Pregnancy Milestones After a Loss

I’m 18 weeks pregnant this week and, if I’m being totally honest with myself, I didn’t think this day would come. My last baby was born at 18 weeks and passed away in my arms 10 minutes after birth. With my previous pregnancies, despite the complications I’ve had, I was never really a nervous mom. I knew this time things would be a bit different but I wasn’t prepared for how emotionally draining this pregnancy would be and how much each tiny milestone would mean to me.

Weekly appointments with the Maternal Fetal Medicine doctor have kept most of my panic at bay, although my visits seem to alternate between being reassuring and discovering new potential complications. I’ve realized that the best I can do is take things one day at a time and celebrate each day I’m still pregnant.

I’m fighting the tendency to avoid getting attached to this pregnancy and celebrating each milestone as a small victory. These are the milestones that have meant the most:

A Positive Pregnancy Test

After a loss, the possibility of another pregnancy often seems so far off in the distant future that it’s a bit of a shock when you realize you have come full circle. For me, denial hit big time. I took 2 home pregnancies tests and requested 3 blood tests. Even after all of those came back positive, I wasn’t convinced until I’d seen the baby on several ultrasounds. Early pregnancy is when many miscarriages happen so it’s normal to feel cautious after a loss. If you’ve announced your previous pregnancies right away, you may be more hesitant to do so now. I decided that I felt okay about spreading the news only to friends and family members that I would tell if I did experience a loss.

Doubling HCG Levels

After a loss, your OBGYN will likely order a 48 hour HCG test. This is a simple blood test but it can give you a good initial idea of how strong the pregnancy is. Your HCG levels should double every 48 hours. If they do, it’s a good indication that the pregnancy is progressing the way it should. My HCG levels quadrupled at the beginning of this pregnancy and it was a huge relief to know that we were at least starting off smoothly.

Finding a Heartbeat

Once you see a heartbeat on an ultrasound (or hear it on a doppler if you are further along in your pregnancy) the risk of miscarriage goes down drastically. This can be very reassuring, as is seeing real proof of your little bean. For me, this milestone was less reassuring than it could have been since I experienced a loss later on in my previous pregnancy, but it was still comforting. I’ve never had a desire to rent or buy a doppler in any of my previous pregnancies, but I have to admit, I was very tempted this time. If my perinatologist hadn’t started bringing me in for weekly appointments, I probably would have caved.

If you do buy a doppler, be sure you avoid anything that says “listening device”. A listening device is much cheaper than a doppler but it’s is only useful in the second and third trimesters when the baby is larger.

Hitting Double Digits

This pregnancy milestone has absolutely no medical significance but for some reason I felt better when I moved into the double digits. Making the transition from 9 weeks to 10 just felt huge to me because those early weeks of pregnancy seemed to be dragging by so slowly that I just felt stuck. There was also the added perk that 10 weeks was just a bit closer to that magic 2nd trimester point when miscarriage rates go down and supposedly morning sickness goes away. I would have been very discouraged at that point if you had told me I’d still be dealing with morning sickness at 18 weeks. Some things are definitely better if we’re kept in the dark.

Moving into the Second Trimester

Depending on who you talk to, the second trimester of pregnancy starts sometime between the 12th-14th weeks of pregnancy. Once you hit that point your risk of early miscarriage goes down and in theory you start to feel a bit better. I’m still waiting for all that extra energy that the pregnancy books promise but it does feel better to see those weeks adding up.

Passing the Point of your Previous Loss

The most comforting milestone many expectant moms hit in a pregnancy after a loss is passing the point where you lost your last baby. This obviously varies depending on your last experience (and if you went full term before experiencing a loss you’ll likely be nervous until that baby is in your arms). For me, 18 weeks was that key week and until I got this far, I was absolutely convinced that I was waiting to repeat history.

20 Weeks

20 weeks is not much different than 19 weeks except that anything before 20 weeks is technically considered a miscarriage. I delivered an 18 week baby who was born alive and fought for 10 minutes to try and breath and I can tell you that nothing about that felt like a miscarriage. My son died in my arms with his tiny hand wrapped around one of my fingers. If you have a loss at 20 weeks or beyond, you don’t have to deal with insensitive family members trying to convince you that you only had a miscarriage.

Hospital policy varies but at many hospitals, 20 weeks is also the point where you can go straight to labor and delivery verses stopping by in the ER if you have any problems. I’ve found most ER staff to be clueless when it comes to pregnancy so I’m anxiously counting down the days until I hit 20 weeks this time.

Anatomy Ultrasound

Typically you’ll have an anatomy ultrasound between 18-20 weeks of pregnancy. This ultrasound can give you a good idea if your baby is developing properly and has any markers for chromosomal problems. If you want to know the gender, you should be able to determine that at this point too. I’ve found that knowing the gender helps you bond a bit more with the baby before birth.

Until I found out this baby was a girl, I had trouble separating her in my mind from the previous baby that I lost. I know that doesn’t make much logical sense but it was a trick that my brain played on me. Apparently I wasn’t the only one. My 6 year old son asked me several times if this baby was his lost brother coming back to our family.

The Point of Viability

A baby is viable between 23 and 24 weeks. Before that point, no measures will be taken to save the baby’s life if she is born prematurely. Survival rates go up drastically at 24 weeks and even though it’s best to keep babies cooking much longer than that, it is a huge comfort once you hit the point where you know your baby has a shot. I may have a party when I hit 24 weeks. Seriously.

Every Week Counts

Once the baby is viable, each week is something to celebrate. Survival rates go up each week and the chance of serious complications and lifelong health issue go down. The good news is, the days go by slowly but the weeks often go by quickly. . . or at least that’s what we tell ourselves after the fact.

37 Weeks

37 weeks is considered full term and the likelihood of the baby needing to spend time in the NICU is much lower. This is also my official pregnancy deadline because I’m not allowed to get further than 37 weeks since I have a history of abruptions and growth restriction.

Due Date

I may be a total dork, but I get really excited when I buy food with an expiration date past my due date. In previous pregnancies I would get all excited when yogurt expired after my due date and then when milk expired after my due date. I’m a long way off from that still but I’m already smiling at the dates on my milk carton.

What milestones meant something to you in a pregnancy after a loss?