The first time Stephanie Himel-Nelson got pregnant, in October 2000, it was by accident. She was in law school, and her delivery date was scheduled to fall during her bar exam. "I was really torn and conflicted about it," she recalls.
It was only when she miscarried that Himel-Nelson and her husband, a Navy reservist, felt the loss. "When I had that miscarriage, we realized we really did want to be parents and we wanted it to happen sooner rather than later," she says. Within a couple years, she and her husband started trying to conceive -- this time, intentionally.
Early in her second pregnancy, Himel-Nelson had another miscarriage. Then another. After her third pregnancy loss, "we were really in a low place," she says. "We talked about our options. We talked about adopting."
An estimated 8% to 20% of all pregnancies end in miscarriage. In the past, women who miscarried were told to wait 2 to 3 months. Today the thinking has changed, since several studies show no increased risk with shorter intervals between pregnancies.
"There is no medical benefit to waiting," says John R. Sussman, MD, an OB/GYN practicing in New Milford, CT.Emotionally, though, you may need time to regroup. Some couples join a support group or undergo grief counseling to help them cope with their loss.
After losing one baby, women often worry about miscarrying their next child. When you do start trying to conceive -- especially after a second or third miscarriage -- your doctor will probably recommend tests to make sure there aren't any issues with your chromosomes, immune system, or uterus.
Right in the middle of tests to find the reason for her miscarriages, Himel-Nelson became pregnant. In September 2004, her son Hollis was born. "It was the most amazing feeling in the world," she says. "I sort of forgot about everything that happened before." Six months later, she got pregnant again, eventually giving birth to younger son Holden.
"Give yourself permission to be upset," she says. "You'll have your happy ending one way or another -- whether it's the family you expected or something different."
You can't control many causes of miscarriage, Sussman says. Yet there are a few things you can do to help ensure a healthy pregnancy.
Ban bad habits. If you still smoke, quit while you're ahead. This bad habit might double your risk of miscarriage. Drinking more than a couple cups of caffeinated coffee (or soda) daily has also been linked to pregnancy loss. To be on the safe side, switch to decaf.
Stay cool. Running a fever of more than 100º F might increase your odds of miscarrying. You can't avoid getting sick, but if you do have a fever, take Tylenol to bring it down. Sussman also advises his pregnant patients to stay out of hot tubs.
Be safe. The trauma of an accident can end even the healthiest pregnancy. Always wear your seatbelt in the car. Hold off on skiing, contact sports, and other potentially dangerous activities until after your baby is born.
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UpToDate: "Patient Information: Miscarriage (Beyond the Basics)."
John R. Sussman, MD, obstetrican/gynecologist; New Milford, Conn.; assistant clinical professor, Department of Obstetrics and Gynecology, University of Connecticut School of Medicine; co-author, Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss, Taylor Trade Publishing, 2000.
Baba, S. Human Reproduction, published online Dec. 14, 2010.
Weng, X. American Journal of Obstetrics & Gynecology, published online Jan. 28, 2008.