If you’ve suffered pregnancy loss like a miscarriage, trying to conceive can be daunting because of the emotional and physical roller-coaster experience you’ve been through.

In fact, the term “rainbow baby” refers to the baby parents welcome after losing a baby to miscarriage, stillbirth, or neonatal death.

Though Simon and Pauline (not their real names) had been trying for a baby for five years after getting married, the stork steered clear of the couple. When Pauline finally did get pregnant in her early 30s, she suffered not one but two miscarriages. Demoralised yet determined to expand their family, they decided to try again after a two-year wait conceived successfully. Pauline is now a mother of two healthy kids, ages 8 and 10.

If you have suffered a miscarriage earlier, don’t give up hope. Fertility experts report that miscarriages without any known causes are pretty common and your chances of a successful pregnancy following such a loss are relatively high.

For women who are younger than age 30, the risk of miscarriage is around 10 per cent. From 30 to 34 years, it is 15 per cent, between 35 and 39 years, 25 per cent, and above 40, it’s 50 per cent.

“Most of my patients who unfortunately experience a first early miscarriage end up with successful next pregnancies that are uneventful. Many of them require no further intervention.”

Says Dr Liana Koe, an obstetrician and gynaecologist at Thomson Medical Centre’s STO+G Practice “Most of my patients who unfortunately experience a first early miscarriage end up with successful next pregnancies that are uneventful. Many of them require no further intervention. In fact, I recently delivered three of them.”

Dr Koe offers insights on the best approach to conceiving after a miscarriage:

Are there any known causes of miscarriage?

Yes. The most common cause of a miscarriage is chromosomal abnormalities which refer to problems with the genetic DNA material of the baby which are usually sporadic, meaning they are not passed down from the parents, and happened by chance. Early miscarriages (less than 3 months of pregnancy) are unfortunately very common, and happen in one out of five women, for no apparent reason.

When is the best time to try again after a miscarriage, before and after age 35?

The risk of miscarriage increases with age, so it is advisable to try again at a younger age. You can try for a baby once you and your partner feel emotionally and physically ready.

What are the chances of miscarrying again if you’ve already had a miscarriage?

The good news is that most miscarriages are one-off events, and chances of a successful subsequent pregnancy are high. You are not at an increased risk if you have had one miscarriage. However, the risk does increase if you have more than one miscarriage, going up to 40 per cent with three or more miscarriages. If this is the case, further tests may be needed.

4. Are there special tests necessary before I try again after a miscarriage?

As mentioned, most miscarriages are one-off events, and no further testing is required. Some couples may have an underlying medical condition causing recurrent miscarriages (three or more miscarriages), and this happens in 1 per cent of couples. In these cases, further testing is recommended. These include:
* Antiphospholipid syndrome: Blood test for antibodies that can lead to recurrent miscarriages;
* Genetic factors: Blood DNA test for the couple, and the baby (if possible), to look for genetic abnormalities that could be passed down;
* Ultrasound scan of the womb: The abnormal shape of the womb may lead to miscarriage; and
* Diabetes and thyroid problems: Blood tests to check for these medical conditions.

“Being overweight, smoking, alcohol intake and excessive caffeine (more than 2 cups per day), may also increase the risk of miscarriage. Factors that can be modified should be changed or stopped prior to the next pregnancy."

5. How does one prepare the body again for pregnancy after a miscarriage?

After a miscarriage, light bleeding is expected for about one to two weeks. Thereafter, the period should return in four to six weeks. Ovulation will occur two weeks prior to the menses, and there is a chance of pregnancy even before the next period. If you and your partner are not yet physically or emotionally ready, contraception to prevent pregnancy is advised.

Once the period returns, and a follow-up check with your gynaecologist is normal, you and your partner can start to try for baby when you’re ready.

The woman should keep a healthy BMI, reduce or stop smoking, avoid alcohol intake, and reduce her caffeine intake.

6. What can one do to ensure a healthy pregnancy and reduce the risk of another miscarriage?

Other factors such as age, being overweight, smoking, alcohol intake and excessive caffeine (more than 2 cups per day), may also increase the risk of miscarriage. Factors that can be modified should be changed or stopped prior to the next pregnancy.

As for all couples trying for a baby, folic acid of at least 400 mcg a day should be consumed up to three months prior to getting pregnant.

7. What can one do to reduce the feelings of anxiety or stress after a miscarriage?

Many women feel tearful and emotional for some time afterward. Family and friends’ support are important. You should always talk to your doctor if you are experiencing grief for a longer period of time, or feel that you need help in coping. Finding and joining support groups can be useful. Some couples can feel disconnected ― it is important to talk to each other and provide support when you can.

8. Any final tip or advice for women who have miscarried and are hoping for a rainbow baby?

It is important to know that having an early miscarriage can be quite common, but the silver lining is that it tends to not recur. However, for patients with recurrent miscarriages, make sure you get the help and tests that are needed. Sometimes no cause is found, but one has to continue to hope and be strong. During these pregnancies, I will tend to see them more frequently and provide hormonal medications during the first or second trimester to support the pregnancy and hopefully reduce pregnancy loss. 

Photos: iStock

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