Women often agonize after a miscarriage, not only because of their sadness in losing a wanted baby, but also worrying about how long they will have to wait to try again. Common obstetric advice has been to wait until a woman has experienced two periods because of the belief that a delay will reduce the risk of another miscarriage.
A recent study followed over one thousand women who had experienced 1-2 early pregnancy losses, most of them before 20 weeks, up to six menstrual cycles, and for those achieving pregnancy, until the outcome of the pregnancy was known. Contrary to the common obstetric advice, the researchers found that women who started trying within three months of the loss were more likely to get pregnant quicker and have that pregnancy lead to a live birth (over 53%) compared to those who waited more than three months to begin trying (36%). There were no differences in complications of pregnancy between those who did and did not wait.
Since this study relied on the women’s self-reports of when they started trying to conceive again, the dates may not be precise. However, the authors concluded that there appeared to be no physiological reason for delaying pregnancy attempts after a non-ectopic, non-molar, under 20-week gestational age pregnancy loss. It is important to note, however, that other studies have found that a short interval between pregnancies and a subsequent pregnancy is associated with increased risks of pregnancy complications (e.g., preeclampsia, premature rupture of membranes, low birth weight, and preterm delivery) but many of these studies were based on full-term births.
The results of this recent research probably comes as good news to many women who feel great pressure to conceive quickly after an early loss, especially older women who believe their childbearing years may be limited or those who needed assisted reproductive technology and realize the process may take longer than they desire. But, being physically safe and emotionally prepared to try to conceive after a miscarriage are two different issues.
Couples need time to process their loss and grieve after a miscarriage. Although a subsequent pregnancy and live birth has been reported to lessen grief, how can a couple know if they are emotionally ready to try to conceive again?
While the physical symptoms of readiness to try again may be easy to spot (talk to your obstetrician and follow his/her advice), the emotional symptoms are harder to determine and only you can know if you are ready to try again. But, I would like to give you a few questions to consider in making your determination:
Have you given yourself time to grieve your loss?
Do thoughts of your baby no longer occupy every thought?
Do you feel you want another baby or do you still yearn for the baby you lost?
Are you no longer crying most of the day; is your appetite back to normal;
are you able to sleep normally again?
Are you back into your regular routine?
Do you feel strong enough to cope with:
a negative pregnancy test?
another loss? Talking to other women who have experienced
a loss and gone on to have healthy babies can often help with this fear.
the uncertainty of the future?
the multiple and often conflicted feelings that a subsequent
pregnancy raises (e.g., hope, anxiety, sadness, guilt for being
hopeful and happy)?
Is your partner ready to try again?
If you are spending much of your day crying, have a reduced appetite, difficulty sleeping, and have not been able to get back into your regular routine, it is probably not the best time to try again. Some may tell you that you need to be able to feel comfortable seeing or holding others’ babies or returning to your obstetrician’s office to be ready. But these situations may feel difficult for a long time. Understand that you never fully finish your grief process. I carry the memory of the babies I lost years ago in my heart and remember them at various moments throughout the year – anniversary dates, Mother’s Day, when I think of my own child having babies someday… The grief we feel after losing a baby is a complicated and difficult grief as no others knew your baby nor the hopes and dreams you had for your baby and for yourself becoming a parent. Others did not see or hold your baby and may have difficulty understanding the depth of your sadness. This lack of emotional support can make it more difficult for you to work through your grief.
As you start to contemplate trying again, you may find that your feelings fluctuate from one day to the next, sometimes even moment to moment. One minute you may think you what to get pregnant again and at other times feel convinced you couldn’t go through this whole process again. You may be obsessed with getting pregnant, yet still not truly feel ready.
Trying for another baby doesn’t mean you forgot the baby you lost, but over time the idea of trying for another may start to feel OK as you start to feel stronger and courageous enough to take that leap of faith again.
Schliep, KC, Mitchell, E, Mumford, S, Radin, RG, Zarek, SM, et al. Trying to conceive after an early pregnancy loss: An assessment on how long couples should wait. Obstetrics & Gynecology, 2016: 127(2): 204-212.