Becoming pregnant after experiencing preterm birth can be nerve-wracking, overwhelming, and for many, downright terrifying.  It is impossible to know how things will go or to prevent all complications, but we can control some things.  Here are some tips to help you prepare for your pregnancy.

Before You Get Pregnant

  • Review your medical records
  • Schedule a preconception appointment with a perinatologist or high-risk obstetrician
  • Continue to take your folic acid and eat nutritious foods
  • Maintain a healthy lifestyle

Review Your Medical Records

Knowledge is power so before you get pregnant, or as soon as possible after you get pregnant, request a complete copy of your medical record from your obstetrician (OB)/midwife, the delivering hospital, and any other providers you saw (sonographer, perinatologist, etc).  Review your records carefully.  How did they manage your complication?  What medications were you given?  How did they manage pain during and after delivery?  What were the results of any lab work?  What were the findings of any pathology reports?  If you had a c-section, review the operative report to confirm what type of incision was made on your uterus.  This is important because the type of incision on your uterus may not be the same as the external incision, and certain types of incision carry higher risks of uterine rupture than others if a vaginal birth after cesarean (VBAC) is attempted.

Once you have read your medical record carefully, compile a list of questions to discuss with your doctor(s).

Preconception Consultation

Schedule a “preconception consultation” with a high-risk obstetrician or perinatologist before you get pregnant.  The doctor should be able to assess your risk with future pregnancies and recommend the best treatment plan.  Bring a copy of your complete medical record for the doctor to review.  Here is a list of basic questions to ask:
  • Based on my history, what are the chances that I will have another preterm birth?
  • What can I do to reduce that chance? (medications, supplements, interventions, diet, exercise)
  • The March of Dimes recommends that you wait 18 months before getting pregnant again after a full-term pregnancy. How long should I wait before trying to conceive again after a premature birth?
  • How would you manage my pregnancy?
  • What would you recommend if x, y, or z happened?
  • Do you serve as the mother’s primary provider and/or do you only work in consultation with an OB?
Expect the doctor to do some tests.  Blood tests can detect genetic, autoimmune and clotting disorders.  The structure and shape of your cervix and uterus can be determined by an ultrasound and other tests.  Knowing your family medical history, if possible, can be very helpful to your doctor.

Consider scheduling preconception consultations with your previous OB and/or any other OB that you may want to be your primary obstetric provider.

Maintain a Healthy Lifestyle

Eating regular, nutritious meals and snacks will help to improve your mood AND help your body heal.  You should also take a folic acid supplement every day and eat foods that contain folate, the naturally occurring form of folic acid . The March of Dimes recommends that all women of childbearing age consume 400 micrograms of folic acid daily.  Beans, peas and lentils have the highest amount of folate per serving.  Many vegetables are an excellent source of folate, including spinach, collards, romaine lettuce, asparagus, broccoli, okra, brussel sprouts, corn, avocados, cauliflower, beets, carrots, celery and squash. Citrus fruits, such as oranges and grapefruit as well as papayas and strawberries contain folate. It is also available in sunflower seeds and peanuts.

If you are breastfeeding or breast pumping, the March of Dimes recommends eating foods high in Omega-3 fatty acids or using supplements.  These foods include flaxseeds, walnuts, and soybean products – such as tofu, green leafy vegetables – like spinach, fatty fish – such as salmon or sardines. Some products, such as milk or eggs, can also come fortified with Omega-3s. Be sure that you are eating foods high in protein and calcium.

Many lifestyle choices that you make before you are pregnant can help you and your baby to be healthier when you do become pregnant again.

During Pregnancy

For many of us, our babies were born before we had a chance to finish preparing for their arrival.  Get started a little earlier this time around.
  • Schedule a hospital tour
  • Sign up for a birthing class
  • Sign up for a cesarean birth class – especially if you know you will be having a medically-indicated scheduled c-section
  • Create a prenatal appointment organizer – you may have extra monitoring appointments so keep all your questions and action items organized in one place.  Below is a free sample prenatal appointment organizer. 
  • Sign up for a breastfeeding class

Prepare a Birth Plan

As we all know, birth does not always go according to plan.  Nevertheless, you can use the process of writing a birth “plan” as a way to clarify what is most important to you.

Besides the typical birth plan considerations, consider how you can make the birth and time immediately following as family-centered as possible.  What would that look like to you?  Minimal separation?  Lots of skin-to-skin?  Lots of time for bonding?  Early support with breastfeeding?  Something else?    

If you know you will be having a medically-indicated c-section, review the paper “The natural caesarean: a woman centered technique”and this video demonstration and discussion of the technique.  If you would like to incorporate some of these ideas, share the paper and video with your OB and schedule a “consultation appointment” to discuss your wishes.  Request that it be the last appointment of the day or before lunch so that your doctor is not rushed.

If it looks like your pregnancy may end early, what do you want to plan to do?  Use hindsight of the previous experience to help you think through how you can make the best of the situation.  Maybe you want to pre-record yourself reading a special book to leave with your baby.  Or have pictures of you, daddy and older siblings ready to go on the isolate as soon as possible.  This time around you may have more warning or just choose to prepare for an early arrival “just in case”.

A birth plan is not exclusively for full-term, complication-free births.  A birth plan is for any birth and its preparation can help you organize your desires and wishes so that you make the most of any situation that unfolds..

Learn more

Prepare a Breastfeeding Plan

Prepare a breastfeeding plan to clarify for yourself, and those who support you, exactly how you want to approach breastfeeding and pumping.  Consider consulting the following books as you think through your breastfeeding plan:

Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers
, Chapter 4: "The First Week of Breastfeeding" gives specific detail about what to do during the first 24 hours and throughout the first week to make sure you build a solid milk supply.

The Breastfeeding Mother’s Guide To Making More Milk
, Part 5: "Surviving the Present and Planning for the Future" has a nice discussion about how to make peace with previous breastfeeding disappointments and how to prepare for the future.

Call the lactation department at your delivering hospital (your OB should have their contact information) and ask for their assistance in creating a breastfeeding plan for you before you arrive at the hospital.  Tell them your history and why this is so important for you.  Tell them that you would like them to visit you as soon as possible after the baby is born.  Ask them for any tips on how to maximize your breastfeeding success within your particular hospital.

Take Care of Your Mental Health

Without a doubt, being pregnant after having a baby born prematurely can feel like being on a rollercoaster.  Some days you are confident and at peace, other days you are full of worry and anxiety.  For many, the weeks around the time that their preemie was born can be especially nerve-wracking.  Expect to feel emotional.  Identify people in your life with whom you can share your thoughts and feelings without feeling judged or dismissed.

Consider working with a professional therapist to help guide you through the pregnancy.  Go to 2-1-1 Call Center Search (  to find a qualified therapist in your area. You can also check with your insurance company or Employee Assistance Program.

Watch for signs of Post Traumatic Stress Disorder (PTSD). 

Celebrate and Enjoy Every Moment!

At times it may be difficult but as much as possible ENJOY your pregnancy.  We all know what a blessing it is to go to term, alas, we also know that sometimes babies come early so we must savor every moment.  Take pictures, journal, and document every milestone!  No matter what, you are doing a wonderful job and deserve to enjoy and celebrate your pregnancy!