Managing Pregnancy After Stillbirth
Ways to address pregnancy feelings and anxiety after a stillbirth
My husband and I lost our daughter Genevieve to stillbirth in 2011. Before we had even left the hospital, I was pleading with him to try for another baby. I didn't think about the journey ahead of me, only my goal of bringing home a healthy baby.
At first, I was terrified to get a positive pregnancy test. How could I survive nine months of another pregnancy now that I had experienced the worst that could happen at the end of it? But as we struggled to conceive, I focused only on becoming pregnant. And when I finally saw those two lines, I felt immense relief. But that was soon replaced with the realization that I would spend the next nine months holding my breath.
One of the greatest comforts to me over the next excruciating months was learning how many other women felt the same fear that I do and yet survived subsequent pregnancies. And what we learned may help others who follow us down this difficult, but hopeful, path.
The relief (and fear) of a new pregnancy
Angela Rodman, a 30-year-old stay-at-home mom in Salem, Oregon, was so focused on becoming pregnant after losing her daughter Charlotte shortly after birth that Rodman was taken aback by the fear that hit her during those long nine months. "I wanted to be pregnant again so badly I didn’t think about the entire 40-week arc of pregnancy and how difficult it would be."
Anxiety is a common emotion in any pregnancy. But women who have had a stillbirth feel a different kind of fear, one that is rooted in experience, says Christiane Manzella, PhD, a senior psychologist who specializes in grief at the Seleni Institute. "Women who have been through loss know that the unthinkable is possible," she says. "That realization changes everything."
These women remember the moment that they learned their baby had died and the way they felt when they came home to an empty nursery. And that experience turns another pregnancy into a perilous leap of faith.
Separating anxiety from true medical concerns
"Women need to address the real concerns that exist," says Manzella, "while separating the other fears connected to the previous loss." That means talking with your doctor about what may have caused your stillbirth and whether any particular risks can be reduced. If there are medical issues to be managed, then you and your doctor can create a plan to address them.
Most women will have extra monitoring during a pregnancy after loss. Even when the pregnancy appears normal, doctors take precautions to reduce the risk of a repeat stillbirth.
I now see a perinatologist for in-depth ultrasounds and monitoring of the baby’s heartbeat and movements. Perinatologists, who have special training in fetal monitoring and treatment, can watch for problems with the placenta, amniotic fluid, and the baby’s growth. Most doctors also recommend that women who have experienced a stillbirth do daily kick counts during the third trimester.
I always feel reassured after an appointment with my perinatologist. I can't guarantee the outcome of my pregnancy, but I know that I've done everything I can to have a healthy baby.
Managing your anxiety
Once you are confident that your pregnancy is in good hands, it's time to create your own plan for managing your fears.
Get support. Manzella suggests finding at least one friend who you trust who will listen to your fears about the pregnancy. For Brooke Taylor, a college professor in St. Louis, who lost her daughter Eliza to stillbirth, having a network of moms was critical to her emotional health during her subsequent pregnancy.
"I was so fortunate to connect with three other moms whose situation mirrored mine," says Taylor. "We formed an informal support group and emailed each other constantly – multiple times a day – throughout our pregnancies."
Express your fears. Beyond speaking with supportive friends or other moms, Catherine Monk, PhD, associate professor of clinical psychology at Columbia University, recommends keeping a journal to have a place where you can freely write down every worry – small or large.
Practice good sleep habits. Monk also emphasizes making sleep a priority so that you feel better able to cope with stress during the day. You can read, listen to music, or meditate to unwind before bed. If your mind races at night, jot down worries in a journal to deal with them during the day instead.
Be prepared for uninvited conversations. Decide ahead of time how you want to handle questions from strangers about whether this is your first baby and what your birth plan is. These questions dredge up a lot of sadness and having answers ready can help you avoid falling apart in the grocery store checkout line. Some women always want to acknowledge the baby they lost, while others prefer not to share such details with strangers.
Take it day by day. "Instead of thinking about reaching full term, I thought about making it through the first trimester, then to viability, then through the second trimester," says Rodman. "Setting small goals helped reduce some of the panic and anxiety."
Get professional help if you need it. If your worrying feels out of control or is interfering with your quality of life, you might want to seek counseling, Manzella says. Some women have memories or flashbacks that are very disturbing. "Counseling can help process and diffuse the intensity of these memories," says Manzella.
Know that anxiety is normal and ok. Worried women should know that their fears are not likely to hurt the baby, says Janet DiPietro, PhD, a professor of developmental psychology at the Bloomberg School of Public Health at Johns Hopkins University. "There are no direct neurological connections between fetus and mother," says DiPietro, who has personal experience with the worries of pregnancy after loss. Her second son was stillborn, and she describes her next pregnancy as a "white knuckler."
It's normal (and ok) to scale back your preparations for the baby
I still have a crib set up from my pregnancy with Genevieve, but I don't plan to decorate the nursery until I bring home the new baby. I have turned down offers of a baby shower from friends. This is partly because these preparations remind me of how much hope and joy I lost when Genevieve died. But also because my focus is bringing home a healthy baby.
Many women I spoke to for this article also expressed the fear that preparing too much (or at all) felt like inviting disaster.
"I had done such extensive preparation before Eliza was born that I couldn’t bring myself to do much of anything until I was holding a live baby in my arms," says Taylor.
Manzella says that it is normal – and healthy – for women to cope this way because preparing can be too scary. "No matter how resolved that grief and pain is, that a woman had a pregnancy loss shapes how she experiences subsequent pregnancies."
A different gender may bring mixed feelings
Most parents who have experienced stillbirth say that the gender of a subsequent baby didn't matter. Yet it's difficult to let go of the dreams that took root for the baby they lost.
Taylor was happy to have a second daughter because after losing Eliza she had "grieved what I knew might have been my only opportunity to raise a daughter."
When I lost Genevieve, my older daughter lost the opportunity to grow up with a sister, so I couldn't help hoping that she would have a second chance at one. But of course, the most important thing is that my baby be healthy, so even thinking about a specific gender made me feel guilty, which is perfectly normal, says Manzella.
Or people can feel guilty when they are disappointed by a different gender. “My grief was intensified by a million not getting a little sister to pass Addison's things down to,” says Keleen Crawford, an administrative assistant in Olympia, Wash., who lost her daughter to stillbirth. "I feel cheated out of my excitement for my son. Grief and loss stole that from me."
For other parents, having a child of a different gender makes it easier to distinguish their babies. Whatever your expectation or hope for your baby's gender is, know that it is normal to feel conflicted.
The birth might not be what you expect
Even after surviving a nerve-wracking pregnancy, women aren't always elated the moment their healthy baby arrives. Every mother I interviewed for this article said that their subsequent births were more difficult than they expected.
Crawford remembers that her reaction to her son's birth surprised both her and her doctor. "I was holding him, soaking him in, but also feeling like this moment still felt wrong," Crawford says. "I felt like I let everyone down by not crying tears of joy or showing excitement, but I just could not do anything but stare."
"When you do have a healthy baby, there's a huge element of shock," says Monk. Women may numb themselves to the experience because of their fear that something will go wrong.
Taylor realized in the late stages of labor, "how terrified I was that something would be wrong with this baby. I had the crazy thought that if I pushed the baby out, he or she would be broken into pieces."
In the end, Taylor says, she "was able to reach down and pull the baby onto my chest and see her pink and crying. It was literally the greatest moment of my life," she says. "I just wish it had been like that both times around."
A few more ways to cope
Every woman will have different ways of handling a pregnancy after loss. Here are a few tips that have helped me.
Consider changing your doctor and hospital. I had liked my doctor's minimalist approach during my first two pregnancies, but after losing Genevieve, I knew I needed someone more sympathetic. I also found it traumatic to return to the place where I had learned of my daughter's death. I wanted a fresh start.
Keep busy. Try taking a class, doing volunteer work, or even just getting interested in something as simple as a new TV series. I've found that the more free time I have, the more I worry.
Let yourself enjoy the new pregnancy if and when you can. After many months of trying to pretend I wasn't pregnant, I have finally bought a few snuggly outfits for this baby. I know that, despite my efforts to remain detached, I love this baby already. In that way, this pregnancy is perfectly normal.