Wednesday 20 July 2011

Pregnant after a Premature Baby

I still regularly visit premature baby forums and I would like a pound, please, for every time I have read "I am pregnant again and not getting the monitoring or follow up I thought I would". I did a quick ask around on Facebook for my friends opinions and this post is as a result of that.

There are several different scenarios when you have had a premature baby. Firstly the baby may have been delivered to save the life of the mother - which is the case in pre eclampsia as well as other conditions. Ultimately the baby is in trouble too, but the primary reason for the delivery, is to ensure the safety of the mother. The next scenario is the most common, the early delivery for an unspecified reason. Thirdly and less common again, is the early delivery for a specified reason such as infection, or known incompetent cervix.

Many women are told "it's just one of those things" at the time of delivery. And "it may not happen again". I think the most crucial thing is to have a follow up appointment after delivery. In some hospitals its offered automatically. In my case I had a six week check after birth with the consultant. We discussed what had gone wrong in this pregnancy, and we discussed future management of any subsequent pregnancies (right before she suggested we get Joseph a nice puppy instead!)

If this hasn't been offered, I would suggest requesting it. You can either go through your GP (you will have a standard 6-8 week check offered at you surgery) or you can try contacting the hospital directly.

When thinking about trying again, I feel at this point its a good idea to request a pre-conception consultation at your hospital. GPs vary in how much experience they have had with "problem pregnancies" and at this point you may have to stand your ground. A pre conception appointment is a chance to properly discuss what went wrong. Usually in early deliveries, the placenta is sent away for testing, and often these results take a while to come back. So you may have been told initially "it was one of those things" but these tests can reveal more information that can be utilised to assist with management of future pregnancies.

In the case of pre eclampsia it is even more important, in my opinion, to have a pre conception consultation. Pre eclampsia is dangerous to both mother and to baby. There are things that can be done to help keep it at bay, and it doesn't necessarily return in subsequent pregnancies. The earlier you are monitored and put on treatment if required, the better chance you have of having a later, well-managed delivery.

There are trials taking place at the moment assessing the safety and efficacy of progesterone, which is used to help prevent premature birth (it is also used to help prevent miscarriage), the OPTIMUMM trial.

If you have fallen pregnant, don't leave it to chance. It is unlikely anyone will just pick up and read your notes, and the normal protocol for second pregnancies is to have less midwife input not more. So unless you are assertive, and flag up your previous pregnancy problems with your mid wife, you are not magically going to receive better care and preventative treatment.

Having made friends with many mothers of premature babies, and seen lots of subsequent pregnancies, I have seen some examples of exemplary care, and unfortunately, a lot of these examples have been around the London area. But good care should be available everywhere, and often is, but you may need to seek it out.

I think personally, the saddest thing about a subsequent pregnancy, is the loss of innocence, and the loss of a gentle, non invasive pregnancy. If you've had a premature baby, you know what can go wrong, and you live with that anxiety every day, wondering what is around the corner, which I think can be helped by having a good team around you.

I was heartened that in a lot of cases, as the second pregnancy progresses, there is a point where you care considered normal, some time after the gestation in which you had your previous baby, things start to relax, and you can enjoy being pregnant. The access to birthing units, waterbirth etc following a premature baby appears to vary, but some that will depend on the reason your baby came early. If you have had a pregnancy that threatened your life, it is likely you will require regular if not continuous monitoring, and your access to some of the methods offered to "normal" labouring women, may not be open to you. What I would say on this is if someone has said "no" ask them for evidence. No medical person, nurse or doctor, should be offended if you ask for evidence, evidence based practice is the norm, and usually there should be data or studies to back up a decision.

I also think message boards play an important role too. No internet forum should be used as a replacement for medical advice from you own team, however sometimes its good to bounce scenarios and get opinions from other people who have walked your path.


  1. I was fortunate to have a very good relationship with my consultant in the CMFT Placenta Clinic. I requested that he carry out my 6week postnatal review, and he also agreed to meet with me for a pre-conception chat in advance of number two (last September now!) Amongst other advice, he told me to get back in touch with them once I had a confirmed pregnancy - the Clinic midwives will handle my entire pregnancy next time.

  2. Good points. :) I am in Canada. Had a 31 weeker and for my 2nd pregnancy with twins I was closely monitored each month by ultrasound, as my 31 weeker arrived very unexpectedly. We watched for incompetent cervix, as you mention, and things seemed to be going well, until I noticed sudden changes that were not the "norm." 3 days after the sudden changes, along came 27 weeker twins. You never know if you will be a "candidate" for another pre-term delivery, but it is best to ensure you are being watched by the appropriate specialists. In my case I had an OB and a Midwife, watching over me. In hindsight, I do wish I had insisted I automatically be referred to the high risk physicians available at the closest hospital (an hour away) to monitor me and ensure as much as possible was done to prevent a pre-term labour, given the fact we didn't know why baby #1 arrived so early. My biggest suggestions are to definitely ask as many questions as possible, ask for proof/facts, ask how many times your OB/Midwife has been involved with pre-term labour situations and finally, make sure you trust your instincts. I did and I am very glad for that!

  3. I've not had an appointment to see my consultant, but my GP has sent off for information from my 6 week appointment (at 11 weeks). Nobody told me whether they sent my placenta off or not. But I got told the other week that my aunt (mums sister) had to have a stitch put in at 30 weeks as she had a weak cervix. If I would have known this maybe they could have looked out for it, but at least I know IF we have another one that could be the reason behind it all :/

  4. Sadly, it probably would not have made a difference. My husband has a family history of pre eclampsia (it can be male factor that causes it) and I was still ignored. Definitely ask for a consultants appointment at some point, or a birth reflection, so you can plan if and when you start considering making Charlie a little playmate!

  5. Allison Dixley21 July 2011 at 11:40

    Just another example of how the NHS fails mothers.

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