How Soon Is Too Soon?
Article By Ann Douglas
For many couples, it's natural to want to become pregnant again right away after going through the heartache of losing a baby. But a recent study suggests that it may be in a woman's best interest to delay her next pregnancy for a full year rather than trying to become pregnant again as soon as she gets the official go-ahead from a doctor or midwife.
The work of researchers from the Department of Psychiatry at St. George's Medical Hospital in London, England -- which was reported in the June 26, 1999 issue of the British Medical Journal -- indicates that women who have had a stillbirth may need a full year to mourn the loss of their previous baby before embarking on another pregnancy. Furthermore, it suggests that those women who do become pregnant within the year following their loss may be more vulnerable to anxiety and depression both during and after their subsequent pregnancy than women who choose to wait a little longer before conceiving again.
No Magic Number
Despite this recent evidence, many experts are loath to impose any time limit on a couple and urge that the decision be more flexible. While some obstetrician-gynecologists routinely recommend that couples wait six months to a year before attempting another pregnancy, in order to come to terms with their loss, others -- like Mark Perloe, M.D., Director of Reproductive Endocrinology, Infertility, and In Vitro Fertilization at the Atlanta Medical Center -- feel that there's no compelling reason to wait that long. "In a lot of cases, the waiting will cause stress in and of itself," he says.
Deborah Davis, Ph.D., author of Empty Cradle, Broken Heart, agrees. " It's different for everybody," she says. "I tell parents that they're ready to try again if both partners agree that they're brave enough to risk it and settled enough to handle it."
Cindy Hughes, whose first child was stillborn, needed to start trying again as soon as possible after losing her daughter. While her pregnancy following the stillbirth was extremely stressful, she has no regrets about her decision to start trying again right away. "I found the birth of my daughter Madeleine to be the single most effective means of helping me heal," she says.
Margaret Lightheart, M.D., Associate Clinical Professor of Obstetrics-Gynecology at McMaster University in Hamilton, Ontario, says that there's often no reason to delay a subsequent pregnancy. "I think the year after the loss will be full of anxiety, whether or not the woman is pregnant again. In some instances, not being able to start trying to conceive again generates additional anxiety as well."
Lightheart says that she is particularly reluctant to recommend a delay if a woman is approaching the end of her childbearing years. "I don't make the decision to tell a 41-year-old woman to wait a year lightly."
Medical Reasons to Consider
Still, Lightheart and others caution, there can be medical factors that need to be taken into consideration when a couple decides to start trying again, such as the reason for the loss. For example, if the loss was due to diabetes, the woman will want to get her blood-sugar levels under control before attempting another pregnancy.
If a woman's body isn't ready to support a pregnancy by the time that she conceives again, she faces an increased risk of experiencing a repeat miscarriage, says John R. Sussman, M.D., co-author of the forthcoming book Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss. It takes time for her uterus to recover and for her endometrial lining to build back up to healthy levels. Most doctors recommend that a woman wait until she's had at least one period, but ideally two or three, before trying again. Certainly, if she's had a cesarean delivery she needs to give her uterine incision a chance to heal properly.
And even after the decision has been made to try again, says Davis, a woman shouldn't be surprised to find herself second-guessing the decision. "You'll go back and forth in your feelings about having another baby." And even if you do decide to wait at least a year, as the British Medical Journal study suggests, don't buy into the myth that you need to "be completely over" your grief before you embark on another pregnancy. "If that were true," says Davis, "no one would ever try again."