Pregnant after a loss: seeing your baby early

Hope and fear, side by side

A positive test after a loss can bring mixed feelings. The UK charity Miscarriage UK describes feeling “hopeful and cautious at the same time,” while carrying “the fear that it could happen again” (Miscarriage UK).

A 2008 study by researchers in Berlin followed 342 women after a miscarriage at up to 16 weeks. The 108 with questionnaires from the first trimester of a new pregnancy reported more pregnancy-specific anxiety than 69 pregnant women who had never miscarried (Bergner and colleagues, 2008). A study in Norway and Sweden recruited 2,072 women who had been pregnant before, in 1986 to 1988, and analyzed 1,458. The 401 with a past pregnancy loss or newborn death reported more anxiety and depression symptoms on questionnaires at 25 weeks of their next pregnancy than the 1,057 without (Mainali and colleagues, 2023).

In a small study by U.S. researchers, 63 women pregnant after a loss were asked about holding back their emotions. More than half (58.7%) reported some “emotional cushioning”: guarding their feelings and putting off bonding in case of another loss. It went along with more pregnancy anxiety (Côté-Arsenault and Donato, 2011).

When scan days are the hardest

The UK charity Tommy’s calls anxiety around scans “scanxiety” (Tommy’s). In a UK study, 14 women with recurrent miscarriage were interviewed about the early weeks of a new pregnancy. All valued the reassurance scans gave, but “any optimism they felt after a positive scan was short-lived” (Bailey and colleagues, BMJ Open, 2019). European guidance calls anxiety about pregnancy after recurrent loss “both normal and understandable” (ESHRE guideline).

About “rainbow babies”

You may hear a baby born after a loss called a “rainbow baby.” Cleveland Clinic describes the image as “something beautiful after a dark time — a rainbow after the storm” (Cleveland Clinic). Not everyone takes to it. For some parents, says Tommy’s, a rainbow baby “doesn’t take away the grief they feel about their loss” (Tommy’s). Use the words that fit you.

What early care your doctor or midwife may offer

Your care “will depend on your medical history and your local clinic’s policy,” as Tommy’s puts it (Tommy’s). In England, NICE says early pregnancy assessment services “should accept self-referrals” from women who have had recurrent miscarriage, or a previous ectopic or molar pregnancy (NICE). None of this promises a scan, so ask early.

After one miscarriage

The NHS says: “Most women who’ve had a miscarriage go on to have a successful pregnancy in the future” (NHS). In the UK, you can ask your GP or early pregnancy unit about an early scan, Tommy’s says, “but this may only be offered when there is a medical reason” (Tommy’s). In the U.S., Cleveland Clinic says heart rate checks and prenatal visits “can go a long way toward relieving anxiety,” and suggests asking for them (Cleveland Clinic).

After two or more miscarriages

The UK’s Royal College of Obstetricians and Gynaecologists (RCOG) defines recurrent miscarriage as “three or more first trimester miscarriages” (RCOG). Europe’s ESHRE and ACOG in the U.S. both count two or more losses (ESHRE, ACOG).

• UK. The RCOG says women with unexplained recurrent miscarriage (three or more, by its definition) “should be offered supportive care, ideally in the setting of a dedicated recurrent miscarriage clinic.” Some of these clinics and early pregnancy units “may offer an ultrasound scan and follow-up in the early stages,” says Tommy’s (Tommy’s).
• Europe. In its advice on organizing care, ESHRE lists “additional/early scans if wanted” as part of “supportive care in the next pregnancy/ies” (ESHRE guideline). It isn’t a graded recommendation.
• U.S. ACOG’s patient guide covers tests and a checkup before trying again; it doesn’t discuss scans in a next pregnancy, so ask your doctor or midwife. It says: “About 65 in 100 women with unexplained recurrent pregnancy loss have a successful next pregnancy.”

After an ectopic or molar pregnancy

In the UK, Tommy’s says that after either you should be offered an extra medical scan at 6 to 8 weeks “to check that the baby is developing in the right place” (Tommy’s). If no one mentions it, ask. A keepsake scan can’t take its place.

After an ectopic pregnancy, NHS advice in England is to tell your GP “as soon as possible so early scans can be carried out to check everything is OK” (NHS). In the U.S., the StatPearls medical reference stresses “timely pregnancy testing and early ultrasound evaluation” after a past ectopic (StatPearls).

In England, after a molar pregnancy, blood and urine tests check that hCG, the pregnancy hormone, is returning to normal (NHS). In the UK, you’ll be advised not to get pregnant until this follow-up ends, and to tell the follow-up service if you do (Miscarriage UK leaflet). In the U.S., Mayo Clinic says that in a later pregnancy, “a care provider may do early ultrasounds to check your condition and make sure the baby is developing” (Mayo Clinic).

After a later loss or stillbirth

In the UK, after a stillbirth or a later loss, Tommy’s says you “should have a plan of care made with you early in your pregnancy.” It adds: “If you would like more scans or appointments than offered, you can ask for more” (Tommy’s).

If you have bleeding or pain

In the UK, call 999 or go to A&E for any of the symptoms above. The NHS in England says to call 999 if you’re pregnant with vaginal bleeding and the bleeding is heavy, or you have severe tummy pain or pain in your shoulder, or you feel sick, faint or dizzy (NHS). For light bleeding or spotting with no or only mild pain, it says to call your maternity unit or, if you’re under 20 weeks, an early pregnancy unit. If you can’t reach one, it says to call NHS 111.

How to ask for what you need at a scan

1. Pick a week with something to see. On an internal scan, the sac typically shows at about 5 weeks and an embryo with a heartbeat at about 6 (Society of Radiologists in Ultrasound). A belly scan shows each about a week later (AAFP). Waiting for a period after a loss “helps with clearer dating,” says Miscarriage UK (Miscarriage UK). How early can an ultrasound see a pregnancy? has more.
2. Say it at the start. Tell the sonographer about your loss. Tommy’s suggests you “tell them beforehand you’re feeling anxious.”
3. Choose how you see the screen. You “might ask to have your screen off at first or to be told straightaway if a heartbeat is detected,” Tommy’s says (Tommy’s). At one NHS hospital, “the person scanning you will give you the choice” (Leeds Teaching Hospitals).
4. Ask them to talk you through it. A good-practice guide for UK scan staff asks them to warn you before they go quiet. Women told its authors they “start to guess something is wrong if you go quiet or turn the screen away” (Miscarriage UK).
5. Ask who gives the results. In the U.S., Cleveland Clinic says that “in most cases, the sonographer won’t discuss your ultrasound results”; an obstetrician goes over them (Cleveland Clinic). At the NHS hospital above, you’re told in the scan room. Why the sonographer may go quiet has more.
6. Bring someone, and plan the rest of the day. Tommy’s suggests talking beforehand about how they can help, and notes you may “feel emotionally drained afterward.”
7. Say if internal scans are hard for you. Internal or belly ultrasound? covers consent and chaperones.

What a good scan can tell you, and what it can’t

At an early medical scan, the sonographer checks that “the pregnancy is growing in the womb (uterus), whether there is a heartbeat and whether the pregnancy is the right size” for your dates. Those are good signs. But “a scan will just show how the baby is growing at that time,” Tommy’s says. “It can’t predict how your pregnancy will progress” (Tommy’s).

A heartbeat is a good sign, but not a promise. In an Australian study that followed 697 women with no symptoms and analyzed 696, the risk of miscarriage after a heartbeat was seen “fell rapidly with advancing gestation” (Tong and colleagues, 2008). When can you see the heartbeat on an ultrasound? has the figures. That study wasn’t about pregnancies after a loss. After recurrent loss, ESHRE recommends basing prognosis on “woman’s age and her complete pregnancy history,” so ask your doctor or midwife about yours (ESHRE).

If a scan can’t show what you hoped, it can simply mean it’s early, or that your dates are off. It can also be a sign of a problem, and only your doctor or midwife can tell which. Tell your doctor or midwife, even if you feel well. No heartbeat on an early ultrasound explains what comes next.

If you find yourself wanting a scan every week, talk to your doctor or midwife. The FDA says scanning purely for keepsakes “has been discouraged,” and the AIUM “strongly discourages the nonmedical use of ultrasound” (FDA, AIUM). ACOG says ultrasound should be used only to answer a medical question or bring a medical benefit (ACOG Committee Opinion 723). Is an early ultrasound safe for the baby? and Safety, in plain words have more. Is an early reassurance scan worth it? weighs it up.

Partners and family

A partner loses the pregnancy too. “It is sometimes assumed that miscarriage is easier for the partner who was not physically pregnant,” Miscarriage UK writes. “But this is your loss, too, and your feelings are valid” (Miscarriage UK).

A London study recruited 192 couples after a miscarriage or ectopic pregnancy and sent them standard questionnaires; at 1 month, 60% of partners and 78% of women replied. Some of the partners (all were men) reported clinically relevant levels of post-traumatic stress, anxiety or depression, though fewer partners than women did. Among those who replied at 1 month, 7% of partners met the criteria for post-traumatic stress, against 34% of women (Farren and colleagues, 2021).

In the next pregnancy, you may each feel different things. “One person might feel eager and optimistic, while the other feels anxious or guarded,” says Miscarriage UK, which suggests “open and gentle conversations” (Miscarriage UK). Invite your partner to the scan if they’d like, agree who does what, and point them to support of their own. PSI runs a free online group for fathers grieving a pregnancy loss (PSI). The Sands helpline, below, also supports grandparents.

Where to find support

If anxiety or low mood is taking over, tell your doctor or midwife, as Mayo Clinic also advises (Mayo Clinic).

• In the U.S. Call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262). It’s free, confidential and available 24/7 in English and Spanish (HRSA). Postpartum Support International’s HelpLine, 1-800-944-4773, offers support and resources (PSI), and PSI’s free online groups include “Pregnancy After Loss” (PSI groups).
• In the UK. Tommy’s midwives’ helpline is free on 0800 0147 800, 9 to 5 on weekdays (Tommy’s). Miscarriage UK, formerly the Miscarriage Association, has a support line on 0303 003 6464 (Miscarriage UK). After a stillbirth or the death of a baby, the Sands helpline, 0808 164 3332, offers support with “coping with another pregnancy after the death of a baby” (Sands).

If you’d like an early look in Glendale

Our Pregnancy Check, in Glendale, is a short, private 2D ultrasound in the first 10 weeks. We point out what you’re looking at on a big screen, and tell you what we could and couldn’t see. Partners, family and friends are welcome, or come on your own.

The price is $100, with no referral or insurance needed, and 8 black-and-white prints go home with you. If you’d like to come, call (818) 243-7010 and give us the first day of your last period; we’ll tell you whether it’s a good day. If it’s too early to see, you come back for a second look, almost always at no charge. Same-day appointments are often available.

A keepsake scan can’t check on your health, date your pregnancy or replace the early medical scan your doctor or midwife may offer. Whatever any scan shows, tell your doctor or midwife, even if you feel well. How a Pregnancy Check works.

From a due date, even a rough one, the planner sorts our sessions into those ready now and those opening next. The dates you type stay on your device.

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