TTC timing after csection and baby loss


Q: I lost my micro-preemie daughter at 26 wks. she had tetrology and was birthed via c section. her apgars were 2, 2, and 5. she died about an hour after delivery. how long do i have to wait to start trying again? in the hospital, they told me 18 months, but we would like to start sooner. here are the surgeon's notes:

"After general anesthesia had been induced, a Pfannenstiel incision was made. The fascia was then incised in a transverse direction and extended out to the lateral margins of the subcutaneous incision. Upper and lower fascial layers were bluntly and sharply dissected off the underlying rectus. The recti were bluntly separated in the midline, the underlying parietal peritoneum exposed, and bluntly entered to create a small opening into the peritoneal cavity. The incision was extended upwards to the upper level of the fascial dissection, downwards to the superior margin of the bladder. A Balfour retractor was placed into the wound and the uterus and its lower segment inspected. There was minimal development of the lower segment and therefore a decision was made to perform a classical cesarean section in order to have enough room to safely deliver this very preterm delivery. "

Symptoms:  None

A:   You seem to have undergone a classical c section and suffered many pregnancy westages. As a general rule, you should probably hold off on trying to conceive again for 18 to 23 months — about the same waiting period recommended for women who deliver vaginally.

That may seem like a long time, but you've just had major surgery and you need to let your body recover and replenish its loss. For instance, you may be depleted of some vital nutrients or anemic because of the iron transferred to your baby and placenta during pregnancy, as well as the blood loss you suffered during childbirth. Women who deliver via c-section lose twice as much blood — about two pints on average — as women who deliver vaginally. The scar on the womb need time to heal, too, especially in classical sections, like that of yours!

Studies have also shown that women who conceive less than six months after giving birth may have a higher risk for complications such as a ruptured uterus or a premature or low-birth weight baby. You'll need some time to adjust to your new life as a parent, too, before you add another baby into the mix. By giving yourself plenty of time to heal and to get acclimated to parenthood, you'll give your next baby the best start in life. The decision may be dicey, as you are in your late thirties, and the chance of fertility fades with time. However, at least an year seems to be safer temporal gap for conception for most. This time period is again variable. The best time to get pregnant can differ from woman to woman, and the health care provider's decision about specific circumstances needs to be sought.

In view of the unfavourable past medical history, it is recommended that you do not take any decision based on impulse, especially if not endorsed by your ObGyn. Please take a second opinion and make an informed choice.

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