PGAL: Pregnancy after Miscarriage

After a miscarriage, women have different reactions to trying to conceive again. While some women need time to heal and mourn the loss, others feel that the only way they can heal is to get back to trying. I definitely fell into the second camp, but I know women who have felt quite the opposite.
Regardless of when you start trying and when you get pregnant again, you will probably find that this pregnancy is wholly different than the last one. The blissful ignorance will likely be gone, and, if you're anything like me, it'll be replaced by fear and paranoia. The veil has been lifted, and you now no longer believe that pregnancy equals a baby. In addition to now being more aware of miscarriage statistics (1 in 4), you may also have doubt in the ability of your body. Almost always, this skepticism is unwarranted (the vast majority of women who have a miscarriage will have a healthy pregnancy the next time around), but I personally felt little comfort in those facts. My body had failed me, or at least that's how I felt, and so when I got pregnant again, there was less celebration and a lot more fear.

After you accept that this pregnancy is just not going to be the same effusive, effervescent journey that the last one was, there are things that you can do to help ease what is referred to in the loss community as "pgal-brain" (pregnant after a loss brain).

Here are some things that helped to ease my paranoia and stress as I went through my second pregnancy:

1. Let your obstetrician know your background--if you "only" had one pregnancy loss, it's unlikely that your doctor will implement any additional monitoring during your second pregnancy. That being said, it's still important that the doctors caring for you know where you are coming from. Letting your doctor know that you're pgal will make them more understanding about those paranoid phone calls and premature trips to labor and delivery that will undoubtedly crop up along your journey. Also, talking about loss, at least for me, has made me feel so much less alone.

2. Go for Vanity Ultrasounds--since I was pregnant with mono-di twins during my second pregnancy, and therefore, I was high risk, I had no shortage of ultrasounds to soothe my paranoia. Most women, however, will not have this to keep them calm. If you're pregnancy is "normal", you'll likely have 1-3 ultrasounds, and that leaves long stretches of time without hearing the soothing sound of your little one's heartbeat. Luckily, you don't have to jump through insurance hoops to get an ultrasound. While not everyone can afford it, non-medical ultrasound facilities exist in most areas and offer scans for $50-$250. Now, as stated, these ultrasounds aren't for medical purposes. They aren't going to look for deformities, but they are able to show you a beating heart and a kicking baby. When your pgal brain is working overtime in the paranoia department, sometimes that's all you need to see. If you can afford to be scanned at one of these facilities, I highly recommend scheduling an appointment for a time when you have a substantial gap in your regular monitoring.

3. Buy a Doppler...in the second trimester--Dopplers, like the ones used by your obstetrician, are available online for about $60. These devices are a simple way to verify that your little one's heart is still beating when that pgal brain strikes you. In the later part of my pregnancy, my doppler was my best buddy, but I will caution pgal moms about a couple of Doppler faux pas that I frequently see women make and that I've made myself. First, wait to purchase your doppler until at least week 12. I know some women find a heartbeat with Doppler as early as nine weeks, but this is rare, and not finding the heartbeat will only make your pgal brain worse. I didn't start using my Doppler with my second pregnancy until I was in my fifteenth week, and I recommend waiting this long as you should be able to find the heartbeat with greater consistency at this point. Another Doppler problem is that the device usually comes with a small amount of gel. Once you run out of this, several sites say you can use any old lotion in the Doppler gel's place. I would recommend not doing this. It never worked as well for me and just served to make me paranoid. Doppler gel can be bought on amazon for less than $10, and it's worth it for a clearer audio quality. Last cautionary note: limit the frequency and length of your Doppler usage. Check with your doctor for safe usage, as I've read a few things that suggest you shouldn't be doing daily home scans for hours at a time.

4. Communicate with your partner--Sometimes it's easy to forget that your partner is pgal too. Even though they're not growing a baby inside of them, they're probably having the some doubts and phobias that you are. No one is better equipped to relate to what you're going through than this person. Sometimes I didn't want to express my doubt and lack of investment in my second pregnancy to my friends, coworkers, and parents, because I didn't want them to doubt it as well. In moments like this, it was wonderful to have my husband--someone around whom I didn't have to put on a happy and hopeful face.

5. Join a PGAL support group--for me, the pgal board on thebump.com and the Facebook group "chasing rainbows" were my lifeline. Being able to talk to people who were experiencing the same emotions I was made me feel normal and cared for. Sometimes pregnancy boards online can be a little catty (women+Internet+pregnancy hormones=drama), but I found that the pgal community tends to be largely free of these distractions and negative vibes. Maybe this is because women on the pgal board are just grateful to be pregnant and appreciate the miracle a little more than women on other boards. Anyway, I highly recommend joining a group, either online or in your community, that is equipped to relate to and support your pgal specific needs. Even lurking on these boards without posting will remind you that there is life, and hope, after loss. It's also nice to watch other pgal women successfully have their babies; it will reinforce the fact that you're probably going to be just fine the second time around.

6. Distract Yourself--Early on in your second pregnancy, distraction is really the best way to soothe the pgal brain. You'll be tempted to second guess every symptom you have and countdown the days until your next appointment. There's no way to stop this, but I really recommend engaging in some activities that are not pregnancy related to keep your mind busy. To do this, you can take on extra jobs at work, go on weekend trips, plan non-baby related home improvements, or even just pick a new (and long) television series to watch on DVD. You'll have plenty of time to be pregnant and be a mom later on...take that tumultuous first trimester to enjoy your pre-baby life. Doing so will take your mind off of all the pgal worries.

Being PGAL was one of the most difficult things I've ever had to do. After safely delivering my boys, I had more than a few good cries to release all the tension and fear I kept bottled up for nine months. I'd start shaking in sobs and tell my husband "I was just so worried for so long!". There are things you can do to make it easier, but it likely will never be easy. I was worried literally up until I looked over in the warmer in the OR and saw my boys safe and sound. My husband cried in the labor and delivery room because he was still afraid for both me and the babies. More than anything, I hope you remember that it's okay to be scared. It's also okay to be sad about your loss even as you celebrate the new life inside of you. Just be honest about your emotions, remember that statistically you're probably going to be just fine, and reach out to others when your emotions seem to be waging war against you.

You will be a mother one day; try to enjoy the journey as much as you can!