Pregnancy after NICU

Making the Decision: Another Baby After Neonatal Care

Deciding to have another baby often isn’t a simple task. Having another baby after NICU when your first (or previous) was sick or premature is a whole different – incredibly complex – ballgame, with no rule book.

“When are you going to have another baby?” It’s the question that every mother gets asked after they have had their first baby. For a mum who has been through NICU, the answer isn’t that simple.

There is so much to consider before thinking about pregnancy again. It takes a while after coming home from NICU for the dust to settle, to move out of fight or flight and for us to process our emotions. We may feel okay, but then certain triggers hit; first birthdays, nursery, end of maternity leave, sickness and we find that we are wobbling and needing to make sense of what we have been through.

So thinking about having another baby after NICU can lead to so many different emotions and that is okay. If you think you would like to try for another child after a premature baby or sick baby, there may be some things to consider first…

EVERYONE HAS THEIR OWN STORY

Some of us may have weighed up the risks and feel ready to have another baby and fall pregnant.

Some may be desperately wanting another baby, but feel the risk is too high and therefore experience the grief that comes with that.

Some may not want another baby but feel the pressure to.

We may be on different pages to our partner.

And there are some of us who feel ready, who pluck up the courage to start trying and it doesn’t work in the way we hoped; we may have issues with fertility or may experience loss.

This is heartbreaking after building that courage and taking the plunge to only have it feel like it slaps you back across the face. It is yet again more loss, more grief, more sadness, more anxiety and that is incredibly painful.

Know you’re not alone in it, there are many parents who are going through what you have been through, it is okay to talk about trying to conceive and having another baby after NICU.

HAVE YOU PROCESSED YOUR NICU EXPERIENCE?

There might be some things that are helpful to think about…

How do you feel about your NICU experience?

How would you feel if it was going to happen again?

How do you feel about being pregnant again and having another baby?

Do you have any idea of what it might bring up for you?

Do you know what the risks are for having another baby?

Do you know what another pregnancy might look like?

It might be helpful to access a birth debrief to make sense of what you went through or to seek out therapy to process some of your emotions and develop coping skills.

Are you being led by fear?

Find your village

WHERE IS YOUR PARTNER AT?

It is important to check in and have a real conversation with your partner to make sure you are on the same page if you’re thinking about having another baby after NICU. Together you can talk about what your fears are, what your worries are, what your hopes are and how you are going to manage all of that together.

Carve out some time, where you don’t have devices or distractions and where you can clearly and honestly voice your feelings.

If they aren’t ready for another baby or if they are worried, it is important to talk through those worries and how you would cope with them together, so that you can move from fear into problem solving as a team.

THE EMOTIONS YOU EXPERIENCE IN A PREGNANCY AFTER NICU

Pregnancy after NICU is likely to come with feelings of worry, uncertainty and fear, as well as feelings of excitement and joy. It isn’t straight forward when you have had a previous birth trauma or baby in NICU.

Expectant mothers are often shielded from the reality of trauma and NICU. So when we’ve already been through it, it is like our reality bubble has popped and we are suddenly aware of all the things that could happen to us and our babies.

There are so many different feelings that you will feel throughout your pregnancy; it’s a rollercoaster, so practice acceptance and validation of your emotions… it’s okay to feel however you feel about your next pregnancy.

PLAN WHAT IS IN YOUR CONTROL

With so much being out of our control during pregnancy and birth, plan what you can control.

Can you spend some time talking to a professional about what pregnancy may look like, what birth may look like, what your options are, whether there is anything you can do to possibly prevent another NICU stay?

Consider if another NICU stay was to happen, how you might cope and what you can do to be able to get through it.

Think about how you are going to be supported throughout your pregnancy by staff and by your friends and family, be explicit about what you need to ease any anxiety you may have.

USE IT AS A TIME TO RECREATE MISSED MOMENTS

You may have had missed moments in your previous pregnancy and have grief attached to that – things like missed baby showers, shopping for the baby, taking maternity photos or decorating the nursery – so try to do these things slightly earlier in this pregnancy so that you get to experience them this time.

LEARN TO LET GO OF WHAT YOU CAN’T CONTROL

Tolerating uncertainty and feeling out of control can feel incredibly anxiety provoking. But the more we try to grapple with things we can’t control, the more distressed we can feel.

Learn to notice your thoughts and your feelings; know that they pass, know that they don’t define you and that your thoughts aren’t facts.

Take a deep breath and trust that you can do hard things, you have done hard things.

If you are struggling to do this on your own, it is absolutely okay to access support and get some help with coping.

Aileen’s Story - IVF mumblings

When we found out we were pregnant with twins, I knew there was a chance we would spend some time in NICU. Despite this, I felt totally unprepared, especially when we found ourselves there at 30 weeks, following a crash emergency section under general anesthetic.

The experience was a rollercoaster. Initially, both babies were doing well but following a series of complications and surgery, we lost our boy twin Eoin after 7 weeks. Just a few days later, we brought his sister Lucia home.

It took us 5 years and 7 rounds of IVF to fall pregnant first time around. Therefore, we didn’t think it would happen naturally, (or so quickly) the second time. When Lucia was 6 months old (3.5 months corrected), we found out we were pregnant, which was a complete shock.

This time, I made it to 36 weeks but following another emergency section, we were back in NICU, almost exactly a year later. Although this time was less traumatic, it was hard nonetheless, probably because both stays were in such close proximity. When I was wheeled into NICU to see Cillian, I saw that his incubator was right next to where Eoin had been and I broke down. All the previous emotions came flooding back. The ‘good’ points this time were that we knew what to expect and that things were more likely to be straightforward. I also felt comfort in the familiarity of the team who were very sensitive to our situation.

Susannah’s Story

My first baby girl was born in July 2018, I had a perfect pregnancy, I had popped in for monitoring a couple of times for reduced movements, but nothing was ever found of concern. Suddenly at 36 weeks I had a huge gush of water at home, I was admitted and induced 36 hours later. Baby was on her side which resulted in a traumatic episiotomy and KIWI delivery, she was born in poor condition and taken straight to NICU. She was only there a day, I didn't see her until she joined me on the ward as I was too unwell. I have no memories of the day she was born, only 2 photos, no dressing her, no magical hour and no first feed, and to this day I find this painful. (I am a breastfeeding supporter and so also thought this was our breastfeeding journey over). After 2 days on the ward and one night home she was rushed back in as an emergency with extremely high levels of jaundice (almost requiring a transfer to GOSH), again I couldn't touch or feed her for 4 days, the treatment and checks lasted two long anxious weeks, we were both an emotional wreck. At 3 weeks she was again admitted for severe gastric issues and eventually diagnosed with allergies. She was 6 weeks old before we were in the clear and could begin to relax and enjoy her.  

There was no question in my head that I would have another baby, I'm an only child and always wanted more than one, my husband was more unsure as he also felt the trauma and stress of our eldest's birth and aftermath. I had been given no reason for her prematurity that would impact another pregnancy, knew our jaundice risk factors (opposing blood group to mum, premature birth and instrumental delivery) and how to avoid them (or treat earlier) and was going to head off the allergy issue by cutting out the relevant foods in pregnancy. I was told a second instrumental delivery was rare and was determined to get what I had missed - the pool birth, the skin to skin, the home quickly to my eldest and enjoy the newborn bubble.

However, despite being again very well during my second pregnancy , early tests showed I had low PAPP-A (causing higher risk of Pre-eclampsia and pre-term birth) and an 'iffy' cervix. I was monitored closely, had regular scans and was very well in myself. Everything was going well, the baby had the same blood group as me, and we had an 'early duck out' plan in place to go to section rather than another instrumental delivery to avoid the extreme jaundice. At 32 weeks I went to MDU as I had a bleed, monitoring was fine and it was decided I had lost my show, I had a swab taken to check for infection. I began to have regular patches of contractions from this point and found out from the swab I had GBS (so that was labouring at home to the last minute out the window as I would need antibiotics in labour). But oddly I began to be at peace, I accepted our time was probably up and prepared for him to come (prem clothes and nappies in my bag). My waters went at 33+5 and I knew that was it. After 48 hours monitoring it was decided I needed an emergency section. I determined mentally that even though it was not the birth I wanted, it was our story and I was determined to recall every minute, no matter what. My son was born and needed immediate resuscitation, and to go to NICU, other than a quick glance I didn't see him until the next day. He remained there for 3 weeks, and I'm grateful I was allowed to stay on the unit. Of course I wanted it to be different, and I missed my daughter terribly, she wasn't allowed in, only to the cafe downstairs. Whilst I would never choose this we both found the experience much easier the second time round, I understood the medical side, it was less scary, I knew I could still breastfeed after it all, and in general I look back on that NICU stay with some fondness. So even though his delivery was earlier, and he was needing more support, I found it less stressful in many ways.

I still have tough days, I won't have any more children and do have a sadness that I didn't get the birth, the skin to skin, the feed. I do find baby showers difficult, and would have loved to experience the 'last bit' of pregnancy, I loved being pregnant. But in general I have for the most part reached a stage of acceptance, of our story, of how we got through as a family, and have pride in that.

The next bit isn't really NICU related - but it's where my current mental health, anxiety issues stem so might be relevant/interesting. When my son was 8 weeks, 2 weeks corrected, we were just finding our feet, physically for me from the section, and emotionally from the separation and whole experience, especially for my 4 year old. I took him to A and E as he had a fever and was lethargic, he went downhill very quickly after our arrival until he was dangerously unwell and diagnosed with GBS meningitis, we are very lucky he pulled through and are now dealing with the after effects of the infection on his tiny body. This is where my mental health really fell off the cliff, I felt it was so unfair after all we had been through, the effect on my 4 year old of me leaving again for 4 weeks and the constant health anxiety I now experience along with many ongoing appointments I find extremely stressful, ten times more so than a second NICU stay, the GBS was just bad luck.

Tasha’s Story

I have had two children. Both were born at 34 weeks via emergency c section. They are now 8 and 3 years old.

My pregnancy had been fairly smooth with no real hiccups along the way. I had been experiencing some reduced movements so I had decided to get checked out. At this point I was exactly 34 weeks pregnant and just made the blind assumption that all would be ok and Id be home in an hour or so with reassurance that my little girl was fine. We were seen fairly quickly and they wanted to do a quick scan of the heartbeat before anything else. While being monitored my baby was experiencing some bradycardic episodes (Low heart rate). It was decided that an obstetrician would need to come and check me and my baby over. By the time he arrived the bradycardia had become sustained and my daughters heartrate had not gone above 50 beats per minute. Without any warning the obstetrician said we don’t have time and announced he would be delivering my baby right now. I was put to sleep for a CAT 1 emergency C Section. All of this happened in a 5 minute window. It was by far the most horrific experience I have ever faced. I woke up screaming in pain and with no baby next to me. She had been whisked to NICU. My daughter was born at 14:39 on a Friday and I didn't get to meet her until gone 10 am the next day. I had countless messages congratulating me on the birth of my child before then and I felt empty. I felt like I had failed at motherhood at the first hurdle because I couldn’t even give birth the "normal way". She stayed in NICU for 3 days and then a normal ward for another 3 days before we were discharged together. This was in Sep 2014 and she is now nearly 9 and doing amazingly.

For many years I could not bring myself to say that I gave birth to her because I truly felt like I hadn't done that. My husband had been asking me for a second child for a while but I couldn’t bring myself to do it. I had a constant fear that the same thing was going to happen. I did always know I wanted several children so after a while and after talking to my doctor I was told that nothing could have prevented my first experience and it was just one of those things. My daughter had been perfectly healthy even if early so I felt like I was ready to try again.

4 1/2 years after having my daughter I found out I was pregnant a second time. When I got started with a midwife I was given an appointment with an obstetrician. When I went to this appointment I found out that I had reduced blood flow to my placenta and I would be monitored and put on aspirin to try and increase the blood flow. It became a high risk pregnancy. It was not smooth sailing this time around with severe sickness and pelvic pains.

I ended up going in twice with reduced movements at around 32 and 33 weeks. Both ended up being absolutely fine but they decided to book me in another scan to check things were ok and this was booked for the next afternoon. However I woke up in the morning being sick and with absolutely no movements so I didn’t wait for the scan and just went into the assessment unit. They suspected that I was in early labour at again exactly 34 weeks so I was taken to the labour unit. Here we realised my second child like my first was experiencing bradycardic episodes and I was in excruciating pain which having been given morphine was not touching the pain at all so we ended up with another emergency C Section. This time I was awake and it turned out my previous c section scar was pulling apart internally. I was bleeding internally and my daughter was being starved of oxygen. She was whisked to NICU where she did not take her first unaided breath for 15 minutes. She stayed in NICU for 13 days before being allowed home to us. She could not tolerate breast milk or standard formula and just couldn’t digest it so we had to have a specialised formula until she was 1. She is now a healthy 3 year old who is about to start school in September. I do worry though that being prem and born 6 months prior to covid has weakened her immune system as she constantly seems to fall ill with coughs, colds and infections. More so than any other child I know but luckily it doesn’t end up severe it just panics me each time she gets ill.

I can honestly say for me it was a really cathartic experience second time round. Although it was an emergency it felt so much calmer than the first time round and it was the experience that made me realise that I couldn’t have given birth naturally with either children as we wouldn’t be here today. It put to bed a lot of my concerns that I had faced after my first child even though I didn’t get the "normal experience" I had so desperately craved after my first. I am now medically advised against any more children which makes me sad but I am grateful that my children are here and healthy.

As someone who has a late preemie I sometimes feel like I don’t belong on preemie pages or with those born at full term without NICU. I feel lucky that our NICU stays were short 3 & 13 days respectively but that does not mean they were not horrific and I am just so grateful that we have not faced any long term effects. Since having my youngest I now suffer with anxiety and I struggle a lot with the experiences I have had. It's hard to see people with better experiences. I never got to experience labour or a full term pregnancy. A lot of times I am ok with that but sometimes there are bad days. A memory will come up on Facebook of them being super tiny and I am back to feeling emotional and angry about everything that happened. I would however do it all again to keep them safe

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