author of Parenting Begins Before Conception. "I counsel couples to take time to heal their souls and experience closure after a loss." But no matter how much time passes after the loss, the decision to try for another pregnancy is difficult. Many of these unfortunate couples still struggle with the loss of a baby they imagined rocking to sleep while at the same moment dealing with the timing of a subsequent pregnancy.

What Your Spouse May Be Feeling
Everyone deals with sorrow in distinct ways. Miscarriage centers on the woman's body and what happens within, and her spouse may feel left out of the grieving process. "A spouse can fix dinner, help keep the house clean, and look after other children in the home, but he's dealing with an intangible loss," says Luminare-Rosen.

"I was so devastated by our loss, but found it hard to express my grief when my wife needed so much care," says Steve Miller, who lost his first child to miscarriage. "I knew though, that until I resolved my grief I could not think about another baby." Miller fell in love with the prospect of fatherhood and all it entails well before he met his child. He lost a dream as well as a child with his wife's miscarriage.

In contrast, many men don't begin bonding until they've felt the first kick or heard the whoosh of the heartbeat at the doctor's office. When a miscarriage occurs before these milestones, he may not have had enough time to fall in love with the baby. "I don't think my husband actually grieved for the loss of the baby in my first miscarriage. He was too worried about losing me," says Peggy Vincent, who experienced an ectopic pregnancy.

A spouse's needs may get pushed into the background while he tends to his partner's physical and emotional distress. Luminare-Rosen urges couples to share their feelings with each other and outsiders. "Join support groups, or get online and chat with others about their losses," she says. "Write in a journal, talk to friends or seek counseling if it becomes to much too overwhelming."

Take Your Emotional Temperature
Fear and anxiety, hopelessness and powerlessness, frustration and anger, resentment, guilt and inadequacy pull women in a multitude of directions after a loss. "Only you can assess your emotional readiness and decide when or if you're ready to risk heartache again for a shot at the ultimate prize: a healthy baby," says Ann Douglas, co-author of Trying Again.

"I lost my desire to have another baby," says Holly Byrne, who experienced a miscarriage at 8 weeks during her third pregnancy. "I had two little children who needed a mom, and that took all of my time after our loss. Slowly, after about a year, thoughts of holding, nursing, and loving another baby began to drift back into my mind."

Fertility issues drag couples through a smorgasbord of highs and lows after a miscarriage. Secondary infertility (a medical term used for couples who experience infertility only after a successful pregnancy or miscarriage) shocks couples who don't anticipate problems when they decide to try again. "You have, at best, a 20 percent chance of conceiving in any given menstrual cycle," says Douglas. "If you're still feeling emotionally fragile, it may be too soon to jump back into the fire again."

"It's important to go into a subsequent pregnancy with your eyes wide open," says Douglas. The next pregnancy may not result in 2:00 a.m. feedings, and couples should consider all possible outcomes of a subsequent pregnancy. "The worry doesn't end when you conceive. The next 40 weeks could be the most stressful, nerve-wracking time of your life," says Douglas.

"I think every mother who chooses to attempt a subsequent pregnancy will find the next nine months difficult and needs support," says Meira Saks, who has experienced five miscarriages, one infant death and is the mother of five living children. Saks and her husband eagerly took the plunge after each loss, believing having a baby after a loss helped them to heal and trust in the promise of life again.

The entire nine months may feel like a roller coaster ride of emotions. However, for most women passing through each milestone helps break down the waiting and makes it more manageable. Some women heave a sigh of relief after the first trimester, then the first ultrasound. Passing the anniversary of their previous pregnancy's end also helps put that chapter away and make room for optimism. "I didn't dare hope. I bought no baby clothes and made no plans, wouldn't discuss names and just tried to pretend I wasn't pregnant," says Vincent of her subsequent pregnancy after her ectopic pregnancy.

"You don't stop grieving and then start trying," says Douglas. "Some women know very quickly when they are ready to try again while others need more time with their grief before embarking on another journey."

"Expect to be afraid," says Luminare-Rosen. "Many women have trouble bonding with the new baby until after the date of the previous loss has passed."

Health Considerations
Your body may need time to heal after a miscarriage, especially if you've had surgical procedures. Dr. Sussman, co-author of Trying Again, advises waiting at least one normal cycle to physically give the body a rest after a miscarriage. "After a still-birth or full-term pregnancy loss, I advise waiting at least three months," he says.

While some health care providers and couples opt to take a subsequent pregnancy easy, not treating it like a high-risk pregnancy, others feel it's better to keep a tight eye on how everything is progressing. "I advocate early and intensive prenatal care after a miscarriage," says Dr. Sussman. "We want to assure ourselves that everything is off to a good start so we monitor hCG levels and perform an early ultrasound to verify the presence of a fetal heart beat."

Going For Gold

"Reassess your life and make a specific game plan on what you can do to actively help prepare your body and mind for another pregnancy," says Luminare-Rosen. It's not about judging, blaming or shaming. "Feel your grief and find ways to reframe the experience so you can move forward."

"I was eager to get pregnant again right away," Peggy Vincent says. "After I recovered from surgery and dealt with my anemia, I became proactive, taking my temperature daily and trying to conceive in a very methodical way. I needed time to recover physically from very traumatic surgery, and my soul also needed time to heal, but I desperately wanted a baby."

After her ectopic pregnancy and two healthy babies, Vincent thought her family was complete. When another pregnancy caught her by surprise at age 41, with two teenagers and a thriving midwifery practice to juggle, she was ambivalent. But, when the pregnancy ended in miscarriage she fell into a deep depression. "I cut everyone off, lost weight, and lived by connecting the dots of everyday tasks," she says.

Three months after the miscarriage, she still found it impossible to get through a day without at least one meltdown into misery. "My husband and I fought, discussed and reasoned, even though having a baby is 100 percent emotional," says Vincent. They agreed to try for four months, and if she didn't get pregnant, they would stop. "I think I got pregnant 10 minutes later."

"If you have to consciously decide, then it's probably the wrong time," says Cynthia in Trying Again. "It's kind of like being in love. You always wondered how you would know, but when you were, you just knew it. I think it's the same. When you're ready to try, you'll want to try. It's really that simple."