But the scene, described by former President George W. Bush in his interview with Matt Lauer of NBC News on Monday night, has started a national conversation — both about his mother, Barbara Bush, and about the complex psychological fallout from miscarriage.

Mr. Bush called his mother’s action “straightforward,” and added that it illustrated “how my mom and I developed a relationship.” Some opponents of abortion reacted approvingly. Other commentators called Mrs. Bush’s behavior the action of a depressed and angry person. 

But experts say the incident is hard to interpret half a century after the fact. Indeed, it was extraordinary in at least one respect, they add: Mrs. Bush made a point of directly confronting the loss at a time when the subject was largely taboo. 

When a middle-class woman miscarried in postwar America, doctors often whisked the fetus away as if there were no loss of life at all, only embarrassment; women whispered about it between themselves but hardly ever discussed it openly. 

“It wasn’t thought of as losing a life; it was more like a medical mishap,” said Dr. Randi Hutter Epstein, a physician and the author of “Get Me Out: A History of Childbirth” (Norton, 2010). “And although women felt it privately, they didn’t feel it was worthy of going to see someone, or seeking help.” 

In recent years, however, that thinking has been flipped on its head. “It’s now a much bigger deal,” Dr. Epstein said. “There are support groups where women can go,” and therapists who specialize in treatments.
Most women survive the loss without lasting psychological distress. But the experience can hit as hard as the death of a spouse or any other family member, and women’s reactions can be extreme in the months after the loss. Some isolate themselves, hiding their grief; others lean on friends and family for support; most consider the fetus to be very much a part of themselves, a ghostly presence. 

“The attachment to the fetus lasts long after the pregnancy is over, for months and sometimes years,” said Richard Neugebauer, an epidemiologist at the New York State Psychiatric Institute and Columbia University.
In a landmark 1997 study, Dr. Neugebauer found that the rate of depression was more than twice the average among 229 women who recently experienced a spontaneous miscarriage. The timing did not matter: women were at higher risk regardless of whether the pregnancy failed after eight weeks or the child was stillborn. 

The study also documented a yearning, a grief that lasted for many months and seemed to stalk the women like some shadow of the lost child, Dr. Neugebauer said. A number of women patted their bellies as if they were still pregnant; others would see children on the street, strangers, and have a sudden, visceral sensation: “That’s my child.” 

In a class-action lawsuit filed in the mid-1990s, a group of women sued an Ohio hospital for psychological damages when they learned that their miscarried fetuses had been preserved — without their permission. “From their point of view, a part of them and their future had been violated,” Dr. Neugebauer said.
For those reasons, therapists often address personal issues that go deeper than the immediate loss. 

“The attachment usually starts well before the child is even conceived, in the story people tell themselves when they’re fantasizing about having a child,” said Janet Jaffe, a psychologist with the Center for Reproductive Psychology in San Diego and co-author, with Martha Diamond, of “Reproductive Trauma” (A.P.A., 2011). “Everyone has this reproductive story, it’s usually unconscious, and one reason that they feel so awful is that the story has gone awry.” 

The psychological wound tends to go deeper, studies find, when the woman is childless; and if it is the last of a string of miscarriages, it forces people to make a series of tough choices.

“Then it’s a question of ‘Should we adopt? Should we try again?’ and on and on,” said J. Donald Schumacher, a psychologist who is president and chief executive of the National Hospice and Palliative Care Organization. “And this is where you start to see discord between husband and wife.” 

Each woman, and each couple, may shape the story in a different way to find relief, psychologists say.
Bereavement counselors say some couples conduct ceremonies, sometimes full religious services, complete with cards and “remembrances” of the deceased — and continue to remember with tokens like a Christmas tree ornament, year after year. Others walk away and grieve privately, independently. 

None of this was the rule when Mr. Bush was a boy — when it was more likely that a woman would be told to simply let it go, that thinking about it too much would drive her crazy. 

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