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. 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:

    Lenora,
    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… http://handtohold.org/support/grief/ 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. http://donate.handtohold.org/site/Survey?SURVEY_ID=1381&ACTION_REQUIRED=URI_ACTION_USER_REQUESTS Thank you again for sharing your story and helping others know they are not alone. Jennifer

  4. Ariel06122016 says:

    Today i came home without my only son…and i was asked the hardest question and; I couldn’t think how to answer the seemingly simple question “well how are you feeling?”as I left the hospital. “How do I feel? “How do I feel!?” Like I want my freaking son back! Like my soul has been shredded and my breast and body show the signs there was life but there is an empty space between my heart and my vagina that is void (my womb)…! How can I act as though I did not remember the soft kicks, or the fluttering way he swam around after I had juice…how do I respond to how many months are you now? How do I answer “how are you feeling “? When what I feel is lost.

  5. After being told at my 20 week ultrasound that my cervix is very short I was worried. I have had 4 full term babies, and only had complications with my daughter who is my youngest out of all 4 pregnancies. This was baby number 5 for us. So, I called my doctor office being 25 weeks exactly because of blood mixed in with a mucus discharge and was told it was nothing to worry about. Pain kept getting worse and worse as the night went on, finally I called back to my ob, told them I’m going to the er, because the pain wasn’t going away. Upon admission I was 3cm dilated, no cervix plug, and wAs in fact in labor, it took them 3 and a half hours to get me transported to a different hospital, where I actually delivered at was in transport in the back of the ambulance with a medic that had no knowledge of pre term labors and delivery, he left my baby girl just lay in between my legs. Didn’t suction out her mouth or nothing No oxygen, it was a mess. Made it to the hospital with the nicu team waiting. Was told she was going to make it, only to be told an hour later that they were sorry she wouldn’t make it, who is at fault here??? I’m so heart broken, I don’t even know what to think. My baby is gone, when she should’ve had a chance. This all happened on 12-30-16. Where do I go from here.

  6. Leigh Ann Torres says:

    Hi Kim,
    We are so very sorry for your loss. I have forwarded your information to our Family Support Navigators to reach out to you. Someone should be in touch with you shortly. In the meantime, know that you are in our thoughts, and please contact us at support [at] handtohold [dot] org if you do not hear from someone.

  7. Michelle hiller says:

    Hello everyone I’m so sorry for everyone’s loss. My angel was born on 1/4/2017. I found out I had a short cervix at 19 weeks. It’s was only at 1.5cm. They put me in bed rest and gave me progesterone cream. I went to the doctors later that week and my cervix stayed the same so we kept with the progesterone cream. i went to the emergency room 3 days later because I had mucous coming out. They said everything looks okay and there’s no reason to check my cervix because it was just done. So 5 days later I had a doctors appt at 20 weeks and 3 days and my cervix was gone. The sac was coming down. They admitted me and placed a emergency cerclage in to hope that it would hold. The doctor said he’s never seen anyone go that fast especially on progesterone. The cerclage was a prayer during it because he had to place the sac back in. I was high for infection and was at the hospital for 3 days. They discharged me and was on bed rest. Well the next day I felt water come out and when I went pee I could feel her sac. I was placed on a bed pan and inverted my bed. I had contractions every 5 minutes and they had to push fluid into me. It stopped and the doctor did an amniocentesis to heck for infection so they could try another cerclage. Unfortunately it was horrible news. There was one and I had to deliver her. I was 21 weeks and 2 days. My sweet baby girl who was so strong and healthy. She was born with a heart beat but died on my chest 20 minutes later. She was 13 oz and 11 inches long. She was so gorgeous. I feel so guilty because it was my body that failed her. It’s my first pregnancy and for me to get pregnant took 3 IUI’s since I am gay. I want to be a mom so bad. The pain it so hard to deal with. Thank you for letting me share!!!

  8. Leigh Ann Torres says:

    We’re so sorry for your loss, Michelle. Please don’t hesitate to reach out to us for support, and one of our family support navigators will contact you.

  9. Hi all-

    I am so sorry for all of the losses on this page and know your pain all too well.

    Michelle- your story in particular sounds so similar to mine. I lost my son on 1.30.2017. My husband and I had tried IUI multiple times and were unsuccessful. We decided to go with IVF last year and were blessed with a successful pregnancy. I learned through fertility treatments that I have a unicornuate uterus (half of a uterus, shaped like a banana). My fertility doc had told me that I would be followed closely by a high risk doc as well as my OB. Miscarriage, preterm labor, c-section and breach are all risks with a unicornuate uterus. I didn’t realize just how great the risk is and thought once I had passed my 16 week mark that my risks were slim. I had a big appt. scheduled for Tuesday the 31st and my OB was going to measure my cervix and decide if I needed to be transferred to the care of a high risk doc at that time. Unfortunately, from my research I should have been seeing a high risk doc from the beginning. I was feeling really uncomfortable on the Sunday before my appt. I had a light crampy feeling and my low back was really sore, I couldn’t get comfortable in any position. My husband suggested that I call the doc on call, the doc said to come in to be safe and that it was likely nothing. They hooked me up to a monitor when I arrived and confirmed that the cramping was in fact contractions. My cervix had thinned completely and the sack was resting on my thin cervix, the doc said I would be delivering my son and since I was just 2 days shy of 21 weeks, he was not developed enough to save. Mine and my husbands hearts were broken. We requested to see a high risk doc, but by the time she came her efforts to save our baby were too late. Our baby was perfect and flipping around on the ultrasound, just before I delivered him. I can’t help to think how things could have been so different had we been with a high risk doc to begin with. Our tiny angel Addison Nicholas was born 1.30.2017 and was our only child. I never expected this and nothing could prepare me for the deep sadness I feel. Burying your child just days after delivering their tiny body is something I could never prepare for. I long to feel his tiny kicks again and would give anything to change this terrible outcome. Nothing feels good and nothing makes it better. I am beyond sad. I am a mom, as I have always wanted to be, it just wasn’t supposed to be like this. I want to try again, but feel so sad for the chance that Addison was never given. I think to myself how it might have been easier had we lost him early on in the pregnancy, but am so grateful to have been given the time with him we had, to feel his little life inside of me and hold him for the hour he lived outside, with just a tiny heartbeat. We just have to have faith that God has a bigger plan and purpose, I just can’t see it right now. RIP to our tiny Angel Addison and all the other sweet angels that left our world too soon. I pray for peace in all of our hearts and that we will all have a better outcome with future pregnancy.

  10. My heart goes out to all who have lost their children, I recently lost my second set of twins , four children I do not get to see grow up. I learned that even though people have years of knowledge and are qualified to say what treatment is necessary for you and your child, you should always do research, always ask questions, every pregnancy is different, if you feel something feels off, don’t ignore any pain or discomfort, change in vaginal discharge,back pain, going to a e.r 10 times and coming out ok or catching something before it gets worse is better than leaving hospital without your child, I have an incredible love for my babies that are no longer with me, and will forever stay in my heart, what is keeping me from not going with them is my amazing husband who has been gluing my heart together and my future children who will learn how strong their parents are and what the real meaning of life is. This is incredibly hard time for a lot of people, be strong, be positive. You cannot undo what has been done, but learn from it and try to prevent it from happening again.

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Site last updated August 16, 2017 @ 11:03 am; This content last updated June 22, 2014 @ 12:09 am