A Hopeful, Supported Guide to Pregnancy After a PMAD or Loss

Holding Both Joy and Fear

It is essential to give yourself permission to feel both joy for this pregnancy and fear from the last one. The two are not mutually exclusive. One does not cancel out the other. Holding space for both is the reality of a subsequent pregnancy.

This is a Different Pregnancy, and You Are a Different Person

This is not a repeat of the past. This is a new baby, a new experience, and you are entering it with the wisdom and resilience you gained from your previous journey.

Navigating Pregnancy After a Perinatal Mood or Anxiety Disorder (PMAD)

If your last postpartum period was clouded by the darkness of depression, the panic of anxiety, or the terror of intrusive thoughts, the thought of "going back there" can be a primary source of fear.

The Fear of a Relapse: "Will it happen again?"

This is the central question for anyone who has experienced a PMAD. Having a history of a PMAD is a significant risk factor for experiencing one again, but it is not a guarantee. The most important difference this time is that you have awareness. You know the signs, and you know that treatment is available and effective.

Proactive Steps to Protect Your Mental Health

• Assemble Your Team Early: Do not wait until you are struggling. Start seeing a perinatal therapist early in your pregnancy to process your previous experience and create a proactive mental wellness plan.
• Consider Medication: If medication was helpful for you in the past, have a conversation with your provider about the risks and benefits of using it during this pregnancy and postpartum period.
• Know Your Triggers: Understand what contributed to your previous PMAD. Was it a lack of support? A traumatic birth experience? A struggle with the fourth trimester? Knowing your vulnerabilities allows you to plan for them.

Navigating Pregnancy After a Loss

A pregnancy after a loss is often called a "rainbow baby," but the journey can feel more like a storm of anxiety than a beautiful rainbow.

When Innocence is Lost: The Anxiety of a New Pregnancy

The blissful ignorance of a first, uncomplicated pregnancy is gone. You are now acutely aware of everything that can go wrong. This can lead to a state of hypervigilance, where you are constantly scanning for signs of trouble. It is a journey that requires immense emotional support.

Common Triggers and Milestones

• Early Ultrasounds: These can be a source of intense "scanxiety" as you wait to see a heartbeat.
• Reaching the Gestational Age of Your Previous Loss: This can be a particularly painful and anxiety-provoking milestone.
• A Decrease in Symptoms: A sudden disappearance of morning sickness can trigger a panic, even though it is a normal part of pregnancy.

Our guide to grief and loss counseling can be a helpful resource for processing the unresolved grief from your previous loss.

Building Your "Rainbow Team": Essential Support for This Journey

You cannot and should not do this alone. Proactively assembling a supportive team is crucial.

A Trauma-Informed and Compassionate Medical Provider

You need an OB/GYN or midwife who understands your history and takes your anxiety seriously. You have the right to a provider who will offer extra reassurance, be patient with your questions, and work with you to create a sense of emotional safety.

A Specialized Perinatal Therapist

A therapist who specializes in perinatal mental health, trauma, and/or loss is an invaluable part of your team. They can provide a safe space to process your fears and give you concrete coping skills to manage your anxiety.

Your Partner: Navigating This Journey Together

Your partner is also on this journey with you, and they may be carrying their own fears and anxieties from the last experience. Open communication is key. If you find you are struggling to connect, couples therapy can help you navigate this time as a team.

Practical Strategies for Managing Anxiety

Acknowledge Your Triggers

Name what you are afraid of. Saying it out loud to your partner or therapist can take away some of its power.

Create a "Worry Window"

Instead of letting anxiety consume your entire day, set aside a specific 10-15 minute period each day to allow yourself to worry. When a fear pops up outside of that window, gently tell yourself, "I will think about that during my worry time."

Advocate for Your Needs

Do not be afraid to ask for what you need. This might mean asking for an extra ultrasound for reassurance or requesting that your provider explain everything they are doing in detail.

Preparing for a Different Postpartum

Building Your Postpartum Plan

Create a detailed postpartum plan that is focused on protecting your mental health. This should include plans for meals, help with childcare, and dedicated time for you to rest.

Knowing the Early Signs of a PMAD

You and your partner should be well-versed in the early warning signs of postpartum depression and perinatal anxiety. Having a plan in place for who to call if you start to struggle can make all the difference.