In Part 1 of this article, AFTER MISCARRIAGE: Postpartum Care for Mothers Experiencing Loss, we discussed the care a woman should receive in the first several weeks after a preterm loss (or stillbirth) to help her through the grieving process, to assure her return to vitality, and—according to the precepts of Traditional Chinese Medicine—to increase her chance of a successful pregnancy the next time she conceives.
Here in Part 2, we’ll address the question: When should we try to conceive again? It would be nice if there were one, but the answer is that there is no one answer. Conceiving life is a sacred event, and there is no single fact or consideration that can offer a single best answer for everyone.
However, since there are biological and emotional ramifications of pregnancy and loss, there are factors we should consider when deciding when it’s best to try to conceive again.
The western medical industry essentially considers one factor when making recommendations: What is the statistical likelihood of carrying the next pregnancy full-term when conception happened x amount of time after a miscarriage?”
That is indeed the ultimate question in any woman’s mind. However, the western medical industry offers studies with tremendously conflicting results to answer that question.
For example, read this quote from an article in Time Magazine:
"A new report by researchers at the University of Aberdeen in Scotland suggests that sooner may be better. The scientists found that women conceiving within six months of a miscarriage have better chances of a successful and complication-free second pregnancy than women who conceive later. But the conclusion is contrary to an earlier report from Latin America that found higher pregnancy rates among women who waited at least six months to conceive; that report formed the basis of the World Health Organization's (WHO) 2005 recommendation that women delay pregnancy for six months after miscarrying."
Information like that leaves would-be parents without clear direction and without seeing the whole picture.
In Traditional Chinese Medicine (TCM), the general recommendation is for a woman to wait six months to try to conceive again.
Why six months? Why wait at all—especially when many women do conceive again so quickly after miscarriage?
Waiting exactly six months is not necessary for all women, and some women may require more time. Here are the factors considered in TCM when recommending a wait period:
• A woman’s body has experienced huge hormonal shifts, and the body requires time to readjust.
• A woman has experienced a loss of chi (“energy”), blood, and jing (described in western terms as “kidney strength” or “life-force”)—an abundance of which is required to carry, deliver, and nurse a healthy baby.
• A waiting period helps the mother rebuild strength—not just to assure that the next pregnancy goes full-term, but also to increase her chance of a healthy postpartum recovery; of a healthier, stronger baby; and—down the road—a healthy menopause and golden years.
Though not often discussed or understood in western medical circles, the postpartum time can be one of great strengthening or significant diminishing of a woman’s health and vitality long term. I contacted internationally acclaimed Dr. Ning X. Fu to discuss this issue.
Before coming to the United States, Dr. Ning X. Fu, O.M.D., Ph.D taught at the Chengdu University of TCM and the International Acupuncture Training Center in Beijing. She was also an editor of the Journal of TCM and Pharmacology Information. Now in the States, she is a senior professor at Five Elements University of Traditional Chinese Medicine and has a private practice in Silicon Valley. This is what she had to say:
“When I first discovered women in America have no recovery time or care after miscarriage I was shocked. In China there is a government-mandated period of three weeks in which she has leave from work and receives postpartum care. Without proper care, the chi and blood loss in her body after miscarriage can lead to blood stasis (or stagnation).
For women who miscarry, it is often easy for them to conceive again — but it is also easy for them to miscarry again.
This is because the chi deficiency, blood deficiency and blood stasis, in the short-term, can make it difficult to carry full-term. In the long-term it can lead to fibroids, tumors, and cancer.
The resting period is a time to fortify the woman’s chi and blood, remove stagnation, and restore her body to strength. In addition to three weeks of rest and care, the mother is advised to wait until six months after her miscarriage to try to conceive again.”
Our discussion so far has addressed a few of the physical reasons for waiting. There’s another issue to discuss: Grief.
Miscarriage can be traumatic for women—and trauma leaves physical and emotional wounds that require time and attention to heal, even if a woman had postpartum care in the first month to several weeks.
From my personal experience, after my second miscarriage the sight of blood (even in basic food preparation) would send me into a state of anxiety and grief that could last several minutes or hours. Being immersed in the birthing world, I frequently hear stories from mothers about the ways they are haunted by grief, guilt, and anxiety after their miscarriages, even years later.
Though these responses are common, they are not to be ignored. Conceiving again in that state—of course—can bring joy and help lift one into a healthier state. But is it ideal to conceive in that state? Is it ideal to embark on any new and significant life journey from a weakened position, or in the hopes that it helps us bounce back? The answer to those questions is personal, and I asked professionals in the industry for their input.
Elly Taylor, a relationship counselor and author of Becoming Us said:
“Following a miscarriage (and I have had two myself) it is not uncommon to go through a process of mourning. There is no right way or wrong way to grieve, but cycling back and forth through feelings of shock, denial, anger and depression are common. Expressing these feelings in our own way or through a creative outlet—such as writing, singing, dancing, or painting—and sharing them with a good listener, dissipates the emotional energy of them and allows our body to recuperate. Using this time is also important from a relationship perspective: going through this process as a couple can bring us closer.”
Angelique Chelton, CLC, CBE, SBD is a Certified Lactation Counselor, Certified BEBE Educator, Stillbirthday Birth & Bereavement Doula and Director of Education & Training for Stillbirthday. This is what she had to share:
“Families who consider conceiving soon after a pregnancy or perinatal loss may want to carefully weigh that decision. While there is no one right path, each family needs to think about what the decision to conceive means for them in their personal situation- only they know what will be most healing and healthiest for them.
Will trying to conceive and/or being pregnant soon after a loss allow the family needed emotional and physical space to do the work of grief? Will the family have the energy and emotional resources to focus on the subsequent pregnancy as fully as they’d like? How will acute grief emotions impact a baby in the womb?
A family is ready to conceive when they have made peace with the death of the child who has been lost—conception before this time may complicate integration of a family’s grief experience and the emotions surrounding the subsequent pregnancy.”
We’ve addressed physical health, mental health, and now…what about age? A question that could likely be on the minds of readers 35+ is: Aren’t I wasting precious time if I wait?
There’s no single way to address this concern either, so I’ll just share my story with you. I conceived naturally the first time I tried at 38 and miscarried. I waited for 6 months, tried and conceived again, and miscarried again.
Now I was 40. Could I really spare even a day to wait again? Not according to most recommendations one would likely hear. It was a very difficult decision, but we concluded that, again, the physical and emotional healing time could not be skipped and we decided to wait. Then, during the waiting period, urgent family matters had us traveling back and forth overseas for several months—not a situation in which we felt it wise to conceive. Six months turned into waiting another entire year—and then we conceived again, and had a beautiful home birth when I was 42.
In lieu of the one answer to “when to try again,” here is an answer: No matter how long you decide to wait (or not), allowing yourself and finding support to move through the grief, and giving your body the assistance it needs to return to vigor and strength after loss, will greatly support the cause.
This article is intended for informational purposes only and should not be used as a substitute for professional medical care.
Image: Together We Dream, used with permission by artist Sofan Chan
 In TCM, this entails—under the care of a professional—varying combinations of the following: rest, special postpartum exercises, massage, a special postpartum diet, certain prohibitions (i.e. no cold beverages), acupuncture and herbs.
This is the story of Paulina, a woman living in Iceland who follows The Birthing Site. She shared her story with us and we reached out to her. I read her story on her website and emailed with her to get to know her and understand her situation so I could help her tell her story to the world so that other mothers who may be going through similar situations know they are not alone, and know that there are many ways to approach a pregnancy with multiples.
The first time I got pregnant was in December of 2010, but we were saddened when I miscarried in February of 2011. Little did I know that I had PCOS which could complicate my ability to become and stay pregnant. We continued to try naturally while my gynecologist tracked my cycles, ran blood tests and eventually gave me Pergotime to help me ovulate. Almost a year later (December 2011,) he referred us to a fertility clinic in Iceland called ArtMedica. We made an appointment and got in about three months later. During this time we were still trying to conceive the natural way, but we didn’t have much hope.
After over a month of hormone therapy, a checkup revealed that two follicles were ready to be releases. I injected another medication meant to encourage my ovaries to release the eggs and underwent an IUI procedure. We had to wait two weeks to find out if the procedure was successful – probably the longest two weeks of my life. I was exhausted and incredibly nauseous and just wanted to know if it had worked. Finally we were able to take a pregnancy test and it was positive!
At week 6, we went to the fertility clinic for an ultrasound to check on development. We saw two precious heartbeats and were overjoyed. Friddi swore he saw a third heartbeat but at that time, the doctors said there were only two.
I went for another ultrasound at 9 weeks. After a few minutes of looking at the screen, the doctor began to look worried. I asked her if something was wrong and all she said was “this is not good.” I was terrified and asked “Are there three?” She said “No,” and then held one hand up, pointed to it and said “There are five.” I was shocked and overwhelmed; I had so many thoughts racing through my mind I didn’t know what to think now.
After the ultrasound they sat me down to discuss our options. I wanted to know how this had happened. Apparently, the doctor noted that in addition to the two follicles that were ready, there were also two more that were approaching maturity, and apparently a fifth that nobody noticed. When I injected the hormone that was meant to release the two that were ready, it released all five, and all of them were fertilized when I had the IUI procedure.
They began discussing “reduction,” a term I had never heard before and was not sure what they meant. They explained that carrying 5 babies to term is challenging and possibly risky to all of the babies and the mother and that the safest thing to do would be to terminate three of the five in order to provide the best chance for the remaining two, and me, to make it to term. They told me that with each additional baby, the average delivery date was reduced by two weeks, (thus twins are usually born around 38 weeks, triplets around 36 weeks, and so on.) Having five would increase the chances of them being premature and possibly not surviving.
I was so upset and overwhelmed by the emotional rollercoaster. First we can’t get pregnant, then when we finally do, we get pregnant with FIVE and the doctors are telling us we should only keep two. Nobody should ever have to make this decision. I kept thinking about how we just wanted one baby, and all the other moms who try and can’t get pregnant; now here we were pregnant with more than my body could handle and we had to decide how many to get rid of? I wanted desperately to keep them all, but the more I researched, the more I learned that keeping all of them was risky for both them and I. Even with reduction there is still risk to them and I, but at least the risk would be significantly less than if there were all five. Was it selfish to want to keep all of them, or was it more selfish to only keep a few? What if they all survived but I didn’t? Friddi would be left with five babies who wouldn’t have a mother. How fair would that be to all of them?
I went home and tried to call Friddi, but it took forever to get a hold of him because he was working as a fisherman at this time and was out at sea. When he came to the phone I told him and just broke down in tears. I felt horrible about having to call him while he was out, but he needed to know. After I got off the phone with him I called my midwife who told me we could probably keep three, and that she would put me in touch with a nurse she knew who had triplets. I felt a little better, but I was still an emotional wreck. I had to get my mind off of things for a little while and focused on work for a while (I have the freedom to work from home if I need to.)
In the following days, I started reading about multiple pregnancies and selective reduction. I discovered that selective reduction may increase the chances of survival for the remaining babies, but that the procedure increased the risk of premature labor and miscarriage, something that was already a risk with multiples. My head was swimming with information, and I was constantly bombarded with everyone’s suggestions about what to do. Ultimately it was our choice, but I felt it was our responsibility to make the best choice for the babies and to try to give them the best chance of surviving. We went for another checkup at the hospital at which point all five were still developing. This came as something of a surprise because with this many multiples, one or two often die early on. Friddi was now willing to keep all five and we kept reading and talking to doctors to try and sort everything out. Over the next two weeks, we thought long and hard. Ultimately we decided to keep three, against the suggestion to only keep two by the Icelandic doctors.
We went in for the reduction procedure and I was a wreck. Friddi sat next to me and watched the procedure on the screen to make sure they didn’t kill more than the two we agreed on. The procedure was horrible; it hurt like hell and I felt as though they were taking a part of me. I felt the loss, pain and anguish as they terminated two of the fetuses. The worst part was that it felt as though they knew what was going on but were helpless to do anything. This was the most horrible feeling in the world and I hope nobody else ever has to go through this.
At 19 weeks things had been going fine until we went in for a checkup. I was told that I had an incompetent cervix and it was “funneling” which means that it was beginning to dilate too soon. In the U.S. when this happens, a cerclage is performed (a stitch to hold the cervix closed) but the doctors in Iceland felt that it was too risky with a multiple pregnancy. They sent me home for strict bed rest and told me that there was a high chance of still birth or miscarriage. The following week my cervix had shortened again, leaving it only 3cm long, and I was beginning to have contractions. I was terrified because I knew that if the babies were born now they wouldn’t survive. At 21 weeks I was admitted to the hospital for preterm labor and they couldn’t stop the contractions even with medications.
After 19 hours of labor Ársæll Leo was born. At this time the doctors tried to stop the other two from being born but it was too late when the amniotic sac from Annelise broke. She stayed without any fluids for many more hours, and the contractions slowed down. At this point, we wanted to try to save the last one, but for it to be possible Annelise had to be born and we did not know how long this was going to take. After so many days of being with contractions, and so many hours of being in labor, we tried to speed up her birth with medication.
Annelise was born shortly after the medication was started. Unfortunately, the placenta from the first two did not come out, which meant keeping Finnbjörn inside longer became impossible. The placenta needed to come out in order to close the cervix, and avoid infections. We did not want to make this big decision, but it was necessary. We felt that if we were to have any hope of having a healthy pregnancy in the future, we had to do this. The doctors broke Bjössi’s sac and he was born very quickly.
All of our triplets were so perfect, so beautiful, with a strong heartbeat and willingness to breathe in our world. However, their bodies were too small (25-28 cm) and underdeveloped that the only thing we could do was to hold them until they passed away. We cradled them in our arms and told them how much we loved them and how precious they were to us. One of the hardest things to do in life is to see your kids die without even being able to spend some years with them, teaching them everything you know and appreciating everything they do-- even the naughty stuff.
We had a traditional Icelandic burial ceremony. We went to the cemetery where a priest said some words, with our closest friends and family members. We decided to cremate them, not sure why but that was the first thing that came into my mind. It was a good decision because while being in the cemetery I would have never wanted to let them go away, and I would have wanted to kiss them and hug them again.
We placed them above Friddi's grandmother who is buried next to her husband. We wanted them to be in between but that was not holy ground, so they had to be placed above her. We wanted the great grandparents to take care of them because they were really good with children when they were alive.
People keep saying that time will help me heal, but I certainly don’t feel that way. I keep on thinking about them every day. The pain is so hard that the few words, hugs and emotional support is not enough to get over it. After losing three babies people need more than a month, (which is what is given by law to parents who lose children from stillbirth here.) We know that there are people around the world who have had it worse. While it doesn’t make it any easier, it helps us to remain hopeful that eventually the pain will not be so bad, though I can’t imagine it ever going away completely.
We’d like to start a family as soon as possible, but right now we are focusing on trying to heal and spending some time with my family in Mexico. Friddi wants to finish school first so he can support a family without worrying, but that means we would have to wait another 3 years and I don’t know if I want to wait that long. It’s hard because I am a mother of three, but all of my babies are in heaven rather than here with me. Every time I do anything, I think about how I should have my babies with me and what they would be doing now.
For the full story on the site Paulina built to share her story, please follow this link: http://www.apmedia.is/triplets/
People in the US are rediscovering the mind/body benefits of a 30-40 day postpartum recovery period for new moms during which they rest, are cared for, eat special foods for rejuvenation, and are supported by family and postpartum care providers. This, of course, leaves mom better able to care for and bond with her new baby, and to return to her old strength, if not even an increased vitality—quickly!
In China the term for this time is called “sitting moon” (zuo yuezi in Mandarin—one month being “one moon”), but cultures throughout Central Asia, Southeast Asia, and the Far East have similar practices, each with their own special techniques and care providers. This postpartum care is not considered something only for the wealthy or indulgent. It is considered vital to the mother’s recovery, her long-term health, and her ability to care well for her baby and easily produce abundant milk.
The affects of the neglect that postpartum mothers and new babies experience in the US are obvious. Just a glance at the statistics for postpartum depression and mothers failing to nurse (when they wanted to) tells of the need for a new look at this ancient practice of a “sitting moon.”
It was long ago, but this need was recognized at one time in the US, and postpartum recovery practices were followed. In Marriage & LOVE, published in New York in 1894, Ruth Smythers writes:
“After the birth of the baby, the mother…should not get out of bed for ten days or two weeks. The more care taken of her at this time, the more rapid will be her recovery.”
But today, the majority of women in the US do not receive the postpartum care and nutrition that is considered a fundamental part of a family’s experience around the world.
Worse, the most neglected and forgotten mothers in our culture are those who lose their baby preterm.
Statistics vary, but Western and Traditional Chinese Medicine (TCM) doctors will tell you that up to 40-50% of all conceptions end in miscarriage—many of them before a woman realizes she is pregnant, and she simply has a “period” that is a few days late. However, the number of women who miscarry further into their pregnancy—after the body is in full swing of its myriad, major changes—is still enormous. In the US the estimate for annual miscarriages is 900,000-1,000,0000.
How are these women treated? How are they cared for?
Being immersed in the “birthing world”, I hear tales often of the cold nonchalance with which these women are handled, and I’ll offer two examples from personal experience.
When I had a miscarriage, not knowing what was happening other than pain that left me unable to walk, I went to the hospital. Very quickly, with profuse bleeding, what was happening became apparent, yet the staff still wanted to “check” me. After extensive probing with an internal sonogram device, I asked the tech what she had to report to me. She said, “I’m not allowed to say anything.”
About an hour later as I sat shivering and bleeding in the ER, the doctor came in and said, “You’ve had a miscarriage.” (As I’d told them earlier, I knew that.) Then he said, “On the way out, the girl at the front desk will give you a paper you need to read.” And he left. Apparently recognizing the void of feeling in the exchange, the tech then approached me, patted my arm and said, “Hopefully we’ll see you in the L&D next time.”
The paper they provided contained the headline, “YOU HAVE EXPERIENCED A PRETERM LOSS OF YOUR PREGNANCY” and had a list of side-effects I should watch for, and return to the hospital if I believed I was experiencing, as they could be fatal. And that was it.
A friend experienced her loss at approximately five months. Because of her baby’s size at that time, she actually had a full L&D experience. They allowed her to see her baby (she had to fight for this) and because he was just a few weeks below the cutoff age to be given to the parents for burial, he was taken away from her and the body was disposed of according to hospital procedures. She’d known she was losing him, and had planned in her mind a funeral on the beach and a proper burial, but she was denied that, and sent home, again with a list of “things to watch for.” And that was it.
Though miscarriage is extremely common—a woman holding in her hands the body of what she thought would be her lifelong love and devotion, and saying goodbye—it is trauma.
Our treatment of mothers experiencing this loss is unconscionable, but I believe it is—for the most part—simply a lack of knowledge that there are intricate and loving traditions practiced around the world to help speed postpartum moms of miscarriage to a healthy and happy recovery (that also, according to TCM, increase the likelihood of her having a successful pregnancy the next time she conceives).
While our “system” provides no guideline for postpartum care for mother’s who miscarry, at least, sometimes, family and/or friends come to care for the mother—for a day or two. Sometimes, women don’t even receive this emotional or physical assistance.
But according to the precepts of TCM, a postpartum mother who’s miscarried requires more attention and care than a mother who delivered her full-term baby. Amy Wong, an internationally acclaimed expert in this field, writes that, “Natural delivery requires at least 30 days of rest, while Cesarean delivery, miscarriage, and abortion require at least 40 days.”
Why would a woman who’s had a miscarriage require more support and recovery time?
She’s experiencing an enormous spiritual loss—few things are harder for a mother than losing the child who has entered her life, even if briefly.
Her body has made the enormous, taxing hormonal and other physical shifts of pregnancy.
To experience strong shifts of mind, body, and spirit simultaneously, and then to be left alone and expected to return to life as usual in the next few days…many moms do “bounce back.” However, it is a formula for depression, anxiety, and panic attacks—which, in fact, afflict many mothers who even have the joy of holding their new baby in their arms postpartum.
I see—frequently—mothers who have miscarried and are asking for help and guidance on social websites.
Of course the Internet and people we meet online can be wonderful resources, but…
we can do better for these women.
For those interested in learning more about the traditional practices used for postpartum mothers who delivered full-term or miscarried—doulas and midwives can offer great support, and there are several books I’d recommend as a start:
A final thought for postpartum mothers who’ve experienced loss:
Gratitude is powerful medicine. It is helpful if we can focus (with enormous effort) on feeling gratitude for having been pregnant even briefly, since so many of our dear sisters who want to be mothers may never experience that profound blessing.
May we all grow in love and compassion through our challenges, and experience health and joy on our journey!
Read the second part of this article CONCEIVING AFTER MISCARRIAGE: When to Try Again & Increasing Ability to Carry Full Term to learn more.
 Real Advice from 1894 Marriage & Love, Ruth Smythers, Spiritual Guidance Press, New York City, 1894; republished by Lyons Press, Guildford, CT, 2011, p. 92
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