I’m pregnant with my rainbow baby and am so terrified I’ll lose this pregnancy that I barely leave the house. What are the chances I’ll have another miscarriage/stillbirth? What can I do to avoid it? And how can I calm down and enjoy my pregnancy?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

I can’t imagine a tragedy greater than the loss of a child. From the incredibly brave women I’ve worked with who have navigated this heartbreak and from experiencing it myself, I have learned how common it is for fear to encase the heart after loss. Although the conception of a rainbow baby, a baby conceived after a pregnancy loss, is a joyous discovery for many women, it also marks the beginning of a fraught experience. An experience that’s a swirl of guilt, hope, anxiety, healing, and fear that the cruelty of loss will strike again. And then there’s the stress of being stressed: you know stress isn’t good for pregnancy, but you just can’t shake the stress that stems from your trauma. It can feel like an impossible situation.

But here’s a stat that can hopefully soothe some of those nerves. According to a study published in the Journal of Human Reproductive Sciences, only about 2 percent of women will have a repeat miscarriage (pregnancy loss before twenty weeks’ gestation) — most go on to have a healthy pregnancy after the initial loss. In regard to stillbirth (pregnancy loss after twenty weeks’ gestation), a study published in the British Medical Journal found that while women who have had a stillbirth have a higher chance of experiencing another one, the likelihood of this occurrence is rare.

And now for the murkier component of this question, the emotions. Some women feel like they’re turning their back on the child they lost by allowing themselves to be happy and hopeful about the new baby they’re carrying. But you have every right to let joy bubble to the top of your swirl of emotions. And when you keep making the choice, over and over again, to allow yourself to feel positive emotions — even if it’s just glimmers of those emotions — you begin teaching your brain (and heart) that it’s able and allowed to move forward, and you begin to realize that moving forward doesn’t mean leaving your angel baby behind. Throughout it all, keep reminding yourself that your angel baby will always be in your heart, even on days when you don’t think about the loss.

What to do

Find a care provider who is vigilant about helping you understand (as much as possible) what happened in your last pregnancy and is confident about how to support you through this one. This type of care can help you relax a bit more into pregnancy. If you had a stillbirth, consider hiring a maternal-fetal medicine specialist (MFM).

In addition, ask for more prenatal visits if you feel anxious something will happen in the interim. A family member of mine who experienced a stillbirth requested a prenatal visit every two weeks during the first two trimesters of her next pregnancy, and a visit every week in the third trimester. And don’t be afraid to check in if you feel like something is off. Soothing your fears is more important than not calling your care provider too often.

Is there anything else that can help prevent a subsequent pregnancy loss? Maybe. According to the aforementioned study published in the Journal of Human Reproductive Sciences, there are various factors that could potentially help you avoid another pregnancy loss, if your initial loss was unexplained. And a study published in Australian and New Zealand Journal of Obstetrics and Gynaecology found that 50 percent of miscarriages are unexplained. But many of those are caused by genetic abnormalities, which can’t be avoided unless preimplantation genetic testing (PGT) is utilized during an in vitro fertilization (IVF) cycle.

Because there’s some debate about the most effective strategies for preventing pregnancy loss, talk with your care provider about whether the following interventions could be useful for your unique situation. Keep in mind that because research is ongoing with many of these treatments, your care provider might not be comfortable recommending them.

  • Folic acid: Stay on top of taking your 400 mg of folic acid daily, as it helps prevent major birth defects in the baby’s brain and spine.
  • Emotional support: Seeking support from a therapist can help you move through the unique fears attached to your pregnancy. In addition, utilizing alternative support (after your care provider gives you the go-ahead) like acupuncture or hypnotherapy could alleviate stress. You can also use the following link to access a guided meditation I made for women wanting to experience more joy in their rainbow baby pregnancy: yourserenelife.wordpress.com/rainbow-baby/.
  • The norms: Promote a healthy pregnancy by eating a nutrient-rich diet, exercising regularly, taking your prenatal vitamin, and staying away from no-nos like alcohol, cigarettes, and illicit drugs.
  • Environmental factors: Limit exposure to harmful products like mercury, solvents, paint thinners, pesticides, and heavy metals. Talk with your care provider about other hazards to avoid.
  • Chronic conditions: If you have chronic health circumstances such as diabetes, high blood pressure, or other ailments, make a plan with your care provider about how to stay on top of treatment.
  • Sleeping on your side: Because sleeping on your back could impact the flow of blood and oxygen to the baby, sleeping on your side is the safest option. A pregnancy pillow does wonders for making this comfortable.
  • Aspirin: Some believe that taking a daily baby aspirin can help prevent pregnancy loss in women with high levels of inflammation. But do not take aspirin without explicit instructions from your care provider.
  • Progesterone: In some cases, progesterone can help prevent miscarriage in women who experience bleeding in the first trimester.
  • Low molecular weight heparin (LMWH): The use of LMWH has sometimes been found to help minimize the chance of pregnancy loss.
  • Human chorionic gonadotrophin (hCG): Because hCG plays a critical
  • role in the establishment of a pregnancy, it’s believed that hCG injections might help prevent early pregnancy loss.
  • Steroids: The steroid prednisolone has been found to reduce the amount of a type of cell called uterine natural killer (uNK). Women who have had recurrent miscarriages often have elevated levels of uNK.
  • Intravenous intralipid solution: Much like prednisolone, intravenous intralipid solution therapy helps prevent natural killer cells from attacking a fetus. While not all women are candidates for this treatment, it’s often beneficial for those with endometriosis, autoimmune disorders, connective tissue disorders, or rheumatoid arthritis, as these women are more likely to have elevated levels of active natural killer cells.
  • Immunoglobulins: This is a type of antibody made by the immune system to battle bacteria, viruses, and other not-nice invaders. Injections of immunoglobulin are especially needed for immune-deficient patients, in addition to those with a negative blood type. While controversial, immunoglobulin therapy is sometimes used to help prevent pregnancy loss for a woman who has experienced recurrent miscarriages.

With all that said, I want to stress how important it is to avoid blaming yourself for your loss. While there are many ways we can promote a healthy pregnancy, a loss is often caused by circumstances out of our control. Give yourself credit for all you’re doing to nurture your well-being, and do everything possible to release guilt and adopt trust in your body’s ability to move through this pregnancy with ease.

If you’re having a hard time enjoying this pregnancy because you’re steeped in grief, it might be supportive to find new ways to honor your child who has passed. For example, instead of viewing your grief as the prime way to honor them, you can plant a memorial tree that you regularly meditate by, or write letters to the child. Whatever practice you’re drawn to can help you connect to that child, assuring you they’ll never be forgotten while also maintaining enough emotional space to give loving focus to your current pregnancy. Of course, you’ll still have moments of regret, anger, and sorrow, but they’ll no longer be the main channels of connection with your child who has passed on. You’ll now have a new channel that fosters emotional relief and evolution.

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