For many women who have had a miscarriage, subsequent pregnancies can be a white-knuckle ride of worry, waiting, and a relentless need to check on the baby's well-being.
During my own pregnancies following my miscarriages, I found that connecting with women who had gone through the same experience – and learning how they managed – was the best coping mechanism. Here are some things they taught me.
Connect with women who understand
Your local hospital or mothers' group may offer a support group for women who are going through pregnancy after a loss.
"A support group can make an enormous difference, not just within the group, but in terms of meeting other women you can talk to on the outside," says Heather Roselaren, LCSW, a Berkeley-based therapist who specializes in working with families coping with loss. "These are women who know what you're talking about without you having to explain."
Opening up to your friends can also be beneficial. "Many people shared their own miscarriage stories with me," says April, 43, a mother of two in Orinda, California who only wanted to use her first name. "Knowing that so many people had miscarriages before the birth of their children was probably the most helpful thing for me."
Know when to protect yourself
Although support from women who understand what you are going through can be very helpful, "it can also be difficult to hear the stories of those with a more recent loss once you are on your way to feeling better," says Carol Cirulli Lanham, PhD, author of "Pregnancy After a Loss."
If a particular topic feels difficult for you to discuss, don't be afraid to let someone know you'd rather not have a conversation about it. Christiane Manzella, PhD, clinical director of the Seleni Institute suggests trying something like, "thank you for sharing your experiences but this is not a good time for me to talk about this," and then ask them about another topic you’re interested in hearing about. "That way you acknowledge their support, but state what you need," says Manzella.
Similarly, she recommends being careful about reading shared experiences online. "Blogs can be extraordinarily helpful, or they can be triggering," warns Manzella. "You may want to ask yourself, 'Is what I'm reading bringing me a sense of support or is it retriggering the pain and trauma I experienced?'" Take a break from reading about loss and pregnancy online if it's making you experience the pain all over again.
Find a doctor who understands
After Nicole, 40, of San Francisco who only wanted to use her first name, experienced her fifth miscarriage, she knew it was time to change doctors. "I felt broken, heartsick and despondent, and my doctor had been less than supportive."
If you are pregnant after having a miscarriage, "you have different needs than someone who has not experienced a loss," says Lanham. "Never hesitate to call the doctor when you're concerned. If you are met with disapproval, consider finding a different doctor."
Nicole felt grateful to her new doctor for this very reason. "I assumed that every bleeding episode meant I was losing the pregnancy, but my new OB was sympathetic to my journey and so patient with me."
Get the tests that help you relax
Bridgette Thomas, 41, of San Francisco, felt like she was holding her breath waiting for her amniocentesis results: "I needed to know there was chromosomal normality to feel peace and joy about the pregnancy," says Thomas. "So it probably wasn't until the 20-week mark that I felt I was not going to lose the baby."
April felt the same way. "I made the choice to have amniocentesis because I just really needed to know that everything was OK."
For women who are concerned about the small risk of miscarriage (1 in 200) from amniocentesis, newer options can offer some reassurance without the risk, says Charles Lockwood, MD, professor of obstetrics and gynecology and dean of the Morsani College of Medicine at the University of South Florida.
"In the era of cell-free fetal DNA testing, far fewer women will need an amniocentesis," says Lockwood. "This [noninvasive] test identifies more than 95 percent of major fetal chromosomal abnormalities with a false positive rate of only 1 to 2 percent."
Besides an initial scan to date the pregnancy, the nuchal translucency screen at 11 weeks and a 20-week anatomy scan, Lockwood says that there is no reason to have additional ultrasounds. But for women who find comfort in getting multiple ultrasounds (like me), he adds that there's also no definitive evidence of increased risks if you have more than three ultrasounds.
Know that worrying about blood is normal
For women who have had a miscarriage, the sensation of vaginal discharge can be upsetting. "I checked my underwear so many times I thought I was going to have to put a restraining order on myself," says Jill Galante, 45, of San Diego.
Nicole felt the same way when she experienced heavy bleeding throughout her subsequent pregnancy. "I kept a super bright LED flashlight next to our toilet, so I could carefully inspect the toilet paper every time I went to the bathroom. I also went to the OB at least once a week to make sure I still had a viable pregnancy."
Sex can also be triggering, because it can result in discharge and blood. According to Lockwood, "There is no benefit to [avoiding] sex as long as the cervix is not dilated." But many women choose to hold off anyway out of the fear of seeing blood in their underwear afterward. For women who are too anxious to have sex, affectionate hugging and touching, "which is so essential for a healthy relationship," says Manzella, can actually help by helping to soothe fears – and help you feel connected.
Find solace elsewhere
Manzella cautions that it can be tricky to rely on constant reassurance from checking your underwear, using flashlights, or (in my case) asking for biweekly ultrasounds. "While sometimes it helps to get an ultrasound, be aware that the reassurance can become a loop of distress in itself. It's best to find multiple ways to give yourself that reassurance when you need it."
If you find yourself wracked with anxiety except for an hour or so after a reassuring ultrasound, you may benefit from a new tactic that doesn't rely on medical verification that the baby is OK.
"Women benefit from staying engaged with the activities that they love, their work, some light exercise, and their relationship with their partner," Manzella says. "Have tea with your friends, watch a movie, and talk about matters not related to your pregnancy or loss."
If you find yourself caught up in repetitive anxious thoughts, try engaging your mind with other things such as listening to music, focusing on a physical sensation (such as your breathing), or even applying lotion. "Using your favorite hand cream can literally fool your body into paying attention to that sensation and helping reduce ruminative or intrusive thoughts."
Another way to limit the cycle of anxiety is giving yourself a time limit for worrying about your pregnancy. If you set aside 10 or 20 minutes just to worry, it may help you compartmentalize these sometimes overwhelming feelings. (Be sure to do this early in the day so it doesn't interfere with your sleep.)
Differentiate your pregnancies
"Look for even tiny things that differentiate the subsequent pregnancy from the previous one," advises Roselaren. "Remembering that this is not only a different pregnancy, but a different baby, can make a big difference."
Some women choose to invest in new maternity clothes or replace any baby items they collected during the previous pregnancy. It is also best to reconsider a name you had already picked out for the baby that you lost.
In my case, a local charity (Bananas Bunch, based in Oakland, California) connected me with a woman who had the same due date I did for the baby I lost. Giving this mother the car seat, clothes, and toys I had stockpiled for the baby I miscarried felt meaningful to me, and it gave me a fresh start for my subsequent pregnancies.
Seek professional help if you need it
"It is normal and even healthy to find yourself occasionally feeling sad even though you are pregnant again," says Lanham. However, there may come a point when you realize that you would like help coping with the feelings of being pregnant after miscarriage.
This is especially important if your anxiety is interfering with your daily functioning, or if you have a lack of appetite, sleeplessness, or periods of uncontrollable crying. Manzella suggests finding a mental health professional who has expertise dealing with reproductive loss.
Now that our family is complete, my girls like to hear the stories of how much I cared for them, even when they were just the size of a bean. I show them the dozens of grainy ultrasound photos and remember the hundreds of times I held my breath during those pregnancies – as well as the moment when I finally cradled them in my arms and exhaled.