Pregnancy After Miscarriage: The Right Time May be Sooner Than You Think


When I was in the prep area, waiting to have my D&C, I remember having a very long chat with the OBGYN who would be performing the procedure.  It was a “getting to know you” of sorts, as we had never met before that day.  I was emotional, having learned only 24 hours earlier that our pregnancy was already ended, only my body had refused to miscarry on its own.  The doctor and I discussed my reproductive past, especially my year of trying to conceive before getting pregnant.

“Lots of women feel like once they miscarry, they want to start trying again right away,” he told me.  “You may feel ready, too.  But you really need to wait at least three months, to give your body a chance to recover from the loss.”

Three weeks later, at my checkup, my pregnancy hormone levels came back somewhat high, and the OBGYN changed his mind.  “Once your HCG levels are back to zero, you two can feel free to start trying again,” he said.

I walked away from that appointment somewhat puzzled.  Why would it now be ok for us to try and conceive, when a few weeks earlier I was told I should wait? 

In the end, because of the amount of time it took just for the hormone to decrease, I waited his first recommended three months simply because I had no other option.  When my final draw came back negative, I was given the official green light.  We conceived about a month later.

As I talked with more and more women who had experienced miscarriage, I learned that almost all of us got conflicting advise from doctors.  Some were told to wait three months, others, six.  Some heard from their doctors that they should wait one full cycle to make sure that their uterine lining built back strong.  Others were told that they should wait a cycle to make it easier to date the new baby if they get pregnant.  Every doctor seemed to have a different period of time and reason: depleted folic acid, weak lining, wait for testing to come back, or even just “we don’t think you are emotionally ready.” 

It’s not surprising that the women who miscarried heard no consensus, since the medical profession seems to have no consensus, either.  According to a recent report, despite the fact that the World Health Organization had been recommending women wait six months after a miscarriage to try and conceive again, a new study says that women who conceive within six months of a loss actually have healthier babies with their next pregnancy.  The study, it must be noted, used data on women from Scotland, while WHO recommendations take into consideration evidence from countries with widely disparate economic and social circumstances, where health indicators for women in poorer countries are far more dire than in high-income countries, and in which too many births too close together have been identified as a contributing factor to high rates of maternal death and illness and infant and child mortality.

For healthy women, however, the findings suggest new strategies after miscarriage may be appropriate for healthy women.

From Time Magazine:

Dr. Sohinee Bhattacharya, an obstetrician at University of Aberdeen, led an analysis of more than 30,000 Scottish women in the national health registry who had lost their first pregnancy but were able to conceive a second time. In line with the WHO’s advice, she found that a larger proportion of women (59%) conceived six months or more after miscarriage, compared with 41% who became pregnant within six months.

But the latter group, it turns out, was also least likely to miscarry again, and more likely to have a live birth. Women who conceived within six months of their miscarriage were 34% less likely to miscarry again, compared with those who became pregnant six months to a year after the initial miscarriage.

The study concludes that within developed countries, age is much more of a factor towards rising risk of miscarrying, and that the assumption that miscarriage depletes the body as much as a full term birth does is simply untrue.  By telling women to wait six months to start trying to conceive again, you heighten her chances of miscarrying due to advancing maternal age without actual adding any physical benefits.

For many women who decide to start a family at an older age, waiting six months to attempt another pregnancy may work against them, since age is itself a primary contributor to miscarriage. “If a woman is over 30, then waiting another six months will reduce her chances of getting pregnant at all and increase her chances of having another miscarriage, simply because of the age difference,” Bhattacharya says. “Our research shows that there is no justification in terms of health reasons for delaying.”

This news comes as a great relief, especially to the women who do choose to begin trying for another baby right away, since one of the greatest fears of pregnancy post-miscarriage is that of losing another baby.  Many women find themselves terrified of trying to conceive too soon, afraid that simply their impatience will bring about a child with possible genetic defects or even worse, another loss.  And for those who do suffer a subsequent loss, the guilt of wondering if the baby might have made it if she had just waited a little longer can be truly devastating.

Miscarriage itself is difficult to deal with on an emotional level.  Often, it’s not just the loss of the baby a woman mourns, but also all of the time that is lost, too – time spent trying to conceive, time spent carrying a child that was never going to be born.  The less time women can safely spend before trying once more to build the families they want, the better.

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  • nycprochoicemd

    As you state, there is an important distinction here, that this study was in a developed country.  I think a lot of our reluctance in the medical profession comes from knowledge from developing countries, in which a repeat pregnancy that soon after miscarriage or fetal demise does indeed pose greater risk, both to mom and fetus, or infant if born.  This is of course in the setting of few resources, chronic malnutrition, and lack of access to medical care.

     

    I’m glad you were able to get to the bottom of it!  As long as my patients aren’t anemic and have no other medical problems that would make pregnancy less likely to be successful or pose risk to them, I’ve been telling them that there’s no reason not to go ahead as soon as they feel like it.  It is also important for older women to know (sadly, older means over 30-35) that waiting a year may not be a good idea because of the decline in fertility.