Pregnancy after a loss often brings mixed emotions. The tragedy of losing a baby can make it impossible for parents to go back to thinking of pregnancy as a happy time that results in a healthy baby. Instead it can be filled with anxiety and fear. However, most health professionals are aware of this and extra care, monitoring and reassurance will be a crucial part of your next pregnancy.
"In both pregnancies, the anxiety was at a level most probably cannot even begin to imagine. Being pregnant is such a triumph but such a delicate state of being. Every day you would check for bleeding and expect it to be over. Every time the scans began, the pause before you hear you baby's heartbeat you are convinced it just doesn't exist and they have gone again. You worry every moment of those pregnancies."
Sarah, who lost her son Tristan at 38 weeks (Read Sarah's story here)
Extra care during pregnancy
Your pregnancy following a stillbirth should be put into a ‘high risk’ category because you had a previous stillbirth. It means you will get extra care and extra scans to keep an eye on your baby’s growth and development. Although this does not get rid of the anxiety most parents find it very reassuring. You are likely to be under the care of a consultant rather than midwife-led care.
The number of extra scans and appointments you get will depend on your doctor and the cause (if known) of your baby’s death. If you would like more scans or appointments to the number offered, ask for them.
Tommy's Rainbow Clinic
If you feel that you want to be cared for at a different hospital, or with a different medical team, talk to your GP about how to get a referral. Tommy’s operates a specialist clinic for families who are pregnant again after a stillbirth. This centre is at St Mary’s Hospital, Manchester, where families can access specialist care from anywhere in the UK.
As your due date approaches, you may be offered an induction for your peace of mind, even if your pregnancy has been uncomplicated, so if this is something that would help you speak to your consultant about the timing and type of delivery.
Am I at higher risk of another stillbirth?
Studies have shown that women who had a stillbirth are at an increased risk of another and this is why the extra care is so important. You will to be monitored much more closely, and potential problems should be found earlier and managed, for example, with an earlier delivery date.
If there was a specific problem, such as IUGR, diabetes, pre-eclampsia or other medical conditions, then there may be an increased risk that is associated with the condition re-occuring. Depending on the cause of your previous stillbirth you may be advised to take certain medication in the next pregnancy.
For your own reassurance, you should not hold back from seeking reassurance if you are concerned about anything at any point during the pregnancy. You can find some tips here on speaking up in pregnancy.
A note on flu vaccines in pregnancy after a stillbirth
Some women who have not been given a cause of death for their child worry that the flu vaccine may have caused it, and are anxious about having the vaccine in a following pregnancy.
A systematic review (very reliable research evidence) of all the current research into the flu vaccine and pregnancy outcomes has reported that the flu vaccine does not cause stillbirth and in fact there is some research to show that getting the flu in pregnancy increases your risk of stillbirth.
The vaccine is recommended by the NHS as well as RCOG and RCM because of the benefits to you and your baby. Getting the flu in pregnancy is a serious matter. As well as increasing your risk of stillbirth it puts you at risk of :
- developing complications, particularly if you get it in the later stages of pregnancy
- giving birth prematurely
- having a low birthweight baby.
Managing anxiety in pregnancy after a stillbirth
Many parents describe pregnancy after a stillbirth as a difficult and very anxious time.
"No one understands. You have a people magnet protruding out in front of you all the time and you are asked again and again, “Aww, is it your first?" You try to stop further questions with a curt "No" but then the next, "So how old is your other child?" which means you have to explain to a stranger something so intimate and heavy. Even when you talk to family or friends, they all say "Oh it won't happen this time. They are taking proper care of you now, dismissing your genuine concern and anxiety.'"
Sarah, who lost her son Tristan at 38 weeks (Read Sarah's story here)
"I felt very uncomfortable being congratulated on our rainbow pregnancy. As far as I was concerned there was nothing to congratulate until I brought a live baby home from hospital. We chose not to tell family until 17 weeks, and close friends at 19 weeks. If I could have gone through the whole pregnancy without telling anyone and then brought a baby a home, that’s what I would have done. It felt that people thought that we were OK because we were pregnant again, that we had accepted what had happened, that we weren’t grieving any more, none of which was true of course."
It is hard not to be overwhelmed with fear of losing another baby and quite normal to not be able to imagine taking a live baby home, even throughout a rainbow pregnancy. If you’re finding it difficult to cope day-to-day and anxiety is proving debilitating, talk to your GP. It might be possible for you to have some counselling, or talk to someone about coping strategies for managing your anxiety. Your midwife may also be able to refer you to a mental health specialist midwife who can offer additional specialist support.
"One day you’re confident and excited but the next day the doubts creep in and you worry the baby isn’t moving. Before you know it you’re feeling as if you are neurotic."
Amy, who lost her son Jack at 27 weeks
Tips for reassurance in pregnancy after a stillbirth
- Try not to bottle it up - let your midwife, doctors or hospital know if you are worried about something, need an extra scan or want to talk through any concerns. Some people worry about ‘wasting time’ - you’re not, and no-one will think that.
- Monitor your baby’s movements and report any reduction immediately. The hospital is open 24/7 so you can go in at weekends if you need to.
- Find out if your maternity unit runs a clinic or drop in session for bereaved parents who are pregnant - this can be a place for you to go for reassurance and support where you are not surrounded by parents-to-be who are pregnant for the first time. It might also be an opportunity to meet other local bereaved and pregnant mums.
- Always take a list of questions with you to appointments and a pen to note down important points. This can be helpful because anxiety can make it difficult to remember things on the spot, and might distract you from absorbing all the information.
- Let your midwife know particularly difficult dates for you. For example, around the time that your baby died, you might like to request an extra scan or monitoring, for peace of mind. Some parents want to avoid the hospital at this time. If you feel like this talk to your hospital to see if it is possible. You might also find your anxiety amplifies around anniversaries or significant dates - think about getting extra support around this time
- If your maternity notes have not already been highlighted in any way to show that you had a previous stillbirth, ask about marking your maternity notes. Maternity units can mark notes with a sticker so that midwives understand you’ve lost a baby and you don’t have to keep explaining.
- Consider getting in touch with another mum who’s had a similar experience. It can really help to talk things through with someone who understands. A charity called Sands, which focuses on support after a stillbirth, might be able to put you in touch with another mum.
- Try writing down your thoughts and worries. Lots of people use journaling as a way of releasing their emotions, fears and anxieties.
- Ask your care provider for a tour to see the place you will be giving birth. Often having a visual picture before the day and being aware of the lay out can relieve some anxieties especially if this is a different hospital.
- Ask your midwife to help you write a birth plan. You may be able to get extra support, such as a single room after your baby is born, flexibility with visitors and longer visits from the midwife or health visitor once you’re home with a new baby.
- Don’t put yourselves under too much pressure to pack a hospital bag or buy items for your baby. Often mums feel that they might be jinxing the birth doing this. There’s no immediate need for most of it. Speak to your midwife. Your hospital may have a supply of clothes and nappies for immediately after the birth, and you can buy anything else you need later.
"I found the best way to manage and cope with my feelings was to have a chat with people, especially my two friends who were going through something similar. Then we could talk about the children we lost. I also kept a diary during my pregnancy so if I ever felt I needed to air my feelings, I had that."
Jennifer, who lost her son Alexander at 36 weeks
"We didn’t prepare anything, not one thing. We put our house moving plans on hold – I couldn’t bear the thought of buying a house with bedrooms that we might never fill."
Pregnancy can feel like an eternity stretching out in front of you.
- Take one day at a time. If necessary, break the day down into segments: perhaps morning, afternoon and evening.Think to yourself, I’m going to get through this morning by going for a walk and getting some fresh air.
- Look after yourself extra carefully. Grief is tiring, even more so if you are pregnant.
- Self-care - looking after yourself by giving yourself time out and doing things you enjoy or make you relax - will help you get through each day.
Parenting children after a stillbirth
Parenting children who are born after the loss of a baby can bring extra anxiety. Babies seem so fragile, and the conflicting care advice from parenting manuals and books can add confusion and worry: ‘Am I doing it right?’ ‘Are they OK?’.
Having experienced death makes it much more difficult to assume that things are fine. Do what you feel is needed to ease your anxiety and get through the early months. Keep your baby sleeping close by you in your room, use baby monitors or check on them frequently during the night. If possible explain your fears to those close to you and ask them to help out and be vigilant for you so you can get some sleep. The Lullaby Trust has information on how to keep your baby safe as they sleep.
"I think it’s also completely underestimated and not really documented how stillbirth can affect you as a parent. Despite my constant reminders to myself to be ‘in the moment’, the first six months of my rainbow baby’s life are a bit of a blur. Midwives and health visitors kept telling us to sleep, but my husband and I wanted to take it in turns to watch him breathe. It felt like they just didn't understand, the stakes were so high and he was so precious. I am still very dependent on a breathing monitor in his room, something that I never needed with my first son. Once one of your children has died, you realise bad things can happen to anyone, and it's hard not to think the worst.Good friends who have been with me through this entire journey told me just to do whatever could get me through."
When your rainbow baby is older
Andrew’s Rainbow is a book available from The Scottish Cot Death Trust. This is a good resource for children who have been born after the death of a sibling.
A very supportive community has built up over the last few years around pregnancy loss. The page below lists a number of blogs and social accounts from people who have suffered pregnancy loss/es or preterm birth.
"When my son was stillborn, I couldn’t find anything to read about the mum’s personal experiences and what to expect... I needed something real, something I could relate to."
All write movingly about their experiences of loss, life after loss and, in some cases, pregnancy and pregnancy/parenting after loss.
Online communities supporting those who have gone through baby loss or preterm birth