For some, experiencing pregnancy complications can be a traumatic event - even if you deliver a healthy, full-term baby. For others, a high-risk pregnancy can result in even scarier experiences such as health complications for baby, loss or a NICU stay.
Needless to say, getting pregnant after a high-risk pregnancy can bring up strong feelings of anxiety, ambivalence and fear. You don't want to repeat the past, but you also don't feel done growing your family.
What to do when you're ready to conceive again
Here are the 4 steps I strongly recommend you take before you are ready to begin trying to conceive after you've already been through a high-risk pregnancy.
Talk to your partner
Before you make any decisions about moving forward, have an honest conversation with your partner about how they're feeling. Though it was your body that experienced the health complications, delivery and postpartum healing last time, there is a unique type of trauma partners experience during a high-risk pregnancy that's enhanced by the helplessness of being the one "on the outside".
Talk to each other about the experience you've had and where you feel you are now after it's over. Does it feel over to both of you? You'd be surprised how often my clients realize it doesn't yet feel over for their partners when my clients are ready to move forward.
Do you both feel ready for the time, financial and emotional a future pregnancy could require? For example, do you have residual health issues that need to be addressed? Does your baby have medical complications that are taking one or both of your time and energy? Do either or both of you need some time to focus on career responsibilities or increase income before getting pregnant again?
Do either of you have hesitations about moving on? The fear of the past repeating itself is very real. While you don't want to make decisions from a place of fear, you do want to acknowledge it. Fear is one of those emotions that doesn't respond well to being ignored. Look the other way and it just gets louder.
Pregnancy after a high-risk pregnancy may be filled with anxiety, worry and overwhelm. Having strong support from your partner has been shown to improve the health of the pregnancy by reducing physiological stress markers. If you're wanting to do everything you can to have a healthy pregnancy and reduce your risk of pregnancy complications and/or preterm birth in your future pregnancy, it's imperative you begin here.
What happens if my partner isn't ready or doesn't want to but I really want another baby?
That's a question I hear all the time. I'm ready to try again but s/he is too scared or doesn't want to. This goes back to the very first point I made earlier, which is addressing and identifying the trauma your partner is holding on to. My clients have found it helpful to discuss the experiences from their partner's point of view.
What did they say? What did they hear? What do they remember? What keeps them up at night? What are they most worried about going forward?
Take time to understand the situation from your partner's lens. You both went through something together, but you both experienced it from two completely different perspectives. Approach this conversation with curiosity and you'll be amazed what you learn about each other. The more you understand each other, the easier it will be to make a joint decision about when and how to move forward.
Make a preconception appointment
I recommend making this appointment with a high-risk OB and doing it after you've discussed with your partner and have established yourselves on the same page as: yes we're both ready to move forward. You may have many unanswered questions, such as when or how but as long as you're both on the same page that you do want to try again, those questions will be answered eventually.
For some couples, this appointment is made you or your partner is fully ready to make that decision. Sometimes you or your partner (or both of you) need more information before you can make a decision about when or if you want to try again.
Enter this appointment as an "investigator" only there to collect data. The goal of this appointment should be to review what you went through, gain better clarity on why it happened and create a rough treatment plan on what to do going forward to reduce your risk of the same (or worse) happening again.
Download my free "What Should I Ask My Doctor?" checklist of questions to guide your conversation with your perinatologist at this pre-conception appointment.
Please remember that you can make multiple visits to your doctor as you process the information they give you, discuss with your partner and come up with new questions. This is not a linear process and you can go back and forth until you both are really comfortable with the plan and ready to move forward.
Also, if you aren't satisfied with what your MFM has suggested as a plan, seek the counsel of a second opinion until you feel comfortable and secure with the plan. Be sure you have a team on your side who trusts you, sees you as more than a medical chart number, and is going to take a proactive, preventative approach to your next pregnancy.
Deactivate your stress response
This is just as critical a step as the first two, and unfortunately, one I see missed too often in a couple's journey to trying to conceive again. Here's the quick breakdown:
An activated arousal system (the stress response) is associated with a number of risks related to fertility and pregnancy. From an increased risk of miscarriage and failed cycles to pregnancy complications such as preterm contractions, gestational diabetes, preeclampsia and so much more.
When I say deactivate your stress response, I don't mean feel calmer in your head or feel more optimistic. Yes, those are the side effects of a deactivated stress response, and they're very good to feel, but optimism isn't enough. It requires more than talking through your past as you might be doing if you're working with a psychotherapist or psychologist. This is more than just deep breathing or meditation apps that help in the short-term, but fail when you're triggered by a loss anniversary, a pregnancy announcement or a failed cycle.
By retraining your body to feel safe, to feel secure and to feel ready for another pregnancy, you will learn how to turn off this stress response, which ultimately activates the repair system (the parasympathetic nervous system) that is designed to help your body heal from the immune, nervous and endocrine changes that occur when your stress response is on.
Body work, such as trauma-informed yoga or massage can be very powerful. You're welcome to work with me privately to learn somatic release of the trauma, guilt, grief, anxiety and fear that is keeping your arousal system activated. Whatever you do, please be honest with yourself about how well it's working. If you find yourself feeling well with the tools you have at your disposal for a day or a week but it disappears with time or with triggers, please find another way.
I want you to know that no matter what darkness you've been through, you can deactivate this stress response without knowing what the future holds. I see it with my clients every day and I promise it's possible for you too. See Rima's story and Amalia's story for hope on how this is possible.
Figure out the timing
For some couples this is simple - wait until you're ready and then you can move forward with trying to conceive. For others, many of my clients included, the timeline is not entirely up to them because of fertility treatments, insurance coverage and even health conditions that could require a shorter window for waiting.
If you are in the first group where you can wait for some time, do it. Get all your ducks in a row. Cross your t's, dot your i's. Whatever you call it, really put in the effort you need to prepare your life, family, finances, marriage and body for pregnancy before you move forward.
If you're in the second group, remember that no doctor can force you to try to conceive before you're ready. A good physician will advise you on ideal timeline but will work with you to optimize your fertility whenever you are ready to try again.
When is the right time? Only you will know. Some of my clients describe it as a "warmth" that flows through their body when they feel ready. Others describe it as this "total relaxation" even when they don't know what will happen. Yet others say it's a gut feeling and they just know. Trust your body to tell you when it's time.
When it's time
Whatever you do, please don't rush this decision and choose the timing without the proper support for you and your partner. Trying to conceive and being pregnant after a high-risk pregnancy can bring up a lot of emotions and memories from your past. Be sure you have the right arsenal of tools and people that you can turn to in order to help you have the healthiest pregnancy possible this next time around.
Finally, remember this. The human body and the human spirit are tremendously resilient, strong and powerful. You are not a victim of your circumstance and you are also not destined to experience any particular thing. Stats are just likelihoods. Diagnoses are just words to describe a set of symptoms. You have more power than you realize to impact the course of your fertility and pregnancy.
Don't let anyone make you forget that.
What's next?
The place I see women get stuck the most is deactivating their stress response.
Feeling like they are trying everything they can but they just can't seem to find the peace or relief they're hoping for. If that sounds like you, take a proactive step with your health and re-train your body to feel safe and reset your nervous system so you can feel calm, reduce anxiety, release trauma and prepare your body for pregnancy.