by Felicia Nash, MD, OB/GYN
©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 your concerns with your healthcare provider and allow them to reassure you. Also allow your partner and your friends and family to support you during this period of anxiety.
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.
Felicia 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 in Austin, TX. 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.