Pregnancy After Preterm Birth or Loss

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

©iStockphoto.com/digitalskillet

©iStockphoto.com/digitalskillet

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.

Comments

  1. Great advice, all around! I’ve had both – a preterm birth (34 weeks, so not intensely traumatic) and a loss (was triplets, went to twins, then lost all) – and while I want to have another baby, I’ll admit to being rather terrified. So much so that it didn’t feel like so much of a hardship to put it off to go back to work for a while.

  2. Christina Smith says:

    I am looking for information/support for myself & family. I just found out that I am pregnant. My last pregnancy was incredibly difficult. My water broke at 24 weeks gestation, was on hospitalized bed rest for 6 weeks. My daughter was taken by emergency c-section at 30 weeks. We both almost bled to death. My daughter, at 2 pounds at birth stayed in the Nicu for 6 weeks & was sent home at 4 pounds. She is now 4 years old, and has no negative signs of her prematurity. However, I still choke up and emotionally relive the trauma of her birth anytime I talk or even think about it. I did not plan this recent pregnancy, and am incredibly terrified. It is my desire to gather information/support to alleviate some of the worry & stress so that I can enjoy and celebrate this pregnancy.

    I am thankful to have found the Hand to Hold organization. The work your organization does is so critical & important.

  3. I just experience a preterm labor on aug. 29, 2012. My baby as delivered at 16wks and did not survive. This was due to an incompetent cervix. We tried to warn our obgyn of a previous LEEP procedure but it was to no avail. No one listened because we did not have a history of preterm labor. However, now that a preterm labor has occurred, they are able to offer preventative care in the future. But at what cost??? Someone had to die first.

  4. C – so sorry for your loss, it can be very frustrating to not be ‘heard’ by your doctor. I also had a LEEP procedure years before my pregnancy problems, I was under the impressions as along as they did not remove a large portion of the cervix ( a large portion would not be normal in LEEP procedure) than it should have no effect on your cervix long term.
    I had one Full Term child (although dialated early), a preemie at 32+5 weeks, a miscarriage at 18 weeks, and then a 31+5 day preemie. Both my preemies were small for gestational age first one came home in 5 days last stayed in the NICU a month. Last is 6 years old and I think I am pregnant after a my husband had a vasectomy 3 years ago!! Will find out tomorrow…Scared…. our outlook is complex and terrifying!

  5. Had my first planed pregnancy in 2009 lost the baby in dec 09 at 22weeks, got pregnant in 2 mths time(unplaned)lost that at 7weeks followed doctors advice and rested the uterus for 2yrs 7mths,got pregnant again in aug 2012(planed) had baby premature at 26weeks 4days,he lived for 5days died on 31of feb.LET me mention that my first preg i had a cyst on the outside of my uterus at 4cm was told it would not affect baby 2 weeks later miscarriage. My last preg was special really thought this was the 1 but had complications from 7weeks with UTI,16weeks UTI AGAIN,had a good break then there again at 24wks infection,still dont know what but treated with clomidazole for 1 week,went back to clinic at 25-3days to find out i had infection again given naystatin to insert daily.NOTE I have no pain or contractions when my cervix begins to open so when my water broke while i was asleep imagine my suprise happen same way all 3 times,trying to get preg right away as it doesnt seem to matter how long i wait.

  6. i give birth to a baby boy on 6 month pregnancy. i lose the baby same day. i was bleeding a lot when i was at the hospital i start getting pain , i did not not know it was labor pain.

    can i know if somebody has same problem as me and second time get a baby .

  7. I lost my baby boy at 21 weeks (7/12) due to skeletal dysplasia. On 12/25/12 found out I was pregnant again at 10weeks I had a miscarriage. On 7/13 got a positive pregnancy test and on 11/5/13 I lost my beautiful girl due to incompetent cervix. My Dr. Advice me to wait 3-6 months to let my body heal. I don’t think I will be trying anytime soon as my heart is broken into a million pieces. I believe that my mind has to be mentally stable before falling pregnant again I don’t want to put any extra stress on my future pregnancy.

  8. This is great advice. I had my daughter at 28 weeks from preterm labor. The doctors were unsure as to why I went into preterm labor. It has almost been 2 years, and I’m still terrified for my next child. This is a great course of action to help ease fears and help prevent preterm labor. Thanks!

  9. I just went through the most devastating thing that has ever happened to myself and husband. This past November we lost our baby girl as I went into preterm labour at 23 weeks 5 days. I really want to try for another but when is too soon,you know…..One hand wants to try now and the other hand has this guilty feeling as I feel Like people will judge that it is so soon after. I am also terrified that the same thing will happen if I fall pregnant again. I have a two year old which was born full term (overdue) and then I have a preterm birth, so confused. Has anyone experienced a healthy pregnancy/labour after preterm?…would love to hear some positive success stories. Thanks

  10. Dear Amy~
    We are so sorry for the loss of your baby girl. Each pregnancy is different, and it is absolutely possible to experience a healthy pregnancy after a preterm delivery. Because of the circumstances of the early delivery, your OB/GYN may have some additional advice for you when/if you are ready to try again. If a cause was identified (and there may not have been), it also may give your physician more ideas how to support you to prevent another early birth or ensure even a few more precious days or weeks are gained, which can make all the difference. Many of our bloggers take up this topic on our blog – here is one: http://www.preemiebabies101.com/2012/10/neonatal-loss/ You are also welcome to post this very question on our online support group via private message at http://www.facebook.com/LifeAfterNICU – Parents posts questions (anonymously if desired), and 12K families weigh in. This is a topic that many families have very personal experiences with, so I feel pretty confident you’d get the responses you are looking for. If we can match you one-on-one with a fellow parent who has had a similar journey to yours, please let us know (no expiration date on this offer). You can reach us at support [at] handtohold [dot] org. Sending a virtual {hug} your way. Best, AmyC

  11. I have 3 year old twins that were born at 26 weeks. One of them still has a slew of med problems but doing better than I ever imagined. I’m having an internal battle about having another baby. I had to have a cerclage with the twins and didn’t realize that my first pregnancy I also had an incompetent cervix cuz I dilated to 4 within the first 6 months but nothing was done. I’ve recently had a LEEP done to remove precancerous cells. We are thinking of having another baby hoping for a girl since we have 4 boys. Has anybody else had an incompetent cervix and a LEEP and had another baby?

  12. Hi, I have lost my baby at 26 weeks preterm labour. I am shattered. Want to try for another baby ASAP. Pls inform me if it’s Ok that I start trying just now. My earlier case was my very first case in which I had normal delivery and doc gave no reason for my waters breaking at such an early stage. Please help…

  13. I had a miscarriage last year in May and then In February found out I was pregnant again, the pregnancy was going fine but at 24 weeks I went into labor and had my first son Deklyn on July 6th and he lived for a day and it was devastating for me to loss my first baby. I am wanting to try again but my husband says it is too soon so I got on the depo shot but once it wears off I want to try again for another baby but I am afraid of having to go through this again.

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