subsequent pregnancy

Where in our minds do we place our past loss that is respectful of our baby but that also leaves room for the new one? It is very important to come to terms with this thought and complete grieving before conceiving again. Unresolved grief after a miscarriage can mean we may not invest any emotional energy to bond with this baby until we feel safe to do so because of the pain from the remembered previous one. This can be a conscious or unconscious decision. Among other things, unhealed grief may lead to postnatal depression after the birth of a new baby, as unlikely as it may seem.

Even though our bodies are able to ovulate and conceive four to six weeks after our miscarriage, we believe it does not necessarily follow that we are all emotionally ready to cope with a healthy full term pregnancy. The decision is a personal one and perhaps dependent on an age factor but we recommend taking into account your state of mind over the grief of your loss before making a decision. The next baby does not replace the lost one, as is sometimes expected, (see more details under ’Things we may not know’ & 'Advice that another baby will fix this') which can exacerbate unresolved grief and may also cause post-natal depression. Recent information in the British Medical Journal (August 2010) about a study that followed women in Scottish hospitals suggests that the optimum time for conceiving again is with-in 6 months so that still gives time for a reasonable period to grieve. One partner may also feel ready before the other and this can be a problem as becoming pregnant again needs to be a mutual decision.  Full partner support is crucial as research indicates that women who have experienced a miscarriage have a higher chance of a successful pregnancy when given lots of reassurance and emotional and psychological support.  This is especially true after multiple miscarriages.

statistics of success

• Couples with no history of miscarriage or if their last pregnancy was a live birth, have an 80% - 85% chance of a successful pregnancy.
• This only drops by 1% if the last pregnancy was terminated
• Couples who have had one miscarriage still have an 80% chance.
• Those who have had two miscarriages drop to 72%
• Three previous miscarriages drops to 43%

Even those who have more miscarriages will usually have a baby eventually, if they feel they can continue to try, although hormonal, structural and infectious causes continue till treated (see 'why miscarriages happen').

Chance chromosomal abnormalities are unlikely to reoccur. Five percent of couples have chromosomal abnormalities which are passed on to

common fears
As a result of miscarriage the carefree, joyful innocence of having a baby is lost. The subsequent pregnancy is often a time of scepticism and uncertainty, women steeling themselves against stress that fluctuates between overwhelming fear and a low level anxiety. Trying to remain emotionally stable as well as being constantly aware of possible threats to the pregnancy (rather than to ‘my baby’) is paramount but often in a disengaged way. This only usually ends when a healthy child is safely

we often

• Have a fear of finding blood in our knickers every time we go to the toilet.
• Worry about any twinge of pain in our abdomen.
• Fear that "overdoing things" will bring on a miscarriage, so we treat ourselves as if we were extremely fragile.
• Worry that the outcome of the pregnancy will be abnormal in some way. Almost everyone worries about this, but for people who have had a miscarriage, the fear of abnormality is often much greater.
• Fear buying or borrowing baby clothing and equipment, having a baby shower, accepting presents before the birth or preparing a nursery
• Have an expectation that having other living children will be helpful in allaying anxiety after a miscarriage
• Try to protect ourselves from another emotional blow, and may distance ourselves from the reality of having a baby, viewing our pregnancy as an ‘impersonal biological condition’, refusing to think about names etc. 
• Then worry about the outcome of this emotional detachment when we recognise it

coping with fear

• Use the time before you try getting pregnant again, to build yourself up physically. Really take care of yourself. You deserve it!
• Get lots of emotional support for yourself also. Consider joining a support group or finding other people who have been through similar experiences and are thinking about a subsequent pregnancy. It helps to be able to talk with others who have been there and done that. NZ Forums are often useful and counselling an alternative if you feel you have become too obsessive or depressed
• Keep a journal writing down all your fears, tears, hopes and excitement. Share your feelings with your partner.
• Substance abuse when unaware of a pregnancy until weeks or months after conception may have caused your miscarriage but it may not have been the reason either, so holding onto the guilt around this is pointless and soul destroying.  Instead learn from past experience and be aware and responsible this time.
• Make sure you really trust your medical professional. If you do not feel you are getting the care you deserve or your fears are not taken seriously, consider changing.  Do not be concerned with the professional’s feelings, just your own. It is your choice and is important.
• If you have had multiple miscarriages and live in a large city, there may be a re-current miscarriage clinic available where you can receive special help (see ‘Resources’).

pre-pregnancy

• Continue looking after your body. Eat well. Get your weight to a reasonable level. Try a diet suitable for pre-pregnancy (see www.joyfullivingservices.com/preventingmiscarriage.html)
• To help your body be at its optimum we suggest taking additional supplements. Some now come in pre-packaged form. You will need Omega 3 and pre-natal multi vitamin & mineral formula to help your body be at its optimum. Also 400 micrograms Folic Acid minimum (800 recommended by NZ midwives and buy from a chemist, not the supermarket, as their dosage is too low, often only 300) before pregnancy and until 12 weeks gestation, to help normal development of the baby's nervous system preventing defects like spina bifida as well as miscarriage.
• Folic acid can be taken in a lower dosage for your whole pregnancy if you wish.
• A medical professional can give you the latest information and make other suggestions and if necessary have some basic testing done – we suggest this after 2 or more miscarriages.
• You may consider consulting a naturopath or an acupuncturist
• Read up on helpful information. Suggestions are listed under 'resources' e.g. (Miscarriage; Why it happens and how best to reduce your risks - A doctors guide to the facts. By Henry M. Lerner, M.D., OB/GYN Amazon)

once you become pregnant again

• Try light exercise like walking, swimming, or pregnancy yoga.
• Take time out to relax as much as you can. Try massage, listen to relaxing tapes or soft gentle music. Go for a walk in the park or at a beach.
• Go to Websites like SPALS to help keep you positive.
• Avoid the list of things that can lead to miscarriage.
• Let the housework build up and don't go that extra mile at work, at least for the first 3 months. Do as little as you can and ask family and work mates to help out. Tell them how fearful you are feeling. If possible, give up work for that time at least if you feel too stressed, as stress is associated with miscarriage.
• Helping yourself will give you more confidence to know that you have done the best you could for yourself and your baby.
• Dare to be positive if you can. Try visualising yourself holding your healthy happy baby in your arms or, if it feels comfortable, buy something for your baby.
• Information from the internet; Once the heart beat is seen on a scan there is only a 4% to 5% chance of miscarriage, depending on the speed of the heart-beat. It should be 120 to 160 times per minute. (BMP)
• Hang in there! Remember that the odds are firmly in your favour, even if you have experienced multiple losses. Hopefully your fears will lessen as the weeks pass.

after birth
A doctor we consulted felt that some first time mothers are categorised as depressed but often it is the period of time it is taking to adjust from the unperceived impact of the responsibility that a new baby has on their life and the loss of the previous lifestyle/company they may have enjoyed. An anxious and often a lonely time but not necessarily classed as depression. Joining other first time mother’s in a coffee group where you are all probably having similar feelings should help. Comparing notes on baby care and a new way of life can be comforting and enlightening. In NZ groups of 1st time mothers are often organised at hospital but enquiries can also be made through other sources like medical professionals, churches, parent groups or family friends.

However, if you have not been able to overcome your fears, counselling will help resolve the situation and should be considered. If a negative frame of mind continues, it prevents proper bonding with your baby and parenting as well. It is also very easy to drop into post natal depression. We have spoken to various women who tell us on the recommendation of their doctor, they had free counselling from a psychologist along with group therapy run by their District Health Board (NZ), which was a great help to them. They learned useful techniques to prevent negative thoughts and were offered various other suggestions and support and gradually overcame their problem. They are so pleased they asked for help, feeling it would have negated the point of having a baby without making this effort to change, and they would have missed truly being able to love and enjoy their longed for child.

(a compilation of information, some quoted courtesy of Kate Frykberg & the Wellington Miscarriage Group).