Emily Oster, PhD

Uterine atony — when the muscles of the uterus are weaker and do not contract enough after birth — can interact with other conditions which cause bleeding. So the short answer is: yes, PPH could be caused by retained placental products exacerbated by uterine atony.

Uterine atony typically will recur in a later pregnancy but treatment is better if you expect it — more pitocin after birth to encourage contraction, for example. Retained placental product is more common is you’ve had multiple C-sections, although it is often unpredictable. Unfortunately, there is relatively little that can be done before delivery to prevent it.

Our target audience for the book is people who had complications in a prior pregnancy or birth and would like help navigating or considering a second pregnancy.

I’m sorry this wasn’t in the book! It’s covered more extensively in Expecting Better and I wrote about it long-form here. https://elemental.medium.com/what-to-expect-when-you-have-a-miscarriage-74114d2bb7de

The choices here are absolutely complex and — like many complications — there is a lot of personal preference. A D&C is the fastest way to complete a miscarriage, but many women prefer to manage miscarriage at home. Taking medication works in about 80% of cases, with 20% needing a subsequent D&C. In the end, these are all safe options — if incredibly hard — and talking through what you want with your doctor is crucial.

Ask her! This question is so personal, and everyone’s approach is going to be different. But the simple question: “How can I best support you in this journey?” is going to give you a lot of what you need to know. Holding onto joy while living with the possibility of grief is among the hardest things.

The answer here depends a little bit on why you had the abruption. Sometimes, a placental abruption is clearly due to an event like a car accident. In that case, there is not much reason to worry about recurrence. If the abruption was unexplained, then your doctor may want to watch you more carefully. This would likely mean more visits, especially towards the end of pregnancy, and probably a planned C-section or induction at 39 weeks.

Yes! The structure of the second part of the book is to discuss specific conditions, and then go into the risk of recurrence and possible treatment options (along with a discussion of how to talk to your doctor about your options)

Yes — in the chapter on preterm birth we talk through the recurrence risks and also possible explanations. On average, for women who deliver a first baby between 32 and 36 weeks, there is about a 15% chance of a preterm birth in a second pregnancy. This is an average — the recurrence risk is lower if there is an avoidable reason for the preterm birth (like infection) and possibly higher if there is a systematic reason.

If you do pursue another pregnancy, it’s certainly a good idea to talk to your doctor in advance to see if you can understand anything more about why this happened in your case, and what treatments might be available.

This is a great question. The short answer is that this data isn’t available in any systematic public way. Researchers are sometimes able to get this for particular hospitals or systems, but there isn’t a public reporting system.

You CAN ask at the hospitals you are considering, or ask related questions — C-section rate, for example. A caution is that hospitals that treat a higher risk population of patients will seem to have “worse” outcomes, even if they are better hospitals overall.

We discuss the evidence on progesterone in the context of preterm birth in that chapter. In the case of miscarriage, the data overall doesn’t provide strong support for a role of supplementation in preventing miscarriage. In the largest randomized trial of this treatment for recurrent pregnancy loss there was no impact on pregnancy rates or outcomes. Having said that, there are smaller trials or more specific ones that suggest there could be some small effect in some cases. This is a case with a lot of clinical disagreement about what the best course of action is.

Meg is correct — it’s not in this book, although our hope is that the general discussion in the first part of the book would be helpful regardless of condition. We have this on a list of topics to consider adding to a later edition (and to ParentData).

Not in this book — but there is a long discussion of this in Expecting Better and one here as well:

External Cephalic Version (ECV) for Breech Babies

This is very well said! “Data is not bossy” is the shorthand I sometimes use.

Hi Everyone! It’s Emily. I’m a professor of economics, a mom of two and a runner. And I write ParentData! I’m so thrilled to have you all in this community and I can’t wait to hear more from you.