Don’t put off pregnancy after a miscarriage
August 8, 2010 by blueromance
Women who get pregnant soon after suffering a miscarriage found to have better chances of healthy pregnancy and birth, finds study
Waiting up to six months to try to get pregnant after a miscarriage may be unnecessary, a new study has suggested. This contradicts World Health Organistion guidelines that recommend waiting six months after a miscarriage to begin trying for a baby.
The study looked at the pregnancies of over 30,000 women, finding that those who got pregnant within six months of having a miscarriage were less likely to have another, a termination or ectopic pregnancy. The figures also suggested that these pregnancies were less likely to be at risk of caesarean birth, a premature delivery or a baby with low birth weight.
A fifth of pregnancies miscarry and the chances of this occurring increase with age. Although authors of the study cannot explain their findings, they have suggested that the decline of fertility over 30 may be a factor. Women who miscarry in their late 30s have a better chance of conceiving if they don’t wait for another six months.
“I think it’s going to be reassuring for women, many of whom want to try again soon after a miscarriage but are worried about doing so,” said Ruth Bender Atik, director of the Miscarriage Association.
Miscarriage can take time to get over both physically and emotionally and many women need six months or more to recover. This study reassures that if you do feel ready before six months, you can safely try again.
Trying Again after a Miscarriage
This can be the most difficult topic of all, because everyone has an opinion, and your doctor and your friend’s doctor, and internet sources, and your mother, and your partner will all say different things. You will personally go from wanting to try again RIGHT NOW to never wanting to try again, sometimes in the span of five minutes. You may not agree with your doctor. Your partner may not agree with you. You are already grieving, and upset, and feeling like a failure, and thinking too long about this topic can make you feel so very much worse.
Accept that there are many opinions. Let me tell you a bit about why.
Doctors are trained to recognize that a woman needs emotional healing, but not really to help them or explain it to them, since it goes beyond their "bones and tissues" type of practice. Three months is considered the average amount of time a women will grieve hard over a loss, and will have a difficult time (and be a difficult patient) if she gets pregnant prior to that. While there are a few doctors who believe that your uterine lining must take three cycles to get back to rebuilding itself fully each time (especially after a D&C, where it gets scraped pretty thin), most doctors know that it doesn’t really matter in about 80% of the cases, and getting pregnant again right away does not carry any increased physical risk or miscarriage risk.
So even among doctors, some will say the standard "wait three cycles" and might even scare you into thinking you’ll have another miscarriage if you don’t wait, and others will say go ahead and try again now.
As for my opinion, I’ve been running this site for three years, and have talked to about 2,000 women who have had miscarriages. From what I’ve seen, you really should wait for one cycle to complete, because if you do not, you will experience one of two situations, both of which will cause you much unnecessary grief and pain:
1. If you do get pregnant again before having a period, you will not establish a reliable Last Menstrual Period date (your miscarriage date is of no use). You will run into lots of problems when you go in for your first prenatal sonograms and blood tests, causing you tons of grief (often for nothing) and can wreck your relationship with your doctor (supporting the "difficult patient" theory.)
For example, the blood test will say you are six weeks; you will insist you are eight. The sonogram will not show a fetal pole yet, but you have read that you should see a baby by now. You will think your doctor should do something, but he or she will just say your date is wrong and come back in a week. You will spend a week of torture, wondering if the baby is dead, and why do you have to wait for answers. All these things can be avoided by knowing your LMP, or preferably ovulation. Most of the time, the babies are fine, but sometimes you are having another miscarriage. Everything is murky because you don’t know for sure when you got pregnant, because you didn’t complete a full cycle.
2. If you have retained tissue, your period will be "late" (although all post-miscarriage periods take more than four weeks and are late) and you can even have a POSITIVE PREGNANCY TEST, but you are not pregnant. This is hCG left in your system from the miscarriage, which has not completed. You may begin bleeding and cramping and think you are having another miscarriage, but you are just still going through the first one. We have had women on the site grieving over a 2nd lost baby, naming it and everything, when it turned out she only had missed tissue from the previous loss. Having a D&C does not guarantee that all the tissue was taken. About 1/4 of the women on this site with missed tissue had a D&C. If you did not wait for a real period, you will not know if a pregnancy test really means you are pregnant again, or if your loss has become a long drawn-out ordeal.
Additionally, charting and even ovulation predictor kits are not reliable tools during that first cycle after a miscarriage, and the body will put out lots of signs of fertility or lack of it as it tries to adjust itself. Women may be absolutely sure of their pregnancy’s gestational age, and still be wrong! Once you get past that point, try the sperm meets egg plan to see if you can speed up the trying again process.
On the other extreme, not getting pregnant that first cycle, or for the next few, when you are fervently trying, will actually push your grief further down the line, month by month, and it can really be detrimental to healing, your life, and your relationship. Often your life will completely revolve around trying again and you will feel even more a failure, more unable to cope. This may also happen if you wait, but is more likely to pull you into a clinical depression if you are not yet dealing with your loss and are still having some hormonal upheaval.
Even if you feel like you are fine, the grief is really out there, and you need to work directly through it. I don’t worry about the women who write about crying and saying they can’t go on. They are working through their pain and grief. I worry about the woman who just wants to try again, and doesn’t mention or think about the pain of losing a baby.
In the end, this is your life and your body, your baby, your future, and your decision. Make your choices well, and try not to look back.
Monitoring a New Pregnancy
Some doctors will respond to your worries and bring you in for additional hCG tests and early sonograms to monitor the new baby more closely. Most will not do anything. It can be frustrating and scary to think about waiting until 8 or 9 weeks to see the doctor, when every day brings a new twinge or cramp or cervical discharge that makes you panic.
I think it is reasonable, if you have had only one loss, to still request an early blood test and a sonogram at 7 weeks to see the heartbeat. This will reassure you. If you have had more than one loss and no healthy babies yet, then you should be able to request more frequent monitoring of your hCG and progesterone levels, just to see where the pregnancies are failing. This could help give you a clue as to a cause.