Thursday, July 2, 2015

miscarriageCARE: When She's Pregnant Again

When a woman has a miscarriage, it permanently affects her thoughts and feelings about pregnancy, especially her own. It's important to understand that a pregnancy after a miscarriage is different for her, and the standard reactions and questions one would ask a newly pregnant woman may not be helpful, caring, or appropriate for her. This post details some of the things to keep in mind when a woman you know who has had a miscarriage is now pregnant.

According to the American Pregnancy Association, there are a few things to be aware of when it comes to pregnancy after miscarriage.

  1. There's no such thing as "too fast." A woman's periods can return as early as 3 weeks after a miscarriage, meaning that her ovulation took place well before that. Depending on her health, both physical and emotional, her relationship situation, and her health care provider's recommendation, she could be pregnant again within a month. As mentioned before, some women never even have a period between miscarriage and a subsequent pregnancy. 
  2. A woman's chance of having another miscarriage does increase after having had one miscarriage. It is not an alarming increase, but it is an increase nonetheless, and she is very likely aware of (and constantly thinking about) that fact. 
  3. Depending on a number of factors, subsequent pregnancies in a woman who has miscarried may be monitored more closely by her health care provider--but they also may not. 
And now for the things to keep in mind when a woman is pregnant after a miscarriage.

1. She might tell you right away, but she might not.

And unless you will also be a parent to this baby, she is under no obligation to tell you at any point. Miscarriage often has a polarizing effect. Some women decide that caution is pointless after a miscarriage, and they broadcast their news to their circles quickly, seeking a support network early on. Other women decide that dealing with people through a miscarriage was hard enough that all pregnancies from here on out will be kept tightly under wraps--from everyone. One thing is certain: a woman who has been through a miscarriage now knows exactly who is in her support network . . . and who is not. While you may feel left out if she doesn't tell you about a pregnancy, it is most important that she feels comfortable and supported during this time. 

2. She might not seem excited about being pregnant.

Perhaps she delivered the news calmly and quietly. Perhaps she offered a small smile when you told her how happy you were for her. Perhaps she whispered it to you with fear in her eyes. Trust me, you are not the reason she's not jumping up and down and clapping her hands with giddiness. This subdued attitude likely began the moment she had a positive pregnancy test in hand, and will likely continue for months, if not the entire pregnancy. Even though, medically speaking, pregnancy after a miscarriage is most likely a fresh slate, she probably doesn't feel that way. Like young children learning about a hot stove the hard way, her loss has now shaped her perception of pregnancy; she will likely treat it with care and caution now. Observe her own demeanor before jumping up and down and clapping your hands at her news. 

3. Her health care provider, and the way they approach this new pregnancy, is up to her. 

She may completely trust her health care provider, but you think she should switch over to someone who could hand a high-risk pregnancy (whether she actually is or not); on the other hand, you think she's in good hands, but she wants to find someone else who makes her feel safe and comfortable. Perhaps she can't stomach walking into that same office after what she's been through. Perhaps she feels that her doctor is too aggressive and she wants someone who can help her feel laid back and calm. Perhaps she feels that her midwife is too relaxed about pregnancy and she wants a take-charge health care provider to give her clear directions. At this point, her choice in health care provider will be more about finding someone who reassures her and makes her feel safe. Let her make that choice herself (offer advice when asked, then let her decide). She will likely feel anxious about her appointments from now on, and a provider that reassures her is essential. 

4. Advice is either tricky, annoying, or hurtful. 

General advice about pregnancy can be tricky when given to a woman who has already been pregnant before. She is already going into this pregnancy with some experience--and a negative one at that. She won't need, and likely won't want, advice about things she's experienced before. Asking her what's new this time around can be a good way to feel out where she might want some tips, but it's probably safest to wait until she asks for some advice. 

And whatever you do, do not offer advice about making this pregnancy work. Remember, miscarriage is not something that can be prevented, and there is no medical evidence that things like cutting out caffeine completely, staying off her feet, eating certain foods every day, or going to the doctor every week can prevent a miscarriage. Advice like this gives her the message that she is in control of miscarriage, implying that her previous miscarriage (and any future miscarriages) was because she didn't follow the correct routine. Allow her health care provider to give her medically sound advice, and allow yourself to just be there for support. 

5. She will crave the "unpleasant" things.

Swollen breasts? Stretch marks? Fatigue? Constant nausea? Heartburn? Bad skin? 

She wants it. She covets it. These things mean that she is REALLY pregnant. These things will become her pillars of strength and reassurance. She will be so thankful for her morning sickness as she crouches over the toilet bowl losing the breakfast she never got to finish. While most women would rejoice for a nausea-free day, she's trying not to panic at the sudden absence of symptoms. Every moment of queasiness and discomfort, for her, will be a glorious reminder that her body is definitely pregnant, so before you ask her about morning sickness, ready to share horror stories, be aware that she's probably much happier about it than you think. 

6. She cannot wait to feel the baby move.

From the moment her morning sickness ends, she's ready to feel the baby move. It will be even worse if she ended up being a woman with no sickness. Those weeks with no symptoms will be difficult for her to say the least. When she finally does feel the baby move, she'll likely monitor it with obsessive diligence. If the baby fails to kick at 9:00 a.m. like it has for the last month, she'll immediately imagine the worst. This is true for most women at this stage of pregnancy, but understand that it's likely more difficult for the woman who has had a pregnancy loss. 

7. She will compare her pregnancies.

As explained in previous posts, a pregnancy that ends in loss is still a pregnancy, no matter how short. If she miscarried at 8 weeks before, those first 8 weeks of her next pregnancy will be meticulously compared to the lost pregnancy. It's also likely that she will avoid doing certain things or being in certain situations because they have become associated with miscarriage in her mind. And yes, even though medical evidence shows no correlation between slipping on the stairs and miscarriage, she's probably subconsciously made her own correlation and will take the stairs VERY slowly now. 

8. She might use "if" statements instead of "when" statements.

This can be disconcerting and awkward for some people, but it is reality for her. She is all-too-aware of the fact that a pregnancy can end in a loss, and saying "When the baby is born," is not a guarantee. She is not morbid or pessimistic; she is simply being realistic in the face of an uncomfortable reality. 

If she doesn't use "if" statements, then perhaps you're finding it difficult to engage her in speculation about the future. She doesn't daydream out loud with you about what the baby will be like or about what she thinks labor will be like. She will gladly talk about what's happening right now, but she doesn't talk about her future plans. This is another product of her experience with pregnancy loss. Allow her to savor what her pregnancy is like today, and don't push her into a future that doesn't exist yet. 

9. She will wait longer to do a lot of planning and/or nesting.

If she had to box up a newborn onesie that never clothed the child from her pregnancy loss, she probably isn't out there buying things for her subsequent pregnancy. Perhaps she's made a lot of plans or she has a lot of ideas, but when you ask her what she purchased or what she's done she tells you "Nothing yet." Perhaps she doesn't want a baby shower before the baby arrives. She might adamantly refuse to do anything until she enters her second trimester. Despite what Pinterest makes us think, a baby doesn't need beautiful nursery before it's born. It won't hurt anyone if she wants to wait to do everything. 

10. She will still envy other pregnant women.

The joy and innocent excitement of other women might be hard for her. Stories about the fun her friends had trying to conceive might make her feel left out. Her own experience has now been tinged with loss and the stress of trying to conceive after that loss. It's a lot less fun and a lot more like work. Even a strong and grounded woman who celebrates another's pregnancy does so with a remembered pang in her heart. 

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