It would be comforting to think that complicated pregnancies are the rare exception but, in fact, they affect a huge share of women. If we put together all the conditions that complicated a pregnancy — miscarriage, preterm birth, preeclampsia, hyperemesis gravidarum, and many more— we are talking about perhaps 50 percent of pregnancies. One implication of this is that when women consider a second or later pregnancy, as many as half of those pregnancies carry an extra layer of difficulty.
We all hope not to be in this situation – we hope you are not in this situation – but many people are and we do not discuss it enough. The lack of discussion is harmful. So many pregnancy complications are kept quiet, or secret. This can contribute to a feeling of aloneness, and it can make later pregnancies even more complicated to manage.
We are here to say: there are steps to take more ownership if you are thinking about pregnancy after complications. Navigating or planning a pregnancy after complications can plunge you into an unfamiliar world of medical decision making. Conversations with medical providers can be hard and scary, and often people felt that they were given a choice about what to do without really having the full set of information they needed, or they weren’t given any choices at all.
Data is one important input to moving forward, but another key is knowing the right questions. To make these hard talks as useful as possible, you need a script— a way to be prepared to get the information you need, and a way to structure the conversation. You need to have some understanding of how your provider is thinking about your situation so that together you arrive at the best possible result. In The Unexpected, our book on navigating pregnancy after complications, we suggest you start with three steps.
First, prepare yourself. Engage with the question of a possible future pregnancy. Is this the right choice? Is now the right time? How can you know if you’re ready? What supports would you need to put in place – emotional, material – to make this possible?
Second, prepare your material. Get your medical records. Talk to your doctor about your last pregnancy. You are the best keeper of your own information and having it at your fingertips will be enormously helpful. In most cases, you can and should access detailed medical records from a first pregnancy. Any information you have can help inform the future.
Finally, prepare your conversations. Especially when things are medically complicated, it can feel daunting to talk with a provider. This conversation will be easier if you come in with a set of concrete questions – basically, a script.
1. Are you able to explain in simple terms what happened to me and, if you know, why it happened to me?
2. What important tests did I have and what did they reveal? Were any of them abnormal?
3. What treatments did I receive? Which ones worked and which ones didn’t?
4. Was I seen by other specialists? If so, what did they contribute?
5. What are the facts I need to know if I were to try to explain this accurately to another doctor?
6. Is there anything I need to do or know prior to another pregnancy?
7. Is there anything you would recommend I do differently, or a treatment I should receive, in a future pregnancy?
With some understanding of your own medical history, and these questions, our hope is that you’ll be better prepared to navigate this tough situation. There is one more, very crucial, note. If a pregnancy didn’t go the way you planned — regardless of the outcome — here can be a sense of loss. Of course this is the case with miscarriage or stillbirth. But it’s also true for birth trauma, for preterm birth, for having a cesarean delivery if you anticipated a vaginal birth, or for any unexpected or difficult portion of the pregnancy and birth.
We naturally come into a first pregnancy with a set of expectations for pregnancy and birth. If your experience differs from those expectations, that can bring on grief. That sense of loss is commonly dismissed—“Well, you had a healthy baby! You don’t have to worry about what happened before.” This is, frankly, bullshit. Yes, experiences vary, and some people are able to accept what happened more easily than others. But you deserve to process in whatever way you need to. So, get the support — therapy, writing, meditation, whatever works for you — that you need now.
From THE UNEXPECTED by Emily Oster and Nathan Fox, published by Penguin Press, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2024 by Emily Oster.