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This is a transcription of a portion of a Healthful Woman podcast.

Cassie’s Question

Our first question in this Mailbag episode was from Cassie:

“I’m a very healthy, almost 34-year-old, who had an incomplete miscarriage with MVA at about nine weeks. This was my first experience with pregnancy, and I’m just wondering what your advice is on how to manage anxiety with subsequent pregnancies.”

Dr. Fox’s Response

I’m glad you asked me this question because it’s something that does not get talked about a lot, and is very important. So, I think the instinct that most doctors have, and maybe most patients have, regarding a miscarriage and the subsequent pregnancy is sort of the medical side of it. “Am I at increased risk of a miscarriage again? Do I have to do any tests? Are there any things I need to do differently in the next pregnancy to prevent it?”, which is obviously very valuable as a conversation. And, you know, we’ve had podcasts on this, and we’ve had questions about this on “Mailbag” podcasts. And, you know, it’s its own topic.

But I think what you’re bringing up is such a relevant point, and not just relevant, but prevalent. I think that for many, most, or all people who’ve had a miscarriage in their previous pregnancy, the next pregnancy is going to have a tremendous amount of anxiety over what’s going to happen with this pregnancy. Now, obviously, different people process this differently, and different people have varying levels of anxiety at baseline and about this. And it is quite complex to sort of know who’s going to have more or less anxiety in the next pregnancy and why they might be. But your question is what to do about it.

And I think the first thing that I would say, which is the most important, is for everyone to recognize that it’s normal and it’s okay to have anxiety in a pregnancy about any complication, but certainly about one that you just experienced. And so, whether it’s miscarriage that you asked about, or whether it’s a preterm birth, or whether it’s something, you know, preeclampsia or hemorrhage or, you know, God forbid, a stillbirth or something that happened in the next pregnancy, there’s going to be anxiety. And based on what the event was or what the outcome was that someone’s going to be anxious about, it’s often going to dictate sort of the pattern of that anxiety.

So, for example, when you’re talking about anxiety over miscarriages, whether it’s someone who had a miscarriage in their last pregnancy or someone has a history of multiple miscarriages or whatever it might be related to miscarriage, that’s obviously an early pregnancy complication. So, what tends to happen in my experience, which makes a lot of sense, is that in the very beginning of pregnancy, anxiety is extremely high. And then with each week or month that passes, that anxiety becomes less, which makes sense, because as you’re pregnant and you don’t miscarry, the anxiety over miscarriage is going to be reduced.

Now, obviously, some people might have anxiety over other issues coming up from pregnancy, but the pattern tends to be high at the beginning and diminishing with time, versus if the event we’re talking about happens at the end of pregnancy. So, let’s say someone had a preterm birth or someone had a hemorrhage or something like that. Usually, it’s the opposite pattern, where anxiety at the beginning of pregnancy is relatively low. And then by the time you get to the end of pregnancy, it’s obviously going up and up until that point happens. And so, that’s number one: to recognize what it might be like.

And of course, it’s normal. A lot of people sort of have, I like to call and I’ve called it in prior podcasts, this, like, meta anxiety, which is I am upset or worried about the fact that I am anxious. Right? There’s the anxiety itself. And then there’s sort of, like, the feelings about your feelings. And I think that the feelings themselves, right, the anxiety over miscarriage is obviously normal. It’s something that it’s…it’s expected. It’s something that’s predominantly not preventable because that’s normal. You’ve been through something terrible, and you’re possibly going to have that again. So, you’re going to be anxious about it. And so, that part of it is sort of, like, the normal physiologic response to an event that happened and possibly happening again.

But the meta level, the feelings about the anxiety, I think that’s the part where we can really help to say it’s normal to have these feelings. It’s okay if you’re kind of a wreck at the beginning of pregnancy. It is acceptable to be anxious and to sort of worry about whether this is going to happen again. And then…so, that’s number one, just to recognize it, and sort of talk about it, and not have it be hidden…I have found that, for a lot of people, removing that, like, guilt over my feelings has been very helpful, so that people can just focus on the feelings themselves.

Now, how can we actually reduce the anxiety? Well, you know, at the end of the day, you’re not going to take it away. And that’s sort of understandable. But I do think that, for some people, they find it to be very helpful to have more frequent visits early in pregnancy or maybe more frequent ultrasounds early in pregnancy, so that they can sort of see and track that things are going well. Other people don’t want that. Other people are like, listen, I just want to get pregnant and not think about it, and come to 6 weeks later when I’m, you know, 10 weeks. And if everything’s well, great. And if not, I’ll deal with it. And that’s fine, too. And so, a lot of it is sort of self-awareness of what is going to help you be less anxious or as low anxiety as possible under the circumstances. And for some people, that means very frequent visits, which is great. And for other people, it means fewer visits, which, again, if medically okay, is also fine.

And so, I usually will leave it to the person. I’ll say, like, what is it that you would like to reduce your anxiety over the possibility of a miscarriage? And people will…if given choices, they’ll usually be able to know which choice is best for them. I think that sometimes we don’t give people choices, which is unfortunate. I think, sometimes in medicine, we’re very one-size-fits-all, which is…it’s understandable because sometimes with big systems, it’s hard to individualize. And so, I get it. But it is a little unfortunate because ideally, we should be able to at least try to individualize for each person what is the best option for her in this pregnancy, and try to be as accommodating as humanly possible under the circumstances.

For some people who have severe anxiety, sometimes they need to be in therapy, and sometimes they need to be, you know, taking medications. And that’s okay. If it reaches that level, it reaches that level. And again, it’s not…you know, when we remove the judgment over the feelings, we can just address the feelings themselves. Are they affecting, you know, the ability to do day-to-day things? Are they not affecting that ability? And so, these are sort of the kinds of questions we go through to determine what level of response is needed to help you get through those feelings, particularly in the first trimester.

Learn More on the Healthful Woman Podcast

In this podcast episode, Dr. Fox discusses several other pregnancy concerns and provides reassurance. To learn more about our patients’ stories, we encourage you to check out the full episode.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!