Everything Pregnancy

What to Expect from a Pregnancy After Stillbirth or Miscarriage

Pregnancy after loss is different both physically and emotionally. Doctors and moms who now have their own rainbow babies tell you what to expect.

Pregnancy after miscarriage Monkey Business Images/Shutterstock
During my first three pregnancies, I worried about potential complications a normal amount. Then, I'd move on, and focus on enjoying the special time leading up to my babies' births. But seven months ago, I lost my fourth pregnancy late in the second trimester. Everything changed when I learned complications don't just happen to other people. Now that I am expecting another baby, I obsess over what could go wrong. The fear and anxiety feels overwhelming at times, so much so, that sadly, it's a challenge to truly embrace this pregnancy.

Maternal-Fetal Medicine specialist Rob Atlas, M.D., from Mercy Medical Center, told Parents.com these feelings are not unusual. "There can be quite a bit of fear, anxiety and many [women who are pregnant following a loss] have some degree of depression," he explained.

NICU nurse Stacy Schultz, who lost her twins when they were born at just 20 weeks, is also familiar with these powerful emotions. When she became pregnant with her son six months after the devastating loss of Emilyn and Hailey, she understood this baby wasn't immune from death. The first time, "Nothing could go wrong," Schultz says. This time, she explains, "I wasn't just worried about what ended up killing my girls, prematurity, but every other complication that can befall a pregnant woman."

"Fear was the most difficult aspects of the post-loss pregnancy," she continues. "Fear of losing my baby, fear of bonding and trusting that I would bring him home. If I expected to bring him home, then it would jinx things, and I would lose him too."

Schultz further explains the tangled web of emotions one can expect to face during those long nine months. "I felt like I needed to cherish every moment, but let's face it, pregnancy is tough!" she says, adding, "The first day I was grateful for nausea, but before long I couldn't wait until it was over. Then I felt guilty, like if I wasn't thankful and happy for it, I was disrespecting the memory of my girls, as they showed me how easily it could all be taken away."

Lara Friel, M.D., obstetrician-gynecologist at the Division of Maternal-Fetal Medicine at The University of Texas Health Science Center at Houston/McGovern Medical School, and author for Merck Manuals, tells Parents.com guilt is also a normal feeling to have after miscarriage or stillbirth.

With my own guilt as a constant companion, I am now nearing the point in my pregnancy when I lost my angel baby. So, I torment myself with a new set of agonizing questions: Will I make it past that terrifying milestone? If I do, what happens next? Is it okay to plan for my baby's birth? And how could that be different from the births of my other children?

"For me, I needed [my son's birth] to be as different as possible from Emilyn's and Hailey's," Schultz said. "I needed their presence in the room though, and I had a picture of them put up."

Dr. Atlas cautions there are potential birth complications women need to be aware of after loss, especially if they get pregnant again quickly. "We call it short-interval pregnancy. Patients who conceive quickly after a loss, usually within 6 months, run a higher risk of prematurity," he says. "This is usually related to a patient who has had a late loss (after 20 weeks)."

"Many women want to get pregnant again after a loss, quickly," Dr. Friel acknowledges. "However, short inter-pregnancy intervals have been found to be associated with a number of harmful outcomes for both mother and child, including increased risk of preterm birth, low birth weight, and preeclampsia. Women who attempt to get pregnant again quickly may also be at increased risk of anemia."

She advises women to allow time for rest and recovery both physically and mentally after loss and before trying to get pregnant again, and explains, "Every pregnancy requires a lot of resources—iron, folic acid, calcium—which need to be restored prior to the next pregnancy. It's recommended that women continue to take a prenatal vitamin daily."

But ultimately, Dr. Atlas has found the emotional challenges to be the most significant, and encourages women to get help. "Speak openly with [your] practitioner and seek professional care and support for as long as [you] need," he recommends.

Dr. Friel seconds that notion, telling us, "I strongly recommend counseling or therapy for patients who experience a miscarriage or stillbirth. There are also support groups for parents who have had a pregnancy loss, or siblings who have lost a new member of the family."

"My saving grace came through March of Dimes' [online community], Share Your Story," Schultz shared. As for me, it is a combination of support from my husband, my family, a therapist, and our pastor that has slowly helped me face every aspect of life after loss, including this pregnancy.

No matter where you seek help, just be sure to find that support. Know that you aren't alone, and everything you are feeling post-loss, and during a subsequent pregnancy, is normal and expected.