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.
My husband was ready very soon after our Son’s early birth and short life. I couldn’t even imagine ever trying again. After supporting me through my healing, with his love and patience, I agreed with my husband that we should get pregnant. Five years and two months after our Son’s short life, we were blessed with our beautiful daughter 💕
I loved this article! Even though I didn’t lose my baby, my pregnancy was very scary. I was diagnosed with pre-eclampsia, recommended an abortion, and my pregnancy was called “unviable”… at 20 weeks! My son was born premature and my pregnancy + his NICU stay left me emotionally exhausted. Not that it compares to a loss… but I’m terrified of a second pregnancy
I lost my daughter 12/21/17 my water broke at 21 wks 3 days she was born naturally she weighed 1 pound 1 ounce and she looked looked like a porslin angel she was perfect I never felt so much love and pain within a minute of holding and looking and my precious daughter that passed after I had her her lungs were not mature it’s only been days I’m still grieving and my emotions are like a rollercoaster.i can never replace Nadia but I won’t give up on having a child.i thought to myself how will I ever be able to love anyone the way I loved and still love her my journey of healing has just begun
Jade,
We are so sorry to hear of your loss. Please accept out condolences and know that are here for you. If you would like to speak with a Family Support Navigator, please contact us at support@handtohold.org or fill out this form and we will contact you: http://bit.ly/2sRkgcZ
Hi Jade. I too just lost my son Riley at 21 weeks when my water broke on 12/28/17. I’m so sorry for your lost and feel your pain. I’m here if you ever want to talk. May God bless you
I lost my son at 24 weeks, 3 days due to spontaneous premature birth (no reason after all the testing) in Jan 2018. The hardest was holding him without the ventilator and wires, as he passed away.
To all those women who have lost their babies early…
You will have your good days and your bad days. For me, I did not expect the emotional process to take as long as it did. Each day, you take three steps forward but two steps back.
Seek support in your husbands and those close to you, but most importantly, remain in your faith. My hubby and faith in God helped me through. I am gaining strength to help me for the future.
I have no doubt that myself and all you ladies will have healthy beautiful babies in the future! Stay in prayer even when you want put your hands up and turn the other way.
I lost my baby Laylah at 18 weeks on 6/10/2017, she was our first born. There were no indications of Laylah having any genetic problem and the chromosomal testing came back normal. My pregnancy throughout showed no signs of complications until around the 16th week when I showed all of the signs of preterm labor. I had my monthly prenatal visit on 6/9/17 and expre4ssed my concern to my then obgyn but he stated everything seemed fine but asked me to pray and remain positive since anything could happen. I came home, crying, and decided to listen to Laylah’s heart beat. I then woke up at 3am on the 10th to very painful contractions and labor signs. I remember knowing that she would be born but prayed in such despair for it not to be that. Laylah then arrived a few minutes later and broke our hearts. Now a year later, and a second miscarriage at 3 weeks, we have decided to start trying once again but now under the care of an MFM provider. I still get crying spells and become nervous with the idea of pregnancy but we are both hopeful that soon we will be able to raise a baby,
Me and my girlfriend recently lost our son. he arrived preterm, 24 weeks. She recently started to blog about what we went through and are going through in an effort to heal and to help others going through what we are going through. Here is the link to where you can see her posts. Hope this helps some of you guys the way it’s helping us.
jeska512.home.blog
Hi Eduardo. We are so sorry for the loss of your son. Thank you so much for sharing your family’s journey with us and with our families. I’ll plan on continuing to follow your story. Let Jeska know that she’s so brave to share her story and I’m sure it will help many others going through their own grief journeys. If you or Jeska need any additional support, please let us know how we can help. -Leigh Ann
We lost our daughter a week ago. 11/13/19. She was 19 weeks, due to cervix insufficiency.
I am on an emotional rollercoaster. Some moments i feel fine, others I’m angrier than I’ve ever been, others I’m so sad I feel like I’m swimming in a dark pool and sometimes the guilt hits me like a ton of bricks. It was physically and emotionally one of the most traumatic events of my life. I’m confused by the emotions and sometimes the lack of emotions.
I want to take the saddness from my husbands eyes. We tried for 5 years and belived our Rielly was our miracle baby.
Even through all this and even though its only been a week, we feel like we can’t give up on making our family. But I’m anxious and nervous about being pregnant again. What if it happens again?