Exploring the Unknown: A Journey Through Pregnancy After Loss

About a year after my daughter died, I was sitting in a tattoo shop picking out a font for her name wondering if this would be the month my secondary infertility finally came to an end. I picked a font to go with a beautiful butterfly I had chosen, and the artist would go to work tattooing my ankle. A beautiful symbol of remembrance. Little did I know this symbol of remembrance would be a huge comfort throughout my pregnancy after loss. A few days later, I would find out I was pregnant. A gift from my daughter, a year after her birth and subsequent death. In the year leading up to my pregnancy after loss, I was severely depressed but very high-functioning. On top of the grief, I experienced secondary infertility. Looking back, I was in survival mode, living in proverbial clouds. I felt out of control. I had no control or say in losing my daughter, no control over when I would fall pregnant again, and no control over the outcome of future pregnancies. I hated it.  Finding out I was pregnant again brought a myriad of emotions. I was numb, happy, sad, terrified, cautious, excited, and still. So. Damn. Out. Of. Control. I frequently doubted my ability to carry a baby to term and was convinced that even if I did carry a baby to term, I wouldn’t leave the hospital with a baby. I struggled with this in my 2 pregnancies after loss. My thoughts were consistently very dark. Very anxious. It was a scary blissful time.

 

“Today, I’ll choose courage over comfort. I can’t make commitments for tomorrow, but today I’m gonna choose to be brave and I know what that means”.

 

Brené Brown’s Netflix special “The Call to Courage” premiered during the first trimester of my 1st pregnancy after loss. The timing was perfect. I remember watching it and deciding that regardless of the outcome, I would navigate this pregnancy with courage. “Today, I’ll choose courage over comfort. I can’t make commitments for tomorrow, but today I’m gonna choose to be brave and I know what that means”. I used this quote as my screen saver and looked at it several times throughout the day. Pregnancy after loss is difficult, to say the least, each pregnancy containing its own unique set of nuances; but somehow, I survived it, twice. Here’s how:

 

I was straight Delulu

I lived in delulu land. I know that sounds crazy but hear me out. On some level, you have to be delusional. Knowing that your baby could die at any point and still choosing to try again. To embark on the pregnancy journey again in hopes that it ends with a live baby that you get to take home with you. You have to believe that this pregnancy is different, that lightning won’t strike twice when deep down you know it can and it has for so many others.  I chose to believe that each pregnancy would be and end differently.

 

My doctors were PAL friendly

In my first pregnancy, it was discovered that I had cervical insufficiency. I knew that in any future pregnancy, I would have a preventative cerclage placed and be considered a high-risk pregnancy. I had done a lot of research and asked a lot of questions. I was prepared with a lot of information. I was expecting my doctors to be open to addressing my concerns and openly communicate with me at each step of this process. I was referred to a Maternal Fetal Medicine (MFM) specialist to perform my surgery and then monitor my cervical length. I would see them from week 12 to week 24 providing that everything went according to plan with my cerclage.  My first pregnancy after loss was with the same doctor as with my previous pregnancy. She knew my history and was very accommodating. She provided extra care and helped to put my mind at ease. She was willing to work with me so that I was seen biweekly between her office and my MFM and more frequently if I wanted. She was overly cautious at times, but I appreciate her desire to help me in my goal to go home with a baby. My MFM was also extremely accommodating. She offered additional ultrasounds and to see me more frequently in the weeks leading up to my “loss week”. She gave me the full picture of what my options were. Some things could be done preventively, or we could take the wait-and-see approach. With my history, I chose the preventive route, and she supported my decision.

“It was very important to me to have some sense of familiarity even with the new OB”

My third pregnancy, the second after loss, was with a new OB due to a change in career and insurance. It was very important to me to have some sense of familiarity even with the new OB, so I made sure my OB was willing to work with my MFM. My OB made the time in my first appointment to discuss with me what process worked in my previous pregnancy. She was very attentive and willing to do what made me comfortable. She was open to doing ultrasounds as frequently as I wanted and whatever I needed to put my mind at ease.  My doctors checked in with me often to see how I was feeling emotionally, especially close to my loss week. I wasn’t ever made to feel like my concerns were too much or that I was overreacting or asking too many questions. They celebrated each milestone with me and mentioned my daughter often, even using her name at times, highlighting the supportive care that I received.

I didn’t share the news

I shared the news pretty immediately with close friends and family during my first pregnancy. Everyone knew by the time I was 7 weeks. For my 2nd and 3rd pregnancy, I waited. I shared with close family and friends when I was about 10 to 12ish weeks. I didn’t hide it, but I also didn’t acknowledge that I was pregnant until I was quite obviously pregnant. I didn’t want to talk about it. There are many reasons that I chose not to share. One reason is that it is very difficult to tell people that your baby died. People make insensitive comments when your baby dies. They say things like “That just wasn’t the baby that was meant for you”. I feared the comments. People make insensitive and inconsiderate comments during a “normal” pregnancy. I did not want to experience that, so I just didn’t share. I didn’t want to explain to people (during my second pregnancy) that this was actually NOT my first pregnancy, I had been pregnant before, I just didn’t have a living child. It felt easier and safe to just not acknowledge it as much as possible.

 
I became very focused on creating routines and tasks

Pregnancy after loss can feel powerless. You know just how little control you have in carrying a pregnancy to term and even leaving the hospital with a baby. Instead of focusing on what was outside of my control, I focused on what was in my control. I focused on tasks and creating goals. After the first trimester, it is often seen that you are in the “safe zone” as the chance of miscarriage lessens. If you have experienced a 2nd or 3rd trimester loss, stillbirth, or infant loss you know that there truly is no “safe zone”. I sat down with a calendar and labeled each week of pregnancy. In my first pregnancy, I was 23 weeks and 6 days when I went into premature labor.  So, I was hyperaware of delivering prematurely and survival rates. I labeled the weeks based on the level of prematurity and survival rates. With that information, I created goals. My first goal was to make it 24 weeks and surpass my first pregnancy. Then 26, 28, and so on as the chances of survival increased. I alternated seeing my OB and MFM every other week or so from weeks 12 – 24 when every other week appointments started with my OB. In my 3rd pregnancy, I developed gestational diabetes, so I was seen by both my MFM and OB frequently throughout my third trimester. I scheduled my appointments in advance, when possible, to have them on my calendar. I put everything on the calendar, weekly progesterone shots, appointments…everything, and focused on following the routine. Checking things off as I did them. In addition, I took weekly photos in celebration of being pregnant another week!

     

 

I planned for a premature delivery

With cervical insufficiency, the risk of premature delivery increases. Delivering prematurely was a very real possibility and I wanted to do what I could to be prepared in the event that it happened. A common question that I see asked in PAL support groups is “When did you allow yourself to buy things in your subsequent pregnancies after loss”. It is such a relatable question and really made me think. How do you plan for a premature delivery when you can’t bring yourself to purchase anything for fear of not bringing a baby home to use it? The dilemma. I decided this “sweet window” existed between 28 and 32 weeks. The chance of survival is high at that time, so although still risky, I decided that is when I would purchase and prepare for my baby’s arrival. I didn’t need much for my 3rd pregnancy, but I felt slightly safer earlier on to purchase the things that I did as my cerclage and cervix held up very well in my second pregnancy. I allowed myself to think I would at least make it to 32 weeks of pregnancy. I purchased almost everything that I needed in that window. I also had my baby shower about midway through the window. I packed mine and the baby’s bag by 32 weeks. I would also recommend keeping your bag in your car if you work outside the home or taking it with you for doctor’s visits just in case you are admitted to the hospital for any reason. I was admitted to the hospital during my third trimester in both my pregnancies after loss. We have “hospital districts” here so I chose my OBGYN near hospitals that had amazing NICUs and were close to a children’s hospital with a level 4 NICU. I didn’t travel so that in the event I did go into premature labor I would be where my doctors were and near family/friends. I researched and learned the process for NICU hospital stays and graduations, etc. My oldest son was born a few days prematurely. While he did not have a NICU stay he still had to “graduate” to be discharged. I was thankful that it was something I planned for.

Things that I did differently in my 3rd pregnancy

In my 3rd pregnancy, I felt a little more grounded. I had a routine that helped me survive my previous pregnancy and I felt good about implementing what had worked again. With my severe perinatal anxiety, I decided it was best for me to go to weekly therapy and talk through my anxieties and fears in a non-judgmental space. I was able to process the unexpected things that happened and the major life changes that occurred. My first pregnancy after loss I developed preeclampsia and had to be induced. This led to an unplanned c-section. I decided that I wanted more support in the delivery room. Rules were changing frequently due to COVID protocols, I wasn’t guaranteed multiple support people. I had considered hiring a doula and when I found out it was a guaranteed support person regardless of COVID protocols, I was SOLD! Getting a doula was extremely empowering. She helped me plan for labor and advocated for me when I was unable to do so with hospital staff. She directed my support people during my labor and helped me remember the skills I had learned to manage labor pains. She also did so much during pregnancy, talking through ways to address things with my doctors and managing my gestational diabetes. It was a great support and one I would gladly choose to utilize again.

 

My challenge to you: Embrace the fear, tolerate the discomfort, and figure out what works for you in your pregnancy after loss.

 

What’s next for me?

One thing that I wished I had was a journal that laid out some of these tips and tricks to help me during my pregnancies after loss. I am working to create a journal to help other moms navigate their pregnancy after loss experience. Interested in learning more? Sign up for my emailing list!

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