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Trying to conceive after a preterm birth or pregnancy loss can feel overwhelming. Many parents experience a mix of hope, fear, and uncertainty. In this guide, we’ll walk through emotional readiness, medical considerations, and what to expect in a future pregnancy.
Emotional Readiness After Pregnancy Loss or Preterm Birth
Before trying to conceive again after a preterm birth or loss, it’s important to make sure you are emotionally ready to move forward with trying for another pregnancy.
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.
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.
Learn more about Hand to Hold’s Counseling Program
“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 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.”
When to Try Again After a Preterm Birth or Loss
If you feel that you are emotionally ready to try for another pregnancy, the next step is to schedule an appointment with your provider to determine if you are physically healthy enough to pursue pregnancy once again. It’s rare that your physician would 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.
How to Prepare for a Healthy Pregnancy After Preterm Birth or Loss
When you meet with your doctor, you will review prior pregnancy or NICU experience, then create a plan for monitoring next pregnancy. Ask your doctor about your specific risks given your history, what could change with this next pregnancy, and how you will be monitored differently.
You will also want to talk to your doctor about any nutritional changes you may need to make, their recommendation for prenatal vitamins, and managing any chronic conditions you may have.
Medical Considerations for Future Pregnancies
In some cases, your doctor may recommend additional interventions to help reduce the risk of another preterm birth. These may include progesterone supplementation, more frequent cervical monitoring, or procedures such as a cervical cerclage, which involves placing a stitch in the cervix to help it remain closed during pregnancy.
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.
Build a Support System for Your Next Pregnancy
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.
Get Support During Your Journey
There are many ways to get support as you navigate this journey.
- Hand to Hold Counseling
- Virtual Support Groups – groups available for NICU parents, parents enduring a high-risk pregnancy, and for bereaved parents
- Request a Peer Mentor
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.