Another baby after preemie UPDATED

[redblue]

DH and I want another child. DS was delivered at 30w3d, PTL just started out of the blue (started spotting, slight period-like pains), it was initially halted with Procardia but 12 hours later my water broke and DS was delivered 10 hours later.

I am terrified to have another preemie. DS was in the NICU for 56 days, had a brain bleed (that resolved, thank God), a NEC scare and finally came home on an apnea monitor for 6 months.

I have been to see an MFM and he seems confident everything will be hunky dory, he says I have an 30-40% increased risk of PTL. I have been offered progesterone shots and regular cervix checks. To me 30-40% is a significant risk.

Has anyone been in this position? How did you decided whether to just be OAD or to try for another. Add into the mix my age (37), we have to make a decision sooner rather than later.

Thanks for reading.

UPDATE

I have an appointment booked next week to consult with another MFM.  Thanks again for all the advice and support.

[wavepool]

First, I'm sorry you're in this situation. Before having a baby, it seemed like everything surrounding it would be so exciting and happy, then something like this happens and it's the scariest time of your life.
My husband and I talk about this often. O wasn't a preemie, but had a NICU stay and his prognosis wasn't good for a while. My h is just too terrified to have another. He always says the same thing, worse, or something different could happen and he just doesn't think he can go through it again.
If you really desire to have another child, do you think therapy/counseling could help you get through the PTL part? Also, I'd probably go to another doctor for another opinion just to hear it from someone else and see what they have to say.
I hope you find the resolution you need!

[Deleted]

My SIL delivered her first at 28 weeks. She has two kids, less than 2 years apart. With her I think they did suspect some kind of cervix issue and used a cerclage the second time. She was also pushing 40 and knew she wanted at least 2 kids, so they just did it. Her second was full term (and both are now very healthy, happy kids at 6 and almost 5).

Not an easy choice, for sure, but I thought happy anecdotes are worth sharing.

[stretchad]

I'm right there with you. DS was born 7 weeks early. I was being monitored by MFM from the get go of the pregnancy because of concerns over my cervix (i had a previous D&C and Asherman's). But at 16 weeks U/S showed complete previa, which never resolved. I had a bleed at 31 weeks, was on hospital bed rest for a week, home for a week, then had another bleed at 33 weeks and delivered DS via C-section 40 minutes after being checked into the hospital. I had 2 blood transfusions and DS was in the NICU for 4 weeks.

I haven't consulted with my doc yet, but I do know a subsequent pregnancy has a lot of issues. Increased risks of another previa, the risks that another previa would be worse, my cervix issues, trouble getting pregnant (I did IVF), and a previous molar pregnancy...we've decided to be one and done. It's risky for me, risky for the baby. But in all honesty, I'm not getting rid of my frozen embryos yet and DH isn't getting snipped or anything. It's a really hard decision.

[ijack]

I had a horrible first pregnancy - bleeding from the very beginning, a partial abruption at 17w, another at 23w which resulted in being admitted to the hospital and being told that I needed to decide how far to take life savings measures, being on hospital bed rest for 6 weeks and then not knowing I was in labor until I was 8cm and delivering at 29.5w, a 2.5lb baby and 50 days in the NICU. I get you, definitely.
For me I always knew that I wanted a second one, but it took me a long time for me to be ready again. Once I was okay with the thought of having another pregnancy that went exactly the same (or worse) and even okay with having another preemie, I knew I was ready. I talked to my parents and put a plan in place if I did end up on bed rest again. My OB was super confident that it wouldn't happen again and was awesome throughout the whole thing. She promised to do everything she could to ease my mind and she really did.
My second pregnancy was a total 180 and everything I hoped it would be. I was extremely nervous the whole time and really didn't relax until I was induced. But really it came down to me wanting another child enough that I would go through all that shit again. It took me almost 3 years to be comfortable, but I did get there.
swank has a slightly different story about having a preemie after a preemie, so hopefully she'll comment too.
Lots of hugs!

[thejen626]

My SIL had her first baby at 31 weeks. She had to take some kind of medication throughout her second pregnancy to prevent early labor. She ended up needing to be induced around 41 weeks.

Good luck to you!

[Susie]

I haven't personally, but our goddaughter was born at 31 weeks.  Her mom's water broke at 30 weeks and some days, just sitting on the couch.  It was totally unexpected.  They were able to stop labor and keep her pregnant in the hospital long enough for steroids to have some benefit for her lungs.  She delivered by cs at 31 weeks.  The doctors never had any idea why it happened, and I know it was scary for her with #2 (which she did have, 2 years later).  Each week past 31 weeks with #2, she announced with great trepidation that she was "more pregnant than she'd ever been before!"  For unrelated reasons she had a scheduled cs with #2, and everything went fine and normally, no PTL issues.

Another friend of mine went into PTL at 23 weeks with twins.  With bed rest and other interventions, they managed to stop labor until 36 weeks, at which point the twins were born healthy and didn't need NICU time.  The intervening 13 weeks were a nightmare for them.  They've decided, partly because of this experience to be twins-and-done.

In short, whatever you decide is reasonable.  I agree that maybe a 2nd opinion might make you feel more comfortable and be worth pursuing if you are thinking you want to have a second.

[sjh722]

Another positive anecdote, my friend's first DD was born at 30 weeks. Her second was a scheduled repeat c/s at 39 weeks, no complications, she just had appointments more frequently throughout the pregnancy to keep an eye on things.

Another friend lost a baby at 20 or 21 weeks to PPROM, I think, and she went on to have 2 more healthy, full-term babies within a few years.

I understand that it would be a scary choice. Good luck with whatever you decide!

[jacquez1]

I'm sorry your son had a rough start. Prematurity blows! In my case I had very clear cut IC. So I knew if we decided to try for a second child I would get a cerclage. I ended up getting a TAC which is the most aggressive cerclage available because I was so freaked out about having another preemie. I did weekly ultrasounds and progesterone shots.  No bedrest.  My H and I weighed the options for a while but in the end it was just a leap and we did it. I was scared out of my mind until around 32 weeks. Everything worked out fine with my 2nd DD being born by rcs at 38w2d. The delivery, hospital stay and her first year were so incredibly, wonderfully different than the first. Best of luck with whatever you decide!

[longtimenopost]

It's scary, but we are getting ready to TTC after DD2 was born at 26 weeks and now has CP. Over the summer we discovered I had a large uterine septum that likely caused DD1's stillbirth and DD2's prematurity. I had surgery last week to remove the septum so as soon as we get the go ahead, we will try for #3. Since we don't know for SURE that the cervical incompetence that led to DD2's birth was due to the septum (though it is most likely), I may or not get a cerclage with another pregnancy. I will definitely be getting a new OB and seeing an MFM.

I truly believe that having more children is the right choice for our family, and that DD2 and future siblings will benefit from each other. We are lucky to have family help (my parents in their early 60s are retired) and will have a plan in place should I need to go on bedrest or have another NICU stay.

[jessnpaul]

DS was born at 32 weeks (but he was more like a 28-weeker due to IUGR) and spent 2 full months in the NICU which included surgery. He's been back and forth to the Peds ward a few times and this Friday we're having his 5th surgery in his 2.5 years of life! It has not been easy!

However, due to my age (40), we've been TTC'ing for the last year. My OB thinks what happened to me last time was a fluke and I'd be fine this time. Unfortunately I'm dealing with secondary infertility now and may have to be OAD... but we're still doing everything we can to have a second as I'm a big fan of siblings

It's a personal decision though... and if you're not ready, OAD is okay too!

[marclovesme]

I struggle with this because DD was preemie, and though she didn't require a long NICU stay, it emotionally scarred me. I was high risk from 11 weeks on, but they never thought I'd deliver early... Looking back, I was a mess the first 9 months of DD's life because she was born early.

After having conversations with my doctor, any future pregnancy I have will be "automatically" high risk. I literally shut down once he told me that. Even thinking about it is upsetting. I personally need to work through that to entertain the thought of another child.

Aside from that, financially speaking OAD puts our family in a better position. I think I use that more as my crutch due to the emotional/psychological stuff related to having a preemie.

[mudslide]

I had PPROM at 30w5d and was able to stay pregnant until induction at 34w. Looking back, I think I'd had contractions starting around 24w but didn't realize it.

My MFM told me that with the progesterone shots I have an 80% chance of carrying to term.
I'm still scared but we will see what happens

Eta: definitely ask about cervical ultrasounds. I will have to have those if I get pregnant again.

[osulori]

My coworker's situation was similar in ways to swank's-her older son was born at 31 weeks and his little brother made his entrance two years later at 29w. Her doctor has told her that her situation was definitely in the minority, but that they were also pretty confident that if she and her H chose to go for #3 it was highly likely they'd have a similar outcome. Since both boys had relatively uncomplicated NICU stays and are now happy, healthy, totally typical kids they decided to not take that risk (basically they decided to quit while they're ahead). I can't fathom how hard that decision must be, but whatever you decide to do it will be the right decision.

[ohgillian]

Oct 1, 2014 10:51:09 GMT -5 ijack said:

I had a horrible first pregnancy - bleeding from the very beginning, a partial abruption at 17w, another at 23w which resulted in being admitted to the hospital and being told that I needed to decide how far to take life savings measures, being on hospital bed rest for 6 weeks and then not knowing I was in labor until I was 8cm and delivering at 29.5w, a 2.5lb baby and 50 days in the NICU. I get you, definitely.
For me I always knew that I wanted a second one, but it took me a long time for me to be ready again. Once I was okay with the thought of having another pregnancy that went exactly the same (or worse) and even okay with having another preemie, I knew I was ready. I talked to my parents and put a plan in place if I did end up on bed rest again. My OB was super confident that it wouldn't happen again and was awesome throughout the whole thing. She promised to do everything she could to ease my mind and she really did.
My second pregnancy was a total 180 and everything I hoped it would be. I was extremely nervous the whole time and really didn't relax until I was induced. But really it came down to me wanting another child enough that I would go through all that shit again. It took me almost 3 years to be comfortable, but I did get there.
swank has a slightly different story about having a preemie after a preemie, so hopefully she'll comment too.
Lots of hugs!

This is the truest thing for me. I was surprised by how much I didn't enjoy pregnancy #2 because of all my fears of a repeat. I basically white knuckled it thru until I delivered at 35 weeks and frankly, I was grateful at that point because I was delivering and could stop being afraid. I wish I had been better prepared for how stressful #2 would be. (Why I wasn't, I have no idea.)

[starlily]

DD1 was born at 35 weeks - spontaneous labor She did have a NICU stay, but overall did well. We always planned on two kids and after deciding that we'd be ok if something similar happened a second time, we proceeded as planned.

With DD2, my OB had me go on progesterone shots starting at 16 weeks and cervical length checks every other week between weeks 16 & 24. DD2 was born at 35 weeks, 1 day - spontaneous labor again. Unlike DD1 however, she didn't require any NICU time, just an extra night in the hospital rooming in.

OTOH, being deemed high risk from the start for pregnancy #2 made me a little nervous, but at the same time the extra attention gave me some degree reassurance. I actually enjoyed pregnancy #2 more. I did, however, start getting really nervous around 33 weeks. I had this thing in my head that if I could just get past 35 weeks without anything happening then I'd carry to full term. It didn't quite work out that way, but we still had a good outcome.

[redblue]

Thanks everyone for you kind words and advice. I have decided that I think it would be wise to seek a 2nd opinion from an MFM. I do tend to be a glass half empty kind of girl. I keep thinking of all the what ifs. Prior to DS, I knew very little about premature babies, I now understand preemies and their possible problems perhaps a little too much. We feel very blessed that DS is doing so well, I wonder if we should just be grateful for what we have, so many emotions!!

The other thing is we do not have any family here (we are from the UK). If I was go to on bed rest I am not sure how we could cope with DS. May we would have to fly in a parent?? So much to think about.

Thanks again, it is very comforting to here positive stories.

[starlily]

Oct 1, 2014 17:21:04 GMT -5 redblue said:

Thanks everyone for you kind words and advice. I have decided that I think it would be wise to seek a 2nd opinion from an MFM. I do tend to be a glass half empty kind of girl. I keep thinking of all the what ifs. Prior to DS, I knew very little about premature babies, I now understand preemies and their possible problems perhaps a little too much. We feel very blessed that DS is doing so well, I wonder if we should just be grateful for what we have, so many emotions!!

The other thing is we do not have any family here (we are from the UK). If I was go to on bed rest I am not sure how we could cope with DS. May we would have to fly in a parent?? So much to think about.

Thanks again, it is very comforting to here positive stories.

When you talk to your MFM, ask his/her opinion about bedrest. It's my understanding that the recommendations are changing.

[oswin]

Oct 1, 2014 10:30:43 GMT -5 redblue said:

I have been to see an MFM and he seems confident everything will be hunky dory, he says I have an 30-40% increased risk of PTL. I have been offered progesterone shots and regular cervix checks. To me 30-40% is a significant risk.

Please double check this math. Is it 30-40% overall chance of having a preemie or 30-40% increased risk - so 30-40% more likely than 12.3% (national average) which is around 16.6% overall chance? That's a big difference. Anyway, I have not had a preemie, but I don't think I would let it stop me from having another child.

[faith194]

My brother was a healthy baby. 14 months later, I was born at 34 weeks with pneumonia. I had a 6 week NICU stay, and two more hospitalizations within the first year. When I was 5, Mom gave birth at 24 weeks with my sister with neural tube defects(she did not survive). When I was 7, my mom gave birth to a healthy, full term baby girl and promptly had her tubes tied(not planned csection). How my mother could move forward with each pregnancy after my birth story, and then Sarah's, I will never know! It just goes to show how different each pregnancy can be.

Good luck with whatever you decide!

[isabel]

My MIL delivered DH at 31 weeks. His younger brother was delivered right around his due date, with no complications. I don't have any personal experience, but just because it happened with one doesn't mean it will happen with the next.

[Deleted]

Oct 1, 2014 17:51:15 GMT -5 starlily said:

Oct 1, 2014 17:21:04 GMT -5 redblue said:

Thanks everyone for you kind words and advice. I have decided that I think it would be wise to seek a 2nd opinion from an MFM. I do tend to be a glass half empty kind of girl. I keep thinking of all the what ifs. Prior to DS, I knew very little about premature babies, I now understand preemies and their possible problems perhaps a little too much. We feel very blessed that DS is doing so well, I wonder if we should just be grateful for what we have, so many emotions!!

The other thing is we do not have any family here (we are from the UK). If I was go to on bed rest I am not sure how we could cope with DS. May we would have to fly in a parent?? So much to think about.

Thanks again, it is very comforting to here positive stories.

When you talk to your MFM, ask his/her opinion about bedrest. It's my understanding that the recommendations are changing.

My girls were born at 36w4d so while technically preemie we did not have any NICU time. But, I did want to confirm that many MFM are moving away from bedrest. New research is showing that bedrest does not stop one from delivering early. I went into ptl at 32w6d and from that point on I had regular contractions, usually about 4 an hour, every hour until I delivered. I was on bedrest at the hospital that first week but by the end of the week they sent me home with just instructions to take it easy but no strict bed rest. I did end up staying in bed a lot of the time but that was due to the contractions and just being really large and uncomfortable.

[elocrates]

A little different story than yours, but perhaps helpful none the less:

With DS2 I had PTL which landed me on hospital bedrest at 25w5d. We were extremely lucky they were able to stop labor. It was touch-and-go for several weeks in the hospital and then more weeks at home. He was ultimately born a little after 36w after lots of interventions to prevent labor.
We had always wanted 3 or 4 kids, so I saw my MFM around 10 weeks PP for a consultation. An HSG was normal. All my blood work was fine. So the MFM gave me a structured plan for what we would do next time to prevent the same issue. This helped ease my mind a little bit.

With DS3 I started weekly progesterone injections around 14 weeks and had cervical length checks (ultrasound) every other week from 14 to 19 weeks when my cervical length dramatically shortened. It was right at the cusp of the cutoff for a cerclage, so one was never done. Unfortunately, at 23 weeks (just after the cerclage cutoff) the cervix shortened to nearly nothing, but by that time it was too late for a cerclage. I also had contractions again but starting around 20 weeks. I was put on indomethacin for a while, stayed in the hospital on magnesium at 28 weeks and again at 27 weeks for full blown PTL again, bedrest starting at 27 weeks. Got transitioned to nifedipine for the remainder of my pregnancy starting around 31 weeks. DS3 was born at 37 weeks.

Ultimately a good outcome even after the same problems. I did find it comforting to have such close follow-up and strongly feel that this is what prevented a premature birth for DS3. They were absolutely on top of anything that came up. At my PP follow-up, the MFM stated, "if you have a 4th we are putting in a cerclage right away." We decided to stop at three kids. The risk of recurrence for me is now over 80% since it has happened twice. And the stress it placed on our family was immense. It was, without a doubt, worth it for us.


On a separate note, I have two friends who had preemies for their first due to PTL/ IC (one at 27w, one at 32w). Both had progesterone injections with their second pregnancies and delivered at 39w. According to my MFM, this is by far the more common situation.

[sillygoosegirl]

Oct 1, 2014 17:59:30 GMT -5 oswin said:

Oct 1, 2014 10:30:43 GMT -5 redblue said:

I have been to see an MFM and he seems confident everything will be hunky dory, he says I have an 30-40% increased risk of PTL. I have been offered progesterone shots and regular cervix checks. To me 30-40% is a significant risk.

Please double check this math. Is it 30-40% overall chance of having a preemie or 30-40% increased risk - so 30-40% more likely than 12.3% (national average) which is around 16.6% overall chance? That's a big difference. Anyway, I have not had a preemie, but I don't think I would let it stop me from having another child.

This is what I was going to say. When something is described as a "X% increased risk" it normally makes it sound much riskier than it really is.

[BAMFMrsB]

Oct 1, 2014 20:30:22 GMT -5 @starry said:

I am sure I will be a wreck if I get pregnant again but I also feel comforted in that I know the signs of pre-e / HELLP and could probably respond more quickly (I was wandering around with upper quadrant pain for over a day knowing my blood pressure was out of control). I was not a good advocate for myself last time and I think I would be the next time.

I realize now I was realllllly sick and my body was trying to tell me to stop & rest!! For having a 2nd I just know I'll be very closely monitored. My MFM and OB will be watching me for signs of HELLP and pre-e. I really want another kid and I'm working on DH joining me in this endeavor. ?

I'm fairly certain we'll be 2 and done -- short of winning the lottery or getting like double the salary! Kids are expensive. I'd be happy to have many more kids if we could afford it. Fear of going through HELLP 2.0+ is not holding me back from having another baby.

[cst2cst]

Dd was born at 27 weeks due to severe pre-e, HELLP, and IUGR. DD spent 79 days in the NICU with no real complications and caught up developmentally around one year.

Because there was a blood clot in the placenta I was tested for clotting disorders and found to have factor two gene mutation. Because if that, and how early and severe my pre-e was, my MFM gave me a 50% chance of it happening again, with no way of predicting how early.

We decided not to risk it again. I worried that we wouldn't get as lucky a second time. But we decided to pursue adoption and are waiting to be matched. We both still want two children so we are working to make that happen in a different way.

Good luck with your decision and second opinion.

[wavepool]

Oct 1, 2014 14:18:23 GMT -5 gravytrain225 said:

Oct 1, 2014 10:39:27 GMT -5 wavepool said:

First, I'm sorry you're in this situation. Before having a baby, it seemed like everything surrounding it would be so exciting and happy, then something like this happens and it's the scariest time of your life.
My husband and I talk about this often. O wasn't a preemie, but had a NICU stay and his prognosis wasn't good for a while. My h is just too terrified to have another. He always says the same thing, worse, or something different could happen and he just doesn't think he can go through it again.
If you really desire to have another child, do you think therapy/counseling could help you get through the PTL part? Also, I'd probably go to another doctor for another opinion just to hear it from someone else and see what they have to say.
I hope you find the resolution you need!

I am hijacking, sorry.  There is a pregnancy after HIE fb group if you want me to add you.  There are a lot of posters who are TTC or thinking about TTCing. 

Just saw this. Yes, please! Thank you!

[redblue]

UPDATE

I have an appointment booked next week to consult with another MFM. Thanks again for all the advice and support.

[mudslide]

Oct 3, 2014 18:12:43 GMT -5 redblue said:

UPDATE

I have an appointment booked next week to consult with another MFM. Thanks again for all the advice and support.

I'm glad you're seeing a MFM. I hope it goes well.