A miscarriage often happens quietly. Many women have not yet told friends or coworkers they were expecting. There may be no service, no cards, no casseroles. A few days later she is expected back at work, back at the school pickup line, back to her life as if nothing happened.

But something did happen. For many women, the loss of a pregnancy is the loss of a future they had already started to picture: a name, a nursery, a due date circled on the calendar. That grief is real, whether the pregnancy ended at six weeks or twenty.

Partners, parents and close friends can help by treating it as real, and by watching for the point where grief turns into something heavier.

Grief and depression are not the same

Grief tends to come in waves. A woman may feel fine for an afternoon and then be undone by a baby food commercial or a friend's pregnancy announcement. Over time, for many people, the waves come a little less often.

Depression is more like a fog that settles and stays. It can grow out of grief, especially when a loss is not acknowledged or when a woman blames herself. Signs that sorrow may have become something more include:

• Low mood, emptiness or numbness most of the day, nearly every day, for weeks
• Losing interest in work, friends, food or things she used to love
• Insisting the loss was her fault, or that her body has failed
• Sleeping far more or far less than usual
• Withdrawing from her partner and from people she trusts
• Saying she feels hopeless, worthless, or that there is no point in going on

Partners grieve too, and sometimes in different ways. One person may want to talk about the loss constantly while the other goes quiet. That difference is normal. It does not mean either person cares less.

Saying something, and saying it plainly

Many people stay silent after a miscarriage because they are afraid of saying the wrong thing. But silence can feel to her like the loss did not matter. A simple acknowledgment goes a long way. Tell her you are sorry. Use the baby's name if she chose one. Remember the due date when it comes around.

If you are worried about her, say so directly. You might tell her that she has seemed weighed down for a while and that you want to know how she is really doing. Then listen. Try not to rush toward comfort that skips over the pain, such as reminders that she can try again or that it happens to many women. Those words are usually meant kindly, but they can make her feel unheard.

If she sounds hopeless, ask the hard question: Are you thinking about suicide? People often worry that asking will put the thought in her mind. It does not. Asking directly is one of the most protective things a loved one can do, because it gives her room to tell the truth.

If her answer is yes, stay with her. Keep calm, thank her for telling you, and help her reach care right away.

Where she can turn

A woman who has had a miscarriage will often see her doctor or midwife afterward for a follow-up visit. That appointment is a good time to talk about mood, sleep and grief, not just physical healing. If she is unsure what to say, offer to go with her or help her write a few notes beforehand.

The National Maternal Mental Health Hotline also serves women after pregnancy loss, not only after birth. She, or someone who loves her, can call or text 1-833-852-6262 at any hour, for free, and talk with a counselor who understands this kind of loss.

Some women find comfort in support groups for pregnancy loss, whether in person or online. Others prefer to talk one on one with a counselor. There is no single right way to grieve, and there is no deadline for feeling better.

The small kindnesses

Practical help matters as much as words. Handle a few errands. Field questions from relatives so she does not have to explain again. Gently offer to put away baby items if she wants them out of sight, or leave them exactly where they are if she does not.

Most of all, keep checking in. The loss does not end when the bleeding stops or when the first weeks pass. A text on a hard day, or a quiet visit near the due date, tells her she is not grieving alone.

If you or someone you know is thinking about suicide, call or text 988, the Suicide and Crisis Lifeline, any time. In an emergency, call 911.