Pregnancy after loss: the fear that lasts until birth

Every time she goes to the toilet, she checks first. Only then can she breathe out. It was like that in week seven, and it is like that in week twenty-two. When a colleague in the office kitchen asks whether she is excited yet, she smiles and says of course. Then she goes back to her desk and, for the third time that day, places her hand on her belly and waits for the baby to move.

A pregnancy after loss is a pregnancy with two stories. One is the story unfolding now — growth, scans, movements, purchases she may one day get round to making. The other is the one that has already ended, and which stays in the body as a memory that needs no words. Those around her see the first. She and her partner live both at once.

I wrote about the loss itself in Pregnancy loss: the grief others don’t acknowledge, and about what happens when loss repeats itself in Recurrent miscarriage: when hope becomes dangerous. Here I am writing about the time that comes after: when the test is positive again and a kind of waiting begins that others don’t fully understand.

Everything to do with the health of the pregnancy and the baby — scans, monitoring, the signs that mean you should seek help — is for your gynaecologist or the maternity hospital. This piece is not medical. It is about a fear that no good scan result entirely erases.

A pregnancy that isn’t the first

When people hear that a woman is pregnant again after a loss, they often say: “How lovely, now everything will be fine.” I understand why. They want the story to close. But for a woman who has already lost a baby, a new pregnancy is rarely the end of the story. It is more often the start of a long stretch in which hope and fear mix, sometimes in the same moment.

Research confirms this. A large prospective study in London (Farren et al., 2020), which followed women after early pregnancy loss, found that nine months after the loss around 18% of women still had signs of post-traumatic stress and around 17% had moderate or severe anxiety. Some of them become pregnant again during that time. They do not enter a new pregnancy from “zero”, but with a body and a mind that remember what happened.

A meta-analysis of studies on pregnancies after perinatal loss (Hunter et al., 2017) showed that women in a subsequent pregnancy have more anxiety and depressive symptoms than women without a loss — and that this applies to their partners too. Fear, then, is not a sign that something is wrong with you. It is an expected part of the journey.

Counting the weeks: milestones that don’t bring peace

One of the things I hear most often about pregnancy after loss is counting. Counting the days to the first scan. Counting the weeks to the point when the previous loss happened. Counting to the end of the first trimester, to the first movements, to the date when a baby born too early might survive.

Each of these milestones is supposed to bring relief. And it often does — for a few hours, perhaps days. Then the fear moves on to the next milestone. This is not because the woman is “looking for trouble”. It is because the experience of loss has changed her trust that the story will end well. A milestone helps, but it doesn’t give that trust back.

The days around the date of the previous loss, and the anniversary of that day, are especially hard. The body remembers more than we might think. Some women describe how, in that very week, they felt every day that “it’s going to happen now”, even though the results were good. If you know this in advance, it won’t take you by surprise. You can arrange more support for those days: someone you can call, fewer commitments, more rest.

Emotional cushioning: when you don’t dare to bond

The American researcher Denise Côté-Arsenault, who spent many years studying pregnancies after loss, used the term emotional cushioning for something many parents describe. Parents hold back, consciously or not: they don’t buy baby things, don’t choose a name, don’t tell others, don’t look at the scan pictures too often. Not because they don’t love the baby. Because if they lost it, it would hurt less — or so they hope.

This is an understandable protection, and I wouldn’t call it wrong. But it is worth knowing what it costs. Research with women pregnant after a loss finds that higher anxiety is linked to less pronounced attachment to the baby during pregnancy (Armstrong and Hutti, 1998). Parents sometimes feel guilty because they can’t be glad, because the baby in the womb feels “foreign”, because they don’t talk to it the way they talked to the previous one. And that guilt only adds to the distress.

I want to say something important: attachment does not only happen in pregnancy. The concept of attachment describes a relationship that is built over time, above all in the first months and years after birth. If you hold back during pregnancy, you are not missing something that can never be made up. But you can allow yourself small steps — because they might bring you some joy, not because you ought to.

The body as an alarm

After a loss, the body often shifts into a state of constant readiness. Every cramp, every change in discharge, every easing of nausea can seem like a sign that something is happening. We call this hypervigilance — an excessive watchfulness for danger. It isn’t imagined and it isn’t an overreaction. It is the learned response of a nervous system that has already experienced something that seemed safe suddenly ending.

Alongside it, thoughts tend to appear that turn a small sign into the worst possible outcome in an instant. We call this catastrophising. The problem is not that such thoughts are silly — after a loss they are very understandable. The problem is that the body believes them as if they were already true. I wrote about how to step back from thoughts like these in A single thought can ruin your whole day — if you believe it.

Care is needed here. I don’t want anyone reading this to conclude that every physical sign is “just anxiety”. If something worries you, call your gynaecologist or the maternity hospital. That is not overreacting and it is not being a nuisance. Women who have had a loss often don’t call because they are afraid of seeming hysterical. It is better to ask once too often and hear that all is well than to stay alone with the uncertainty. But if you notice that checking has become constant and reassurance no longer reassures you, that is a sign that part of the fear needs to be addressed elsewhere. More on that cycle in Health anxiety: when every symptom means the worst.

Sadness and joy in the same body

A pregnancy after loss often brings something else that is rarely talked about: grief for the baby who isn’t here doesn’t end because another is on the way. Some women describe how it was precisely with the new pregnancy that a grief hit them which they hadn’t felt before. As if a certain amount of safety were needed before it was allowed to show itself.

Guilt towards the previous baby can appear too. “If I’m happy now, have I forgotten them?” “Is this baby now taking their place?” These are questions people rarely say out loud, because they fear they would sound strange. They don’t sound strange. They are part of how love and loss live together. I wrote about the fear that carrying on with life might betray the one who is gone in Carrying on after a loss: the fear of forgetting him.

The new baby is not a replacement. They are their own person. And the previous baby remains part of the family story — even if others never met them. In relational family therapy, in which I am training, we pay a lot of attention to how a family carries losses that nobody talks about. What stays unspoken is often passed on — into expectations, into fears, into the way parents respond to a child. What is spoken and acknowledged, on the other hand, can find its place.

Two parents, one fear, two ways

Partners often carry fear differently. One wants to talk about it, the other feels that talking about fear invites disaster. One calms down with every good result, the other doesn’t. One would already buy the pram, the other can’t bear to look at baby things.

(composite, not a real person)
“Why won’t you talk about names? Everything’s fine, the doctor said everything’s fine.”
“She said everything was fine last time too.”
“I know. But if we just wait for it to be over, we’ll never feel anything.”
“I do feel things. I just don’t know whether I’m allowed to show that I’m happy. As if I’d be tempting something.”

This conversation isn’t an argument about names. It is a conversation about two different ways of protecting yourself from pain. Neither is wrong. The trouble starts when each of you reads the other’s way as a lack of love or care: “you don’t care” or “you won’t see how scared I am”. I wrote more about how differences in grieving play out in a couple in Grieving as a couple: why you grieve differently and how it need not break you.

Often forgotten is the distress of the partner who didn’t carry the baby. Research shows that partners, too, are more anxious in a pregnancy after loss, yet they are asked how they are less often. At scans they stay on the sidelines, and in conversations with friends they often hear the question: “How is she doing?”

When others think everything is fine now

After a loss, people around you often don’t know how to respond. With a new pregnancy, many breathe a sigh of relief, as if the story were over. This can take away the space for fear from the woman and her partner. “But you’re pregnant now, why are you still sad?” “Don’t think about what happened.”

Parents who lost a baby late in pregnancy or around birth often say that what they most wanted in their next pregnancy was for health professionals and those close to them to acknowledge the previous baby, not act as though they had never existed (Mills et al., 2014). Even a sentence like “I know this is your second pregnancy” or the question “how are you feeling about what happened last time?” can mean more than every reassurance that all will be well.

If someone around you is expecting a baby again after a loss, don’t try to convince them they mustn’t be afraid. You can ask how they are and accept that the answer won’t be “great”. You can remember the date of the previous loss. You can ask whether they would like to talk about the baby who isn’t here, or would rather not. For many, simply being asked is a relief.

What helps through the months of waiting

There is no way to make a pregnancy after loss easy. But there are ways to make it a little more bearable.

Agree on things in advance. You can talk to your gynaecologist about how monitoring will work and ask when and where you can call if something worries you. Simply knowing what to do removes part of the uncertainty.

Small steps of attachment. You don’t have to buy everything. But you can choose one thing that is just for this baby — a song you sing to them, a notebook you write to them in, a name you only say at home.

People who know. You don’t have to tell everyone. But it helps if at least a few people know what is happening, and also know that you have lost a baby before. That way they can ask the right question.

Calming the body. When a wave of fear takes hold, simple breathing can help — for example breathing with a longer out-breath. It doesn’t remove the reason for the fear, but it shows your body that at this moment it is not in danger.

Exercise: today

This exercise is meant for days when fear takes over everything. It takes five to ten minutes. You can do it in the morning, or whenever you notice that you have started counting again.

1. Stop and write down which week and day it is today. Not the one that is coming, and not the one that was. Today.
2. Write down what you know today. Only facts: “Today I am pregnant. The last scan was ten days ago.” No predictions.
3. Write down what you are afraid of today. Honestly, without correcting yourself. Fear written on paper often loses some of the power it has in your head.
4. Do a few minutes of breathing with a longer out-breath — in through the nose, then a slower breath out through the mouth. Keep your attention on the out-breath.
5. Choose one thing today that is just for you or for the baby. A walk, a song, a few lines in a notebook, a conversation with someone who knows. Small and doable.

The exercise won’t remove the fear. But it can help make the day not only a wait for the next scan, but also a day you actually live.

After the birth, the fear doesn’t always go

Many people expect the fear to ease once the baby is born. For many parents it does. For some, though, it doesn’t retreat but changes shape: from fear for the pregnancy it becomes fear for the baby. Is she breathing at night? Why is he so pale? What if something happens?

A study of women after stillbirth (Hughes et al., 1999) found that in their next pregnancy, and after the birth too, they had more symptoms of depression and anxiety than women without this experience. That doesn’t mean it will be like this for everyone. But it does mean it makes sense to keep an eye on how you are, even after the baby is born. I wrote about what mothers rarely talk about after birth in Anxiety in pregnancy and after birth: what mothers rarely talk about, and about depression after birth in Postnatal depression: when you “should” be happy and you are not.

After the birth, a sadness you didn’t expect may also come. As you hold a living baby, you may realise for the first time, fully, what you lost before. That is not a sign that you aren’t glad about the new baby. It is a sign that the loss was real.

Where this doesn’t apply

Not every pregnancy after loss is steeped in fear. Some women and couples go through the next pregnancy fairly calmly — perhaps because they have already worked through the loss, perhaps because the experience was different. That is not a sign that they have “forgotten” or didn’t care. It is simply a different path.

Fear isn’t always only psychological. If there are medical reasons for concern, the fear may be entirely justified and needs to be taken seriously together with your gynaecologist. Psychological support does not replace medical care.

When to seek help. If the fear becomes so strong that you can’t sleep, eat, work or be with your partner, or if thoughts of not wanting to live appear, contact your GP or a psychiatrist. In a crisis, call Klic v duševni stiski on 01 520 99 00 in Slovenia (every day from 7 pm to 7 am) or the Samaritans helpline Zaupni telefon Samarijan on 116 123 in Slovenia (24 hours a day), and in an emergency 112.

There is no one right way. This piece describes common experiences, not rules. Some people need therapy, others the support of those close to them, and others simply not to be told that they ought to feel differently.

What to remember

• A pregnancy after loss is a pregnancy with two stories — the one unfolding and the one that ended.
• Fear that doesn’t ease with good results is to be expected; research shows more anxiety in pregnancy after loss, in partners too.
• Emotional cushioning — holding back from attachment — is an understandable protection, but attachment is also built after birth.
• If something worries you, call your gynaecologist; if reassurance no longer reassures you, part of the fear needs to be addressed elsewhere.
• The new baby is not a replacement; both babies can have their place in the family story.