Medical concerns and care
After a termination for medical reasons, you may understandably have lots of questions when thinking about a future pregnancy. Depending on the diagnosis that led to the termination, you may have a team of professionals guiding you, including genetic counsellors and fetal medicine specialists.
There are different pathways through future fertility and conception, depending on your medical advice. There are too many to explore fully here but some may include:
- Going ahead with natural attempts to conceive
- Natural attempts to conceive followed by extra testing in early pregnancy
- IVF including extra testing of embryos
You might decide to stay with a maternity service that managed your previous pregnancy or seek a different service. Some people can’t bear going back to places that hold traumatic and upsetting memories, while others feel reassured by the familiarity of professionals that supported them last time.
Whether you switch between private and public health, change healthcare providers or add additional care, there is no right or wrong. A sense of agency is important for you.
It is OK if you want to meet with more than one health provider before you choose your antenatal care. It is important that you feel heard, free to ask questions and safe in expressing your fears and worries. Often, doctors and midwives understand that you may need extra appointments, scans and phone calls to help you cope in a subsequent pregnancy. If you have discovered that a condition could potentially recur in future pregnancies, it is important to trust your professional network.
Sex and conception
Most people get medical advice about when they can try for another baby, often at a check-up after their termination. People also often take into account their emotional needs after a termination for medical reasons. Some people take more time to adjust to the reality of trying again and the rollercoaster of uncertainty they face.
If a couple is attempting to conceive naturally, one or both partners might feel pressure and worry that affects how they feel about sex. If you notice this is happening, try to talk and listen openly with each other. Allowing space for each others’ thoughts and feelings with patience and compassion can help (easier said than done!). Even if you are feeling OK, it is worth checking in with your partner, as these are not always easy subjects to open up about. If the grief and stress are affecting you both significantly, a professional counsellor experienced with couples and perinatal grief can provide extra support,
Emotional and psychological struggles
Guilt and self-doubt or self-blame can be hard to shake when you have had to end a pregnancy. Even though you probably hope for and long for another baby, you may still have mixed emotions or confused thoughts around this. Thoughts might include:
- “I don’t want to replace my baby that died”
- “It’s not fair for a healthy baby to live when my other baby couldn’t”
- “Do I deserve to have another baby after what happened?”
- “What if my body somehow fails me again?”
Your logical brain may work overtime, desperately trying to problem solve.This is a way humans sometimes battle with uncertainty and fears. But we can’t always come up with solutions because what happened to your baby didn’t follow a predictable order of events. Instead, try to compassionately reassure yourself that you are naturally very sad that your baby died, that some feelings of guilt are human and probably natural, and that these thoughts signal how much you miss your baby and wish the outcome of their life could have been very different.
You can experiment with talking directly to your baby – either out loud, in your head or by writing to them, telling them how you feel about missing them and about your plans to bring a sibling into the world. This may be too painful for some parents, however many people gain some comfort and meaning from this connection. If you find it helpful, you can even talk to both of them at the same time in your mind, creating a connection between the siblings that you would have nurtured if both were here.
Increased anxiety is a normal part of a subsequent pregnancy after a termination for medical reasons.
Try not to judge yourself harshly for this. You are now in a situation you have never faced before – trying to get through nine long months after you have been through one of the worst experiences imaginable. You might also find that, throughout the pregnancy your mood fluctuates a lot. Sudden surges of grief are expected, which may include frustration, irritability, overwhelming sadness and guilt, as well as anxiety.
Sometimes people are surprised by the difference of a subsequent pregnancy. It is common to feel ripped off by the pregnancy anxiety that inevitably follows a bereavement. The innocence of expecting that a pregnancy will end safely is absent. Joy and excitement may still be present for some people but they are often accompanied by increased fear and worry.
When you begin another pregnancy, you may also struggle with symptoms of trauma as you attend tests, scans and appointments. It might become harder to avoid the locations or types of situations where traumatic events occurred, such as hospitals and ultrasound clinics.
When you can’t avoid these triggers, you might feel the effects in your body – it often takes people back to the moment of feeling unsafe – so you might shake, sweat, feel breathless or your brain might shut down, among other reactions. This can be distressing and unfamiliar, so start experimenting with ways to calm your body down and come back to the safety of the present. Depending on what the triggers were, sensory cues can sometimes help, such as carrying a small bottle of essential oil to distract you from smell, headphones and music to distract you from a noise, or a small and soothing object that you can carry in a pocket to bring your sense of touch into the present. This is a simple version of “dual awareness” – your brain and body are reacting to something unsafe that happened in your past but if you focus your body in this moment, it is possible to connect with a sense of safety right now.
Many people, even those who have never had counselling before, seek professional support to cope with a subsequent pregnancy after a termination.
Another strategy is focusing on small things you can control amidst the unknown. Yourself or your partner can phone ahead to speak with staff at ultrasound or medical appointments. Let them know your last baby died, explain that the environment is really stressful for you and ask them to tell the doctor or ultrasound specialist before they see you. Ask questions that might be helpful, such as “can I get some fresh air if I need to?” or “will I have to be seated in a waiting room with other pregnant people?”. Getting information in advance doesn’t take away the stress but it can reduce anxiety by helping you feel prepared and more in control.
If you are going with a partner/friend/support person, talk about the plan in advance, such as what time you will leave, what route you will take, and whether you will go straight home or to work afterwards, or take some time to regroup. These are things you may have never considered in your previous pregnancy, however it is OK to manage differently this time as it is a completely new and different experience.
If you are experiencing significant and frequent changes in mood that feel overwhelming and are affecting your daily life a lot over a couple of weeks, or if you have thoughts of suicide or self-harm, it is important to tell your GP, psychologist, obstetrician or midwife. They can help increase the level of professional support you need to cope with the pregnancy.
Preparing to bring the next baby home
Many parents who have been through a termination for medical reasons find themselves delaying the rituals of “getting ready” to bring the next baby home. Some people think of it as “tempting fate” or “getting our hopes up”. It is an understandable reaction for bereaved parents trying to protect themselves from further pain and loss.
There is no right or wrong timeline for things. Whatever you decide to do, it won’t “jinx” the outcome of this pregnancy. But there is no need to prepare early if that increases your anxiety. Depending on the gestation of your pregnancy termination, you have a baby’s room ready or partially ready to go. Take your time to grieve for having to go through all this again. Think about whether you want to keep the room the same, keep parts of it the same, or completely change it. You may also be starting this task from scratch if your termination was earlier in the pregnancy. Don’t pressure yourself to “get it all done”. It is much harder to do when you are carrying one baby and processing grief for your other one at the same time.
Consider asking another trusted person to help if you feel overwhelmed by sorting through baby stuff. Think about whether this can be a ritual of honouring both babies and connecting them with each other. You might decide there are a few “special” things you want to keep aside for your baby who has died. Some people find a piece of symbolic artwork or photography a meaningful addition to the room.
Bonding with baby
For parents who have been through a termination for medical reasons, some difficult and confusing thoughts may appear repeatedly. These may sound like:
- “How will I love this baby?
- If my other baby hadn’t died, this one wouldn’t even be here.”
- “I’m scared I will forget my baby once the new one comes along”
- “I don’t want people to think I am replacing the baby I lost”
- “I don’t want this baby to feel like they have to make up for the one who died”
It is natural to have these worries after what you have been through.
Try not to stress too much about your bond with this baby. But if you are feeling really concerned, try whispering or talking to this baby about their sibling – let them know how much you loved them, that you wish they could have met each other and tell them about the special things of their sibling that you have kept.
In reality, one of them will never replace the other, as parents have the capacity to love multiple babies at once. Attachment to babies isn’t always automatic, it can take time for that bond to grow and that is OK.
Sharing news about your next pregnancy
You may decide to be more cautious about how many people you tell and when. There are so many factors in this decision. You may be worried about people reacting as if the new pregnancy makes everything better or that they will forget about your other baby. A major concern is telling people and then a medical or health problem emerges with this baby too. It is totally understandable to be apprehensive about this, especially when you are already so vulnerable.
Initially, tell people who are most able to offer emotional support, whatever happens in the pregnancy. It is OK if this is just one, two or a few people who are supportive and sensitive to your grief. Be gentle with yourself around choosing who to tell and when – the circumstances of this pregnancy are different for you, so it is OK to manage everything differently if you need to.
If you decide that you want to celebrate this pregnancy and new baby by sharing the news widely from early pregnancy, then this is completely OK too.
Professional and peer support during your next pregnancy
There are grief services in Australia that work specifically with bereaved parents following pregnancy loss, including terminations for medical reasons. Some parents first access this support when they start a subsequent pregnancy or even part-way through that pregnancy.
One type of support is professional – this refers to a person who is a qualified, experienced counsellor. The other type of support is peer-based – this refers to a person who has lived experience similar to yours and has brief training in supporting people.
Some people prefer one type of support over others, and some people access both.
If you want to access professional counselling for yourself or as a couple, Red Nose Grief and Loss provides this service for free, Australia-wide. (SANDS used to be a separate organisation but has now merged with Red Nose). They are used to people coming to them as they start another pregnancy after bereavement. They also run an online support group for parents during subsequent pregnancies. It is important to flag that people attending these groups are bereaved for a variety of reasons, such as stillbirth and miscarriage, not only due to termination for medical reasons.
Private counselling is also available from mental health professionals. Check whether they have experience with perinatal grief and loss, and even more specifically termination for medical reasons, before you make an appointment. You can find some qualified practitioners here via the e-COPE directory: https://directory.cope.org.au/
You may also be able to claim some Medicare rebate for three “non-directive pregnancy support counselling” sessions.
If you are looking for peer-based support, The Pink Elephants Support Network has a closed Facebook group specifically for people during pregnancy after loss.