Essential reads & resources

Pregnancy After Loss

The physical, emotional and spiritual experience of miscarriage, stillbirth, or other forms of perinatal loss can have impacts on future pregnancies that are sometimes unexpected. Expecting parents struggling with complex emotions, unresolved fears or lack of appropriate support deserve to know the validity of their experience and their options for navigating subsequent pregnancies in relative safety and emotional well-being.‍

We outline some of the common experiences of parent-survivors and support people navigating the reality of a subsequent pregnancy after loss. Scroll through for additional articles on miscarriage, physical and mental health considerations, and unique reflections for anyone navigating what can be a vulnerable journey of family-making.

• Understanding pregnancy loss
• Pregnant after a loss? It’s okay to…
• Getting appropriate support

Understanding pregnancy loss

Miscarriage, stillbirth, and other forms of pregnancy loss are very common, but rarely discussed openly. We put together some resources for people anticipating, navigating, supporting or recovering from pregnancy loss with the hope of providing accurate information, removing some of the stigma associated with discussing loss, and help loved ones to effectively support a person or family moving through this difficult experience.

• Understanding Miscarriage
• Miscarriage Support in 7 Steps
• Quotes for Grief in Pregnancy
  

Preconception health considerations

In addition to the above resources, it’s important to know that the majority of people who experience pregnancy loss are able to conceive again and have a healthy pregnancy, but everyone’s story is different. If you’ve experienced miscarriage or stillbirth, or if you had to terminate a pregnancy for a health reason, discuss with your health care provider if any aspect of that event has health implications for another pregnancy. A subsequent pregnancy is a new and different experience, but taking that step can help you to identify if any special care or considerations are required in this part of your family’s journey.

Postpartum recovery is one aspect of healing from pregnancy loss, and everyone’s body is different. Ask about optimal timing for conception after your loss, and consider that giving your body enough time to recover fully, while nourishing yourself and getting enough rest, will increase your chances of a smooth conception and pregnancy.

If you and your care provider do identify concerns about conception and pregnancy, you may have more options for family planning than you realize. Assisted fertility technologies, working with a maternal-fetal health specialist, professional support for mental health and stress management, and support in attaining hormonal readiness or other physiological aspects of reproduction may be available, and some insurance programs may cover aspects of fertility care or treatments. Some individuals decide to pursue becoming pregnant, while others consider their options for becoming parents in other ways, such as adoption and surrogacy. These are highly personal decisions to discuss with your closest support people, knowing there is not one “correct” or “perfect” way to make a family.

Pregnant after a loss? It’s okay to need something different...

Loss, miscarriage, stillbirth and grief are complicated experiences. Sometimes a family’s new pregnancy can come with expectations that the pregnant person or couple will feel or behave a certain way. Offer yourself permission to have complex emotions, concerns or needs, and know that your process is 100% valid and worthy of respect and compassion. It is normal, acceptable and 100% human if you...

Have mixed feelings about being pregnant again...

Overjoyed, sad, relieved, frustrated, numb. These are all understandable feelings to have when facing the possibility of new life in your family amidst the reality of the death of a child. It may not be easy to feel all of these things in the same time period, but they are valid responses to loss and change. 

Remember, grieve, talk about and name your child who died...

Honoring our loved ones does not have to happen in secret, and a pregnancy loss is not a shame to be hidden away. Allow yourself to say your child’s name out loud, whether it’s their birth name or simply a pregnancy nickname. Allow yourself the reality of the love, dreams and hope you had for that child, and the power of their impact on your life, however long or short their physical presence with you lasted. 

Skip certain events like baby showers or birthday parties...

It can be difficult to feel or show genuine excitement and calm during events that are focused on babies, parenthood, or children. Compassionate friends will understand, and it is not your job to explain your needs or emotional status to those who do not. Some people who are grieving may also feel like they are better able to celebrate someone else’s good news from a distance. Whatever you choose, know that taking care of your heart is neither selfish nor rude, and that our relationships to certain ideas or reminders can shift over time.

Decline or accept well-intentioned reassurance

We mention some things “not to say” in our article on miscarriage support - even in a thriving pregnancy, it can be tempting for well-intentioned friends to gloss over concerns or minimize the feelings that may come up for a pregnant person who has experienced loss in the past. While the aim is to help, this can actually hinder the expression of important feelings and the healing process. Even medical care providers may accidentally dismiss someone’s feelings or fears by trying to provide information, but this isn’t always helpful. 

Grief itself is a complex process with its own ups and downs, so feel free to reach out to those who understand you best, and seek out others who have shared in a similar experience. You can decline the “help” of those eager to “fix” your feelings with a simple, “I’m not looking for reassurance so much as support in the way I’m feeling,” or, “Thanks, but that’s not what I’m needing right now.”

Feel different or more worried than you did before

Some people who have had children after a loss express the difference in risk assessments between that experience and subsequent pregnancies. “Ignorance was bliss” is a common way to describe the way they felt about not having known, from experience, the worst that can happen. Some people respond to this by wanting a lot MORE information, preparation and planning in their pregnancy, while others prefer to take questions and concerns as they arise. Some people may notice they are more cautious about celebrating, or take longer to feel connected and bonded, waiting for certain milestones to pass before “accepting” the reality of a healthy pregnancy.

After going through a difficult experience, it can be difficult to define new experiences as safe or secure, even if statistically that is more likely. While repeat miscarriages are less common, our personal experiences can’t be summarized in the data, and so if you’ve experienced loss, it makes a lot of sense that you would be extra aware and even hyper-vigilant of risk. This is a very normal psychological response to trauma and adversity, but if worry or anxiety is becoming all consuming or impacting your ability to take care of yourself, it may be helpful to connect with a mental health professional who can help you mitigate anxiety and stress.

Notice certain physical experiences bring up strong emotions

Common pregnancy symptoms like nausea, appetite changes or the lack of menstruation are usually signs of a typical, low-risk pregnancy - but if they are associated with an experience of loss, they may be more difficult to endure, or bring up strong emotions. Likewise, other symptoms that may be harmless or signal a problem, such as bleeding or fever, could be very stress-inducing, especially if these were present during someone’s pregnancy loss experience.

Even more “positive” physical changes that many people enjoy, like an increased libido, or postpartum realities with a healthy newborn, like breastfeeding, can bring up the grief of the experiences that were missed with the child who passed, or guilt about feeling happy amidst sadness.

These responses are valid - your body, brain and heart are trying to make sense of what’s safe, what isn’t, and what simply triggers painful memories. Guilt is rarely based in true fault, but a healing heart may jump to self-blame or negative self-regard. Help your close support people to know what you are going through and find ways to calm your nervous system. Crying, speaking affirmations out loud, or using slow deep breaths can help you move through the physical experience safely, offering yourself some compassion and allowing yourself the possibility that it may get easier. 

Feel your values, sense of humor or outlook has shifted

Many people who consider themselves a “glass half full” type find that their optimism and positive outlook fades or feels less genuine after the death of a loved one. For individuals who have suffered any kind of perinatal loss or trauma, it can feel disconcerting to find that they don’t see the same possibility, humor or hope in the world that they once felt. If that individual becomes pregnant again, they may receive external pressure to “get back to their old selves” and “look on the bright side” now that they are carrying a healthy pregnancy.

This may be easier said than done, and isn’t always helpful. Priorities, personalities and personal belief systems can shift over the course of a lifetime, and they may change again! Whatever is feeling most authentic and real right now is probably what helps to cope, navigate life obligations, and move through a new pregnancy being true to self, which can be a matter of self-care. 

Getting appropriate support

We link above to an overview of considerations for support during miscarriage, but when a family embarks on a new pregnancy, there can be confusion about what kind of support is most helpful, from education to health preparation and even sensitive language of support. Some of the steps that can help someone and their loved ones navigate the blessing of a new pregnancy with valid feelings of grief are listed below.

Professional perinatal support

One of the most impactful thing one can do for their immediate experience as well as their long-term health outcomes is build a support team that includes professional pregnancy and postpartum support outside of the medical system. Health care is integral and saves lives, but not all maternity care providers have the structures in place or time to give additional support to someone struggling with grief or recovery from pregnancy loss. 

Therapy for a couple or family can be very powerful, but even more specific to the pregnancy period, a doula is a great addition to anyone’s reproductive experience, and is an evidence-based way to support long term health and satisfaction. Many doulas are also trained and skilled in bereavement support, holding space for complex emotions, and simply serving as an attentive, compassionate presence. Learn more about doulas, the process of hiring one, and how Seven Starling combines doula and educator expertise with small group support for the comprehensive - and holistic - support that any and every family deserves.

Parents and Grieving Groups

No one can understand a pregnancy loss like someone else who has been through it. An unexpected benefit of this experience being shared widely across families and societies is that no one is truly alone in their feelings, however unique their journey. There are hundreds of forums, support groups, private parents support options and nationwide grief and pregnancy loss organizations dedicated to providing care and connection to those navigating loss, as well as pregnancy afterwards.

• Pregnancy After Loss Support (PALS) offers specific post-loss perinatal support and offers both online options and local directory assistance.
• Return to Zero: H.O.P.E, is a non-profit organization founded by grieving parents committed to better treatment and support and less stigma - they have a variety of virtual support groups for different stages and types of pregnancy loss support.
• March of Dimes is a well-known organization that offers parents and loved ones both information and opportunities to get involved in wider efforts to improve neonatal health outcomes, provide better education, and create community for stories and support.
• Online social media forums may offer less formalized support groups, such as Reddit’s pregnancy after loss page.
• See Seven Starling's overview of miscarriage support for additional resources.

Protecting Boundaries

Sometimes “getting support” can mean discerning who your most helpful connections are and limiting what you share or expect from other parties. As described above, not everyone who wants to be helpful has the skill or understanding to do so, but most people who genuinely want to be supportive are eager to know what they can do. In this way, setting boundaries about your preferences and expectations can be one of the most powerful ways to cultivate the right support for you - which may look different than for someone else. A few ways you can set boundaries and create an effective support team include:

• Declining to share your pregnancy news until you feel most comfortable doing so.
• Choosing to share your news with a select group of people that you trust to honor you.
• Being honest about how you are feeling in an affirming and self-accepting way.(Example: “I’m still feeling a lot of emotions, and it feels healthier for me to stay home. I love you all and I hope you can understand why I cannot attend this year’s birthday party, thank you.”)‍
• Calmly and clearly asking to change the topic if someone is bringing up unwanted topics (Example: “I’d rather not discuss my pregnancy and how I’m feeling right now, but I will let you know if I change my mind.”)‍
• Communicating what you need (and don’t need) from family and support people during this pregnancy in writing, so that you aren’t asked to explain your choices face to face. (Example: “We are looking forward to welcoming little brother, despite the challenges of our last pregnancy and the loss of _______________. We ask you to honor both of our children by using their names and referring to them as siblings - thank you for honoring our family in this way," or ‍“We will not be having a shower this year, and we have everything we need. Thank you for your desire to celebrate our family - you can do so by making a donation to ___________ in honor of ________.”)‍
• Helping your partner, providers, therapists or other support people understand what you are going through without expectation that they will 100% understand. (Example: “I have been feeling really tired and I acknowledge that I’m also feeling sad a lot of days - that is why I am sleeping so much. It isn’t because of you and I appreciate you asking.”)‍
• Show peers and loved ones these articles so we can do the talking and you can attend to what feels most important.

Selected Sources:

• ‍Optimizing Care for Pregnancy Loss. American College of Obstetricians and Gynecologists. Accessed June 2021.‍
• Repeated Miscarriages. American College of Obstetricians and Gynecologists. Accessed June 2021.
• Wojcieszek, AM, Boyle, FM, Belizán, JM, Cassidy, J, Cassidy, P, Erwich, JJHM, Farrales, L, Gross, MM, Heazell, AEP, Leisher, SH, Mills, T, Murphy, M, Pettersson, K, Ravaldi, C, Ruidiaz, J, Siassakos, D, Silver, D, Storey, C, Vannacci, A, Middleton, P, Ellwood, D, Flenady, V. Care in subsequent pregnancies following stillbirth: An international survey of parents. BJOG 2018; 125: 193– 201. Accessed June 2021.