Two miscarriages in three months had taken such a heavy toll on Stephanie Nash that when she became pregnant again that summer an old familiar fear crept back in.

Twins, the doctor said, on the day of the ultrasound.

That's when the tears began to fall, and Nash realized that joy and heartache are sometimes one and the same.

"I just thought, 'I don't know if I can go through this again,'" Nash said. "I was grateful to be pregnant again, but I also felt like I'd been down this road before."

There is a lot that researchers still don't understand about what triggers a miscarriage, which occurs in about one out of every six pregnancies, depending on age and other risk factors. But this transition period after the loss of a pregnancy is an emerging area of study for clinical psychologists trying to predict how a miscarriage can affect parental behavior.

"After a miscarriage, a lot of women think, 'If I can just get pregnant again I'll feel better.' But they end up feeling a lot worse," said Joann O'Leary, a parent-infant specialist at the University of Minnesota who organized one of the first support groups for subsequent parents in the 1980s. "The natural inclination for any mother who's suffered a miscarriage is to detach herself from the child they're carrying when they become pregnant again.

"It's like, they don't even want to think about being pregnant because the pain of losing another one is too great to imagine."

That psychological detachment during pregnancy can have lingering effects even when a healthy child is born, O'Leary said. What research exists suggests mothers who had earlier lost a child during pregnancy tend to be more overprotective and fearful regarding their child's safety, even when compared with the heightened anxiety of the typical first-time parents. In some ways, O'Leary said, subsequent parents are more respectful and sensitive to their child's needs, having themselves gone through a period of profound grief.

"All the fear and anxiety they feel are normal and may always be there," O'Leary said. "One important aspect to these support groups is that women learn from each other how to cope with that anxiety, how to have trust in the world again."

"I was an emotional basket case," said Wotovich, now 41. "Every time I went in for another round of fertility treatments, I was bawling my eyes out."

For the woman, the grief is immediate and complex, and so group members offer guidance on how to deal with the anxiety. Some meditate, others try yoga and acupuncture, said Rosie Roose, coordinator of the Still Missed program.

"The problem with a subsequent pregnancy is you never feel safe," Roose said. "You're robbed of that feeling."

The conversations become so emotionally charged that many parents form strong bonds with one another. Wotovich said she attended meetings for nine months while she was pregnant with her fourth child, and felt so close to the group that she returned to several meetings after giving birth. And she brought her newborn, a boy named Benjamin.

"I felt like it was important to go back and bring Ben just to provide some hope for those women who remained there," said Wotovich, who gave birth to a second child, Matthew, in August. "They needed to know things could work out better than before."

"I was scared the whole pregnancy that something might go wrong," said Nash, who gave birth to healthy twins, Jack and Caroline, in April.

Little things now trigger feelings of anxiety, Nash said, such as when she sees a child left in a car while the parent runs into a store.

"My initial response is always, 'Are you crazy? What if something happens?'" said Nash. "My family thinks I'm a little paranoid about it."

Like Nash, Wotovich describes herself as overprotective and "a worrier;" she admits to constantly checking in on her son Matthew when he's sleeping, just to make sure he's breathing. This despite having a baby monitor at her side.

The lingering effects of a miscarriage can be profound, Nash and Wotovich said. But the Still Missed program has given them the support to control that anxiety and the perspective to look at the big picture.

"You go through some tough losses, and you realize how quickly it can all be taken away from you," Wotovich said. "You understand how fragile and precious life is."