Uterine Inversion What is it? Uterine inversion is a rare complication of childbirth that occurs when part of the uterine wall collapses and turns inside out (in effect, very much like a sock being pulled inside out), sometimes even protruding through the cervix and into the vagina. The full range of problems that can cause uterine inversion is not fully understood, but in many cases it includes the incomplete separation of the placenta from the uterine wall; the placenta then pulls the uterus with it when it emerges from the birth canal. Uterine inversion, when unnoticed and/or untreated, can result in hemorrhage and shock. But that's a remote possibility; the condition occurs rarely and is unlikely to go unnoticed and untreated. Uterine inversion is a rare complication of childbirth that occurs when part of the uterine wall collapses and turns inside out (in effect, very much like a sock being pulled inside out), sometimes even protruding through the cervix and into the vagina. The full range of problems that can cause uterine inversion is not fully understood, but in many cases it includes the incomplete separation of the placenta from the uterine wall; the placenta then pulls the uterus with it when it emerges from the birth canal. Uterine inversion, when unnoticed and/or untreated, can result in hemorrhage and shock. But that's a remote possibility; the condition occurs rarely and is unlikely to go unnoticed and untreated.

How common is it? Uterine inversion is very rare; reported rates vary from 1 in 2,000 births to 1 in several hundred thousand. You are at greatest risk for a uterine inversion if you've had an inversion during a previous delivery. Other factors that slightly increase the very remote risk of an inversion include an extended labor (lasting more than 24 hours), several previous vaginal deliveries, or use of drugs like magnesium sulfate or terbutaline (given to halt preterm labor). The uterus also may be more likely to invert if it is overly relaxed or if the cord is pulled too hard in the third stage of childbirth. Uterine inversion is very rare; reported rates vary from 1 in 2,000 births to 1 in several hundred thousand. You are at greatest risk for a uterine inversion if you've had an inversion during a previous delivery. Other factors that slightly increase the very remote risk of an inversion include an extended labor (lasting more than 24 hours), several previous vaginal deliveries, or use of drugs like magnesium sulfate or terbutaline (given to halt preterm labor). The uterus also may be more likely to invert if it is overly relaxed or if the cord is pulled too hard in the third stage of childbirth.

What are the signs and symptoms? Symptoms of uterine inversion include: Symptoms of uterine inversion include: [image] Abdominal pain Abdominal pain[image] Excessive bleeding Excessive bleeding[image] Signs of shock in the mother Signs of shock in the mother[image] In a complete inversion, the uterus will be visible in the vagina In a complete inversion, the uterus will be visible in the vagina What can you and your practitioner do? Know your risk factors and inform your practitioner if you've had a uterine inversion in the past. If you do have one, your physician will try to push your uterus back up where it belongs, and then give you drugs like Pitocin (oxytocin) to encourage any floppy muscles to contract. In rare cases, where this does not work, surgery is an option. In either case, you might need a blood transfusion to make up for blood lost during the inversion. Antibiotics may be given to prevent infection. Know your risk factors and inform your practitioner if you've had a uterine inversion in the past. If you do have one, your physician will try to push your uterus back up where it belongs, and then give you drugs like Pitocin (oxytocin) to encourage any floppy muscles to contract. In rare cases, where this does not work, surgery is an option. In either case, you might need a blood transfusion to make up for blood lost during the inversion. Antibiotics may be given to prevent infection.

Can it be prevented? Because a woman who has had one uterine inversion is at an increased risk for another, let your practitioner know if you've had one in the past. Because a woman who has had one uterine inversion is at an increased risk for another, let your practitioner know if you've had one in the past.

Postpartum Hemorrhage What is it? Bleeding after delivery, called lochia, is normal. But sometimes the uterus doesn't contract as it should after birth, leading to postpartum hemorrhage-excessive or uncontrolled bleeding from the site where the placenta was attached. Postpartum hemorrhage can also be caused by unrepaired vaginal or cervical lacerations. Bleeding after delivery, called lochia, is normal. But sometimes the uterus doesn't contract as it should after birth, leading to postpartum hemorrhage-excessive or uncontrolled bleeding from the site where the placenta was attached. Postpartum hemorrhage can also be caused by unrepaired vaginal or cervical lacerations.

Hemorrhage can also occur up to a week or two after delivery when fragments of the placenta are retained in, or adhere to, the uterus. Infection can also cause postpartum hemorrhage, right after delivery or weeks later.

How common is it? Postpartum hemorrhage occurs in somewhere between 2 and 4 percent of deliveries. Excessive bleeding may be more likely to occur if the uterus is too relaxed and doesn't contract due to a long, exhausting labor; a traumatic delivery; a uterus that was overdistended because of multiple births, a large baby, or excess amniotic fluid; an oddly shaped placenta, or one that separated prematurely; fibroids that prevent symmetrical contraction of the uterus; or a generally weakened condition of the mother at the time of delivery (due to, for example, anemia, preeclampsia, or extreme fatigue). Women taking drugs or herbs that interfere with blood clotting (such as aspirin, ibuprofen, ginkgo biloba, or large doses of vitamin E) are also at greater risk for postpartum hemorrhage. Rarely, the cause of the hemorrhage is a previously undiagnosed bleeding disorder in the mother that is genetic. Postpartum hemorrhage occurs in somewhere between 2 and 4 percent of deliveries. Excessive bleeding may be more likely to occur if the uterus is too relaxed and doesn't contract due to a long, exhausting labor; a traumatic delivery; a uterus that was overdistended because of multiple births, a large baby, or excess amniotic fluid; an oddly shaped placenta, or one that separated prematurely; fibroids that prevent symmetrical contraction of the uterus; or a generally weakened condition of the mother at the time of delivery (due to, for example, anemia, preeclampsia, or extreme fatigue). Women taking drugs or herbs that interfere with blood clotting (such as aspirin, ibuprofen, ginkgo biloba, or large doses of vitamin E) are also at greater risk for postpartum hemorrhage. Rarely, the cause of the hemorrhage is a previously undiagnosed bleeding disorder in the mother that is genetic.

What are the signs and symptoms? The symptoms of postpartum hemorrhage include: The symptoms of postpartum hemorrhage include: [image] Bleeding that soaks through more than one pad an hour for several hours in a row Bleeding that soaks through more than one pad an hour for several hours in a row[image] Heavy, bright-red bleeding for more than just a few days Heavy, bright-red bleeding for more than just a few days[image] Passing very large clots (lemon size or larger) Passing very large clots (lemon size or larger)[image] Pain or swelling in the lower abdominal area beyond the first few days after delivery Pain or swelling in the lower abdominal area beyond the first few days after delivery The loss of large amounts of blood can make a woman feel faint, breathless, dizzy, or cause her heart to speed up.

What can you and your practitioner do? After the placenta is delivered, your practitioner will examine it to make certain that it's complete-that no part of it is remaining in your uterus. He or she will probably give you Pitocin (oxytocin) and may also massage your uterus to encourage it to contract, in order to minimize bleeding. Breastfeeding (if you will be nursing) as soon as possible will also help your uterus to contract. After the placenta is delivered, your practitioner will examine it to make certain that it's complete-that no part of it is remaining in your uterus. He or she will probably give you Pitocin (oxytocin) and may also massage your uterus to encourage it to contract, in order to minimize bleeding. Breastfeeding (if you will be nursing) as soon as possible will also help your uterus to contract.

You should expect bleeding following delivery, but alert your practitioner immediately if you notice abnormally heavy bleeding or any of the other symptoms listed above during the first postpartum week. If the bleeding is severe enough to be categorized as hemorrhage, you may need intravenous fluids or possibly even a blood transfusion.

Can it be prevented? Avoiding any supplement or medication that may interfere with blood clotting (such as the ones listed on the previous page), especially in the last trimester and the immediate postpartum period, will reduce the possibility of abnormal postpartum bleeding. Avoiding any supplement or medication that may interfere with blood clotting (such as the ones listed on the previous page), especially in the last trimester and the immediate postpartum period, will reduce the possibility of abnormal postpartum bleeding.

Postpartum Infection What is it? The vast majority of women recover from delivery without any problems at all, but childbirth can occasionally leave you open to infection. That's because it can leave you with a variety of open wounds-in your uterus (where the placenta was attached), in your cervix, vagina, or perineum (especially if you tore or had an episiotomy, even if it was repaired), or at the site of a C-section incision. Postpartum infections can also occur in your bladder or kidney if you were catheterized. A fragment of the placenta inadvertently left behind in the uterus can lead to infection, too. But the most common postpartum infection is endometritis, an infection of the lining of the uterus (the endometrium). The vast majority of women recover from delivery without any problems at all, but childbirth can occasionally leave you open to infection. That's because it can leave you with a variety of open wounds-in your uterus (where the placenta was attached), in your cervix, vagina, or perineum (especially if you tore or had an episiotomy, even if it was repaired), or at the site of a C-section incision. Postpartum infections can also occur in your bladder or kidney if you were catheterized. A fragment of the placenta inadvertently left behind in the uterus can lead to infection, too. But the most common postpartum infection is endometritis, an infection of the lining of the uterus (the endometrium).

While some infections can be dangerous, especially if they go undetected or untreated, most often infections simply make your postpartum recovery slower and more difficult, and they take time and energy away from your most important priority: getting to know your baby. For that reason alone, it's important to get help for any suspected infection as quickly as possible.

How common is it? As many as 8 percent of deliveries result in an infection. Women who had a cesarean delivery or those who had premature rupture of the membranes are at greater risk of infection. As many as 8 percent of deliveries result in an infection. Women who had a cesarean delivery or those who had premature rupture of the membranes are at greater risk of infection.

What are the signs and symptoms? Symptoms of postpartum infection vary, depending on where the infection is, but there's almost always: Symptoms of postpartum infection vary, depending on where the infection is, but there's almost always: [image] Fever Fever[image] Pain or tenderness in the infected area Pain or tenderness in the infected area[image] Foul-smelling discharge (from the vagina in the case of a uterine infection, or from a wound) Foul-smelling discharge (from the vagina in the case of a uterine infection, or from a wound)[image] Chills Chills What can you and your practitioner do? Call your practitioner if you're running a postpartum fever of around 100F for more than a day; call sooner if the fever is higher or if you notice any of the other symptoms above. If you have an infection, you'll probably receive a prescription for antibiotics, which you should take as prescribed for the entire course, even if you begin to feel better quickly. You should also get plenty of rest (a near impossibility with a newborn in the house, but do the best you can) and drink lots of fluids. If you're breastfeeding, check with your physician and your pharmacist to be sure that any medication you're given is breastfeeding-friendly (most antibiotics are). Call your practitioner if you're running a postpartum fever of around 100F for more than a day; call sooner if the fever is higher or if you notice any of the other symptoms above. If you have an infection, you'll probably receive a prescription for antibiotics, which you should take as prescribed for the entire course, even if you begin to feel better quickly. You should also get plenty of rest (a near impossibility with a newborn in the house, but do the best you can) and drink lots of fluids. If you're breastfeeding, check with your physician and your pharmacist to be sure that any medication you're given is breastfeeding-friendly (most antibiotics are).

Can it be prevented? Meticulous wound care and cleanliness after delivery (wash your hands before touching the perineal area, wipe from front to back after going to the bathroom, and only use maxi pads-not tampons-for postpartum bleeding) can definitely help prevent infections. Meticulous wound care and cleanliness after delivery (wash your hands before touching the perineal area, wipe from front to back after going to the bathroom, and only use maxi pads-not tampons-for postpartum bleeding) can definitely help prevent infections.

If You're Put on Bed Rest The thought of lying in bed with a stack of magazines and the TV remote may sound pretty appealing-until it's prescribed in the form of bed rest. Bed rest, unfortunately, is no pajama party. Once reality sets in and you realize that you can't even run out for milk or meet some friends for a latte, the appeal of lounging around all day is quickly lost. That's why it's important not to lose sight of the big picture (healthy pregnancy, healthy baby) and to remind yourself that your practitioner probably has good reason for keeping you off your feet.

If you've been put on bed rest, you're in good company. A million pregnancies a year (that's one quarter of pregnancies) are classified as "high-risk" or "at-risk." And 70 percent of these moms will be put on bed rest at some point during their 40 weeks. Even though there is much controversy surrounding the benefits of bed rest, it continues to be prescribed because many practitioners believe, based on their experience with their patients, that it works in preventing preterm labor or slowing the progress of preeclampsia and keeps an otherwise high-risk pregnancy from becoming more complicated. Among the rationales suggested for a prescription of bed rest: Staying off your feet takes pressure off the cervix; it reduces the strain on your heart and improves blood flow to your kidneys, which helps eliminate excess fluids; it increases circulation to your uterus, providing additional oxygen and nutrients to your baby; and it minimizes the level of stress hormones in your bloodstream that can trigger contractions.

Certain moms-to-be are more likely to wind up on bed rest, including those who are over 35, who are carrying multiples, who have a history of miscarriage due to incompetent cervix, who have particular pregnancy complications, or who have certain chronic conditions.

Whether bed rest truly helps prevent preterm labor or minimizes the risks of other complications, it is clear that being off your feet for a long period of time comes with its share of drawbacks. Women on prolonged bed rest can suffer hip and muscle pain, headaches, muscle loss (which can make it much harder to bounce back after delivery), skin irritations, and depression, and may be more prone to blood clots. Not being able to get moving may also aggravate many of the normal symptoms of pregnancy, such as heartburn, constipation, leg swelling, and backaches. Finally, bed rest may decrease your appetite, which might be good for your waistline (what waistline?) but not so good for your growing baby (or babies), who counts on those extra calories and nutrients.

The good-and reassuring-news is that many of the side effects of bed rest can be minimized with these tips: [image] Keep things circulating. Maximize blood flow to your uterus by lying on your side, not your back. To feel cradled and comfortable, put a pillow under your head, a body pillow under your belly and between your knees (or two pillows), and perhaps a pillow behind you as well, if that helps you balance. Change sides every hour or so to lessen body aches and prevent skin irritations. Keep things circulating. Maximize blood flow to your uterus by lying on your side, not your back. To feel cradled and comfortable, put a pillow under your head, a body pillow under your belly and between your knees (or two pillows), and perhaps a pillow behind you as well, if that helps you balance. Change sides every hour or so to lessen body aches and prevent skin irritations.

Types of Bed Rest "Bed rest" is the general term used when your practitioner wants you to limit your activities. But it's likely your marching (or in this case, nonmarching) orders came with a list of very specific can-dos and definitely don't-dos. That's because bed rest comes in a variety of packages, from just getting off your feet every couple hours, to resting in bed but being allowed to get up periodically, to staying in bed with bathroom privileges, to staying in bed 24/7 (sometimes in the hospital). What kind of bed rest you're prescribed depends a lot on why you've been put on bed rest to begin with. Here's the lowdown on each type of bed rest: Scheduled resting. In the hopes of preventing full bed rest later, some practitioners ask moms-to-be with certain risk factors (such as multiples or advanced maternal age) to rest for a prescribed amount of time every day. The recommendation may be to sit with your feet up or lie down (better yet, nap) for two hours at the end of every workday or rest for an hour, lying down on your side, for every four hours that you're awake. Some practitioners may ask you to simply shorten your workday in your third trimester and restrict activities such as exercise, stair-climbing, and walking or standing for extended lengths of time. In the hopes of preventing full bed rest later, some practitioners ask moms-to-be with certain risk factors (such as multiples or advanced maternal age) to rest for a prescribed amount of time every day. The recommendation may be to sit with your feet up or lie down (better yet, nap) for two hours at the end of every workday or rest for an hour, lying down on your side, for every four hours that you're awake. Some practitioners may ask you to simply shorten your workday in your third trimester and restrict activities such as exercise, stair-climbing, and walking or standing for extended lengths of time.

Modified bed rest. With modified bed rest, you're generally prohibited from working, driving, and doing household chores (now that's something to celebrate!). Sitting up at your desk to surf the web is okay, as is standing just long enough to make yourself a sandwich or take a shower. You may even be granted one night a week to go out, as long as your outing doesn't involve a long walk or any stairs. Women on modified bed rest may split their day between the couch and the bed, but going up or down stairs should be kept to a minimum. With modified bed rest, you're generally prohibited from working, driving, and doing household chores (now that's something to celebrate!). Sitting up at your desk to surf the web is okay, as is standing just long enough to make yourself a sandwich or take a shower. You may even be granted one night a week to go out, as long as your outing doesn't involve a long walk or any stairs. Women on modified bed rest may split their day between the couch and the bed, but going up or down stairs should be kept to a minimum.

Strict bed rest. This usually means you need to be horizontal all day except for bathroom trips and a brief shower (a tepid bath is preferred). If there are stairs in your house, you're going to have to pick a floor and stay there. (Some women will be allowed to make a roundtrip once a day; for others it might be once a week.) And your spouse (or your mom or a friend or the person you hire to help you) is going to have to make sure that the chores are getting done and that you have all you need to get by for the day. This may mean keeping a cooler or a mini fridge with breakfast, lunch, dinner, and lots of healthy snacks by the side of your bed. This usually means you need to be horizontal all day except for bathroom trips and a brief shower (a tepid bath is preferred). If there are stairs in your house, you're going to have to pick a floor and stay there. (Some women will be allowed to make a roundtrip once a day; for others it might be once a week.) And your spouse (or your mom or a friend or the person you hire to help you) is going to have to make sure that the chores are getting done and that you have all you need to get by for the day. This may mean keeping a cooler or a mini fridge with breakfast, lunch, dinner, and lots of healthy snacks by the side of your bed.

Hospital bed rest. If you need constant monitoring as well as IV drugs because preterm labor has already begun, you will be admitted to the hospital. And if your labor is successfully stalled, you may need to extend your hospital stay to ensure total bed rest. Your bed may even be positioned at a slight angle (feet higher than head) so that gravity can help keep your babies growing in your womb for as long as possible. If you need constant monitoring as well as IV drugs because preterm labor has already begun, you will be admitted to the hospital. And if your labor is successfully stalled, you may need to extend your hospital stay to ensure total bed rest. Your bed may even be positioned at a slight angle (feet higher than head) so that gravity can help keep your babies growing in your womb for as long as possible.

[image]Move what you can. Talk to your practitioner about doing arm exercises each day (using light weights) to keep your upper-body muscles from weakening-usually allowed if you're on modified bed rest. If you get the go-ahead, you can perform bicep curls, tricep curls, and overhead presses, all in a sitting position. Follow with stretching and shoulder rolls.[image] Stretch what you can, as much as you can. Also check with your practitioner about whether gentle leg stretches-flexing your feet and circling your ankles (without lifting them above hip level)-can be on the bed rest agenda. This can prevent blood clotting in the legs and may keep your muscles a little stronger. Stretch what you can, as much as you can. Also check with your practitioner about whether gentle leg stretches-flexing your feet and circling your ankles (without lifting them above hip level)-can be on the bed rest agenda. This can prevent blood clotting in the legs and may keep your muscles a little stronger.[image] Watch what you eat, and how much you eat. A significant dip in a mom's appetite can lead to weight loss for her and a lower birthweight for her baby-so if you find yours slacking, fight back by grazing on nutritious, easy-to-digest snacks (high-fiber ones, like dried fruit, will also combat constipation). Of course, if you find yourself eating too much (out of boredom or depression), excessive weight gain might also become an issue-so keep an eye on nonstop nibbling, too, especially high-calorie nibbling. Watch what you eat, and how much you eat. A significant dip in a mom's appetite can lead to weight loss for her and a lower birthweight for her baby-so if you find yours slacking, fight back by grazing on nutritious, easy-to-digest snacks (high-fiber ones, like dried fruit, will also combat constipation). Of course, if you find yourself eating too much (out of boredom or depression), excessive weight gain might also become an issue-so keep an eye on nonstop nibbling, too, especially high-calorie nibbling.[image] Keep the fluids flowing. Staying hydrated is always important when you're expecting, but especially on bed rest (getting enough fluids will minimize swelling and constipation, and possibly prevent contractions). So make sure your bedstand is stocked with water and other beverages. Keep the fluids flowing. Staying hydrated is always important when you're expecting, but especially on bed rest (getting enough fluids will minimize swelling and constipation, and possibly prevent contractions). So make sure your bedstand is stocked with water and other beverages.[image] Beat heartburn with gravity. More lying can spell more heartburn. Sitting up slightly in bed (if you're allowed), especially after eating, will keep the burn at bay. Beat heartburn with gravity. More lying can spell more heartburn. Sitting up slightly in bed (if you're allowed), especially after eating, will keep the burn at bay.[image] Keep your expectations realistic after delivery. Cut yourself some postpartum slack, factoring in all that your body has been through. You just won't have the same aerobic capacity or muscular strength that you had before you took to bed, even if you were off your feet for just weeks. So give yourself a chance to recover, and plan on building back up to your former fitness level slowly. Walking, postpartum yoga, and swimming are good beginning activities when your practitioner green-lights exercise again. Keep your expectations realistic after delivery. Cut yourself some postpartum slack, factoring in all that your body has been through. You just won't have the same aerobic capacity or muscular strength that you had before you took to bed, even if you were off your feet for just weeks. So give yourself a chance to recover, and plan on building back up to your former fitness level slowly. Walking, postpartum yoga, and swimming are good beginning activities when your practitioner green-lights exercise again.

Bed rest doesn't just impact your physical well-being. It could also affect your sanity. To stay sane while you're staying horizontal: Reach out. Keep the phone by your side, and let family and friends know they need to be on call for venting (or whining, or worrying, or giggling). Stay connected through e-mail as well (this is one of the many reasons why you'll also want a computer by your side-or a laptop on your lap, or where your lap used to be). And don't forget to visit websites and message boards, where you'll meet other moms-to-be in the exact same shoes (or slippers). Keep the phone by your side, and let family and friends know they need to be on call for venting (or whining, or worrying, or giggling). Stay connected through e-mail as well (this is one of the many reasons why you'll also want a computer by your side-or a laptop on your lap, or where your lap used to be). And don't forget to visit websites and message boards, where you'll meet other moms-to-be in the exact same shoes (or slippers).

Be prepared. Anticipate what you're going to need each day, and ask your spouse to gather it together for you before he leaves in the morning. Stock a bedside mini fridge or cooler with lots of water, fruit, yogurt, cheese, and sandwiches. Be sure the phone, magazines, books, and TV remote are all within arm's reach. Anticipate what you're going to need each day, and ask your spouse to gather it together for you before he leaves in the morning. Stock a bedside mini fridge or cooler with lots of water, fruit, yogurt, cheese, and sandwiches. Be sure the phone, magazines, books, and TV remote are all within arm's reach.

Structure the day. Try to establish a routine-even if the highlight is a soak in a tepid tub followed by a nap, or a morning on the couch followed by an afternoon in bed. You'll feel a little better if you give the day some sort of structure. Try to establish a routine-even if the highlight is a soak in a tepid tub followed by a nap, or a morning on the couch followed by an afternoon in bed. You'll feel a little better if you give the day some sort of structure.

Work from home. If you're on modified bed rest and work in a fully wired field, it may be possible to work from home for all or part of the time you are on bed rest. Between conference calls and e-mails, you can actually be very productive as a gestating telecommuter. Speak to both your practitioner and your boss to be sure everyone is on the same page about what your capabilities and your limits are (and if your job is emotionally stressful, you may not get the go-ahead from the obstetric powers that be). If you're on modified bed rest and work in a fully wired field, it may be possible to work from home for all or part of the time you are on bed rest. Between conference calls and e-mails, you can actually be very productive as a gestating telecommuter. Speak to both your practitioner and your boss to be sure everyone is on the same page about what your capabilities and your limits are (and if your job is emotionally stressful, you may not get the go-ahead from the obstetric powers that be).

Moms Helping Moms Every pregnancy comes with some challenges, but a pregnancy that's high risk (or one that's been complicated) can come with a whole lot more. Facing those challenges is always easier when you've got company-other moms who know exactly what you're going through because they're going through it, too (or have already gone through it) themselves. There may be support groups in your area for the specific pregnancy challenge you're facing (ask your practitioner), but you're also likely to find that support online.

Get your baby shopping done. Pretty much anything you can do in a store, you can do online. So use this bed-rest time to get baby-ready on the web. Register for your layette, order your crib, or find your future doula, lactation consultant, and babysitter online. And while you're at it, order your groceries, too (you're out of milk again, aren't you?). Pretty much anything you can do in a store, you can do online. So use this bed-rest time to get baby-ready on the web. Register for your layette, order your crib, or find your future doula, lactation consultant, and babysitter online. And while you're at it, order your groceries, too (you're out of milk again, aren't you?).

Deliver dinner. While you're waiting for your special delivery, tap into your neighborhood network of restaurants that deliver. Keep those menus within arm's reach, or look for them online. While you're waiting for your special delivery, tap into your neighborhood network of restaurants that deliver. Keep those menus within arm's reach, or look for them online.

Try some movie magic. Sign up with a DVD-by-mail service and catch all those films you didn't have a chance to see in the theater-and won't have time to see once you have a baby in the house. Sign up with a DVD-by-mail service and catch all those films you didn't have a chance to see in the theater-and won't have time to see once you have a baby in the house.

Entertain in bed. Get your friends together for a bedroom potluck or pizza and a movie. (Best part of this plan: They'll have to clean up the crumbs, not you.) Get your friends together for a bedroom potluck or pizza and a movie. (Best part of this plan: They'll have to clean up the crumbs, not you.) Get crafty. Teach yourself to knit, crochet, or quilt. Better yet, have a talented pal come over and teach you. You'll be creating sweet treasures for your little one and getting some much-needed companionship, too. Or take up scrapbooking (you'll soon have more mementos to save than ever before). Teach yourself to knit, crochet, or quilt. Better yet, have a talented pal come over and teach you. You'll be creating sweet treasures for your little one and getting some much-needed companionship, too. Or take up scrapbooking (you'll soon have more mementos to save than ever before).

Get organized. Put all those old photos into an album (finally), or enter your address book into a computer database. You'll be glad you did when you're able to print out those address labels (for your baby announcements, thank-you notes, party invites, holiday cards ...) instead of hand-writing them. Put all those old photos into an album (finally), or enter your address book into a computer database. You'll be glad you did when you're able to print out those address labels (for your baby announcements, thank-you notes, party invites, holiday cards ...) instead of hand-writing them.

Sit pretty. Do the things that make you feel good each day, even when it sometimes seems pointless. Brush your hair, put on makeup, slather your tummy in yummy-smelling lotion (your skin will be itchy and dry anyway). If you can afford it, consider having a hairstylist or manicurist make a house call. (Drop the hint to your friends that this would make a great shower gift.) Don't fall into that "nobody's going to see me anyway" trap-looking good makes you feel good, whether anyone else sees you or not. Do the things that make you feel good each day, even when it sometimes seems pointless. Brush your hair, put on makeup, slather your tummy in yummy-smelling lotion (your skin will be itchy and dry anyway). If you can afford it, consider having a hairstylist or manicurist make a house call. (Drop the hint to your friends that this would make a great shower gift.) Don't fall into that "nobody's going to see me anyway" trap-looking good makes you feel good, whether anyone else sees you or not.

Freshen up. Charge your spouse with changing the sheets on your well-used bed once a week. Keep baby wipes and hand sanitizers nearby to keep yourself clean and relatively fresh between showers and baths. Charge your spouse with changing the sheets on your well-used bed once a week. Keep baby wipes and hand sanitizers nearby to keep yourself clean and relatively fresh between showers and baths.

Start a journal. Think of the bright side: Now's the perfect time to begin recording your thoughts or feelings about pregnancy or bed rest, or writing a few letters to your baby that you can share with him or her in years to come. Check out Think of the bright side: Now's the perfect time to begin recording your thoughts or feelings about pregnancy or bed rest, or writing a few letters to your baby that you can share with him or her in years to come. Check out The What to Expect Pregnancy Journal and Organizer, The What to Expect Pregnancy Journal and Organizer, which can help you preserve pregnancy moments. Writing your feelings down is also a great way to vent. which can help you preserve pregnancy moments. Writing your feelings down is also a great way to vent.

Keep your eyes on the prize. Frame one of your ultrasound pictures, and keep it by your side-so when the going gets tough, you can remind yourself that you have the best reason in the world not to go anywhere at all. Frame one of your ultrasound pictures, and keep it by your side-so when the going gets tough, you can remind yourself that you have the best reason in the world not to go anywhere at all.

CHAPTER 23.

Coping with Pregnancy Loss PREGNANCY IS SUPPOSED TO BE a joyous time, filled with excitement, anticipation, and pink-and-blue daydreams about life with your baby-to-be (mixed in with a little normal trepidation and anxiety). And usually, it is all of those things, but it isn't always. If you've experienced the loss of a pregnancy or a newborn, you know firsthand that the depth of your pain can be beyond words. This chapter is dedicated to helping you handle that pain and cope with one of life's most difficult losses. a joyous time, filled with excitement, anticipation, and pink-and-blue daydreams about life with your baby-to-be (mixed in with a little normal trepidation and anxiety). And usually, it is all of those things, but it isn't always. If you've experienced the loss of a pregnancy or a newborn, you know firsthand that the depth of your pain can be beyond words. This chapter is dedicated to helping you handle that pain and cope with one of life's most difficult losses.

Miscarriage Just because it often takes place very early in pregnancy doesn't mean that miscarriage isn't painful for expectant parents. The grief that can come with a miscarriage is real, no matter how early in pregnancy you lost your baby. Even though you never saw your baby, except perhaps on ultrasound, you knew that he or she was growing inside of you, and you may have already formed a bond, however abstract. From the moment you found out you were pregnant, you may have daydreamed about your baby and imagined yourself a mother. And then, all the excitement of months (and years, and decades) to come abruptly came to a stop. Understandably, you may feel a range of emotions: sad and disheartened over the loss; angry and resentful that it happened to you; possibly withdrawn from friends and family (especially those who are pregnant or just had babies). You may have trouble sleeping and eating at first and accepting the finality of it all. You may cry a lot, or you may not cry at all. These are among the many natural, healthy responses to a pregnancy loss. (Remember that your reaction is what's normal for you.) In fact, for some couples, coping with early pregnancy loss may be, at least in certain ways, just as difficult as coping with a loss later on. Why? First of all, because so many couples hold off on spreading the word about their pregnancy until the third month has passed, even close friends and family may not have been told yet, which can mean that support may be hard to come by. Even those who knew about the pregnancy and/or are told about the miscarriage may offer less support than they would have if the pregnancy had been further along. They may try to minimize the significance of the loss with a "Don't worry, you can try again," not realizing that the loss of a baby, no matter how early in pregnancy it occurs, can be devastating. Second, the fact that there is no possibility of holding the baby, taking a photo, having a funeral and burial-rituals of grieving that can all help offer some closure for parents of stillborn infants-may complicate the recovery process.

Still, if you've suffered a miscarriage (or an ectopic or molar pregnancy), it's important to remember that you have the right to grieve as much-or as little-as you need to. Do this in any way that helps you heal and eventually move on.

Perhaps you'll find closure in a private ceremony with close family members or just you and your spouse. Or by sharing your feelings-individually, through a support group, or online-with others who experienced early miscarriage. Since so many women suffer a miscarriage at least once during their reproductive years, you may be surprised to find how many others you know have had the same experience as you but never talked about it with you, or maybe even talked about it at all. (If you don't feel like sharing your feelings-or don't feel you need to-don't. Do only what's right for you.) Some of the tips for those who have later pregnancy losses may be helpful for you, too. You may also want to read about the Stages of Grief (see box on page 585 page 585), which may or may not apply to you.

A Personal Process When it comes to dealing with a miscarriage or other pregnancy loss, no one emotional formula must be followed. Different couples confront, cope with, and process their feelings in completely different ways. You may find yourself deeply saddened, even devastated by the loss-and discover that healing comes surprisingly slowly. Or you may handle the loss more matter-of-factly, seeing it as a bump in the road to having a baby. You may find that after some momentary sadness, you're able to put the experience behind you more quickly than you might have expected-instead of lingering over the loss, you may choose to look ahead to trying again. Just remember: The normal reaction to a pregnancy loss is the reaction that's normal for you. Feel whatever you need to feel in order to heal and move ahead.

Accept that you may always have a place in your heart for the pregnancy you lost, and you may feel sad or down on the anniversary of the due date of your lost baby or on the anniversary of the miscarriage itself, even years later. If you find it helps, plan on doing something special at that time-at least for the first year or so-that will be cheering yet allows you to remember: planting some new flowers or a tree, having a quiet picnic in the park, sharing a commemorative dinner with your spouse.

Coping with Repeat Miscarriages Suffering one pregnancy loss can be hard enough to cope with. But if you've suffered more than one, you may find it infinitely harder-with each loss hitting you a little harder than the last. You may be discouraged, depressed, angry, irritable, unable to focus on the rest of your life (or on anything beyond your losses). The healing of your psyche may not only take a lot longer than the healing of your body, but the sadness can be literally debilitating. What's more, the emotional pain may lead to physical symptoms, including headaches, appetite loss or overeating, insomnia, and overwhelming fatigue. (Some couples handle even repeat losses more matter-of-factly, and that's completely normal, too.) Time may not heal all, but it will definitely help eventually. In the meantime, patience, knowledge, and support may be your best remedies. Pregnancy loss support groups may be available in your area, so ask your practitioner, or find a support group online, if you think that might help you (some couples prefer to turn to each other for support). Sharing with others who have suffered through pregnancy losses, especially multiple losses, can help you feel less alone, as well as more hopeful. Most of all, don't let guilt add to your burden. Miscarriage is not your fault. Instead, try to focus on how strong you've been (even if you haven't always felt that strong) and how determined you are to have a baby.

While it's normal to mourn your loss-and important to come to terms with it your way-you should also start to feel gradually better as time passes. If you don't, or if you have continued trouble coping with everyday life-you're not eating or sleeping, you're not able to focus at work, you're becoming isolated from family and friends-or if you continue to feel very anxious (anxiety is an even more common sympton following miscarriage than depression is), professional counseling can help you recover.

Try to remind yourself that you can-and most likely will-become pregnant again and give birth to a healthy baby. For the vast majority of women, a miscarriage is a onetime event-and actually, an indication of future fertility.

Loss in the Uterus When you don't hear from (or feel) your baby for several hours or more, it's natural to fear the worst. And the worst is that your unborn baby has died.

You are likely to be in a fog of disbelief and grief after being told your baby's heartbeat can't be located and that he or she has died in your uterus. It may be difficult or even impossible for you to carry on with any semblance of your usual life while carrying around a fetus that is no longer living, and studies show that a woman is much more likely to suffer severe depression after the delivery of a stillborn if the delivery is delayed more than three days after the death is diagnosed. For this reason, your emotional state will be taken into account while your practitioner decides what to do next. If labor is imminent, or has already started, your stillborn baby will probably be delivered. If labor isn't clearly about to start, the decision of whether or not to induce labor immediately, or to allow you to return home until it begins spontaneously, will depend on how far you are from your due date, on your physical condition, and on how you're doing emotionally.

The grieving process you will go through if your fetus has died in utero will probably be very similar to that of parents whose baby has died during or after birth. The same steps will help you begin the long healing process, including, when possible and practical, holding your baby in your arms and having a funeral or memorial service. See below for more.

Loss During or After Birth Sometimes the loss of a baby occurs during labor or delivery, sometimes just after delivery. Either way, your world comes crashing down. You've waited for this baby for months-and now you're going home empty-handed.

There's probably no greater pain than that inflicted by the loss of a child. And though nothing can completely heal the hurt you're feeling, there are steps you can take now to lessen the inevitable sadness that follows such a tragedy: [image] See your baby, hold your baby, name your baby. Grieving is a vital step in accepting and recovering from your loss, and it's difficult to grieve for a nameless child you've never seen. Even if your child has malformations, experts advise that it is better to see him or her than not to because what is imagined is usually worse than the reality. Holding and naming your baby will make the death more real to you and ultimately easier to recover from. So will arranging for a funeral and burial or a memorial service, which will give you another opportunity to say good-bye. If there is a burial, the grave will provide a permanent site where you can visit your baby in future years. See your baby, hold your baby, name your baby. Grieving is a vital step in accepting and recovering from your loss, and it's difficult to grieve for a nameless child you've never seen. Even if your child has malformations, experts advise that it is better to see him or her than not to because what is imagined is usually worse than the reality. Holding and naming your baby will make the death more real to you and ultimately easier to recover from. So will arranging for a funeral and burial or a memorial service, which will give you another opportunity to say good-bye. If there is a burial, the grave will provide a permanent site where you can visit your baby in future years.[image] Save a photo or other mementos (a lock of hair, a footprint), so you'll have some tangible reminders to cherish when you think about your lost baby in the future. Try to focus on the details you'll want to remember later-big eyes and long lashes, beautiful hands and delicate fingers, a headful of hair. Save a photo or other mementos (a lock of hair, a footprint), so you'll have some tangible reminders to cherish when you think about your lost baby in the future. Try to focus on the details you'll want to remember later-big eyes and long lashes, beautiful hands and delicate fingers, a headful of hair.

Postpartum Depression and Pregnancy Loss Every parent who loses a baby has reason to feel sad. But for some, the sadness can be deepened by postpartum depression and/or anxiety. Untreated, postpartum depression can prevent you from experiencing the stages of grief that are essential to healing. Though it might be hard to distinguish postpartum depression from the depression brought on by the tragic loss of a baby, any kind of depression requires help. If you're exhibiting signs of depression (loss of interest in everyday activities, inability to sleep, loss of appetite, extreme sadness that interferes with your ability to function), don't hesitate to get the help you need. Speak to your prenatal practitioner or your regular doctor, and ask to be referred to a mental health professional. Therapy-and, if necessary, medication-can help you feel better.

Lactation Suppression When a Baby Dies If you've suffered the devastating loss of your baby, the last thing you need is another reminder of what would have been. Sadly, nature can deliver that reminder when the end of pregnancy (even when it has ended tragically) automatically signals the beginning of lactation, and your breasts fill with the milk that was intended to feed your baby. This can be incredibly painful to cope with, both physically and emotionally-as can handling milk production that has already been fully initiated (because your baby died after you started nursing or pumping in the NICU).

If your baby died in utero or at birth, and you never had a chance to nurse, you'll have to deal with breast engorgement. Ice packs, mild pain relievers, and a supportive bra can help minimize the physical discomfort you'll feel. Avoiding hot showers, nipple stimulation, and expressing milk from your breasts will help avoid further milk production. The engorgement will pass within a few days.

If your baby died after you already began nursing or pumping (as might happen with a baby in the NICU), ask the nurses in the hospital or a lactation consultant for help. You'll likely be advised to remove enough milk (using a pump, or manually if you prefer) to reduce the pressure in your breasts but not enough to empty them and encourage more production. The frequency and duration of pumping varies from one woman to another, depending on the amount of milk you've been producing, the frequency of feedings, and the length of time since the birth of your baby, but, in general, you should gradually go longer between expressions and pump for a shorter period of time. Be aware that it's normal for drops of milk to be present in your breasts for weeks or even months after breastfeeding and/or pumping is discontinued.

If you have a large amount of milk, either in storage or in production (if you're producing a lot of milk or if you were pumping for twins, for instance), you might want to consider donating your breast milk to a milk bank. Donation of the milk may help you find some meaning in the death of your baby. But, as always, do what helps you most.

[image]Discuss autopsy findings and other medical reports with your practitioner to help you accept the reality of what happened and to help you in the grieving process. You may have been given a lot of details in the delivery room, but medications, your hormonal status, and the shock you were feeling probably prevented you from fully understanding them.[image] Ask friends or relatives to leave the preparations you made for baby at home. Coming home to a house that looks as though a baby was never expected will only make it more difficult to accept what has happened. Ask friends or relatives to leave the preparations you made for baby at home. Coming home to a house that looks as though a baby was never expected will only make it more difficult to accept what has happened.[image] Keep in mind that the grieving process usually has many steps, including denial and isolation, anger, depression, and acceptance. Don't be surprised if you feel these emotions, though not necessarily in this order. And don't be surprised if you don't feel all of them or if you experience other emotions instead or in addition. Everyone is different and everyone reacts differently, even in a similar situation-especially such a personal one. Keep in mind that the grieving process usually has many steps, including denial and isolation, anger, depression, and acceptance. Don't be surprised if you feel these emotions, though not necessarily in this order. And don't be surprised if you don't feel all of them or if you experience other emotions instead or in addition. Everyone is different and everyone reacts differently, even in a similar situation-especially such a personal one.[image] Expect a difficult time. For a while, you may be depressed, very anxious, or just deeply sad and have trouble sleeping, eating, or focusing at work. You may be short-tempered with your spouse and with your other children, if you have any. You may feel lonely-even if you're surrounded with people who love you-and empty, and you may even imagine you hear your baby crying in the middle of the night. You will probably feel the need to be a child yourself, to be loved, coddled, and cared for. All this is normal. Expect a difficult time. For a while, you may be depressed, very anxious, or just deeply sad and have trouble sleeping, eating, or focusing at work. You may be short-tempered with your spouse and with your other children, if you have any. You may feel lonely-even if you're surrounded with people who love you-and empty, and you may even imagine you hear your baby crying in the middle of the night. You will probably feel the need to be a child yourself, to be loved, coddled, and cared for. All this is normal.[image] Cry-for as long and as often as you feel you need to. Cry-for as long and as often as you feel you need to.[image] Recognize that fathers grieve, too. His grief may seem less intense or more short-lived-partly because, unlike you, he didn't carry the baby inside him for so many months. But that doesn't make the pain he's feeling any less real or the process of mourning any less vital to healing. Sometimes, fathers may have a harder time expressing their grief, or they may bottle up their emotions in an effort to be strong for their partners. If you sense that's the case with your spouse, you may both find comforting release in talking the pain out. Encourage him to share with you, with a counselor, or with another father who's been through such a loss. Recognize that fathers grieve, too. His grief may seem less intense or more short-lived-partly because, unlike you, he didn't carry the baby inside him for so many months. But that doesn't make the pain he's feeling any less real or the process of mourning any less vital to healing. Sometimes, fathers may have a harder time expressing their grief, or they may bottle up their emotions in an effort to be strong for their partners. If you sense that's the case with your spouse, you may both find comforting release in talking the pain out. Encourage him to share with you, with a counselor, or with another father who's been through such a loss.[image] Take care of each other. Grief can be very self-absorbing. You and your spouse may find yourselves so consumed by your own pain that you don't have the emotional reserves left to comfort each other. Unfortunately, relationship problems can sometimes result when partners shut each other out that way, making recovering even more difficult. Although there will almost certainly be times when you'll want to be alone with your thoughts, also make time for sharing them with your spouse. Consider seeking grief counseling together, too, or joining a couples support group. It may not only help you both find comfort but also help preserve-and even deepen-your relationship. Take care of each other. Grief can be very self-absorbing. You and your spouse may find yourselves so consumed by your own pain that you don't have the emotional reserves left to comfort each other. Unfortunately, relationship problems can sometimes result when partners shut each other out that way, making recovering even more difficult. Although there will almost certainly be times when you'll want to be alone with your thoughts, also make time for sharing them with your spouse. Consider seeking grief counseling together, too, or joining a couples support group. It may not only help you both find comfort but also help preserve-and even deepen-your relationship.[image] Don't face the world alone. If you're dreading the friendly faces asking, "So, did you have your baby?" take a friend who can field the questions for you on the first several trips to the supermarket, dry cleaners, and so on. Be sure that those at work, at your place of worship, at other organizations in which you're active, are informed before you return, so you don't have to do any more difficult explaining than is absolutely necessary. Don't face the world alone. If you're dreading the friendly faces asking, "So, did you have your baby?" take a friend who can field the questions for you on the first several trips to the supermarket, dry cleaners, and so on. Be sure that those at work, at your place of worship, at other organizations in which you're active, are informed before you return, so you don't have to do any more difficult explaining than is absolutely necessary.[image] Realize that some friends and family may not know what to do or say. Some may be so uncomfortable that they withdraw during the mourning period. Others may say things that hurt more than help: "I know just how you feel," or "Oh, you can have another baby," or "It's a good thing the baby died before you became attached to it." Though they certainly mean well, they may not understand that no one who hasn't lost a baby can know how it feels, that another baby can never take the place of the one you lost, or that parents can become attached to a baby long before birth. If you're hearing such comments frequently, ask a close friend or relative to explain your feelings and to let others know that you would rather they just say they are sorry about your loss. Realize that some friends and family may not know what to do or say. Some may be so uncomfortable that they withdraw during the mourning period. Others may say things that hurt more than help: "I know just how you feel," or "Oh, you can have another baby," or "It's a good thing the baby died before you became attached to it." Though they certainly mean well, they may not understand that no one who hasn't lost a baby can know how it feels, that another baby can never take the place of the one you lost, or that parents can become attached to a baby long before birth. If you're hearing such comments frequently, ask a close friend or relative to explain your feelings and to let others know that you would rather they just say they are sorry about your loss.[image] Look for support from those who've been there. Like many other parents, you may derive strength from joining a support group for parents who have lost infants. There are support groups online, too, that may offer some solace. (Try compassionatefriends.org or missingangel.org.) But try not to let such a group become a way of holding on to-rather than letting go of-your grief. If after a year you're still having problems coming to terms with your loss (sooner, if you're having trouble functioning), seek individual therapy. Look for support from those who've been there. Like many other parents, you may derive strength from joining a support group for parents who have lost infants. There are support groups online, too, that may offer some solace. (Try compassionatefriends.org or missingangel.org.) But try not to let such a group become a way of holding on to-rather than letting go of-your grief. If after a year you're still having problems coming to terms with your loss (sooner, if you're having trouble functioning), seek individual therapy.[image] Take care of yourself. In the face of so much emotional pain, your physical needs may be the last thing on your mind. They shouldn't be. Eating right, getting enough sleep, and exercising are vital not just in maintaining your health but also in aiding your recovery. Make a conscious effort to sit down for meals, even if you're not feeling very much like eating. Take a warm bath or do some relaxation exercises to help you unwind before bed, so you'll sleep better at night. Try to build some physical activity into your day, even if it's just a walk before dinner. And let yourself take a break from grieving once in a while. See a movie, accept an invitation to visit friends, take a weekend in the country-and enjoy yourself without feeling guilty. For life to go on, after all, you need to go on living. Take care of yourself. In the face of so much emotional pain, your physical needs may be the last thing on your mind. They shouldn't be. Eating right, getting enough sleep, and exercising are vital not just in maintaining your health but also in aiding your recovery. Make a conscious effort to sit down for meals, even if you're not feeling very much like eating. Take a warm bath or do some relaxation exercises to help you unwind before bed, so you'll sleep better at night. Try to build some physical activity into your day, even if it's just a walk before dinner. And let yourself take a break from grieving once in a while. See a movie, accept an invitation to visit friends, take a weekend in the country-and enjoy yourself without feeling guilty. For life to go on, after all, you need to go on living.[image] Remember your baby as privately or publicly as you need to. When it comes to a memorial service, do whatever feels right to you. That might be a completely private ceremony-which allows you and your spouse to share your feelings alone-or one that surrounds you with the love and support of family, friends, and community. Remember your baby as privately or publicly as you need to. When it comes to a memorial service, do whatever feels right to you. That might be a completely private ceremony-which allows you and your spouse to share your feelings alone-or one that surrounds you with the love and support of family, friends, and community.[image] Honor your child's memory in a way that has meaning to you, if that helps. Buy books for a child care center that serves kids in need, or donate to an organization that helps disadvantaged expectant and new moms; plant a tree or a new flower bed in your backyard or in a local park. Honor your child's memory in a way that has meaning to you, if that helps. Buy books for a child care center that serves kids in need, or donate to an organization that helps disadvantaged expectant and new moms; plant a tree or a new flower bed in your backyard or in a local park.[image] Turn to religion, if you find it comforting. For some grieving parents, faith is a great solace. Turn to religion, if you find it comforting. For some grieving parents, faith is a great solace.[image] Do become pregnant again, if that's what you want-but not in an effort to feel better or to replace the child you've lost. It's best to wait until the period of deepest sorrow has passed before contemplating conceiving again. See Do become pregnant again, if that's what you want-but not in an effort to feel better or to replace the child you've lost. It's best to wait until the period of deepest sorrow has passed before contemplating conceiving again. See page 586 page 586 for more. for more.[image] Expect your pain to lessen over time. At first, there will be only bad days, then a few good days mixed in; eventually, there will be more good days than bad. But be prepared for the possibility that remnants of the pain may last a lot longer. The grieving process, which may include nightmares and fleeting but painful flashbacks, is often not fully completed for as long as two years, but the worst is usually over three to six months after the loss. If after six to nine months your grief remains the center of your life, if you're having trouble functioning or focusing, or have little interest in anything else, seek help. Also seek help if, from the beginning, you haven't been able to grieve at all. And remember that postpartum depression can cloud the healing process, too; see Expect your pain to lessen over time. At first, there will be only bad days, then a few good days mixed in; eventually, there will be more good days than bad. But be prepared for the possibility that remnants of the pain may last a lot longer. The grieving process, which may include nightmares and fleeting but painful flashbacks, is often not fully completed for as long as two years, but the worst is usually over three to six months after the loss. If after six to nine months your grief remains the center of your life, if you're having trouble functioning or focusing, or have little interest in anything else, seek help. Also seek help if, from the beginning, you haven't been able to grieve at all. And remember that postpartum depression can cloud the healing process, too; see page 579 page 579.[image] Recognize that guilt can unnecessarily compound grief and make adjusting to a loss more difficult. If you feel that the loss of your baby was your punishment for having been ambivalent about your pregnancy, or for lacking the nurturing or other qualities necessary for motherhood, or for any other reason, seek professional support to help you understand that you are in no way responsible for your loss. Seek help, too, if you've suffered self-doubts in the past and now believe your doubts have been confirmed (you couldn't produce a live baby). If you feel guilty even thinking about getting your life back to normal because you sense it would be disloyal to the child you've lost, it may help to ask your baby, in spirit, for forgiveness or for permission to enjoy life again. You might try doing it in a "letter," in which you express all your feelings, hopes, and dreams. Recognize that guilt can unnecessarily compound grief and make adjusting to a loss more difficult. If you feel that the loss of your baby was your punishment for having been ambivalent about your pregnancy, or for lacking the nurturing or other qualities necessary for motherhood, or for any other reason, seek professional support to help you understand that you are in no way responsible for your loss. Seek help, too, if you've suffered self-doubts in the past and now believe your doubts have been confirmed (you couldn't produce a live baby). If you feel guilty even thinking about getting your life back to normal because you sense it would be disloyal to the child you've lost, it may help to ask your baby, in spirit, for forgiveness or for permission to enjoy life again. You might try doing it in a "letter," in which you express all your feelings, hopes, and dreams.[image] Sometimes, organ donation may be possible when a baby is born alive and with some functioning organs but has a hopeless prognosis. The possibility of helping another baby live may bring some comfort in that case. Sometimes, organ donation may be possible when a baby is born alive and with some functioning organs but has a hopeless prognosis. The possibility of helping another baby live may bring some comfort in that case.

Loss of One Twin The parent who loses one twin (or more babies, in the case of triplets or quads) faces celebrating a birth (or births) and mourning a death (or deaths) at the same time. If this happens, you may feel too conflicted to either mourn your lost child or enjoy your living one-both vitally important processes. Understanding why you feel the way you do may help you better cope with your feelings, which may include all or just some of these: [image] You may feel heartbroken. You've lost a baby, and the fact that you have another doesn't minimize your loss. Realize that you're entitled to mourn the baby you've lost, even as you're celebrating your other baby's birth. In fact, mourning that loss is an important part of the healing process. Taking the steps for grieving parents described in the previous section can help you more easily accept your baby's death as a reality. You may feel heartbroken. You've lost a baby, and the fact that you have another doesn't minimize your loss. Realize that you're entitled to mourn the baby you've lost, even as you're celebrating your other baby's birth. In fact, mourning that loss is an important part of the healing process. Taking the steps for grieving parents described in the previous section can help you more easily accept your baby's death as a reality.

Why?

The painful question "Why?" may never be answered. But it may be helpful to attach some reality to the tragedy by learning about the physical causes of the death of a fetus or newborn. Often, the baby looks perfectly normal, and the only way to uncover the cause of death is to carefully examine the history of the pregnancy and do a complete examination of the fetus or baby. If the fetus died in utero or was stillborn, pathological examination of the placenta by an expert pathologist is also important. Knowing what happened (and this isn't always possible to determine) doesn't really tell you why it happened to you and your baby, but it helps bring closure to the event, and it will help you prepare for a future pregnancy.

[image]You may be happy, too, but ambivalent about showing it. It may seem somehow inappropriate to be excited about the arrival of your surviving baby or even disloyal to the one who didn't live. That's a natural feeling but one you'll need to try to let go of. Loving and nurturing the sibling is a wonderful way of honoring your lost baby-besides, it's essential to your living baby's well-being.[image] You may want to celebrate, but don't know if it's okay to. A new baby is always something to celebrate, even when the happy news comes with sadness. If you're uncomfortable holding a baby-welcoming event without acknowledging your loss, consider first holding a memorial ceremony or farewell for the baby who has passed away. You may want to celebrate, but don't know if it's okay to. A new baby is always something to celebrate, even when the happy news comes with sadness. If you're uncomfortable holding a baby-welcoming event without acknowledging your loss, consider first holding a memorial ceremony or farewell for the baby who has passed away.

Pregnancy Reduction Sometimes an ultrasound reveals that one (or more) of the fetuses in a multiple pregnancy can't survive or is so severely malformed that the chances of survival outside the womb are minimal-and worse yet, that the ailing fetus may be endangering your other healthy one(s). Or there are so many fetuses that there is a significant risk to the mother and all her babies. In such cases, your practitioner may recommend a pregnancy reduction. Contemplating this procedure can be agonizing-it may seem like sacrificing one child to protect another-and may leave you plagued with guilt, confusion, and conflicted feelings. You may come to your decision of whether to proceed (or not proceed) easily, or it may be an excruciating decision-making process.

There may be no easy answers, and there are definitely no perfect options, but you'll want to do whatever you can to make peace with the decision you end up making. Review the situation with your practitioner, and seek a second opinion, or third, or fourth, until you're as confident as you can be about your choice. You can also ask your practitioner to put you in touch with someone from the bioethics staff of the hospital (if that's available). You may want to share your feelings with close friends, or you may want to keep this personal decision private. If religion plays an important role in your life, you'll probably want to look to spiritual guidance. Once you make your decision, try not to second-guess: Accept that it's the best decision you can make under the difficult circumstances. Also try not to burden yourself with guilt, no matter what you choose. Because none of this is your fault, there's no reason to feel guilty about it.

If you end up undergoing pregnancy reduction, you may expect to experience the same grief as any parent who has lost one or more babies.

[image]You may view your baby's death as punishment, perhaps because you really weren't sure you wanted or could handle being the parent of multiples or because you wanted a girl more than you wanted a boy (or vice versa). Though this kind of guilt is common among parents who experience a pregnancy loss of any kind, it's completely unwarranted. Nothing you did-or thought or imagined or wished for-could have caused the loss.[image] You may feel disappointed that you won't be a parent of multiples. It's normal to be sad over the loss of this excitement, especially if you've been imagining and planning for the arrival of multiples for months. You may even feel twinges of regret when seeing sets of multiples. Don't feel guilty about feeling that way; it's completely understandable. You may feel disappointed that you won't be a parent of multiples. It's normal to be sad over the loss of this excitement, especially if you've been imagining and planning for the arrival of multiples for months. You may even feel twinges of regret when seeing sets of multiples. Don't feel guilty about feeling that way; it's completely understandable.[image] You may be afraid that explaining your situation to family and friends will be awkward and difficult, especially if they've been eagerly awaiting the twins. To make facing the world a little easier, enlist a friend or close relative to spread the word so you won't have to. In the first few weeks, try to take someone with you when you go out with your baby, so they can anticipate and answer the inevitable-and possibly painful-questions. You may be afraid that explaining your situation to family and friends will be awkward and difficult, especially if they've been eagerly awaiting the twins. To make facing the world a little easier, enlist a friend or close relative to spread the word so you won't have to. In the first few weeks, try to take someone with you when you go out with your baby, so they can anticipate and answer the inevitable-and possibly painful-questions.[image] You may have trouble handling the reactions and comments of family and friends. In trying to help, friends and family may overdo the excitement when welcoming your living child, without acknowledging the one you've lost. Or they may urge you to forget your lost baby and appreciate your living one. As well intentioned as their actions and words may be, they can hurt and upset you. So don't hesitate to tell people-especially the ones who are closest to you-how you feel. Let them know that you need to grieve for what you have lost as well as celebrate the new arrival. You may have trouble handling the reactions and comments of family and friends. In trying to help, friends and family may overdo the excitement when welcoming your living child, without acknowledging the one you've lost. Or they may urge you to forget your lost baby and appreciate your living one. As well intentioned as their actions and words may be, they can hurt and upset you. So don't hesitate to tell people-especially the ones who are closest to you-how you feel. Let them know that you need to grieve for what you have lost as well as celebrate the new arrival.[image] You may feel too depressed over your loss to care for your new baby-or, if you're still pregnant, to care for your baby by taking the best possible care of yourself. Don't beat yourself up over your unhappy or conflicted feelings. They're normal, and completely understandable. But do make sure that you get the help you need so you can start meeting your baby's needs-both physical and emotional. Support groups may help, and so can counseling. You may feel too depressed over your loss to care for your new baby-or, if you're still pregnant, to care for your baby by taking the best possible care of yourself. Don't beat yourself up over your unhappy or conflicted feelings. They're normal, and completely understandable. But do make sure that you get the help you need so you can start meeting your baby's needs-both physical and emotional. Support groups may help, and so can counseling.[image] You may feel that you're alone in your pain. Getting support from others who know what you're going through can help more than you can imagine. Find that support in a local support group or online. You can contact Centers for Loss in Multiple Births (CLIMB), at You may feel that you're alone in your pain. Getting support from others who know what you're going through can help more than you can imagine. Find that support in a local support group or online. You can contact Centers for Loss in Multiple Births (CLIMB), at climb-support.org.

Stages of Grief Whether the loss of a baby comes early in pregnancy, near term, or at delivery, you'll likely experience many feelings and reactions. Though you can't wish them away, understanding them will eventually help you come to terms with your loss. Many people who suffer a loss go through a number of steps on their road to emotional healing. These steps are common, though the order in which the first three occur may vary; so, too, may the feelings you experience.

[image] Shock and denial. There may be numbness and disbelief, the feeling that "this couldn't have happened to me." This is a mental mechanism designed to protect your psyche from the trauma of the loss. Shock and denial. There may be numbness and disbelief, the feeling that "this couldn't have happened to me." This is a mental mechanism designed to protect your psyche from the trauma of the loss.[image] Guilt and anger. Desperate to pin the blame for such a senseless tragedy on something, you may blame it on yourself ("I must have done something wrong to cause the miscarriage" or "If I'd been happier about the pregnancy, the baby would still be alive"). Or you may blame others-God, for letting this happen, or your practitioner (even if there is no reason to). You may feel resentful and envious of those around you who are pregnant or who are parents, and even have fleeting feelings of hatred for them. Guilt and anger. Desperate to pin the blame for such a senseless tragedy on something, you may blame it on yourself ("I must have done something wrong to cause the miscarriage" or "If I'd been happier about the pregnancy, the baby would still be alive"). Or you may blame others-God, for letting this happen, or your practitioner (even if there is no reason to). You may feel resentful and envious of those around you who are pregnant or who are parents, and even have fleeting feelings of hatred for them.[image] Depression and despair. You may find yourself feeling sad most or all of the time, crying constantly, unable to eat, sleep, be interested in anything, or otherwise function. You may also wonder if you'll never be able to have a healthy baby. Depression and despair. You may find yourself feeling sad most or all of the time, crying constantly, unable to eat, sleep, be interested in anything, or otherwise function. You may also wonder if you'll never be able to have a healthy baby.[image] Acceptance. Finally, you'll come to terms with the loss. Keep in mind that this doesn't mean you'll forget the loss-just that you'll be able to accept it and get back to the business of life. Acceptance. Finally, you'll come to terms with the loss. Keep in mind that this doesn't mean you'll forget the loss-just that you'll be able to accept it and get back to the business of life.

No matter what you're feeling-and given your situation, your feelings may be all over the emotional map-give yourself time. Chances are that you'll feel progressively better-and better about feeling better.

Trying Again Making the decision to try again for a new pregnancy-and a new baby-after a loss isn't always easy, and definitely is not as easy as those around you might think. It's an intensely personal decision, and it can also be a painful one. Here are some things that you might want to consider when deciding when-and if-you try again: [image] Trying again for another baby after losing one (or more) takes courage. Give yourself the credit you deserve-and the pat on the back you need-as you embark on this process. Trying again for another baby after losing one (or more) takes courage. Give yourself the credit you deserve-and the pat on the back you need-as you embark on this process.[image] The right time is the time that's right for you. It may take just a short time for you to feel emotionally ready to try for another baby-or it may take a much longer time. Don't push yourself (or let others push you) into trying too soon. And don't second-guess yourself (or paralyze yourself) into waiting longer than you have to. Listen to your heart, and you'll know when you're emotionally healed and when you're ready to contemplate a new pregnancy. The right time is the time that's right for you. It may take just a short time for you to feel emotionally ready to try for another baby-or it may take a much longer time. Don't push yourself (or let others push you) into trying too soon. And don't second-guess yourself (or paralyze yourself) into waiting longer than you have to. Listen to your heart, and you'll know when you're emotionally healed and when you're ready to contemplate a new pregnancy.[image] You'll need to be physically ready, too. Check with your practitioner to see whether a waiting period will be necessary in your case. Often, you can try as soon as you feel up to it (and as soon as your cycle begins cooperating). If there's a reason why you have to wait longer than you want to (as may be the case after a molar pregnancy), use the time to get yourself into the best physical condition possible for conception (see Chapter 1), if you're not already. You'll need to be physically ready, too. Check with your practitioner to see whether a waiting period will be necessary in your case. Often, you can try as soon as you feel up to it (and as soon as your cycle begins cooperating). If there's a reason why you have to wait longer than you want to (as may be the case after a molar pregnancy), use the time to get yourself into the best physical condition possible for conception (see Chapter 1), if you're not already.[image] A new pregnancy may be less innocent. Now you know that not all pregnancies end happily, which means you probably won't take anything about your new pregnancy for granted. You may feel more nervous than you did the first time, especially until you've passed the anniversary of the week you lost your last pregnancy (and if you lost your baby at or just before or after birth, you may worry more the entire time). You may try to keep your excitement in check, and you may find that your joy is tempered by trepidation-so much so that you may even hesitate to attach yourself to your new baby until that fear of loving and losing again has dissipated. You may be extra-attuned to every pregnancy symptom: the ones that give you hope (swollen breasts, morning sickness, those frequent runs to the bathroom) and those that trigger anxiety (those pelvic twinges, those crampy feelings). All of this is completely understandable and completely normal, as you'll find out if you reach out to others who've carried a new pregnancy to term after experiencing a loss. Just make sure that if these kinds of feelings keep you from nurturing and nourishing your new pregnancy, you quickly get some help working them out. A new pregnancy may be less innocent. Now you know that not all pregnancies end happily, which means you probably won't take anything about your new pregnancy for granted. You may feel more nervous than you did the first time, especially until you've passed the anniversary of the week you lost your last pregnancy (and if you lost your baby at or just before or after birth, you may worry more the entire time). You may try to keep your excitement in check, and you may find that your joy is tempered by trepidation-so much so that you may even hesitate to attach yourself to your new baby until that fear of loving and losing again has dissipated. You may be extra-attuned to every pregnancy symptom: the ones that give you hope (swollen breasts, morning sickness, those frequent runs to the bathroom) and those that trigger anxiety (those pelvic twinges, those crampy feelings). All of this is completely understandable and completely normal, as you'll find out if you reach out to others who've carried a new pregnancy to term after experiencing a loss. Just make sure that if these kinds of feelings keep you from nurturing and nourishing your new pregnancy, you quickly get some help working them out.

Looking forward to the ultimate reward-that baby you're so anxious to cuddle-instead of looking back on your loss will help you stay positive. Remember, the vast majority of women who have experienced a pregnancy loss or the loss of a baby go on to have completely normal pregnancies and completely healthy babies.

More from What to Expect What to Expect What to Expect the First Year The reassuring and comprehensive month-by-month guide to child care in the first year.

"It delivers on its promise . . . Better than any current book on infant care."

- MARK D. W D. WIDOME, MD, MPH, PROFESSOR OF P PEDIATRICS, THE P PENN S STATE C CHILDREN'S H HOSPITAL ***