Trying Again After a Miscarriage: At Your Own Pace, With Compassion

Losing a pregnancy, no matter how early, can leave deep grief behind. If you are reading these lines right now, first know this: everything you feel is understandable, and you are not alone. In this article, let's talk about the questions you may have when you think about trying again, based on what current guidelines say and with respect for your own pace.

First and most important: this is not your fault. The American College of Obstetricians and Gynecologists (ACOG) stresses that a miscarriage is almost never the woman's fault. About half of early miscarriages happen because the embryo cannot develop properly, and the cause is often a difference in the number of chromosomes. Working, exercising, stress, arguments, sex or having used birth control pills in the past do not cause miscarriage. Miscarriage is actually common: according to ACOG, about 1 in 10 known pregnancies ends in an early loss.

How does your body recover? The UK's National Health Service (NHS) notes that after a miscarriage there may be tummy pain for a few days and bleeding or spotting for up to 2 weeks. Some women feel better within a few days or weeks, while for others it takes longer. Because of the risk of infection, the NHS recommends taking a break from sex until the symptoms have passed. ACOG also advises not putting anything in the vagina, including tampons, for 1-2 weeks and going for a checkup a few weeks later. If your blood type is Rh negative and the miscarriage happened at 12 weeks or later, an anti-D injection is recommended. You can talk with your doctor about whether it is needed at earlier weeks.

When does your first period come? According to the NHS, it can take up to 8 weeks for your period to return after a miscarriage, and it may take a few months for your cycle to settle back into its old pattern. ACOG reminds you that you can get pregnant again as soon as 2 weeks after an early miscarriage. If you do not want to get pregnant right away, it is a good idea to use birth control during this time.

How long should you wait? Why does the information differ? In the report of its 2005 consultation on birth spacing, the World Health Organization (WHO) recommended waiting at least 6 months after a miscarriage before the next pregnancy. A later systematic review and meta-analysis from 2017, which included data from about a million women, showed that getting pregnant within 6 months of a miscarriage was not linked to poor outcomes in the next pregnancy. In this study, those who got pregnant after a short interval had a lower risk of another miscarriage and of preterm birth. The studies in the review were observational, so they show that a short interval does not increase risk, not that it lowers it.

Current advice: when you feel ready. The NHS says you can start trying again when you feel ready, once the symptoms have passed. ACOG also recommends giving yourself time to recover emotionally and physically before you start trying, and talking with your doctor about timing. Waiting for one period to make it easier to work out your due date is another option. So the right time is less about the calendar and more about when your heart and body are ready.

Emotional preparation is preparation too. According to ACOG, for many women emotional healing takes longer than physical healing, and your partner's grief may look different from yours. This does not mean one of you is less sad. Feeling anxious in a new pregnancy is also very natural. These may help you:

• Sharing your feelings with your partner, your family or someone you trust
• Asking your doctor for counseling support
• Talking with people who have had a similar experience in a support group

When are repeated miscarriages looked into? ACOG notes that pregnancy loss in the first trimester is usually a one-time event and that repeated miscarriages are rare. According to ACOG, tests to find the cause can be done after two or more miscarriages. The NHS recommends that those who have had 3 or more miscarriages see a doctor and be referred for testing to look for a treatable cause. Even when no cause is found, most women go on to have a healthy pregnancy after repeated miscarriages.

When you decide to try again: Remember to start taking folic acid again; you can find the details in our Folic Acid and Preconception Vitamins Guide. There are also some changeable factors listed by the NHS: smoking, alcohol, too much caffeine, obesity or being underweight can increase the risk of miscarriage. This is not a list of things to feel guilty about, but small steps that can support you on your new journey.

When should you see a doctor?

• Your bleeding has gone on longer than the 2 weeks mentioned by the NHS, or any symptom worries you
• You have a fever or chills, which can be signs of infection
• If your bleeding is very heavy, for example a pad fills up soon after you put it on, or you have unbearable tummy pain, shoulder pain, dizziness or feel faint, call your local emergency number without waiting
• You have bleeding, cramps or fluid coming from the vagina in a new pregnancy
• Your grief has been making daily life hard for a long time

Dear mom-to-be, the baby you lost is part of your story, and it is so natural to miss them. You do not have to rush to try again, and you do not have to wait either. Whichever path you choose, show yourself at least as much compassion as you would show a friend.