Let's get real: PAL is not all rainbows & butterflies
Pregnancy after loss is a gauntlet.
There is nothing quite like the experience of PAL, and only someone who has been through it can really understand that. We've been there, parents, and we get it.
Below are our top tips & recommended resources for every stage of your subsequent pregnancy after the death of your baby.
This will be one of the hardest things you will ever do, second only to waking up every day without the child you are missing. But you can do it. We'll be here for you, every step of the way.
Jump to: Trying to Conceive | Pregnancy After Loss | Resources for PAL
TAKING THE PLUNGE: TTC AFTER LOSS
Trying to conceive after a stillbirth or other pregnancy/infant loss is an incredibly complex, emotional, and personal decision. Even the phrase "trying again" can bring up mixed feelings (and in case you're thinking it, NO, you did not "fail" last time).
Some parents feel a strong desire to quickly become pregnant again as part of their healing journey, while others may wait years or even decide they do not wish to bring another child into their family. No matter how you are feeling, it is completely normal and there is no right answer.
Below are some helpful considerations as you being to contemplate another pregnancy:
Determining the 'Right' Time
First and foremost, talk to your medical provider and go with your gut, as there are no set guidelines and it will depend on the circumstances of your previous birth and medical history.
Many patients will be told by their providers to wait 6 months or a year so that they are "better" able to emotionally handle the stress of the pregnancy, but that is not an evidence-based recommendation. We know from experience that you're never "done" grieving, so don't feel like you have to wait until you're "better." As long as your doctors say you're physically ready, whenever feels right to you is the right time.
Finding Answers
There are many (rarely simple) reasons why a pregnancy may have ended in a stillbirth or other loss. Some causes likely to recur, some are preventable, and others are not. Understanding your prior loss and finding potential answers (or at least eliminating things you don't need to worry about!) will be immensely helpful in a subsequent pregnancy after a loss. This will both help to alleviate your anxieties (will it happen again?) and guide your doctor’s treatment plan.
If your previous child was stillborn, you may have elected to do some testing such as an autopsy, placental pathology, and/or genetic testing. In many cases, though, parents are not encouraged to seek answers, so if you didn't do those things, know that you are not alone - and there are likely still opportunities to learn more, even if your loss was years prior. For example, Yale University’s Dr. Harvey Kliman is a leading researcher in this space and has provided many PUSH families with answers to previously unexplained stillbirths. Dr. Kliman is a placental pathologist and is able to learn a lot from slides of your stillborn baby's placenta, which the hospital you delivered at likely has on file, even if you didn't request this service. (More info & steps to request a placenta review here.)
Additionally, your doctor may choose to run additional blood tests to look for potential clotting issues or genetic carrier risks. If you had preterm labor, you may want to consult with a cervical expert. If you had hypertension, preeclampsia, or HELLP syndrome, you should learn more. The most important thing is to make sure your medical team has closely examined the records of your previous pregnancy to learn all they can about what contributed to your baby's death.
Choosing a Provider
It's crucial to find a medical provider and prenatal care plan that you are comfortable with. Some families elect to stay with their previous provider, feeling more comfortable with someone who intimately knows their medical history and who they feel is dedicated to ensuring a different outcome. Others find that due to concerns about their previous care or simply to minimize the effects of their trauma (PTSD is not uncommon in subsequent pregnancies) it’s critical to see a different provider in order to have a different experience. Choose the option that feels right to you.
Regardless of your choice, it is important to consult with a Maternal Fetal Medicine specialist (MFM) during your pregnancy. Sometimes called a perinatologist, these physicians specialize in high-risk pregnancies and will be able to conduct more detailed and frequent scans and monitoring. Your MFM will work in partnership with your OBGYN, so you can ask your OB who they prefer to collaborate with, or vice versa. (Sometimes you can also find a doctor who is both an OB and MFM.)
Depending on where you’re located, your best bet may be to seek the support of a Rainbow Clinic. A Rainbow Clinic is a specialized prenatal care provider for families who have suffered a previous stillbirth or pregnancy/infant loss. Based on the successful model created in the UK, Rainbow Clinics use an aggressive multidisciplinary approach to reduce the incidence of repeat tragedies for loss families and provide exceptionally empathetic and empowering care. PUSH for Empowered Pregnancy is working hard to bring Rainbow Clinics to more cities in the US!
If you're having trouble finding a provider you trust and who makes you feel heard and respected, check out our database of recommended PAL medical professionals.
PREGNANCY AFTER LOSS: YOU CAN DO THIS
The 40-week journey you will undergo during a pregnancy after loss is both physically and emotionally demanding. Unlike in the pregnancy prior to your loss, you are keenly aware of the potential for devastating outcomes during pregnancy. As such, it is critical that you find the medical, social, and psychological resources necessary to supporting you during this time. It's a long nine months - and it can feel interminable, literally until the very last day! - but you will get through it, and PUSH is here to help!
Advocating For Yourself
Unfortunately, too many of us loss moms learn it the hard way, but one of the gifts our children who have died left us with is knowing that we are our babies' best advocates. Sadly, pregnant people - and loss moms in particular - are frequently treated by our medical system as fragile, hysterical, or incompetent. We call BS on that. You have survived one of the worst things a person can experience, and you are still standing. You are a warrior, and you deserve respect.
Speak up if anything feels off - loudly, if necessary. Demand extra monitoring/scans and whatever tests you need to ensure your baby is doing well and give yourself peace of mind. Ask questions - as many as you can think of - and contact your provider or go straight to the hospital for a checkup, whenever you feel the need. And do not let anyone make you feel bad about it. You have paid an enormous price to earn the right to whatever level of care you desire. If your medical team won't give that to you, find someone who will.
It is our goal that someday every expectant parent will feel as empowered as we loss moms do in our PALs to advocate for the care that we and our babies deserve. If you're not getting what you need in your PAL, we've got your back! Based on our own experiences in subsequent pregnancies and with the expertise of our medical advisors, PUSH has compiled a list of questions to ask your provider, recommendation strategies to get the treatments that you need, and a database of peer-recommended providers. (Coming soon!)
Sample PAL Care Plan
Gone are the days of monthly check-ups and 2 or 3 ultrasounds during your pregnancy. During a pregnancy after loss you can - and should! - expect significantly more frequent touchpoints with your medical providers.
Your specific care plan will of course depend on the circumstances of your loss and your individual medical history, and should be created in partnership with your medical team, including a Maternal Fetal Medicine (MFM) specialist.
But in case you want to get an idea of what to expect, for many of our PUSH Changemakers who have gone through a subsequent pregnancy after a stillbirth, this has included:
Genetic testing in the first trimester
Echocardiogram of baby’s heart if you’ve begun taking an SSRI for anxiety or depression after your loss
Growth scans at 16 weeks, 20 weeks, and every 2-4 weeks beginning at 28 weeks
Weekly biophysical profile ulstrasounds (BPPs) beginning at 28 weeks
Frequent EPV scans to measure your baby's placental volume, ensure the placenta is an adequate size for your baby’s gestational age, and check that both your baby and their placenta are sticking to their growth curves
Nonstress tests for fetal heart rate monitoring, as needed (often weekly starting 28 weeks and 2-3 times per week after 32 weeks)
If desired, an early term delivery via induction or c-section at 37 weeks (which is now supported by ACOG!)
Use of a doula who may specialize in bereavement/PAL
Mental/Emotional Support
We're going to give it to you straight: pregnancy after loss is HARD.
It is absolutely critical that you and your partner (and even your extended family!) are receiving mental and emotional support from as many sources as possible. This can include professional support such as therapy, peer support through in-person or online discussion groups or mentoring, reading books or listening to podcasts that help you feel less alone and can help you process your complex feelings, taking any necessary antidepressant/antianxiety medication prescribed by your doctor, etc. The free Pregnancy After Loss Support App is also a fantastic resource to connect you to tailored content that will help guide you through the most trying aspects of your individual PAL journey.
During and after your PAL, be on the lookout for signs of perinatal mood and anxiety disorders, such as Posttraumatic Stress Disorder (PTSD) and Postpartum Depression/Anxiety (PPD/A), which can surface at any time during or after your pregnancy. The trauma that you have experienced is real, and it does not make you weak to seek help from a trained therapist, psychiatrist, or support group; on the contrary, asking for help is one of the strongest and smartest things you can do.
Remember that this journey is incredibly emotionally difficult, even for the most resilient individuals. Mental and emotional health struggles are understandable and normal, and may pop up even after your healthy "rainbow baby" is born.
RESOURCES FOR PAL
You do not have to do this alone. Many families have walked this difficult road before you, and we are here to help.
Find a Trusted PAL Provider or Rainbow Clinic
View our list of PUSH-approved PAL medical providers here.
Resources for Pregnancy After Loss
Check out our Resources for Pregnancy & Infant Loss page for a list of recommended tools and resources for pregnancy and parenting after loss.
PAL Provider Training
Are you a healthcare provider or birth worker who cares for families pregnant again after a loss? Don't miss our online PAL training modules! (PAL Families, contact us for a code to give your provider to access for free!)
READY TO LEARN MORE? There's plenty more #empoweredpregnancy goodness where that came from! Head back to the Empowered Pregnancy Overview to for even more empowerment. #UnitedWePush