Too many of us have been in these shoes. It’s not an easy path to walk. The road to motherhood is often painted as a blissful stage in a woman’s life where everything is glowing and rosy. We are all well aware by now that up to 25 percent of clinically recognized pregnancies result in miscarriage. And yet we still don’t talk about it much.
For every article out there confirming miscarriage is a normal, natural occurrence, there’s a woman left questioning why it has to be her new normal. To those women, know this won’t last forever. Know it is transient; it is strengthening you; it is going to be a part of your story for a reason. Yes, the child(ren) you lost will matter.
Still, many mamas aren’t prepared for what comes next, or for the flood of emotions and admittedly strange behaviors they’ll experience once they are ready to entertain another pregnancy after miscarriage.
What Constitutes A Loss?
Generally, when people think of miscarriage in clinical terms, they think of first trimester losses. When do most miscarriages happen? The majority — 80 percent — do occur in the first 13 weeks, but the risk of loss after the fifth week is just 21.3 percent, and that drops to only 5 percent after week six. But miscarriage is far too life-altering and sensitive of a subject for us to pretend there is only room for clinical thought patterns.
Miscarriage is used to describe losses that occur before 20 weeks. After such, the medical term is a stillbirth. The emotional after-effects appear to be quite similar no matter what you call it — however, some women miscarriage before they even miss their period. Known as a chemical pregnancy, it’s no less real to the mother who just lost her child. Sadly, friends and family aren’t always as keen on recognizing such as a loss. Ladies, seriously, screw them. You lost your child. Grieve away.
How Long Should You Grieve?
I’ve seen this question often presented in birth support groups I help run. Maybe it’s been a while now. Long enough that people have stopped looking at you in that way when they see you and ask how you’re holding up. Their lives have gone back to normal. Perhaps even your partner seems to have moved on. So why can’t you?
Give it time. Be kind to yourself. There is no right or wrong way to grieve, though I wouldn’t suggest coping using anything that is going to cause you further trouble. There is also a great deal to be said for how our thoughts and actions manifest what happens in our lives.
Personally, I try to actively focus on things that bring me joy. I do not put energy into things that don’t serve me well. Today, many women feel compelled to honor their angel babies. They may post about them on social media or even display an ultrasound photo in their home. If that helps you heal, do it. If it doesn’t, don’t feel you’re any less of a mother or that you loved your child any less if you pack those photos away for safe keeping.
The Reality Of Your Next Pregnancy
1. You May Become A Pee-On-A-Stick Addict
Hey, ain’t no shame in my game. I’ve been there. I will probably always be there. If my darling other half ever reads this, he will most certainly start crunching the numbers on how much money I’ve spent on pregnancy tests. Oops!
Listen, some people have seriously expensive coping mechanisms that can wreak havoc on everyone’s’ lives around them. At least mine only kicks into gear when we’re expecting.
Fellow POAS addicts, unite! I hear you.
We need this reassurance. It calms us. Each time it comes out positive still (even though we just tested four hours ago), we rejoice!
What I would like to warn against is using pregnancy tests to gauge pregnancy progression. Mamas often think the intensity of a test lie means HCG is increasing. There are two problems with this train of thought. First, it’s not always true. Different tests can have different concentrations of dye — even tests of the same brand and batch number.
Second, eventually, you can run into the Hook Effect, wherein HCG reaches such high levels that both antibodies in the test as saturated by such high levels of HCG that the two cannot sandwich together as they are intended to, resulting in a false-negative test result. Thus, you could be trucking along with darkening tests, and suddenly, they’re getting lighter. You panic. You rush to the doctor. You put yourself through a lot of grief for no good reason!
The alternative? You can always request bloodwork from your provider. Two doings of quantitative HCG panels — spaced two to three days apart — will verify whether or not the pregnancy is progressing.
2. The First Trimester Will Drag On… And On… And On…
Those first thirteen weeks will seem oh so long. The golden rule of miscarriages being most common during the early weeks plagues the mom who has already lost a baby. The intermittent worry that it will happen again feels almost constant.
But the truth is, even when you make it into the second trimester, you don’t stop worrying. Some of the tension certainly eases up though once the baby is moving regularly — each punch or kick signals relief. But even the early weeks of feeling the baby move, they can trigger more worry because they are so sporadic. One day baby is moving and the next they aren’t, and you’re forced to accept this too is “normal.”
3. Ultrasounds And Dopplers Will Be Tempting
Ultrasound technology is not as tightly regulated as many argue it should be. Several studies have touted the negative effects ultrasound and Doppler technology can have on a developing fetus, most notably to the brain and overall growth. So we must as ourselves, as mothers, is there a benefit to my baby in using these interventions?
There is no doubt that it can ease our minds, and therefore, benefit us. But at what cost to our babies? The American Journal of Obstetrics and Gynecology published a clinical trial on more than 15,000 women in an attempt to determine whether routine ultrasound screenings improved outcomes for mom or baby. The result? A. Big. Fat. Nope. The publication notes:
“The rates of induced abortion, amniocentesis, tests of fetal well-being, external version, induction, and cesarean section and the distribution of total hospital days were similar in the two groups.”
The Annals of Anatomy published a study back in 2008 on the effects of ultrasound on the brains of mice while in utero. The study went on to note that both groups of mice exposed to ultrasound while in utero saw significant impairment in learning and memory functions, and the anatomical makeup of their brains — upon dissection — was significantly reduced.
In some instances, even trained professionals may be using ultrasound equipment at higher frequencies than regulations allow for. Building upon that, untrained professionals may work at third-party facilities which perform keepsake ultrasounds. The FDA has clearly warned against the use of these facilities.
As you can see, used by an untrained individual, the effects can be quite drastic. And one could argue that expectant moms are untrained individuals. Hence the concern for the use of Doppler’s at home.
A Doppler of your own may seem like a great idea. The problem is that it’s such a slippery slope. Every time we reach for it to calm our nerves and reassure ourselves that our baby is fine, it affirms the internal belief system we are developing that we cannot be content and trust our body until we hear that heartbeat.
Slowly, it becomes something we are checking for daily, often more than once. If we know that even intermittent use of a Doppler during pregnancy can potentially cause fetal damage, and we know that those early weeks are the most critical for brain and organ development, we must question what daily exposure to a Doppler by an untrained professional could potentially do. And until we have data on that, use of such is not known for certain to be safe.
4. You’ll Investigate Your Underwear
Who here has suffered a loss before and now has to peek down below every time they feel anything to make sure it’s not blood? Are you raising your hand with me right now? Pregnancy must be the most inconvenient time to feel compelled to examine bodily secretions. Is there ever a time that we have any more of such than we do while expecting?
And what about all the times we definitely just felt something and nothing is there? Whether you’re waddling down the aisle at the supermarket or in the comfort of your own home, this is a pretty common behavior among moms of angel babies. This one may drive you a bit crazy, but it won’t physically harm anyone. So… as you were.
5. You May Not Get Your Hopes Up
Welcome to motherhood! Do you feel the mom guilt settling in yet? Oh yes, that tends to start before baby is even in our arms. And in this instance, it’s a pretty loaded emotion. Simply put, you might be afraid to get excited. You just may convince yourself that it’s best not to celebrate too much because it will somehow hurt worse should we lose this baby, too. But that’s not how this works, speaking as a mom who’s been there.
You’ll grieve no matter what, and you might even feel bitter that you didn’t revel in it while you could… that you didn’t celebrate the next baby as much as the prior one you lost. Of course, it’s far from easy to just let yourself be elated. The anxiety and fear of going through a miscarriage again can consume you. Rest assured if it does, you’re no less of a mother, and no weaker a woman.
6. You Will Feel Immense Gratitude
While the worry is sure to creep in every time you have a day that isn’t full of nausea or baby isn’t quite as active, it will be tightly interwoven with a multitude of other feelings. Rest assured, your next pregnancy is not a gateway to you turning into a puddle of anxiety.
You will be overcome with the feeling of being blessed. You will love the new baby on board all that much more, having known what it feels like to lose the opportunity to raise your own child. There will be good and bad days. There will be days full of worry, and days full of laughter. There will be tears of sadness and tears of joy.
Do not turn away from yourself during this time. This pregnancy is your experience at welcoming new life into the world. You were never promised it would always last. Immerse yourself in the experience so long as it does.
When Is It Safe To Get Pregnant Again?
The other question often posed is how long a woman should wait until she gets pregnant again. Some women are fine with trying to conceive as soon as they safely can. Others don’t feel so ready. And both are perfectly acceptable.
Others wonder how long does it take to get pregnant after a miscarriage? Generally, and if there are no other fertility problems, a singular loss isn’t going to impact fertility, and statistically, it shouldn’t take any more time to conceive again than it would for someone who has never had a miscarriage.
Still, I do think it’s important that women understand the risks inferred on both sides so that they may make a reasonable assessment of their own situation and circumstances. Is pregnancy immediately after miscarriage still safe? Actually, there are potential risks to entering into pregnancy again a little too soon.
Most medical professionals advise allowing yourself to have two or three cycles before you conceive again could, in theory, allow estrogen and progesterone levels to balance out to optimum levels. This is ideal since you need a good sex hormone ratio and a quality estrogen supply to plump up the lining of your womb — otherwise known as your endometrium — so another implanted embryo has a good shot at survival.
It is also entirely possible to develop postpartum mood disorders following a miscarriage. Women have also reported developing Posttraumatic Stress Disorder and Premenstrual Dysphoric Disorder following such. You don’t have to be anywhere near full term for that to happen.
The same rules apply in safeguarding against it though. A support system, patience with yourself, and allowing time to recover. You’re going to have to open the flood gates when it comes to miscarriage and allow yourself to feel all of that pain. The only way out of it is through it.
One study published in the American Journal of Public Health compared the likelihood of depressive symptoms among women who had miscarried within the previous four weeks alongside women who were pregnant and those who had not been pregnant anytime recently. The study notes:
“Among women who had miscarried, the proportion who were highly symptomatic on the CES-D was 3.4 times that of pregnant women and 4.3 times that of community women. Among childless women, the proportion of women who had miscarried who were highly symptomatic was 5.7 times that of pregnant women and 11.0 times that of community women.”
The recovery isn’t just about your body. It’s not just about waiting for HCG levels to reach zero and for the bleeding to stop. The mind and body cannot be separated, and therefore, time allotted for the mind to recover is just as crucial. Doing so helps you to adjust far better when you do fall pregnant again.
Preventing Miscarriage The Next Time Around
There are some pretty obvious basics we all know by now, right? Don’t smoke. Don’t drink. Make sure any medications you are on are pregnancy-safe. Keep everything as low-stress as possible. You’ve heard it all. Or have you?
There are two aspects of fertility that are often overlooked, and they are major game-changers and as such, deserve more attention: food, and MTHFR.
What Is A Good Pregnancy Diet?
Diet isn’t concrete when it comes to pregnancy. Do plenty of women eat fast food for nine months, pop allegedly poor quality prenatal vitamins, and produce babies who are fine? Sure! No hate. Still, some of us have a bit more fortitude and want to feel we’re going above and beyond. I tend to end up somewhere in the middle myself. I just had baby number four recently, and while I did not take any prenatal vitamins during pregnancy, I did ensure I was eating damn well.
Lots of fresh produce, greens, protein, raw cheese (because I totally hate milk!), protein, tons of water (san fluoride, if you please), and usually some more protein were piled up on my plate. I’m a big fan of the Weston A. Price Foundation diet when I can make it work for my crazy life. But that’s just me.
Full disclosure: I feel competent and capable of researching what path to take and taking care of my body without instruction. That said, I am often asked whether I supplement at all. If there is a documented deficiency, I certainly do. First, with food, and if that doesn’t work, with quality supplements.
Maybe you eat Paleo. Maybe you’re Vegan. Maybe Pescatarian. Maybe you eat whatever you feel like eating. What matters is that you’re getting the nutrients you need, and a big part of safeguarding against miscarriage are those B vitamins.
That being said, trouble can start brewing if you don’t school yourself a bit in this area because not all B vitamins are created equally, and we don’t all process them the same way. B12 and B9 (which is folate… aka folic acid) are critical to a healthy pregnancy.
Folic acid has been added to many food staples in the American diet (namely grains like cereal, bread, flour, pasta, etc.) for decades. That’s great, if you can adequately process folic acid…
No, it’s not a curse word, but many argue it should be. MTHFR is short for methylenetetrahydrofolate reductase. Here’s the skinny on that. In short, MTHFR impairs folate conversion. There are many types of folate. Folic acid is just one kind. Some would argue it’s the poorest quality form of folate.
The problem is, folic acid must go through many steps to become L-methylfolate, and only L-methylfolate can cross the placenta and get to your baby. It’s also the only form that can cross the blood-brain barrier and makes its way into your central nervous system.
So, if you’re downing boatloads of folic acid in your prenatal vitamins, and then some, it won’t necessarily help you if you have mutated copies of MTHFR, which an estimated 40 to 50 percent of the globe is said to.
We all have two copies of this single nucleotide polymorphism (SNP), and we pass one onto our kids. Thus, every human has one copy from mom and one from dad. To be clear, everyone has MTHFR SNPs, but everyone does not have a mutated copy of it.
That’s where the trouble comes in. If you have this mutation, your ability to make that MTHFR enzyme that is needed to clear the body os synthetic minerals like folic acid, and other troublesome invaders like lead and aluminum.
If you have one mutated copy of the c677t variety of MTHFR, you could be making 35 percent less methylfolate in your body. If you have two copies, it is further impaired, with the c677t getting the shortest end of the stick and up to 70 percent less methylfolate production.
The National Institutes of Health states women who have two copies of this specific mutation do have an increased risk of having a child with a neural tube defect, such as spina bifida and anencephaly.
Data regarding MTHFR enzyme activity for the a1298c variety of this mutation is not fully clear, but several studies have documented that it does impair such, albeit it to a lesser degree than c677t. One of the widest studies done on such, published by the Journal of Congenital Abnormalities, also notes the a1298c variety in conjunction with several disorders.
It’s important that women understand MTHFR is an SNP and not a gene in the sense that many people think. It’s not a “defect gene” that is going to directly cause said defect to occur. Rather, B vitamins are critical for proper fetal development.
If you have mutated copies of MTHFR that are impairing your production of folate and its ability to reach your baby, then the baby may not be getting enough of those critical B vitamins, no matter how much you are consuming of them.
Caring for yourself when you have these gene mutations is a two-step process during pregnancy. Not only do you need to consume folate either directly from food or in methylated form, but you may also need to avoid consuming folic acid (in both supplements and food). Yes, this can mean saying goodbye to all things bagels and spaghetti for a while.
It’s best to talk to your provider about this, but folic acid has been known to build up on folate receptors and block the good folate from getting through by way of inhibiting absorption at natural receptor sites, per the Journal of Clinical Obstetrics, Gynecology and Reproductive Medicine.
A lot of women leap at the opportunity to take advantage of prenatal vitamins that are “derived from food,” but if you’re going that route, do be aware even those that come “from food”—like lemon peels or broccoli—may be oxidized during processing and are thus converted to folic acid—something manufacturers do not have to legally make consumers aware of or even test for in their end products.
The Comprehensive Reviews of Food Science and Food Safety study on the stability of folate in fruits and vegetables during processing notes,
“5,10-CH2-H4folate can be converted to H4folate at low pH, which can be oxidized to H2folate (under low pH conditions and/or heating). H2folate can be converted to folic acid (under low pH conditions and/or heating) being susceptible to further degradation.”
As a final note: manufacturers are allowed to refer to folic acid in a supplement as “folate.” The term folate is not akin to natural. Folate is the umbrella term for many kinds of vitamin B9. It can be used to refer to any of them. However, a mineral can only be called L-methlyfolate on a supplement label if it is indeed L-methylfolate.
How To Handle Being Pregnant Again
My dear sisters, grieving was never meant to be a lifelong process. That only happens in country songs. It’s okay to move on. It’s alright to be happy about the child that is on his or her way. It doesn’t mean you’ve forgotten about the child(ren) you’ve lost or that you love them any less.
It doesn’t even necessarily mean you’re over it. But we have to move on. My first miscarriage was among the most painful I’ve endured-on every level. I bled for 72 days. I grieved for years—even beyond the birth of my first two children following my second miscarriage.
I remember crying as my mother drove me home from the doctor’s office, and I watched people eating lunch, driving around town, laughing even. It hit me hard that life really doesn’t stop just because our heart breaks.
Everything keeps spinning. And we must be grateful that it does. I know I am. Because there were days I may not have pulled myself up from my bed and kept going if it weren’t for the life around me. That is a testament to the spark of life inside each of us. The part of us that wants the pain to stop. If you’re in the thick of that grief that now, and it feels like the pain won’t stop unless everything comes to a close, heed my words:
You won’t always feel this way.
Every struggle has the opportunity to be a lesson learned. My advice? Don’t wish away those early weeks. Don’t let the trauma of a prior loss rob you of enjoying what you’re about to gain. A pregnancy that is indeed a blessing.
Remember that we all grieve differently. While you don’t have to process your loss(es) the same way someone else does, you should ensure that you are actually allowing yourself to grieve and doing such in a healthy way.
There’s no magical limit on how long it can hurt. And some losses may cause more torment and anguish than others. There are no hard and fast rules here. It’s a heartache like no other and only time will nurse you back to your old self—or rather, the person you will be now.
Because yes, this will change you. You’ll forever relate to every woman you ever meet or come to know that miscarries. You will never forget the details of your own. You will wonder on that child’s due date who they may have been. And you may often question: why? Sister, the reason for it is unfolding before you. Be mindful. Be present. You don’t want to miss this.
Sources: Comprehensive Reviews in Food Science and Food Safety, Journal of Clinical Obstetrics, Gynecology and Reproductive Medicine, Medline Plus, Medical News Today, American Pregnancy, American Journal of Public Health, American Journal of Obstetrics and Gynecology, Annals of Anatomy, FDA, Fox News, MethylPro, Dr. Will Cole, Genesight, Journal of Congenital Abnormalities, Medical Genetics Summaries