Increasing numbers of parents are recognizing how such rituals provide connection to their community, a sense of the sacred and an outlet to do something about their grief. Some of the rituals actually come from other cultures that are much more open about the subject of death. In Japan, for example, the traditional Jizo ritual has grown considerably over the last couple of decades, since in Japan little distinction is made between pregnancies lost to miscarriage and those to abortion. The ceremony recognizes the need for the mother to apologize for whatever guilt she may be carrying about the pregnancy loss. She may light a candle, make offerings, or tie a red knitted bonnet or bib on a small stone statue. or, the grieving Japanese woman may write the name of a lost pregnancy or child on a paper and send it down the river. It is believed that this paper will float to the mythical River of Souls. Here, the loss spirit will be watched over by Jizo, a benevolent and nurturing caretaker who tends to these loss children. In the United States, increasing numbers of parents are recognizing how rituals provide connection to their community, a sense of the sacred and an outlet to do something about their grief. Ascher notes, "Grieving is physical as well as spiritual. It is an inner journey but its restlessness demands movement." Pregnancy is a rite of passage in culture, and when completed, such rituals bring one back to the world with a new identity. With pregnancy loss, it is an incomplete rite of passage, so there are much fewer rituals.

When doctors and nurses begin to utilize bereavement interventions, they learn to tolerate patients' intense emotions and their own closeness to death. The gratitude of bereaved parents usually convinces hospital staff that their training is effective and worthwhile. "Most bereavement specialists also encourage medical professionals who come in contact with grieving parents to be willing to show their own vulnerable and human side. One mother recalled how important it was to have her physician and midwife present when her baby's death in utero was confirmed. "My doctor got teary-eyed when she saw the ultrasound, and the midwife was visibly moved, too," she remembers. "It meant a lot to me for them to be there and to show that kind of feeling." In one study, a mother felt that the care surrounding her second trimester pregnancy loss at a large metropolitan medical center had been handled poorly -- both medically and emotionally. In addition to other things, she did not see or hold her baby girl when she was born, and initially the hospital staff told the mother that it would not release the baby for burial because it weighed less than 500 grams. When she did not receive an answer to her letter to the hospital's administration and the board of trustees, the mother asked to meet with the obstetrical nursing supervisor. The nurse listened to the story, verified it by checking hospital records and agreed that the mother's experience had been unsatisfactory. As a result, she discussed the issue with the head of obstetrics and the hospital board. The mother was pleased by the positive result of her efforts. She recalls that many changes took place, including the purchase of a camera. Also, pictures and footprints are now kept on record and a social worker is called whenever a loss occurs. Parents are encouraged to see their babies and private burial is offered as an option.

If parents sense that their needs are neglected during their hospital stay, it can be both therapeutic and effective for them to write a letter to a patient representative, social work department, director of obstetrical nursing, or hospital chaplain with a copy to the chairman of the hospital's board of trustees, requesting a follow-up meeting to discuss their experiences. The results of these efforts can be gratifying.

Not every hospital responds so quickly and positively to suggestions for enhancement to their bereavement services, but when patients' criticisms are taken seriously, these institutions can alter their policies in time to provide better care for bereaved parents in the future. Responding can help grieving parents find a way of honoring their baby's memory. As one mother relates, "My work on the hospital bereavement policies gave meaning to a life that never had a chance. It changed my grief and anger into positive...

It was a very, very good feeling to be productive in our baby's name."
Of course, it is not only hospitals that need to respond to the needs of these patients. The clergy are also expected to have a means for helping their parishioners. According to Thomas Moe, author of the book Pastoral Care in Pregnancy Loss: A Ministry Long Needed, who has studied grieving rituals, "for too long the church has lived in the myth of successful American healthcare, by not entering into a deliberate style of ministry to those who are suffering pregnancy loss because of not understanding the magnitude." The church must move out of the world of mythology and into reality and help those people who are really hurting. Another reason for the church not acting quickly is its ignorance that victims of pregnancy loss may truly be grieving. Pregnancy loss includes emotional grief and suffering and, as a result, increases many spiritual problems.

In this day and age, the need to understand and provide caring ministry is very obvious. This service introduces the religious community to the issue of pregnancy loss and describes how to help those who experience such tragedies. Effective ministry in pregnancy loss necessitates a person develop basic life theories to prepare for such in-depth care. With the help of pastoral care, the public and the faith community can develop strategies for individuals who are victims of pregnancy loss.

Recently, the ministry in the U.S. has more closely addressed this bereavement issue. One example is the book Hope Deferred: Heart-healing Reflections on Reproductive Loss. It states, for example, that any kind of death challenges theological assurances, but especially those dealing with the loss of infertility, miscarriage, and stillbirth. Saying that God knows best is actually saying that God doesn't want someone to have children. Or to be told that this is being done by God as a test is to be told that God is a sadist. Such standard reasons do not assure anyone of God's deep love and care during a loss. Encouraging people who are facing the death of a loved one to transcend their situation in order to see the larger good denies the very nature of grief itself.

Blood and death is not how we would describe our ideal meeting place with God. But it may be where God is found. Not the Santa Claus God who rewards virtue and punishes vice; not the grandparent God who gives us what we want; but the resurrecting God who teaches us to 'sing in the shadow of the cross.' Our song may not be the one that we originally hoped to sing. It may not be the one we practiced. But we can learn a new melody, maybe one with a somber counterpoint, and it can soar.

Deborah Brin, who wrote "Use of rituals in grieving for a miscarriage or stillbirth," states that miscarriage or stillbirth may cause a "grief storm that strips away many tender roots and branches of new life in the community that the parents have been nurturing." Creation and participation in a bereavement ritual can bring the grieving parents to a healing resolution. Brin was ordained as a rabbi in 1985 and has served as a pastoral counselor in a number of rabbinic positions. She explains that each ritual will be unique to the person or people who are creating it. This time offers the opportunity to meet the parents' deep need to express themselves. Rituals or ceremonies have an energy flow and focus that make a distinction between what came before and the hopes, desires and possible that exist in the unknown future. Despite when the death occurred, the awareness during the ritual has to be on the "now. A great deal of energy can be brought together for the here and now.

The first question that needs to be asked is what is the main intent of the ritual? There are many possibilities. The clergy or therapists who conduct the rituals already know about the parents' healing process, but it is important to know the stage of grief they are in, what else has occurred since the loss, and what is the degree of difficulty for empowering themselves to help make this even take place. Rituals are creative use of the medium of time -- it is an elongated moment to separate the before from the tomorrow. The parents' wishes on the types of prayers and songs, the length of the ceremony, the individuals invited and other such parameters will alter the overall…