Twenty-two women who experienced a spontaneous abortion were treated during a 15-month period. All patients were seen for counseling sessions immediately after the spontaneous abortion. The initial counseling was followed by patient contacts and by a second counseling session four to six weeks later. All 22 women demonstrated intense emotional reactions to their pregnancy loss, characterized by the seven stages of grief. Guilt was the state that appeared to be the most difficult for the women and their spouses to resolve without help. Counseling sessions are considered an essential part of the total obstetric care for patients who experience a pregnancy loss.