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If you’re one the countless women who have experienced a miscarriage, the loss of a baby before 20 weeks gestation that impacts up to 20 percent of known pregnancies, the thought of trying to conceive again will likely elicit both excitement and anxiety. And while the odds of carrying a pregnancy to term after miscarriage are certainly in your favor—with some 85 percent of women who have had one miscarriage going on to have a successful pregnancy in the future as well as roughly 75 percent of women with a history of two or more miscarriages—pregnancy after miscarriage brings with it all kinds of questions: will I have another miscarriage? When will I feel excited? How do I honor the life of the child I lost, especially if, timewise, that child and this current child couldn’t both have been born?

I can’t answer these questions for you, but I hope that if you’re asking them too, that sharing my story of pregnancy after miscarriage will shed some light on what you might expect to feel, and, at the very least, help you to see that you are not alone.

Gabriella’s story

In October of 2020, my husband James and I conceived our third child. This child was indeed long-awaited, as we’d used natural family planning (NFP) to avoid pregnancy for almost three years following the 2017 birth of our daughter while we figured out why I was struggling so intensely with symptoms of anxiety and depression.

Given the timing of symptom onset, I assumed that I was among the 10 to 20 percent of women who experience clinical postpartum depression. Because women who have previously experienced PPD once are at higher risk than the average woman of having it again, carrying another baby and then potentially having the already-heavy emotional struggles I felt every day compound after the birth was unfathomable.

In August of 2020, I’d finally started the counseling that made all the difference. Having long been terrified of being pregnant and caring for a newborn while struggling so significantly, being open to conceiving baby #3 was tangible evidence that I was healing, that things were better than they had been in a long time.

Proof positive

When I “casually” picked up two pregnancy tests from the local Dollar General on the first day of what should have been the start of my next period, I wondered if I was about to confirm that, as with each previous pregnancy, our lives had changed forever. After waiting two hour-long minutes per test, I saw they had.

The following days were exciting and nerve-wracking. Exciting because we were expecting new life. Nerve-wracking as I wondered if the improvements I was seeing with counseling would “hold” as I navigated this welcome-but-still-stressful experience.

Because we knew from my NFP charts and NaProTechnology lab testing that my body doesn’t make enough of the hormone progesterone on its own, with my previous pregnancy, I’d received large amounts of progesterone supplementation to prevent a deficiency-related miscarriage. Unfortunately, my body had tolerated one form of progesterone exceptionally poorly. Worse, my provider at the time had little sympathy for my pain, as if the baby’s wellbeing were all that mattered.

After the October 2020 positive pregnancy tests, I told my new NaProTechnology provider that of course I wanted my progesterone level tested right away, but that I didn’t want to approach this pregnancy as a “problem” to be addressed with progesterone unless there was a good reason to do so. With my first level coming back in the low normal range, I was prescribed a large dose of oral progesterone, twice the amount that had me falling-asleep-under-the-table-fatigued with my previous pregnancy. I started out at half the prescribed dose on a Thursday to see how my body did for a few days. I had a virtual appointment scheduled with my NaPro nurse practitioner for Monday to create a supplementation plan I could tolerate.

The moment everything changed

On Monday morning, November 2, 2020, I woke before sunrise to go to the bathroom. In the darkened bathroom, I noticed that something felt different when I wiped. I instinctively looked down at my underwear and saw that a large, dark splotch had formed. In the space of a nanosecond I flipped the lightswitch and realized. I was bleeding.

I’m a nurse, and I knew that for pregnant women bleeding is often the first sign of a miscarriage. I also knew of a few women who had bled one or more times throughout otherwise healthy pregnancies. But I had never bled with my son or my daughter.

I was not yet 6 weeks along, I had only just scheduled my eight-week ultrasound with the local OB who would deliver this baby. We hadn’t even told our parents yet. We had no pictures to show of this child whose life only we knew about. After calling James’ parents and mine to ask them to pray, I called the NaPro provider’s office, four states away.

She recommended I ask my local OB’s office for a perforated “hat,” a plastic container to catch urine used in hospitals for patients whose intake and output must be carefully measured. The NaPro office gave miscarrying women hats with tiny holes in the bottom that would allow urine or blood through but catch any fetal body parts or tissue for a respectful burial later on.

When I called the local OB’s office asking for a hat, they brought me in for an ultrasound instead. There the OB who had delivered my son and daughter told me that the baby “was just measuring a little behind” my expected gestational age based on my NFP charting. She showed me the beautiful gestational sac lodged securely in the middle of my uterine wall, a tiny house ready for lots of baby-growing. She ordered a blood test to check my HcG (pregnancy hormone) level, and told me the bleeding might persist for a few days but not to expect the worst. I went home with my husband, somewhat relieved. But that night as I bent down next to my daughter, something came out of me. And I knew.

When I went to the bathroom and checked, there was that beautiful gestational sac I had seen on the ultrasound screen hours earlier, looking for all the world like a miniature, perfectly formed snowglobe. I presumed the tiny strands of blood on its periphery had anchored it to my uterus moments before. I knew that from the moment of fertilization this baby’s eye color, hair color, and many other characteristics were already determined, but standing there sobbing in my husband’s arms in our bathroom, I realized that this baby would never develop to the point of seeing any of those characteristics manifest this side of heaven. This pregnancy was over.

The first few weeks after the miscarriage were heavy. Because we had physical remains we could bury, we were able to have a funeral Mass, which was extraordinarily comforting and consoling. Plus, a funeral Mass conveyed the reality of our loss to others, and for that I was grateful. I distinctly recall walking out of the parish hall after Mass and a small luncheon with our families and feeling so lost—where was I to go now? There was no place to go to bring back our child, who we had named Gabriella Louise.

I would never feel her kick inside me or deliver her, watch her smile or see her first steps. Of all things, I was particularly struck by a letter that came in the mail from the pediatrician’s office a few days later, addressed to “the parents of Eva Marie” (my three-year-old daughter). The knowledge that we would never receive a letter addressed to “the parents of Gabriella,” that the wide, wide world would never know or say her name as we had, pierced me to the core.

Starting to heal

I found the counselor I was still working with particularly helpful as I learned to grieve. She described grief as coming in waves—at first they would be huge and come so close together that I would feel they were constantly crashing over and around me. I didn’t need to fight them. I could let them crash, accepting that I was hurting and that it was okay to feel this way. Gradually, she said, the waves would come less often and with diminished intensity, until they lapped at my feet. In the thick of loss, I could hardly fathom ever feeling differently, when every moment, absolutely every one, was full of emptiness, pregnant with absence.

But I experienced the truth of my counselor’s words as slowly, almost imperceptibly, the grief receded. A little over three months after the miscarriage, the waves of grief were down to my knees, coming several times a day but no longer all of the time or even most of the time. My local OB was comfortable from a physical and hormonal standpoint with our trying to conceive when we’d had one full menstrual cycle after the miscarriage. My NaPro provider recommended waiting two. We had a green light physically and hormonally, and by that point, I also felt emotionally ready to try again.

Using my NFP knowledge of when I had presumably ovulated, the two weeks between that time and when I could take a pregnancy test (on the first day of my expected next period) passed so, so slowly. But the day finally did come, and once again, I waited anxiously before seeing the plus signs. Pregnant.

We planned for this. . . . so why am I not excited?

Being pregnant after a miscarriage feels like a million things. I’ve heard other women say that being able to conceive after a loss felt to them like a triumph over their body, which had failed them previously. I wouldn’t verbalize my experience in quite those words, but I certainly wondered after the miscarriage if I, my rational, decision-making self, as opposed to my uterus or ovaries or what have you, had failed by not taking every last bit of the progesterone prescribed to me from the get-go. Would everything have been completely different if I had? At first, I thought maybe so.

Even with my fears, I was able to acknowledge that this pregnancy was different from Gabriella’s pregnancy from the start. Even before I could test, I was feeling a little queasy, a little tired. I thought “I have to be pregnant. This is just too odd.” And then I was pregnant, and I was actually quite tired every day, whereas the fatigue I had felt briefly with Gabriella had gone away as quickly as it had come, several days before I started bleeding. When I got my initial progesterone level back, I figured there had to be some mistake. It was more than two times higher than my first blood draw with Gabriella, and higher than the first draws in either of my first two pregnancies. I wanted to believe that this was a good sign, not just in the moment but a good sign for the pregnancy, but was scared to think anything beyond ‘This is good, for now.’

This time, too, I felt anxiety right away about all of the things I couldn’t control. Because miscarriage had happened to me, I now acknowledged all of the things that could go wrong during a pregnancy, even past the first trimester when miscarriage risk significantly decreased. The baby could have its cord wrapped around its neck and die. Another thing could happen. Another thing could happen.

Typically, you don’t think that way when your pregnancies have been healthy and normal. But when you get pregnant after a loss, it feels like something terrible could always be around the corner. Right out of the gate, there’s the possibility that the estimated 20 percent chance of miscarriage per pregnancy (the same likelihood as for a woman who has never had a miscarriage) could strike again. If you’ve had two or more losses, the estimated risk bumps slightly to 28 percent, and your risk of miscarrying again after three or more previous losses is 43 percent each time. So there’s all of that. Every time you go to the bathroom or feel the slightest wet sensation, your mind’s already jumped three steps ahead, “Is it blood?” The heart tends to react to the emotional maelstrom by self-protecting, to avoid experiencing that kind of pain again. That’s what my heart did too.

The difficult emotions were exacerbated by the fact that once again the progesterone I was on made me feel truly ill. Each day from weeks five-ish through ten-ish passed in an exhausted, flu-like, hard-to-focus daze. I was grateful that my husband was working from home because I felt like I was sitting in my rocking chair watching life go by. Because of counseling, I determined to pursue what was best for both my baby and myself, and so eventually I told my newest NaPro provider that I needed to decrease the progesterone dosage, that my body simply couldn’t tolerate what I was on. Advocating for my own needs in order to be my best while carrying this baby was a new experience for me, but I still struggled with the thought that I was being selfish and needed to suck it up.

Maybe some women just don’t get excited about getting pregnant

For years, I’ve prayed once a week on the surgical abortion day outside the nearest Planned Parenthood clinic. I have always valued preborn life, so I pray for women struggling with unplanned pregnancies to find the strength and to get the support they need to carry their babies to term. When I felt anxiety and fear rather than excitement about this pregnancy following the miscarriage, I wondered for the first time in my life if my pro-life conviction that every woman has the capacity to be excited about carrying new life was a little naive. Maybe some women really do only feel dread. I’ve since learned that experiencing anxious and depressive symptoms after miscarriage is very common, affecting roughly 1 in 5 women, and that these symptoms may last up to 3 years afterward.

Here again, my counselor offered a much-needed perspective that normalized my feelings and helped me relax. She said that indeed every woman has a heart to receive and celebrate new life, though there may be many layers of pain, trauma, etc. on top of that inherent joy. In my case, there was grief from my miscarriage on top of the joy. I was emotionally trying to protect my heart from further pain by not feeling excited. This was ok, she told me, I didn't need to worry. The joy would come to the surface—I would not need to manufacture it. It would simply take time.

And she was right. I decreased the progesterone dose around week 11, and slowly the side effects started to go away. I had a bit more energy, was able to think a bit better, wasn’t so overwhelmed by everything. My fears of negatively impacting the baby by backing off on the progesterone hadn’t panned out; on the contrary, my natural progesterone levels continued climbing, and at 16 weeks I came off supplementation altogether. That was about the time I started to believe that I was going to have this baby. Even though there are no “guaranteed good outcomes” when it comes to pregnancy, or much of life, I felt safe enough to be excited about this baby.

I also gradually accepted the seeming contradiction of feeling sad to have lost Gabriella and feeling grateful to have this baby, acknowledging that I could not have carried both these babies in this life. A mother’s heart is indeed a mysterious thing, I’ve learned, capable of holding several seemingly conflicting emotions at one time. Losing Gabriella and carrying this new baby have expanded my heart in ways I could not have anticipated. And while I’m grateful for the good that has come from great suffering, I naturally wish I could have learned these lessons some other way.

I’m a little over 30 weeks along as I write this, leaning forward toward my computer with legs widened a bit to accommodate my belly. Yesterday, out of the blue, I really missed Gabriella. Her remains are in a tiny casket in a little church cemetery just outside our small town, and whenever I turn off the interstate and head toward home I look in the direction of that cemetery and say quietly, “I love you, Gabriella.” Yesterday, though, I said a few more things, about how I missed her, how I wished she were here. I was in a very serious car accident several weeks back from which the baby and I were miraculously spared. Did Gabriella have a hand in that, interceding for her mother and little brother or sister from above? I wonder.

If you’re struggling after a miscarriage, feeling uncertain during pregnancy after child loss, or seeking to help a friend or family member who is, I can tell you quietly but confidently that there is hope. I can attest to the truth of the words of Psalm 27:13, “I remain confident of this: I will see the goodness of the Lord in the land of the living.” For me, counseling has helped; time has helped; and the future is something I can anticipate with hope again. Along this painful journey, I have found a way to take care of both me and this baby, and I’m excited to see where this takes us.