Several years ago I had a miscarriage about five months into pregnancy. My husband and I had brought our two daughters to a routine ultrasound to get a glimpse of their growing sibling-to-be. We were devastated when neither sonographer nor obstetrician could detect a fetal heartbeat. My husband talked to the girls while I waited numbly in the doctor’s office for explanation, repair, or the next step. The OB sent us home with a prescription and an appointment for Monday morning in the hospital.

That day was devoted to delivering a dead baby, with most of the accouterments of American hospital birth present: labor-and-delivery ward, beeping electronic monitors, anesthesiologist offering an epidural. It looked and felt, in many respects, just the way our previous live births had, a resemblance to happier occasions that seemed to mock our loss. The hospital nurses were kind, if not quite what was wanted: one absentmindedly put fetal-monitor belts on my belly before the doctor told her to take them off, and another described a Zen garden nearby where I could meditate if I ever wished to “process” it all. The environment of the workaday labor-and-delivery ward made delivering a lost child even harder. Then and after, I sometimes thought a surgery would have been easier: to be unconscious for the removal of the baby, to remember none of it, to have it be as much unlike normal delivery as possible. But at some level what we did felt necessary, as though the process of delivery honored the child. It was the last thing my body could do for the baby, and I was willing to do it. Nurses wrapped up the body of our son and we held him for a moment. My husband and I cried together. We were visited by our priest. With warmth and prayer, he gave care there in the hospital and later at the gravesite, but there was a provisional sense about his gestures, as though he were improvising out of his own kindness rather than acting on long liturgical practice that the church had devised in meeting these crises from time immemorial.

Death before birth brings a profound grief to a family. It blunts hope and forces mothers, in a very immediate, physical way, to confront death. It is a problem of public health, but also a theological problem—“Why does God let this happen?”—and a searing one in the lives of many parents and families.

Christian churches have been strong defenders of the unborn, with Catholics particularly active in opposing abortion and embryo destruction. These positions demonstrate a strong commitment to life before and after birth. But perhaps insufficient care—both in teaching and pastoral settings—has been given to the puzzle of children not aborted who nonetheless die before birth. About twenty percent of pregnancies end in miscarriage (and, given the difficulty of counting early-term loss, the actual rate is higher). Churches that locate life’s beginning at conception ought to meet these losses with gravity, both for the benefit of grieving families and for the witness to life it demonstrates. Difficult questions of science and theology stand in the way of easy answers or comfort. Yet the problem is big enough and occurs frequently enough to require more sustained attention. Churches should do a better job of recognizing this as a theological problem and offering liturgical and pastoral support to those affected by it.

Christian bioethicists critical of some embryo experimentation are often accused of hypocrisy, on the grounds that failure to mourn miscarriages belies their insistence that the embryo (the product of conception in the first eight weeks) is a person. Michael Sandel contends that “the way we respond to the natural loss of embryos suggests that we do not regard this event as the moral or religious equivalent of the death of infants.” Robert George and Christopher Tollefsen take up that argument in their book Embryo: A Defense of Human Life. Parents do mourn miscarriages, they argue, but they note that other factors might condition mourning: misinformation about the nature of the embryo, a shorter and different relationship than what might have been had with a child the parents had seen and held, or limited emotional bonding. These possible parental responses do not determine the embryo’s status. Further, the authors point out, unsuccessful pregnancies may result from incomplete fertilization or chromosomal defects, so what was lost may not have been a human embryo at all.

These arguments, while reasonable, seem emotionally flat. Of course there are differences in the experience of having one’s baby die during delivery and losing a pregnancy when the mother had barely begun to show, but by a prolife logic that names the six-week embryo and the five-month fetus both human children, the losses share common grief. Many churches teach women to value the life inside the womb from its earliest stages, and to view the developing fetus as a child God made, but offer very little in the way of comfort, explanation, or even acknowledgement when that child dies through no act or intent of the parent.

Catholic, Orthodox, and Protestant Christians all indicate hope that a child who dies before birth has gone to be with God. They offer prayer for hurting families. Yet consolation butts up against other primary points of theology, especially teaching on baptism, since these children did not have access to that sacrament. Christian institutions have an uneven history of figuring out what to do for these children, making sense of their deaths and prospects for salvation. Perhaps most famously, St. Augustine posited that without baptism infants could not go to heaven, though they would be spared the extreme punishments of hell as their guilt consisted only of original sin, not personal sin. Later, medieval theologians indicated that unbaptized babies would spend eternity in limbus puerorum, the Limbo of Children, neither heaven nor hell. Doctrines of infant damnation, connoting a harshness people did not want to attribute to God, fell out of favor with many Protestants through the nineteenth century. But in various Christian traditions, uncertainty about the eternal fate of the child has limited the consolation offered to parents.

Before the Second Vatican Council, there was no regular memorial Catholic rite for unbaptized infants, and they were buried in unconsecrated ground (whereas baptized babies were given a Mass of the Angels and a Christian burial). Concern with the problem yielded new pastoral solutions in the years following the council. The 1970 Roman Missal included directions for a funeral for those who had died before birth. And in 2007 the International Theological Commission issued an important report, “The Hope of Salvation for Infants Who Die without Being Baptized.” The reason for the inquiry was itself noteworthy: “In these times, the number of infants who die unbaptized is growing greatly. This is partly because of parents…who are nonpracticing, but it is also partly a consequence of in vitro fertilization and abortion. Given these developments, the question of the destiny of such infants is raised with new urgency.” Miscarriages we always had with us, but advanced embryology had made it possible to fully perceive the genetically distinct life that was begun and lost. The question called for rethinking in light of the church’s witness to life at a time when prenatal life is often discarded. Upholding the high importance of baptism and choosing an idiom of hope rather than assurance, “The Hope of Salvation” suggests that infants who die without the sacrament might, indeed, be received into heaven rather than hell or limbo. The commission found “serious theological and liturgical grounds for hope that unbaptized infants who die will be saved and enjoy the beatific vision,” but added: “We emphasize that these are reasons for prayerful hope, rather than grounds for sure knowledge.”

The doctrines at issue touch big questions about sin—original and personal—and the way of salvation, the meaning of baptism, even the character of God. While the report recognizes that parents grieve for babies who die before birth, and though it gives thoughtful consideration to their  chances of salvation, it hardly engages the dark night of the soul experienced by those who have a miscarriage or a stillbirth. Again, doctrine is its primary concern, yet as the report itself notes, the pastoral context is pressing: “The notion that infants who die without baptism are deprived of the beatific vision, which has for so long been regarded as the common doctrine of the church, gives rise to numerous pastoral problems, so much so that many pastors of souls have asked for a deeper reflection on the ways of salvation.”

One of the painful aspects of losing a baby before its birth, whether to miscarriage or stillbirth, is uncertainty of the meaning of the loss. We might say in general that the death of a child is always painful and sad, parents feel bereaved, and many share their mourning. If prenatal life is more than just potential, then a miscarriage or a stillbirth is not just something that didn’t work out, a nonstarter, something not to be; it is the death of a child before she has had a chance to live. It is a waste. With the loss of a child in the womb, questions come up and stay unanswered at every point. Why did this happen? Was it my fault, a mother might ask, or something I failed to prevent, or did it happen in me but outside my control? Is it a baby or not? If a baby, do I name him, bury him, tell people, mourn in public? This last is not obvious. The loss of a child is worth public sorrow, but if others did not know of the pregnancy in the first place, revealing it after its end can produce a sort of emotional whiplash. Those who did know have to be told, but this is hard, too. As for burial, distressing as it must have been to consign the fruit of one’s womb to unconsecrated ground, a woman may get even less than that in a hospital context, when fetal remains sometimes simply disappear unto disposal.

Our culture of choice contributes to this pain and awkwardness. Arguments about abortion go on, but they proceed within a culture that has adapted to the possibility of “choice” where pregnancy is concerned. We have learned a dual vocabulary to approve wanted pregnancies, rejoice with those who talk about feeling babies kick or scheduling ultrasounds or picking names and nursery décor, while at the same time behaving—linguistically if not in all ways—as though abortion did not concern that kind of creature but just the possibility of a baby that was decided against, a proto-baby rather than a real one. This produces agonizing confusion in the case of pregnancy loss. What is the script for response to someone whose pregnancy ends without a living child? Ready words do not exist either for announcement or condolence.

Thus churches meet an aching need when they offer a service, a public place, recognition, and prayers for those who have lost children in the womb. This can take the form of a memorial service at the time of the loss, helping individual families through the sadness. Churches also may hold other services occasionally, to minister to those who have gone through miscarriage or stillbirth and also to hold up this grief in the congregation as a whole. The church I attend, Christ the Redeemer Anglican in Danvers, Massachusetts, holds an annual service called “Rachel Weeping,” for all who have lost life in the womb. Participants read Psalm 139 (“You formed me in my inmost being; / you knit me in my mother’s womb… / Your eyes saw me unformed; / in your book all are written down; / my days were shaped, before one came to be”). They sing together, though some voices waver audibly in and out. They have a chance if desired to write a note or reflection, to give a name to the child if they have not already done so, to bring along a rose and prayers. The priest later buries the flowers and messages. It is a service that allows important things to be said by the bereaved: I know we lost a baby. Others know we lost a baby. Others mourn with us. God knows we lost a baby, and we trust God receives our babies into His care.

If we hope doctors act to prevent pregnancy loss, addressing risk factors and providing emergency aid and so forth, we should also expect churches to use resources available within the Body of Christ to comfort those so afflicted. Not doing so aggravates the suffering of those who have lost children in the womb and undermines our claims to value and care for prenatal life. Comforting a friend who had miscarried, the theologian L. Serene Jones looked for a way to help her and others bring their sorrow to God. She offers a reflection on the Trinity as a way of making sense of the loss. Considering the pain within God the Father at the death of Jesus, Jones suggests comparison with “the image of the woman who, in the grips of a stillbirth, has death inside her and yet does not die. Consider the power of this as an image for the Trinity. When Christ is crucified, God’s own child dies.... And perhaps most wrenching, this is a death that happens deep within God, not outside of God but in the very heart—perhaps the womb—of God.”

The image has limits, of course, but speaks powerfully of the experience of miscarriage or stillbirth. Caring for a child in utero and then marking her death before birth can be devastating. Many mothers have done it more than once. Openness to motherhood means wide openness to loss. While it is true that some women become pregnant easily when ready, carry happily to term, deliver without extraordinary peril, and settle into parenting, this is not a default story line. Even setting aside struggles of infertility or of children born with great debility, childbearing is a process with suffering built in. Given rates of miscarriage and stillbirth, even for women in the United States, there is a reasonable likelihood that embarking on childbearing will mean losing a pregnancy. In the early days of amniocentesis, sociologist Barbara Katz Rothman’s important study The Tentative Pregnancy showed that women tended to view the expected baby as provisional until prenatal testing yielded healthy results. The perils of birth do not have to make each pregnancy “tentative” until it brings forth a healthy newborn. Instead, they might make us more careful and attentive.

Pregnancy is a great work. Being willing to carry around a new person requires commitment, care, love. It can go badly awry. It requires willingness to see things through when things go wrong. It deserves support. Even if the mystery of death in the womb cannot be answered, still, churches insisting on respect for life should care very much when babies die in miscarriage or stillbirth. They should take seriously the call to comfort Rachel, who weeps because her children are no more. What families struggling with miscarriage and stillbirth seek from the church, beyond the hope for lost children and recognition of their death—if not knowledge of why it happened—is healing and blessing.