with this heartrending decision.
Psychologists and sociologists have conducted many studies on how people grieve at the loss of a fetus. But the vast majority of them have dealt only with women’s reactions. The ones that have included fathers’ feelings generally conclude that men and women grieve in different ways. Dr. Kristen Goldbach found that “women are more likely to express their grief openly, while men tend to be much less expressive, frequently coping with their grief in a more stoical manner.” This doesn’t mean that men don’t express their grief at all, or that they feel any less grief than women. Instead, it simply highlights the fact that in our society men, like my friend Philip, have virtually no opportunity to express their feelings—at least not in the “traditional” way. Many men respond to their grief by doing everything they can to get life back to normal. That often means going back to work and putting in extra-long hours. It’s a way of getting away from the self-blame and feeling of helplessness at not knowing how to comfort their partner. It’s a way of avoiding the barrage of baby images that was probably always there but now seems much more pervasive. It’s a way of coping with their grief and, unfortunately, of ignoring it.
Trying Again
If you’ve suffered a miscarriage and have decided to try to get pregnant again, your goal is to prepare a healthy environment for the baby to swim around in, and to prevent birth defects or other complications.
One of the most crucial times of the pregnancy is between 17 and 56 days after conception. That’s when the organs start developing. But because this stage happens so early on, it’s entirely possible that your partner might not know she’s pregnant. And by the time she finds out, she may have already done all sorts of things that could affect the baby—things she’ll wish she hadn’t done.
For that reason, it’s important to prepare yourselves for the next pregnancy as far in advance as you can. From six to nine months would be great, but even a month or two can make a big difference.
Preconception
The rest of this book is devoted to how to have a healthy, safe pregnancy and a healthy mom and baby. But right now, we’re talking about steps you can take before your partner conceives again that can boost your chances of getting pregnant, make for a less eventful pregnancy, and potentially help you reduce or avoid the expense and emotional ups and downs of fertility treatments.
You never know when your partner is going to burst out of the bathroom waving a little white stick and announce, “Honey, I’m pregnant!” So before the two of you hop in the sack, there are a few things that she should do, you should do, and the two of you should do together to get ready.
Pregnancy after a Miscarriage
Getting pregnant after having lost a baby can bring up a jumble of feelings for both you and your partner. For example, you’ll probably be feeling incredibly happy that you’re expecting again. But you may also be worried that this pregnancy will end the same way the last one did. That could keep you from allowing yourself to become truly engaged in and enjoy the pregnancy—at least until after you’re past the point when the miscarriage happened last time. If your partner is feeling this, she may deliberately keep herself from bonding with the baby, trying to save herself the grief if the worst happens again. If it’s been a while since the miscarriage, you might be angry—in an abstract sort of way—that you’re still expecting, when by all rights you should be holding a baby in your arms right now. But if your partner got pregnant right away, you might be feeling guilty at not having let an appropriate (whatever that means) amount of time pass.
Everyone deals with post-miscarriage pregnancy differently, but there are a few things that may make it a little easier:
• Try not to worry. It may have happened before, but chances are it won’t happen again. Only 1 in about 200 women are what are called “recurrent miscarriers,” meaning that they have had three miscarriages and have never delivered a child.
• Don’t pay attention to other people’s horror stories (you’d be amazed at how insensitive some people can be).
• Don’t tell anyone about the pregnancy until you’re absolutely ready to, and then tell only people you’d want to support you if something bad were to happen (see pages 82–83 for more on this).
• Get some more ultrasounds or listen to the heartbeat—this might help to reassure you that all is well.
• Get some support. If your partner can help you, great, but she may be preoccupied with her own thoughts. Otherwise, find someone else who’s been there and tell him or her how you’re feeling.
• Support your partner. Encourage her to talk about what she’s feeling and don’t make any judgments about what she says. And try to keep her calm. As the pregnancy progresses, for example, and she can feel the baby’s movements, she may become fixated on counting them—worried that there are either too many or too few. Just so you know, anywhere from 50 to 1,000 a day is normal.
WHAT SHE SHOULD DO
• Make an appointment with her health-care provider for a preconception physical. The doctor will:
• Evaluate any and all medications your partner is taking to see whether they’re safe during pregnancy.
• Probably prescribe prenatal vitamins and possibly folic acid supplements (folic acid lowers the risk of some birth defects of the brain and spinal cord).
• Address any medical conditions, such as diabetes, asthma, high blood pressure, depression, epilepsy, obesity, or any problems with previous pregnancies. All of these reduce her ability to get pregnant, and if she does conceive, can increase pregnancy complications and the risk of miscarriage, preterm delivery, and birth defects.
• Make sure her immunizations are up-to-date, in particular chicken pox (varicella), German measles (rubella), and hepatitis B.
• Screen her for sexually transmitted diseases.
• Discuss the birth control methods she’s been using. If she’s been on the pill, she may need to go through a couple of pill-free months before trying to conceive.
• Get healthy. According to the Centers for Disease Control (CDC), 11 percent of women smoke during pregnancy, and 10 percent consume alcohol. Of women who could get pregnant, 69 percent don’t take folic acid supplements, 31 percent are obese, and about 3 percent take prescription or over-the-counter drugs that are known teratogens (substances that can interfere with fetal development or cause birth defects). Getting healthy means:
• Limit caffeine. Some studies show that caffeine can decrease a woman’s fertility and increase the risk of miscarriage or other problems. Other studies find no connection. Just to be safe, though, it’s probably best if she cuts back to no more than two or three cups of coffee per day or switches to decaf.
• Exercise. It’s much better for a pregnant woman to continue an exercise routine she already has in place than to start a new one. If your partner hasn’t been working out regularly, add this to the list of things to talk about with her health-care provider.
• Watch her weight. If she’s overweight (her doctor will tell her whether it’s a problem or not), now’s the time to start slimming down. She definitely doesn’t want to be dieting during the pregnancy. According to the CDC, “reaching a healthy weight before pregnancy reduces the risks of neural tube
