Pregnancy after a stillbirth or neonatal death

After a stillbirth or neonatal death, deciding when or if you want to get pregnant again is a personal decision. There is no right or wrong amount of time you should wait and no single path that works for everyone.

You may have a strong desire to get pregnant again as soon as possible. You may also feel you need to take a break so you can have time to grieve, physically recover and feel emotionally ready. Both responses are valid.

If you have a partner or children, you may consider their needs, feelings and wellbeing. Your cultural and religious background may also play a part in your decision-making.

Sometimes, you may have a medical reason to wait. For example, your doctor may advise you to wait until you have results of medical or genetic tests. These results can influence:

• your future antenatal care
• how your next pregnancy is managed
• the level of care you will receive

Discussing your situation with a health professional can help you decide the best time for you to plan your next pregnancy.

Planning a pregnancy after loss means taking care of your physical, medical and emotional needs. Thinking about each of these before you begin can help you feel more supported and prepared.

Medical needs

After experiencing a stillbirth or neonatal death, you can do some tests to help find out why it happened. This is an important part of planning future pregnancies. Examples of tests include:

• genetic testing (Opens in new tab) on your baby, as well as both of their biological parents
• medical tests on you and your baby
• sending your placenta to pathology (Opens in new tab) for testing
• an autopsy (Opens in new tab) (an examination of your baby's body to help find the cause of death)

Deciding to do an autopsy is a personal decision. You can choose less invasive options than a full autopsy but this may limit the amount of information you get.

Sometimes, your doctors won't be able to find out why you experienced a stillbirth or neonatal death. This can be deeply frustrating and painful. Your care team can support you through this uncertainty.

Your doctor may refer you to a genetic counsellor. Your test results may influence how your doctors will help you manage future pregnancies.

If you have had a stillbirth, you may be at a higher risk of having another stillbirth or complications during your next pregnancy such as:

• pre-eclampsia
• placental abruption
• preterm birth

Before getting pregnant, it is important that you discuss with your doctor what you can do to reduce your risk of complications. For example, if you are living with overweight or obesity, smoke or have diabetes, you may try to address these factors before your next pregnancy. These conversations are not about judgement but about giving you and your baby the best possible start.

Read more about planning for your pregnancy.

Read more about preconception health for women.

Emotional and family support

Some people find that planning a pregnancy after loss triggers anxiety, grief and conflict. Remember, whatever your feelings, they are valid. You do not need to justify them.

If you have a partner, they may be going through their own journey. Sometimes you may want different things. This can sometimes cause tension and affect your communication and relationships.

It is very important you look after your emotional wellbeing. Processing your grief can help you feel more prepared before you try again. Do your best to make sure you begin your next pregnancy with a strong support network and coping strategies.

A counsellor (Opens in new tab) or psychologist (Opens in new tab) can help you work through your feelings and options. You may also find it comforting to join support groups and speak with people who have shared similar experiences.

Pregnancy after loss can bring many different emotions. You may feel hopeful about your baby while still grieving the baby you lost. It is common for these feelings to exist at the same time.

Some parents feel anxious (Opens in new tab) or depressed (Opens in new tab), especially in the first trimester. You may feel high levels of anxiety throughout pregnancy, especially around appointments, scans, milestones or significant dates. Many parents also find that their anxiety increases as they approach the stage of pregnancy when their previous baby died. This is a common and understandable response. You may find yourself paying close attention to symptoms, movements or changes in your body. Feelings of anxiety, vulnerability, stress and worry are common. It is important to speak with your health care provider about how you are feeling so appropriate referrals (Opens in new tab) can be made.

You may also find it difficult to connect emotionally with your baby during pregnancy.

If anxiety, grief or worries about bonding are affecting your wellbeing, speak with your care team. There is always support available. Peer support from others who have had similar experiences can be especially helpful during this time. Journalling and relaxation strategies can also be helpful for coping with pregnancy-related anxiety and fears.

If you have experienced a stillbirth or neonatal death, you may be offered extra antenatal care during your next pregnancy. Many parents benefit from a continuity of care model. This means you will be supported by the same midwife or doctor throughout your pregnancy.

There are also specialist clinics that provide maternity care for families experiencing pregnancy after stillbirth or neonatal death.

Each situation is unique. You are encouraged to share your personal preferences and worries. In consultation with you, your doctor or midwife will consider your wishes, obstetric history and test results to create a personalised care plan.

To check your and your baby's wellbeing, your doctor or midwife may recommend:

• more frequent and flexible appointments
• extra ultrasounds to assess fetal growth and to find pregnancy complications
• genetic testing of your fetus
• cervical length screening (an ultrasound that measures the cervix) between 16 and 24 weeks of pregnancy if you have a history of spontaneous preterm birth

If you know the cause of your stillbirth, your doctor may prescribe:

• low-dose aspirin — if you have a history of placental insufficiency or pre-eclampsia
• extra folic acid supplementation — if you have a history of neural tube defects
• progesterone — if you have had a spontaneous preterm birth

Your doctor or midwife will also discuss the timing of your baby's birth and work with you to create a birth plan that is right for you. Some people may choose a planned caesarean birth.

Your emotional wellbeing is also a priority. You may be offered emotional support, via in-person or telehealth counselling. You may also be able to contact your healthcare team between appointments if you have any worries and concerns.

Aboriginal and/or Torres Strait Islander families experience higher rates of stillbirth than non-Indigenous families. If you are an Aboriginal and/or Torres Strait Islander parent, ask your healthcare team about culturally safe maternity care and support services available in your community.

If you unexpectedly become pregnant, you may feel a range of different or strong emotions. An unexpected pregnancy can trigger mixed feelings of anxiety, grief or hope. What you feel is valid and normal. Even if this pregnancy is unplanned, it may still be wanted.

You do not have to go through this alone. Seek support from your doctor, partner and people you trust. You can also have counselling to help you process. It is important you know your options and rights.

If you have experienced sexual assault, you may wish to report the sexual assault to police.

Read more about making decisions about unplanned pregnancies.

If you or someone you care about has experienced a stillbirth or neonatal loss, Red Nose Grief and Loss (Opens in new tab) has grief and loss support groups online and in person throughout Australia.

Perinatal Anxiety & Depression Australia (Opens in new tab) (PANDA) — call 1300 726 306 to speak with a counsellor.

Stillbirth Foundation Australia (Opens in new tab) offers information and support for people affected by a stillbirth.

The Pink Elephants Support Network (Opens in new tab) provides information and support for people who have experienced pregnancy loss.

Stillbirth Foundation Australia and the Stillbirth Centre of Research Excellence (CRE) created the booklet Guiding Conversations (Opens in new tab) (Parent Guide)

Miracle Babies Foundation (Opens in new tab) supports families who have experienced a pregnancy loss or who have had a premature or sick baby.

Languages other than English

Safer Baby has translated resources (Opens in new tab) in languages other than English.

Information for Aboriginal and/or Torres Strait Islander peoples

If you are an Aboriginal and/or Torres Strait Islander person, you have the right to care that is culturally safe and that honours your cultural needs throughout this experience.

When seeking care, ask your health service about access to Aboriginal Community Controlled Health Organisations (ACCHOs) (Opens in new tab) in your area.

Check your options for telehealth services if you are in a rural or remote location.

Red Nose (Opens in new tab) has grief and loss information and support for Aboriginal and/or Torres Strait Islander families.

Safer Baby has resources for Aboriginal and/or Torres Strait Islander peoples.