One A Child in Mind The Unconceived, Barely Conceived, Unusually Conceived When you think you''re pregnant, and you''re not, what happens to the child that has already formed in your mind? You keep it filed in a drawer of your consciousness, like a short story that wouldn''t work after the opening lines. -Hilary Mantel, Giving Up the Ghost Miscarriage often involves the loss of a unique relationship with a baby--a relationship that may have begun long before the baby was conceived, especially for those who have yearned for a baby for years and may have struggled to get pregnant. But the notion of a relationship existing with our unborn--however developed in the womb he or she may be--took a pitifully long while to grab the attention of medical and psychological research and can still be a fragile one for many. And if this bond isn''t fully understood, the grief flowing from its dissipation when a pregnancy ends has little chance of a healthy expression. From the beginnings of my desire to get pregnant, nearly a year before I conceived my twins, I played out a number of stories in my head that also stirred my heart. Sometimes my baby was a girl, sometimes it was a boy, sometimes it had grown into a child. I would drift into reveries of how I would guide a teenage son to be a feminist or encourage a daughter to embrace physical adventures in a way that I never had. It didn''t stop there-I even imagined becoming a doting grandmother to my grown child''s children.

In early 2002, I took my first pregnancy test. I had, at last, a reason to suspect that my dreams had come true as, tantalizingly, my bleeding had failed to arrive. I knew exactly how the test worked, but I still read and reread the instructions in the packet, worried that if I interpreted them wrongly, I would sabotage any chance of becoming a mother. I prayed to a God I no longer believed in for a second pink line to emerge in the teeny white plastic window of the wand. My fantasy baby, wedged tentatively but tenaciously in my mind for the many months I had been hoping and hoping, was about to become real-or not. And when the second line did appear, the bond with my baby in my mind instantly changed dimension. These heartfelt imaginings I both enjoyed and worried about are often beyond our control. If our thoughts have an emotional charge-such as "I desperately want a baby" or "Maybe this month I''ll be pregnant"-they can easily become tenacious.

Trying to stop thinking about something that concerns-or threatens-us rarely works: the ruminative power of our mind is too forceful. I have yet to encounter anyone who wants to be pregnant and can successfully switch off their hopes, dreams, and fears about it, even if they try. This mental labor in itself contributes to the sparks of a relationship with our unborn: the more we think, plan, daydream, or dream dream about our longed-for baby, the deeper the grooves in our mind become. In neuroscience, this concept has been summed up by the phrase "Neurons that fire together, wire together," coined by a Canadian behavioral psychologist, Donald Hebb, who proposed that the more we repeat a thought, feeling, or behavior, the stronger the neural connections in our brain become. And as these neural connections strengthen, the more we are prone to these thoughts, feelings, and behaviors. Imagine learning that you have a very good chance of winning the lottery over the next few months. I challenge anyone not to think about-or find themselves thinking about-what they would do with their winnings. A real possibility, or probability , of something life changing can worm itself deep into our minds and hearts.

And when a pregnancy is confirmed, this probability-and corollary relationship with an unborn-that had prevailed in mind then literally prevails in body, and in the world too. Claire came to see me in the wake of her first miscarriage at nine weeks, and she left me in no doubt about the strength of her feelings for the baby she was still yearning for. Many other people she had turned to couldn''t seem to understand that, for Claire, it didn''t matter how tiny it was or that she was unable to describe what it looked like. Her connection to her baby had begun months before its conception, and she described her thirty-five days of being pregnant as the most meaningful days of her adult life. While she never used the word "love" to signal how she felt about her child-to-be, it seemed a fitting word to me. Claire had been with her partner Will for five years before they decided to have a child. They had talked about their future family during these years, but it had remained happily abstract until they began to try to conceive. She had wanted to be a mother since her childhood, and had assumed this role would be hers ever since she cared for her "cuddlies" as a little girl and, later, when she changed her brother''s diapers and soothed him when he cried.

At first the couple luxuriated in their plans for parenthood while also enjoying each other, their friends, their holidays, and their careers. Their future baby emerged from the edges of their minds and became a fleshed-out being who could be considered with confidence, ease, and increasing detail: names and parenting styles were discussed. But as the first year of trying to conceive rolled into the second, Claire became less convinced that a pregnancy was going to happen. She described how an increasing lack of confidence in becoming a mother seeped out into a general lack of confidence at work and even among her friends. As her imagined baby crawled away from the easy reach she had assumed for it, Claire would think about it more and more, however hard she tried not to-the neurons were firing together and wiring together. She became increasingly consumed with a desire to get pregnant, and the couple turned to the seemingly endless advice about how to boost their fertility. They gave up alcohol and late nights, bought expensive vitamin supplements, and took up yoga to combat the stress of unfulfilled desires. Sex became less spontaneous and carefree, and more of a necessity around the time of Claire''s ovulation, whether either of them was in the mood or not.

Claire stayed home more, in part because she was feeling more withdrawn, but also to protect herself from witnessing other pregnancies. Each time Claire''s period arrived, it brought increasing sadness and disappointment, as well as an excruciating mix of hope for the next month and despair that the hope might be destroyed again. Writing about his and his wife''s struggle to conceive their son many years ago, the journalist Jon Ronson described his wife''s experience of her period''s repeated arrival as that of an "empty coffin." Those moving words returned to me when I heard Claire talk about her own months of trying to conceive: for her too, each menstrual bleed hurt like a small death. Just as the couple was about to make an appointment with their doctor to investigate their fertility health, Claire''s period was unusually late for the first time. Being pregnant had become so desperately desired, yet so unreliable a notion to believe in, that Claire needed extra proof that the baby she had nurtured in her mind was now actually in her body. It seemed too good to be true. She took four pregnancy tests before believing it herself, and then sharing the news with Will.

Each stick revealed the word "pregnant," and she held on to them, not knowing then that they would become the only physical links to her baby that she would be left with. The months of heartache evaporated in the couple''s all-consuming joy: Claire''s long-cherished fantasy baby now really existed in terms that others could understand. While she assimilated her unprecedented news, her bond with her baby crystallized into one she could really take hold of, and she could now more confidently play out her maternal instincts through nurturing her own body with its new, precious cargo. She bought a pregnancy book, began to explore pregnancy websites, and signed up for email bulletins-she wanted to know everything that she could about her new state of being, and of the being she was inextricably bound up with too. However tiny and unformed as her baby was at this stage, this had no bearing on the strength of what she felt. Claire could rely on a simple piece of technology to swiftly and unambiguously diagnose her pregnancy-although she was in such disbelief that her dreams had come true that she repeated the test. After detecting the presence of the hormone human chorionic gonadotropin (HCG) in her urine, released after an embryo implants to the wall of the womb about six days after fertilization, her pregnancy test literally told her-by displaying the word ÒpregnantÓ-that she was a mother-to-be. Claire took for granted all that she knew about conception-the release of her egg each month and the related bodily symptoms this would bring.

She knew that it would provide half of the genetic material for her baby and that its fertilization would lead to the development of a human baby-and, she happily assumed, a live birth. Up until relatively recently, though, educated and middle-class women like Claire would not have had definitive knowledge of any of this, or of their pregnancies, until many weeks after a hunch. And for centuries, women who miscarried may have been unsure as to whether they had lost a baby at all. It may well be that our ancestors'' relationships to a baby in mind were different from those of a modern woman. Although there are descriptions of pregnancy-and its losses-in historical medical works and other written records, we don''t know very much about how women.