Pregnancy after loss – a (gentle) survival guide

By the time you read this, it’ll have been more than a year since I was pregnant. This is only the second time this has been true in – what? – five years, now. The last time I could say it was when we took an extended break from trying to conceive after our fourth miscarriage. This time around, it means our son is now a one-year-old. 

I could apologise for taking so long to put together a practical post about getting through pregnancy after loss, but, actually, I don’t think it’s a wholly bad thing. I couldn’t have done it justice back when I was pregnant after loss myself. Back then, I was just existing, really. I had no reliable perspective on what I needed, what was helping, and what wasn’t. And while I did write about how I felt – in this piece, and also in this one – I didn’t have the bandwidth to zoom out and consider anything or anyone beyond my own survival and (more literally) our baby’s. 

Which brings me to my first, biggest, loudest recommendation. There is no right way to do this. Nothing I did or didn’t do vanquished my anxiety altogether. There is no ‘one weird trick’ for getting through pregnancy after loss (as much as that might make for a more clickable, popular blog post). It isn’t an experience that can be hacked.  

There were days – sometimes even a little run of days – when I enjoyed being pregnant. But it never felt easy. I was never not watchful or worried. Sometimes, it felt like the pay-off for a comparatively carefree time of it, was a massive anxiety spike and a trip to triage for a session on the heartrate monitor. Sometimes, it would feel a little like punishment for enjoying it ‘too much’. (As much as I would reassure someone else in the same shoes that this is deeply, demonstrably, definitely bullshit).  

I was emphatically not a chill pregnant person. I asked for extra scans throughout the first and second trimesters. I went to triage at least three times over concerns about patterns of movement.     

It feels hard, because it is hard. 

Yet this is the very thing I would have been reluctant to acknowledge back when I actually was pregnant, out of guilt and a deep fear of seeming ungrateful. Whiny, even. 

So I’ll say it again, in case you have a similar fear and inclination to squash down how you really feel: It feels hard, because it is hard. And while this is by no means a ‘how to’ or intended as a prescriptive list, here are some gentle pointers and assorted thoughts on what made it a little bit easier for me and some things I only know with the benefit of hindsight… 

The practical stuff

First, brace yourself for the fact that the healthcare system might not feel set-up for this kind of pregnancy, especially if your losses were early. We were seen at our NHS recurrent miscarriage clinic for the first trimester, but then transferred back into standard antenatal care for the 12-week scan. Although my pregnancy was consultant-led (I think so that I could be prescribed progesterone, up until 16 weeks) this didn’t mean I saw the same doctor each time, and I also saw lots of different midwives and sonographers. Often, they seemed quite taken aback by the anxiety radiating off of me and Dan, like cartoon stink-lines. And I tended to preface all appointments with a little spiel – ‘history of miscarriages. Quite anxious’ – to head off any potential awkwardness.  (You can get pregnancy after loss stickers for the front of your maternity notes, as an extra visual clue, such as these, made by the baby loss charity MAMA Academy, and these – although they tend to be designed for later losses). 

Something I didn’t know to do, but have heard about since from others, is to ask if you can see a case-loading midwife – this means that this same midwife will see you each time, and hopefully be familiar with your story, so you don’t have to explain yourself over and over. 

Also, know that you don’t automatically have to go to your nearest hospital for maternity care, which may well have associations with a previous loss, or losses. In the UK, you have the right to choose which hospital you to go for pregnancy care and birth. A house-move for us in the first trimester meant that we circumnavigated the negative associations with our old hospital by accident. Also by accident, for no other reason than our GP had the wrong fax number, we ended up at a big, teaching hospital, which covers complex maternal medicine, has a midwife-led birth centre on the same site, as well as a neonatal intensive care unit. This ended up being very reassuring to me, as everything we’d need in a worst-case scenario was there. Essentially, it’s worth remembering that you don’t have to go along with what’s the norm for your area. It’s OK to be just a little bit awkward and to consider what makes you, personally, feel safest. Whether that’s planning for a home birth to avoid the hospital altogether, ensuring the shortest travel time possible, a different hospital to the one you miscarried in before, or a bigger hospital with all the bells and whistles. 

And, on the subject of pregnancy appointments, if humanly possible, try not to over-schedule yourself on these days. I was always caught out by how exhausted I felt after scans and midwife appointments, something I can only assume is a kind of come-down after the surge of adrenaline and all the other stuff that puts your body on high-alert in anticipation of the scan, with all the fear and threat that poses.       

Navigating social media

You don’t have to announce it, if you don’t want to. As much as I firmly believe the 12-week ‘rule’ is uncharmingly retro and unhelpful in the scheme of things, I personally did not have the strength to be open about my pregnancy in the early days and weeks. I don’t think we told our wider family until I was over 16 weeks. I didn’t put anything on social media until closer to 20 weeks. 

During pregnancy after loss, the weight of other people’s expectations and optimism can feel like an extra load. Well-meant comments such as ‘it’s different this time, I can tell’ can make you feel more nervous, not less. While it is undeniably lovely to know that other people are wanting and hoping good things for you, rightly or wrongly, the other side of the knife-edge – the sharper blade – is that you feel like you could let them all down at any minute. Sometimes, it feels easier to say nothing.  

Equally, you are allowed to celebrate it and talk about it if you want. It is not jinxing it. Even if you announce before 12 weeks. You are not making anyone feel uncomfortable (or, at least, if you are, they can sod the sod off). Announcing a pregnancy after loss is an admirable act of living in the moment. And announcing ‘early’ has the potential to counter so much silence, shame and mystique that still surrounds early pregnancy and loss. 

Also on the subject of social media, it is OK if you have to withdraw a little from the  discussion around TTC/infertility/baby loss. This can feel emotionally sticky when this community and content have been your main forms of support before you were pregnant. But I know I found it very hard to absorb other people’s stories while in such an intense phase of my own. Try not to feel guilty about not engaging (this is high on the list of things I would go back and tell myself, if I could.) You’re not letting the side down. It doesn’t mean you don’t care. And it’ll come back around. You’ll be able to participate again, when you’re ready. 

This said, there are some great pregnancy after loss specific accounts – such as @tryingyears and @pregnancyafterlosssupport. And I always find the work of the illustrator @fertilit_arty very comforting in my feed. As well as hosting the Finally Pregnant podcast Cat of @tryingyears also runs The Hangout, an online community for people who are pregnant or parenting after loss and/or infertility, as well as ‘finally pregnant’  yoga sessions. 

But I’ll confess, sometimes I found even these brilliant resources hard to engage with. (Although I do wonder now whether I’d have felt better if I’d pushed myself to connect with others just a tiny bit more, for what that’s worth.)  

The anxiety ‘U’ curve

With hindsight, I really, really wish I’d asked about counselling during my pregnancy. I’ve had therapy before, after our inconclusive test results and around the time of our fourth loss. It was the single most helpful thing I did to help myself cope. I vaguely had the idea in the back of my head that it would be wise to go back to the same psychologist if I got pregnant again, but then we moved away and that became impossible. And, of course, the strong fear of getting ahead of yourself in pregnancy after loss makes planning ahead a challenge, to say the least.

Case in point, I was asked whether I needed psychological support at our initial booking-in appointment, and I said no. At the time, my anxiety level was high, but it felt proportional and familiar, and therefore manageable. And I think, if I’m honest, I was worried that I’d no longer be pregnant by the time any appointments came around, had I said yes.  

I also, naively, assumed that my anxiety would ease the further into the pregnancy we got. This was true, but only up to a point. Things got lighter in the second trimester, especially as I started to feel Edward wriggling and squirming. But I hadn’t anticipated the rebound of anxiety in the final weeks of pregnancy, which felt as slow and twitchy as the first trimester, for me. I’ve since been told this is quite a common psychological pattern – a sort of pregnancy anxiety u-curve, if you like. 

I actually ended up starting my maternity leave several weeks early because I was struggling with the pressure and worry. In short, I could really have done with someone objective and professional to talk to in those final weeks. But of course, ironically, by the time you reach that overwhelmed, overwrought place, it can be hard to think straight enough to put in place the help you need. If I’d known about it at the time, I might have explored an online service like Better Help, which somehow might have felt less intimidating or emotionally taxing than trying to go through my GP or antenatal team (as much as I know that is the most sensible thing to do). This is a very thoughtful, useful guide on how to ask for mental health support here, by Michelle, who is a clinical psychologist and has also written masterfully about her experience of losing her daughter, Orla. 

What to read

On the whole, pregnancy books are pretty crap on miscarriage and pregnancy loss. There, I said it.

It’s often covered in a few, cursory sentences, or at best, a paragraph. They say things such as ‘recurrent miscarriage was once a mystery more often than not, but progress has been made in uncovering its causes’ or ‘there are medical interventions that will hopefully enable you to have children’. These things may be technically true, but feel so far removed from the actual lived experience that I can’t help but find them unhelpfully glib. 

Often, the sections on the first trimester are either too brief to be sustaining in those agonisingly long early weeks or they’re too perkily presumptuous, full of planning-ahead tips and tricks. Miscarriage still feels like an afterthought, frankly. (A low point for me was a book I bought in our second pregnancy about exercise, to try to make sense of what was safe/how I could feel safe while exercising after a previous loss, but which avoided the topic entirely.) 

There is also the complicating factor of what you read in previous pregnancies. For example, Rebecca Schiller’s Your No-Guilt Pregnancy Plan would probably have been the ideal place to start in my pregnancy with Edward, because of its gentle, non-judgmental tone – but I started it during my fourth pregnancy when I was trying to ‘think positive’ and so I found it very hard to revisit without bringing up all those memories of how easily it can go wrong. (I did end up finishing it as an audiobook, but only late into my second trimester).

Instead, this time around, I eased myself in gently with a book that isn’t really a pregnancy book at all – Philippa Perry’s The Book You Wish Your Parents Had Read. It’s undeniably a very useful book as a prospective parent, but because it also feels like a good manual for life, I was able to enjoy it without feeling like I was ‘jinxing’ anything. I could tell myself it’s the kind of book I should and would read anyway.   

I also started Emily Oster’s Expecting Better, which forensically unpacks the evidence on things like caffeine, alcohol, and the risks of rare meat, as well as being structured by trimester, so I read each section as I reached a particular milestone. (I read the 2018 edition, but there is now an updated edition for 2021, with an added section on navigating miscarriage – although you may have to go to an American website to order it, as far as I can tell it’s not out in the UK yet).   

Later on, I found the lists of what you need in Marina Fogle’s The Bump Class useful and not too overwhelming. Bits of The Modern Midwife’s Guide To Pregnancy, Birth, & Beyond by NHS midwife Marie Louise stuck with me in the run up to – and during – labour. (Although there is a rather dismissive, throwaway line in it about the relatively recent advice to go to sleep on your side during the third trimester, to reduce the risk of stillbirth. The point she’s making – about not terrifying pregnant women – is a valid one, but given that there’s now proper research behind this advice, I was irritated by it being brushed over as mere ‘clickbait’).    

In truth, I’m not sure I found a pregnancy manual that truly spoke to me on the level I needed it to. Instead, the most rewarding things I read ended up being memoirs about motherhood, namely Rachel Cusk’s A Life’s Work and Anne Enright’s Making Babies.  

Since having Edward, two books specifically about pregnancy after loss have been published which I think I would have been very grateful for – Pregnancy After Loss by Zoe Clark-Coates, the founder of the Saying Goodbye charity, which includes a day-by-day planner and journal, as well as wisdom drawn from Zoe’s own experiences of multiple miscarriages. (I can imagine that Zoe’s writing would be especially comforting if you are a person of faith). The second is called Rebirth: The Journey Of Pregnancy After Loss, by an American therapist Joey Miller, and looks to me like detailed, practical companion guide, with case studies and tips for potential hurdles such as when to start trying after loss, having sex during pregnancy, looking after other children while pregnant after loss, and the dilemma of when to set up the nursery. (For UK readers, it is written with the U.S. healthcare system in mind).  

There is also a very lovely, gentle chapter on pregnancy after loss in Nicola Gaskin’s Life After Baby Loss. 

Other

I wrote lists. So many lists. The thing about the normal pregnancy checklists and timelines is that they often move too quickly and look too far into the future to feel comfortable or practical. Most take the ‘booking-in appointment’ or even the 12-week scan as the starting blocks. But for us, there was a whole marathon to run before we got there. So, I took to writing down my own infinitesimally small milestones, to check off day by day or week by week, never looking too far ahead: ‘Take a digital test. Call and arrange a clinic appointment. 7-week scan’ and so on. Later, I used the same micro-goal strategy to manage what can quickly feel like an overwhelming amount of pregnancy ‘admin’ to manage, when you’re in such a heightened state. ‘24 week scan’. ‘Buy one item of baby clothing’. ‘Make a list of what we need’. (Yes, I put ‘make a list’ on one of my lists. Don’t judge.) 

While I didn’t do any sort of hypnobirthing course, as it just felt like one more pregnancy-focused demand on my attention and time than my nerves could withstand, a kind Instagram friend, Laura, did send me a meditation track, which was very helpful and calming (once I’d worked up the courage to try it). Laura is a hypnobirthing teacher, based in Brighton who has also experienced recurrent miscarriage, something that now informs her practice. (You can find her here). She very generously agreed that I could share the track with my readers here:

What else? I found @tommys_pregnancyhub on Instagram one of the best, gentlest sources of pregnancy information, whether that’s health advice or checklists (more lists..I know, I know…).

Distraction. Distraction. Distraction. I watched A LOT of Buffy the Vampire Slayer and read a lot of pulpy novels about rich, thin women doing glamourous things in New York – a niche genre that really appeals to me when I feel like I need to escape. And escape is what I needed most during pregnancy. Don’t judge your own tastes too harshly. Pregnancy after loss is an intensely claustrophobic experience, with your mind constantly tethered to what may or may not be going on inside your own body (or the body of someone you love). And anything that lets you escape that, even just for half an hour, has to be of value, whatever the film or literary critics might say. 

• Please feel free to share what helped you through pregnancy after loss in the comments here…or email me ! If I get enough of them, I may compile them into a follow-up post (a bit like this one here, on what helps after baby loss). 

[Disclaimer: I am a journalist, not a medical professional of any kind. This is intended to be a list of resources, and a thoroughly unscientific tour through my own meandering experience – please don’t rely on it in place of proper, medical advice or mental health support if you are struggling ].  

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