Pregnancy After Preterm Birth or Loss

by Felicia Nash, MD, OB/GYN at Women Partners in Health



Making the decision to try and conceive after a pregnancy loss or preterm birth involves both emotional and physical health components.  Often couples faced with this decision spent agonizing weeks, months or years dealing with the pregnancy and/or NICU stay.

Attend to Your Emotional Health First

Grief counseling is a great idea for families that lose a pregnancy at any gestational age.  It is important to address your feelings and be able to have a closure with the previous pregnancy before you make a decision about returning to that arena once again.

Grief counseling can also be helpful for families who have a child who had a lengthy NICU stay – after all, we grieve when our expectations are not completely met.  And most of us feel that at the beginning of the pregnancy we can expect to take home a big healthy baby when we are discharged after delivery!  Understand also that you will have anxiety with the future pregnancies… you are only human, after all.  That is okay to a certain degree, but it is important to share with your healthcare provider your concerns and also allow them to reassure you!  Also allow your partner and your friends and family to support you during this period of anxiety.

“There was never a question about whether I was mentally prepared to attempt another pregnancy after our loss in the mid-second trimester.  However, I was not prepared for the fear and anxiety that would overtake me in the first and second trimesters of my subsequent successful pregnancy,” shares Felicia Nash, MD, OB/GYN with Women Partners in Health and mother of four children, one who passed away at 18 weeks gestation.  Enlisting the support of my husband and a close friend was key in helping me ‘vent’ my fears sometimes on a daily basis.  I may have driven them crazy, but it was so important for me to be able to work through these feelings rather than suppress them.”

Consult Your Physician for a Custom-Tailored Plan

If you feel that you are emotionally ready, the next step is to schedule an appointment with your provider to determine if you are healthy enough to pursue pregnancy once again.  Rarely, your physician may advise against future pregnancy.  Your doctor can also direct you as to the duration of time to wait between pregnancies.  This will depend upon the timing of your pregnancy loss or preterm delivery (in gestational weeks).  The mode of delivery (natural vs. Cesarean delivery) will also impact when it is safe to conceive once again.

Your physician may also make recommendations for preventing the loss or preterm delivery in a future pregnancy.  This is highly dependent on the terms of your previous delivery – so these options will vary greatly from patient to patient!  Some options may include a cervical cerclage, routine cervical monitoring and/or progesterone supplementation.

A cervical cerclage is basically a stitch used to enforce the cervix.  The cervix is a tubular structure that should remain long and cylindrical in nature throughout the pregnancy.  Some women develop shortening of the cervix that is not associated with contractions or pain and this can lead to early pregnancy loss or preterm delivery by allowing the water to break or allow an infection to begin.  The stitch would be used as a preventive strategy in a woman with a poor obstetrical history.  Unfortunately, the data is minimal regarding the efficacy of this treatment, but some studies indicate a viable birth rate of 70-90 percent after a cerclage placement.  Other studies, however, maintain that the improvement is much smaller than this.

Cervical monitoring refers to using an ultrasound to measure the length of the cervix.  This is done every 2-4 weeks in women with a poor obstetrical history or a history of procedures done to the cervix which could weaken its strength.  If changes are noted, sometimes bed rest or a cerclage are offered.  While bed rest is very frequently recommended for prevention of preterm delivery, the data does not indicate that it is successful.

In women with a history of preterm labor – that is contractions that are painful, regular and bring about a change in the cervix greater than 3 weeks prior to the due date – progesterone supplementation is often recommended in a future pregnancy.  The progesterone is given as a weekly injection beginning around 16 – 20 weeks of pregnancy and continuing through 34-36 weeks.  Intervening in this manner has been shown to decrease the risk of preterm birth, but only in those women who have had a previous preterm delivery not related to multiples or a fetal birth defect.

Create a Helpful Network to Support You & Your Partner’s Decision

Obviously, there are many issues to contribute to making a decision about further pregnancies.  Using your family, friends and sometimes professional support, you and your partner have to determine when you are ready.  Once you have decided that this is the next step, visit your physician so that you can develop an individually tailored plan that will reduce your risks in a future pregnancy.

Dr. Felicia NashFelicia B. Nash, M.D. and her husband Todd are the proud parents of one daughter and three boys, one who passed away just prior to 18 weeks gestation. After losing her second son, she was shocked and saddened having previously experienced a healthy pregnancy with his big sister. She and her husband have been blessed with the subsequent births of two healthy sons.

Dr. Nash is a board-certified obstetrician/gynecologist with Women Partners in Health, the largest all-female OB/GYN practice in Central Texas, which she joined in 1995.  Dr. Nash’s medical focus is on infertility and mental health, with special interest in postpartum depression. She graduated cum laude from Texas A&M University with a B.S. in Nutritional Science. Dr. Nash’s medical training was done at the University of Texas Houston Medical School. While there, she was awarded membership into Alpha Omega Alpha, an honor society that recognized the top 10% of medical students. She completed her residency training at Wake Forest University in Winston-Salem, North Carolina, where she received the Award for Excellence in Laparoscopic Procedures. She is a fellow of the American Board of Obstetrics and Gynecology, licensed to practice in the state of Texas.


  1. I recently lost my angel Madison on Nov. 16, 2015. My water broke at 17 weeks. My doctor cannot tell me what went wrong. All she can say is that it happens to the best people. My husband and I were traumatized, but we try to stay strong and positive. I have never felt as much emotional pain as I feel now. I feel as if something was torn out of me. A sense of emptyness is an understatement. We are going to try again, but I am so scared about the outcome. God be with us all!

  2. Mommy of 3 Angels and 2 toddler says:

    Hi everyone, sorry to hear everyone loss… Sometimes I fell like the dr are not doing enough or we don’t get enough attention to where the peoblem is held in a matter of time till things goes wrong but that’s just my feeling and opinions. I have now lost 3 babies and they hurt me dearly although I do still have 2 toddlers to bright my days everyday. My 1st baby was a full term no complication 2008, my 2nd was a preterm @ 20 wks and he die after deliever march 2010, my 3rd was a roller coaster ride it went up and down hill… We were in and out of the hospital til full term ( I was told I was going to have her @ 22 wks and will not live but I was put on bed rest at 20 wks with 17p shot, a medication to stop contraction @ 27 wks I went to the hospital with non-stop contraction and was admitted and dr stop the contraction was in hospital for 2 wks then was discharge I was on bed rest for the rest of my pregnancy at 39 week I had a csection and she made it on May 2012, My 4th was a preterm at 20 wks again he was just too small to live I had in December 2012, last my recent one was just a few dates ago… I was so scare the same thing was going to happen and it did. I’m so sad and hurt inside out. I don’t know what went wrong beside having a short cervix. At 17 wks my water broke I went to the ear and was told it wasn’t my water that broke I was relieve, then 2 day later I saw the NP at the dr office and she said unfortunly your water did broke and I could see the ubilicore hanging… My heart drop I wanted to just die right there. Then on that day I was admitted to the hospital the next early morning I had a baby at 4am at 17 wks December 2015. All my miscarriage was boy too I’m so sad cause I wanted another boy for so long and it still didn’t make it or happen although I’m am bless to have my other two toddler ( a boy and a girl). My heart is full with emptyness cause we are not going to try anymore or get pregnant anymore… I guess we were just meant and bless to have a boy and a girl only. But for everyone out there it don’t hurt to try again if you willing to go for it… I wish you guy all the best of luck. I wanted to post my story to show everyone that this is a recent story that me to me as the year end.

  3. Jennifer Beatty says:

    I am so sorry to hear about your loss. I can’t imagine the pain you and your family must be in. I am so glad you reached out and that is a healthy sign of the first steps of healing. We do offer a few articles that might be something to help you along the way. You can find them here… Also… we offer a free peer mentor program where we match you with families who have been through an experience similar to what you are going through currently. Often they are the only ones who truly understand what you are going through on this journey. If you would like to request a mentor, please visit this page and fill out the request form. Thank you again for sharing your story and helping others know they are not alone. Jennifer

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