Pregnancy After a Preterm Birth: Can You Prepare?

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A preterm or premature baby is one born before 37 weeks of pregnancy. The earlier your baby is born, the more likely they are to have health issues. If you have had a premature baby or preemie before and you want to get pregnant again or are already pregnant, you may have some questions. Read on for ideas about coping with aspects—both physical and emotional—of preparing for a new baby when you’ve already had a preterm birth.

Causes of Preterm Birth

 You may know why your preterm baby came early or you may not. Possible causes include:

  • Age: if you are a teenager or over 35, you’re more likely to have a preterm birth.
  • Infection: bacterial infections can cause your bag of waters to break early, leading to preterm birth.
  • Twins: if you’re carrying more than one baby, your babies will likely be born early
  • Substance use: if you use tobacco, drink alcohol, or take other drugs, you are more likely to have your baby early.
  • Stress: if you are under a lot of stress, including that caused by finances, work, relationships, or living situation, your baby is more likely to be born early.
  • Preeclampsia: this pregnancy-related disease is caused by abnormal placental development, which leads to high blood pressure and other symptoms in the parent. The only cure is birth of the baby, which often means that baby must be induced or born via caesarean section.
  • Incompetent cervix: where the cervix softens and opens too early can lead to premature birth.
  • Previous preterm birth: you may already know that having had a premature baby before means that you are more likely to have one again.

Taking Protective Steps in Subsequent Pregnancies

 If you’ve had a preterm birth before, make sure that your care providers know your medical history. If you are not already pregnant, your doctor or midwife will likely advise you to wait at least 18 months before you get pregnant again. This time allows your body to recover and gives you a better chance of having a full term baby. There are plenty of birth control options available to you, both with and without hormones. Another thing you can do to improve your chances of full term birth before getting pregnant again is to make sure you are as healthy as possible before conceiving. Seek treatment for any health conditions, such as diabetes, hypertension, and depression.

If you are already pregnant, be in early communication with your care provider. They may want to refer you to a maternal fetal medicine specialist. Some providers will also prescribe progesterone, a hormone that you can receive by injection that may help maintain your pregnancy. Depending on the options your provider offers, you can receive injections of progesterone from a nurse weekly or inject yourself. Progesterone works best to prevent a subsequent preterm birth when your preterm birth was a result of labor starting on its own, not of you being induced for another reason.

If your prior preterm birth was caused by preeclampsia, your care provider may recommend that you take a daily low-dose aspirin during your pregnancy, which may help to keep your blood pressure in the normal range. If you know that you are at risk for having cervical insufficiency, you may be a candidate for cerclage—a stitch in the cervix that is removed as you get further along in your pregnancy—or vaginal progesterone. Both options can help your cervix stay closed until it is closer to the time for baby to be born. Likewise, if you are using substances, seek help to quit. [1]

Caring for Yourself During Subsequent Pregnancies

It can be traumatic to be pregnant again after having a preterm birth. You may experience anxiety, depression, or post-traumatic stress disorder. While these mental health issues are surprisingly common during pregnancy, you don’t have to suffer. It’s a great idea to get support from both your care provider and a mental health professional if you are struggling even a little bit with your emotional health. Your baby will do better if you are doing better, and decreasing your stress levels will help decrease your chance of a subsequent preterm birth. Take care of yourself physically, too. If you get sick during pregnancy, get treatment and rest as much as you can. Finally, try to exercise if you can—yoga and walking are great options.

Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and children in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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