November is premature birth awareness month, and many of the activities were held last week. I still wanted to help spread some more awareness of what life is like after a premature birth. One area that I find often on support boards, and in conversations with other people is should you have another child after you have a preemie? I think beyond the trauma of the event, and the health needs of your preemie this is the issue that strikes a cord with a lot premature parents.
"Do we risk it all to have another child?" "Could we do this all over again?" "What are the chances?"
And the questions and fears go on and on. I hope to give a little advice on things that I found to be helpful during my second pregnancy. This is not an all inclusive list, and as with everything in my blog I am not an expert. I try to spread a few tid-bits that might help you along. Discussing specifics of your pregnancies and risks are really something to be done with a doctor.
I am a planner, an organizer and I will admit that the word 'anal' has even been used to describe me. So of course a to-do list for a second pregnancy makes total sense to me.
Step 1: Gather information.
I recommend that you call and get all your medical records from the hospital and your obgyn office. This may feel awkward and you may even feel embarrassed. Don't they are YOUR medical records. It is the law that these are made available to you, within a reasonable amount of time. It might take a phone call or few, and some time. You might have to pick them up or have them mailed. I still think this is important. I read mine, and because I have a medical background I understood them. More importantly I took them to other doctors with me.
I had my first child 300 miles from home, on vacation. My NICU team, and maternal fetal specialist were not going to be part of my second pregnancy. So, I met with multiple doctors PRIOR to getting pregnant getting their opinions on my case and the 'what ifs' of my possible next pregnancy. For the doctors to give you answers about your pregnancy they need to look at your previous medical records.
I interviewed about four different doctors for my second pregnancy. I ended up using my original obgyn, with phone consultations with a high risk maternal specialist. I basically set up appointments that involved us talking, I asked questions they gave me answers. One doctor actually asked me if I considered adoption because she thought that would be a better option for me. Obviously, the other three doctors I talked to did not share that view and I left her office upset but glad I had talked with other doctors prior.
I wanted to know what my risks were for having another premature child. They were high. Factors that impact this were explained to me, in the that the more premature you have a child (i.e. how early where they delivered) the more likely you are to have another premature child. Also, why did you have a premature birth? This question is not always easily answered and in some cases not at all. Unfortunately sometimes it occurs quickly, without warning and no outward symptoms. Based on my case, there was suspicion that my cervix was dynamic or incompetent. Making me at high risk for future complications.
I wanted to know how they would manage my pregnancy. What would be my treatment plan, and the logistics of that plan. Could I have these test locally, or would I have to travel to another hospital. A year prior to getting pregnant with our second child I had a rough outline of what would need to happen in my next pregnancy. My plan changed a bit during the pregnancy, but even the bed rest, emergency cerclage and minor hospital stay weren't not completely unexpected because we had discussed them before they happened (years before).
Step 2: Gather support.
Once, I had talked with doctors about my concerns and our risks. I then needed to sit down with my husband and decide if this was something we could do. And I really do mean "WE". I know that during pregnancy it is often very mother focused, but I think that with a high risk pregnancy you really need to make sure that the whole family is on the same page.
I suggest that you might get some counseling as well, prior to getting pregnant. Alone and maybe as a couple. Again talking about your fears and possible outcomes, is important and once you are pregnant and the hormones and stress are occurring well, conversations get all the more difficult.
We kept this a private matter, and I did not tell people outside the family much. I am the type that would have liked to keep my entire pregnancy to myself if I could have but unfortunately I couldn't. I still wanted this second child to be our families decision and didn't really want the added pressure from other people. That being said, you may find a great amount of support and strength from outside you family.
We also had to get our finances organized. I got disability insurance (STRONGLY encourage), as it was highly likely that I would have bed rest. Having a preemie, can be very expensive. The medical bills, and follow up bills and services combined with a cut in your ability to work can really add to the stress. Saving for a second baby is always a good idea, and if there is a good chance that you will have another preemie I think it is essential.
Step 3: Jump into the deep end, and don't be surprised when you panic!
We were discussing a second child during my hospitalization with our first daughter. When deciding different medical options for my treatment, I would always ask what impact it would have on future pregnancies. Then I spent the next two years of my preemies life talking with people and planning for the next pregnancy. My poor husband had more conversations with me, then he probably ever wanted to determine when we would have another child, and listening to all my 'what if' fears.
At some point it was time to jump. Stop talking and start living. It was time to move forward and do what we had planned. Luckily for us, getting pregnant is not a problem at all and so I couldn't over analyze or plan that portion out too much.
I do think you need to realize though that you will panic during your pregnancy. You will have some real scares, even if your pregnancy goes great. I just don't think there is anyway around it. And the closer you get to when you had complications or your had your first child, well that is when the really blank will hit the fan. I mean I know there are a few people out there that are able to just cruise through and put all their fears aside, but I really don't think that is how most people feel.
Being pregnant is such a unique period of time. The feelings of how your body changes, how the baby feels kicking, and unfortunately for those of us with preterm labor issues the way that everything feels like a contraction. During a second pregnancy, it is like being on hyper alert all the time. It is exhausting for everyone. My doctor retired after my pregnancy (seriously, my second daughter was one of the last babies he delivered), and I am sure he was thrilled when I wasn't either in his office or on the phone anymore.
I actually gave up sleeping from about 23 weeks until 34 weeks during my pregnancy. Which is really interesting when you are on bedrest, and not something I recommend. I had contractions constantly at times, but became a master at taking my medications, laying down, talking to the nurses, and talking myself off the cliff of full panic. I had a countdown sheet that I crossed off every day that I was pregnant.
Step 4: ENJOY!
All the issues aside, you do want to enjoy your life and your decisions. And maybe you don't find any of the second pregnancy enjoyable. Maybe even you decide that you can not go through having another child, or despite all your planning that pregnancy won't come. At some point you have to let a breath out and gather your family close and smile. Having a premature child, and a high risk pregnancy(ies), has taught me more about myself than really any other life event. I learned that I was able to survive and do more than I ever though tpossible. I earned each of my children through a lot of work and tears, and I do not take them for granted. And at the end of day, I am happy that I did dare to take the plunge