In Part 1 of this article, AFTER MISCARRIAGE: Postpartum Care for Mothers Experiencing Loss, we discussed the care a woman should receive in the first several weeks after a preterm loss (or stillbirth) to help her through the grieving process, to assure her return to vitality, and—according to the precepts of Traditional Chinese Medicine—to increase her chance of a successful pregnancy the next time she conceives.
Here in Part 2, we’ll address the question: When should we try to conceive again? It would be nice if there were one, but the answer is that there is no one answer. Conceiving life is a sacred event, and there is no single fact or consideration that can offer a single best answer for everyone.
However, since there are biological and emotional ramifications of pregnancy and loss, there are factors we should consider when deciding when it’s best to try to conceive again.
The western medical industry essentially considers one factor when making recommendations: What is the statistical likelihood of carrying the next pregnancy full-term when conception happened x amount of time after a miscarriage?”
That is indeed the ultimate question in any woman’s mind. However, the western medical industry offers studies with tremendously conflicting results to answer that question.
For example, read this quote from an article in Time Magazine:
"A new report by researchers at the University of Aberdeen in Scotland suggests that sooner may be better. The scientists found that women conceiving within six months of a miscarriage have better chances of a successful and complication-free second pregnancy than women who conceive later. But the conclusion is contrary to an earlier report from Latin America that found higher pregnancy rates among women who waited at least six months to conceive; that report formed the basis of the World Health Organization's (WHO) 2005 recommendation that women delay pregnancy for six months after miscarrying."
Information like that leaves would-be parents without clear direction and without seeing the whole picture.
In Traditional Chinese Medicine (TCM), the general recommendation is for a woman to wait six months to try to conceive again.
Why six months? Why wait at all—especially when many women do conceive again so quickly after miscarriage?
Waiting exactly six months is not necessary for all women, and some women may require more time. Here are the factors considered in TCM when recommending a wait period:
• A woman’s body has experienced huge hormonal shifts, and the body requires time to readjust.
• A woman has experienced a loss of chi (“energy”), blood, and jing (described in western terms as “kidney strength” or “life-force”)—an abundance of which is required to carry, deliver, and nurse a healthy baby.
• A waiting period helps the mother rebuild strength—not just to assure that the next pregnancy goes full-term, but also to increase her chance of a healthy postpartum recovery; of a healthier, stronger baby; and—down the road—a healthy menopause and golden years.
Though not often discussed or understood in western medical circles, the postpartum time can be one of great strengthening or significant diminishing of a woman’s health and vitality long term. I contacted internationally acclaimed Dr. Ning X. Fu to discuss this issue.
Before coming to the United States, Dr. Ning X. Fu, O.M.D., Ph.D taught at the Chengdu University of TCM and the International Acupuncture Training Center in Beijing. She was also an editor of the Journal of TCM and Pharmacology Information. Now in the States, she is a senior professor at Five Elements University of Traditional Chinese Medicine and has a private practice in Silicon Valley. This is what she had to say:
“When I first discovered women in America have no recovery time or care after miscarriage I was shocked. In China there is a government-mandated period of three weeks in which she has leave from work and receives postpartum care. Without proper care, the chi and blood loss in her body after miscarriage can lead to blood stasis (or stagnation).
For women who miscarry, it is often easy for them to conceive again — but it is also easy for them to miscarry again.
This is because the chi deficiency, blood deficiency and blood stasis, in the short-term, can make it difficult to carry full-term. In the long-term it can lead to fibroids, tumors, and cancer.
The resting period is a time to fortify the woman’s chi and blood, remove stagnation, and restore her body to strength. In addition to three weeks of rest and care, the mother is advised to wait until six months after her miscarriage to try to conceive again.”
Our discussion so far has addressed a few of the physical reasons for waiting. There’s another issue to discuss: Grief.
Miscarriage can be traumatic for women—and trauma leaves physical and emotional wounds that require time and attention to heal, even if a woman had postpartum care in the first month to several weeks.
From my personal experience, after my second miscarriage the sight of blood (even in basic food preparation) would send me into a state of anxiety and grief that could last several minutes or hours. Being immersed in the birthing world, I frequently hear stories from mothers about the ways they are haunted by grief, guilt, and anxiety after their miscarriages, even years later.
Though these responses are common, they are not to be ignored. Conceiving again in that state—of course—can bring joy and help lift one into a healthier state. But is it ideal to conceive in that state? Is it ideal to embark on any new and significant life journey from a weakened position, or in the hopes that it helps us bounce back? The answer to those questions is personal, and I asked professionals in the industry for their input.
Elly Taylor, a relationship counselor and author of Becoming Us said:
“Following a miscarriage (and I have had two myself) it is not uncommon to go through a process of mourning. There is no right way or wrong way to grieve, but cycling back and forth through feelings of shock, denial, anger and depression are common. Expressing these feelings in our own way or through a creative outlet—such as writing, singing, dancing, or painting—and sharing them with a good listener, dissipates the emotional energy of them and allows our body to recuperate. Using this time is also important from a relationship perspective: going through this process as a couple can bring us closer.”
Angelique Chelton, CLC, CBE, SBD is a Certified Lactation Counselor, Certified BEBE Educator, Stillbirthday Birth & Bereavement Doula and Director of Education & Training for Stillbirthday. This is what she had to share:
“Families who consider conceiving soon after a pregnancy or perinatal loss may want to carefully weigh that decision. While there is no one right path, each family needs to think about what the decision to conceive means for them in their personal situation- only they know what will be most healing and healthiest for them.
Will trying to conceive and/or being pregnant soon after a loss allow the family needed emotional and physical space to do the work of grief? Will the family have the energy and emotional resources to focus on the subsequent pregnancy as fully as they’d like? How will acute grief emotions impact a baby in the womb?
A family is ready to conceive when they have made peace with the death of the child who has been lost—conception before this time may complicate integration of a family’s grief experience and the emotions surrounding the subsequent pregnancy.”
We’ve addressed physical health, mental health, and now…what about age? A question that could likely be on the minds of readers 35+ is: Aren’t I wasting precious time if I wait?
There’s no single way to address this concern either, so I’ll just share my story with you. I conceived naturally the first time I tried at 38 and miscarried. I waited for 6 months, tried and conceived again, and miscarried again.
Now I was 40. Could I really spare even a day to wait again? Not according to most recommendations one would likely hear. It was a very difficult decision, but we concluded that, again, the physical and emotional healing time could not be skipped and we decided to wait. Then, during the waiting period, urgent family matters had us traveling back and forth overseas for several months—not a situation in which we felt it wise to conceive. Six months turned into waiting another entire year—and then we conceived again, and had a beautiful home birth when I was 42.
In lieu of the one answer to “when to try again,” here is an answer: No matter how long you decide to wait (or not), allowing yourself and finding support to move through the grief, and giving your body the assistance it needs to return to vigor and strength after loss, will greatly support the cause.
This article is intended for informational purposes only and should not be used as a substitute for professional medical care.
Image: Together We Dream, used with permission by artist Sofan Chan
 In TCM, this entails—under the care of a professional—varying combinations of the following: rest, special postpartum exercises, massage, a special postpartum diet, certain prohibitions (i.e. no cold beverages), acupuncture and herbs.