The experience of pregnancy is very personal and unique to each individual woman. Although we have come to expect that every pregnancy will be uneventful and perfect, the reality is that one out of four pregnancies ends in some kind of loss. In many cases, those losses are due to random problems that are not likely to recur in a future pregnancy. And generally speaking, the odds of having a healthy baby in a subsequent pregnancy are very much in a woman’s favor. But that is of little comfort to someone who has experienced the tragedy of pregnancy loss. For her, the loss was 100 percent.
As a woman contemplates another pregnancy after a miscarriage, stillbirth or the death of an infant, she needs more than a simple reassurance that the odds of giving birth to a healthy baby are in her favor. She needs to know that it is not unusual for her to have feelings of loss, helplessness, guilt, anger, resentment, and isolation. She also needs to know what to expect during the next pregnancy, from the paralyzing fears to the unbridled joy. Pregnancy After a Loss provides that much-needed guidance.
Carol Lanham, who has been a patient of mine for many years, writes about pregnancy after a loss from first-hand experience. She came to our office in 1994 after experiencing a late pregnancy loss. In the ensuing years, she had two subsequent full-term pregnancies and gave birth to two healthy baby boys. She has combined her own personal experience with that of nearly 100 other women who have experienced loss, from early through late pregnancies to shortly after birth. But this book is much more than a chronicle of personal experiences.
In these pages, the author has extensively researched the benefits of prenatal education and prenatal care. She has recognized the need for excellence in these areas. She has made practical suggestions on how to select an obstetrician and other health team members and has provided information that will lead a woman to realize that she is her own best health care advocate. There are no easy solutions to the problem of pregnancy loss, but these pages do provide guidance and hope on how to approach a subsequent pregnancy.
Though this book is primarily for the patient who has experienced a loss, it also has a great message for physicians and health care providers. Obstetrics is usually a very happy and positive specialty, and those who go into the field are typically caring, sensitive and compassionate individuals. But because the majority of pregnancies do end happily, we sometimes lose sight of the special needs of women who have experienced a pregnancy loss. Although we, as physicians, feel a sense of loss ourselves when a pregnancy ends badly, it is easy to get caught up in our busy practices and overlook the needs of women who need more time and attention. This book underscores how important it is that we, as health care providers, make a more concerted effort to maintain a sensitivity to women experiencing a subsequent pregnancy.
This need for sensitivity is of greater importance today than it ever has been in the past. The incidence of pregnancy loss has been on the increase in recent years as more women put off childbearing until later in life when the associated medical risks are higher. Reproductive technology is also allowing women to get pregnant that might otherwise not have been able to conceive, and puts some in the position of experiencing multiple losses before ultimately achieving a healthy pregnancy. Modern testing also makes it possible to detect pregnancies earlier than ever before, which means women may now know they suffered a miscarriage when they previously might not even have been aware they were pregnant.
In the nearly 40 years since I delivered my first baby, we have come a long way in addressing the concerns of women who have experienced a loss at any point in their pregnancy. Whereas a woman might once have been told to forget what happened and simply get pregnant again, there is now an awareness among medical professionals that we must acknowledge the loss and provide emotional support. Unfortunately, though, misperceptions remain. It is not uncommon for a woman who has experienced a loss to be comforted with the words, "you can try again." This reflects the widely-held, but erroneous belief that a woman who has suffered a loss is magically healed once she becomes pregnant again.
Of course, as anyone who has conceived again after a loss knows, pregnancy is not a cure-all. Often, it only serves to resurrect the grief as the tragedy of the last pregnancy is replayed over and over in a woman’s mind. And the nine months gestation can seem unusually long when coupled with the anxiety that is associated with it. It is for all these reasons and others that I will encourage each of our physicians, nurses, health/education professionals, and associates to become increasingly sensitive to the needs of the individual patient who has experienced a loss and is pregnant again. I feel these pages will provide that guidance.
Uel D. Crosby M.D.
Professor - Department of Ob/Gyn
The University of Texas Southwestern Medical
Center at Dallas