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How to handle 5 common concerns after a miscarriage

©MFMER

If you’ve recently experienced a pregnancy loss, you may not know what to expect afterward. Here are several common concerns that come up after a pregnancy loss and what you should know.

1: What happens when you go home

If you were admitted to the hospital for your miscarriage — generally in the second or third trimester of your pregnancy, or if you experienced complications in the first trimester — you might feel that staying in the hospital will help you recover more quickly. It can also be reassuring to have doctors and nurses around.

A generation ago, people routinely stayed in the hospital for a week or more after having a baby, and it wasn’t much different after a miscarriage or stillbirth. But doctors learned that being in the hospital — when you don’t need the acute level of nursing care that comes with it — can make it more difficult to recover.

If your doctor is worried about your bleeding or you are being treated for an infection, you may stay in the hospital for a few days. But otherwise, the best place for you to heal is at home. There, you’ll sleep better and ideally be surrounded with people who love and care for you. You’ll have your own food and your own shower and a lot less noise when you’re trying to sleep.

Once you’re home, the most important thing to do is to listen to your body. Take it easy and avoid activities that cause pain. Try to get back into your routine as quickly as you can, as getting up and about can speed your recovery. Eat what you want to, shower or bathe as you usually do, and exercise, if that’s a regular part of your life.

2: Bleeding and your next period

It’s common to worry about post-miscarriage bleeding and how long it will last. Most people bleed for 2 to 3 weeks after a miscarriage. This depends on whether you had a procedure or were treated with medications. Bleeding typically lasts longer after expectant or medication management than after a procedure.

You may have all kinds of bleeding patterns in that time — bleeding heavily at first and tapering off over time, bleeding on and off, or bleeding like a period for weeks.

As soon as the bleeding stops, you may wonder about your next period, which should happen anywhere between three and six weeks later. The further along in pregnancy you were, the heavier that first period is likely to be. Be sure to stock up on pads or tampons.

3: Still feeling pregnant

After pregnancy loss, your body parts can be out of sync with each other. Your hormone levels slowly return to normal, despite the sudden loss of the baby. Typically, the nausea and fatigue resolve first, in the first three days after the miscarriage is over. If you were in the second or third trimester, your back and joints will need time to recover.

Breast tenderness is the last thing to improve, as the high progesterone levels that cause this discomfort take the longest to adjust. Your breasts may leak milk, especially if your pregnancy loss was in the second or third trimester. The hormonal shifts after delivery lead to milk let-down and discomfort in your breasts as they swell. You can help reduce how much milk your body produces by wearing a tight-fitting bra (such as sports bras), refraining from any stimulation of your breasts, and facing away from the water in the shower, since heat can cause more milk let-down.

As for weight gain, I tell my patients that it takes as long to lose pregnancy weight as it did to gain it. So if you were four months pregnant when you had your miscarriage, don’t expect to lose the pregnancy weight in any sooner than four months. One of the many injustices of pregnancy loss is that you may still look pregnant for a few weeks afterward.

4: What about sex?

It’s natural to want to be close to your partner when you’re feeling emotionally wrung out. Traditional advice holds that you should refrain from intercourse for two weeks after the loss to allow the cervix time to close and reduce the risk of infection. Although this advice is not based on research, I tend to be conservative in my advice around sex — the better-safe-than- sorry approach.

But this doesn’t mean you shouldn’t orgasm. In fact, I highly encourage it, if you’re feeling up to it. Sexual activity can be a life-affirming way for you and your partner to come together after the miscarriage. And I’m all for the healing power of the release of endorphins and hormones that come with orgasm.

It’s also natural to not feel ready for intimacy after your miscarriage. Your body may be physically healing from the loss, especially if you needed surgery, and you’re likely still bleeding.

Beyond the physical aspects, it’s understandable to be cautious of sex — it could lead to a pregnancy that you’re not ready for or that reminds you of the baby you lost.

If you have a partner, talk about how you are feeling. Try to stay physically close, if that brings you comfort, in ways that aren’t sexual. Hand-holding, cuddling and back rubs are all examples. And if you’re not a touchy person by nature, let your partner know other ways to offer support right now. Give yourself time to feel in control of your body again before thinking about sharing your body with someone else.

5: The baby stuff

One of the many decisions you’ll face in the days after your loss is what to do with the baby things that you may have been given or bought in preparation for birth. If you were far along in the pregnancy, you may have an entire room painted and furnished and ready for a baby. You may have had a baby shower and have a pile of presents awaiting thank-you cards. On the other hand, you may have purchased only a few things.

Like everything else about miscarriage, there’s no right or wrong answer regarding what to do next. If you can’t bear the thought of coming home from the hospital to baby gear and gifts, your partner or your bestie can pack things away before you’re discharged. If you don’t have storage space in an attic or basement, perhaps a family member would be able to hold things that would cause you pain in the coming weeks. You may want to be the one who decides what to put away and what to keep handy. Don’t assume that your partner or your family know what you want — let them know what you’re thinking.

If you have the baby’s room ready, you may agonize over what to do next. Make no decisions in the first days when you’re home, and only go into the room if you want to. When you’re up for it, see how the room makes you feel. If the sight of an empty crib makes you feel horrible, perhaps pack the furniture away. Consider how it feels best to use the room — for remembering the baby, like a chapel as a place of prayer or meditation, or as a quiet room for thinking about the future.

But if the nursery makes you feel hopeful about someday bringing a baby home to it, leave it just as it is, as a testament to both the baby you lost and the one that hopefully awaits you in the future.

I had bought a pair of baby overalls the day I got pregnant for the first time, and they hung on my dresser until I was hospitalized when I lost the baby. My husband, Chad, thought the sight of them would be too painful for me, so he put them in a drawer where I could easily find them but didn’t have to see them when I wasn’t ready. This thoughtful act was exactly what I needed.

An excerpt from Your Guide to Miscarriage and Pregnancy Loss

Kate White, M.D., OB-GYN

Dr. White, author of Your Guide to Miscarriage & Pregnancy Loss, is an associate professor of obstetrics and gynecology at the Boston University School of Medicine and the vice chair of academics in the OB-GYN department at Boston Medical Center. She is a fellow of the American College of Obstetricians and Gynecologists, a fellow of the Society of Family Planning, and a member of the American Public Health Association. As a board-certified OB-GYN, mother and pregnancy loss survivor, Dr. Kate has been caring for women for more than 20 years, helping them navigate every stage leading up to menopause, including periods, childbirth and pregnancy loss. She also conducts research in contraception, has been continuously grant funded for 15 years, and frequently lectures regionally and nationally on topics related to women’s reproductive health. Dr. Kate lives outside of Boston with her husband and their three children.

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