Thank you so much for writing this. I survived 2/5 of the severe maternal morbidity chapter and as a bonus, the pre-eclampsia chapter, and the thing I have been wondering is how to compare the mortality risk of giving birth again to the mortality risks of things I do in my every day life. Given the probability of recurrence and the mortality risk of the types of complications I know I am at higher risk for, is my chance of dying if I have a second baby like my lifetime risk of dying in a car accident? Motorcycle? Sky-diving? (note: I do not do those last two things).

My 4 yr old had to have a CT scan of his abdomen and drink the dye- even though e we asked before and were told no another doctor did tell us after the surgery an ultrasound could have been done instead. Are his chances of developing cancer because of the radiation significantly higher?

Do you discuss or have you encountered pulmonary embolism during labor? Would love to find any other(s) who have experienced this!

Hi Emily! I’m curious if you and Dr. Fox studied the research on SPD. I had it with both pregnancies, and with my second, it was pretty extreme and debilitating – I was using a walker to get to the bathroom at night, for example. (Interestingly, the morning after delivering, I was like a new person after months of declining mobility and pain – it was unbelievable.) My doula described it like this: “SPD is to pelvic girdle pain as hyperemesis is to morning sickness”, which did a LOT to make me feel seen and understood. And miraculously my L&D nurse was 35 weeks pregnant herself (hero) and suffering from SPD, too, so she was able to help me navigate the delivery process and help the medical team to help me with being extremely careful in all the subtle ways that matter with SPD. Anyway, my question is: do you have any research on SPD, and particularly whether one should expect it to happen again if it’s happened before? We are likely to forgo having a 3rd simply because of SPD and how hard it was on my body and our family as a result. So it’s a big question on our minds!

How concerned should I be about the long term impacts of preeclampsia, such as increased risk of heart disease?

Does the book cover TORCH infections like congenital CMV?

Do you cover the increased risk of complications that can come from pre existing conditions such as lupus or other chronic diseases? How do we think about our own personal risk profiles when considering a pregnancy?

In your newsletter, you say, “Our hope is that it can be a starting point for normalizing discussions about these topics…” That feels off to me. It neglects the scores of parents who create and manage safe and supportive spaces for folks who’ve had miscarriages (like r/PregnancyAfterLoss). After my D&C, they sent me home with a giant packet of resources full of groups available to me.

For every person who mentions to me, “people don’t talk about miscarriage,” there are 3-4 others who barely need a cue to start talking about their experience with miscarriage. That’s “anecdata,” sure, but at this point, I think *people do* talk about miscarriage, but talking about it won’t prepare anyone for when it happens. Like any matter of grief. I knew when first trying to get pregnant that miscarriage is a real possibility. Almost every parent in my life had some experience with it. What they didn’t talk about? The decisions and the costs.

I had a missed miscarriage at 10 weeks, and immediately after finding out the news, I had to make very important physical and financial decisions. Pill or D&C? Question: How much does a typical miscarriage cost? It’s rotted, but I have to think like that because my out-of-pocket American insurance sucks.

And then the physical cost. It turns out, my body doesn’t respond to miscarriages well. I had/have raging chronic migraines and stopped ovulating consistently. I needed femara and a whole year just to see another positive pregnancy test. Question: What does recovery look like for different people and different miscarriage types?

I’d love to read about this on your site or in your book, which I’ll be picking up soon because I find myself in conversations about miscarriage *a lot.*

First, thank you so much for this book! I had a relatively easy pregnancy until my water broke at 29 weeks and my son was born by C-section at 30 weeks. I have two questions that aren’t covered in the preterm birth chapter: (1) Is there any data on the mother’s age affecting recurrence of spontaneous preterm birth? I was 41 when my son was born and will obviously be older than that if I get pregnant again. (2) During the C-section, the doctors discovered that the cord was wrapped around my son’s neck, which had been causing his heart rate to keep dropping. Is there any data (or even hypotheses) on that as a possible cause of preterm labor and the probability of recurrence?

One reminder: we have a a story bank focused on pregnancy complications and loss from when I started outlining this project in 2022.

You can visit this here:

https://docs.google.com/spreadsheets/d/1XNhQGs7YI66gHxRiRD1BipFUKJSh8oOSMdZ_rQbRwAY/edit#gid=1169011432

Does the book cover risks for a subsequent pregnancy after a big hemorrhage due to placenta accreta?

I was in the hospital this week for spontaneous preterm labor at 34.3 – very unexpected in an otherwise uneventful pregnancy. The doctor offered the option to get a steroid shot for baby’s lung development but said that recent studies do urge caution for babies that may be born full term due to an increased risk of developmental disorders (https://pubmed.ncbi.nlm.nih.gov/36001315/).

The cutoff for where they wouldn’t give steroids was 35 weeks… Dr. said it was a tough call but she would do it if it were her, so we opted to get the shot.

Since labor stopped naturally and I’m at 35.1, now every day that passes I’m worried that baby is developing a disorder. Can you reassure me that it’s better to be full term / at term with the steroid shot than preterm?

6 weeks PP I had an AV malformation in my uterus and was bleeding out. They embolized that part and saved my life. We are going through the process of seeing if we can have more kids. No one so far knows the data for successful second pregnancies. If you have a malformation, is the whole uterus like that or is it only the one spot that we embolized so it’s done? We can’t find any answerd on AV malformations. I don’t want to die.

Diagnosed with complete placenta previa @ 20 week scan. Hospitalized from 32-35W due to hemorrhage & delivered @ 35W via C-section where accreta was discovered. Able to remove all but 3 pieces & managed bleeding via Bakri balloon and Uterine Artery Embolization. PPH at 4 weeks PP. Finally resolved 3mos PP via hysteroscopy; tests after showed minimal scar tissue.

So thankful doctor preserved my uterus. What are my chances of recurrence of previa and accreta?

I haven’t read this book yet but I look forward to it! Any disucssion included of how long after a male has chemo, his sperm is safe to conceive?

38 and trying to get pregnant again. Took me awhile to get pregnant with my last baby (maybe PCOS, but they aren’t sure). Will this book be triggering for me if I read while trying to conceive or am pregnant? I had a ton of miscarriage anxiety last time.

While on holiday abroad, I experienced several gushes of fluid and was diagnosed with PPROM at 22 weeks, hospitalised for a week and on bed rest for a month. Thankfully I did not go on to lose any more amniotic fluid, and eventually returned home where I was monitored more closely. After initial talk of early induction, another doctor concluded around 8 months I had been misdiagnosed and probably did not have pprom to begin with. I went in to have an elective C-section at ft. However, I’m convinced that my membrane did rupture, but that the tear healed itself. I’d love to have another child but I’m terrified of this happening again and if pprom was confirmed would not want to try for another pregnancy. Would this book provide guidance on how to approach such a discussion with my doctor to better understand the odds & risks?

I had a miscarriage at about 10 weeks, then a pprom at 21 weeks (no known reason although I did have off and on spotting throughout the pregnancy) then a full term pregnancy that ended in an emergency c section due to my baby not tolerating contractions. We are hoping to have another baby but I want to make sure there are no unknown underlying issues before trying again. Are there any specific tests/questions I should request from my doctor before getting pregnant again? Is pprom in second trimester covered in the book?

Hi Emily. I’ve so appreciated how informative your books are and the way it empowered me in my decision making during and after pregnancy. That said, after having 36 weeks of a perfect pregnancy, I felt bad and SO thirsty. Not sure I will ever have an explanation for this but at 38 weeks and 6 days, while in labor, I was diagnosed with preeclampsia with sever features (liver and kidneys/never had high blood pressure). After birth I was given magnesium which to me was more traumatic than the preeclampsia diagnosis. I don’t remember anything during this time. I’m wondering if you could explain more about magnesium as the information I find is not helpful. My understanding is that it brings your risk of seizure from already very low to barely lower. If I have a another baby and have preeclampsia again, I would like to decline this as not only did it make me feel terrible, not remember the first days of my baby’s life, but I also believe it is the reason I couldn’t breastfeed (info on this seems limited but seems like a real thing). Would love to know what data you have regarding magnesium. Thank you!

I tried scrolling through all the questions but has anyone asked about shoulder dystocia? I have a suspected big baby and I’m nervous

I just had a MMC discovered at 19 weeks. Baby measures 18 weeks. All genetic testing came back normal as did the APS clotting testing I requested. My doctor says it was “bad luck.” Does the book cover how to proceed with a future pregnancy? I am so scared of experiencing this twice.

Hi Emily,
Thank you for taking on this work and being a resource to us. I had monochorionic-diamniotic twins and many placental issues during the pregnancy- vasa previa, IUGR of 1 of twins, and ultimately severe sudden preeclampsia with emergency c section at 30w. My understanding is this was all related to twins, but do you know of any data of how this may affect risk of preeclampsia or other placental problems in subsequent pregnancy?
Thanks in advance for your help!

Hi! After my second pregnancy, I had a PP hemorrhage and retained placenta that was about 90% removed with a D&C three months PP. It wasn’t all removed since the bleeding was getting heavy and my dr was worried about having to do a hysterectomy if it continued. I still have spotting about a year later.

We’d love another child in the future. Do you have any intel on getting pregnant again, with retained calcified placenta still present in the uterus?

My son was born at 36w and at 4lbs 10oz. I had a healthy pregnancy but clearly I had IUGR. He’s 5 now and is only in the 10th percentile for growth. What’s the data around long term growth for a premie that also has IUGR? Thanks!

Do you touch on Hypoxic Ischemic Encephalopathy (HIE) or other forms of severe birth injury in your book? My first child had an HIE event and, while I did end up having a second child a few years later, some parts of her birth were eerily similar. For both, my water broke before contractions, both had a low baseline HR & both struggled and with heart rate dips during contractions.

Curious to better understand the pros and cons of bilateral salpingectomy. I’m having a C-section in the next month and am considering the procedure while my doctor already has me open. I love the idea that it greatly reduces my chances of ovarian cancer, but I feel like there are still a lot of unknowns around how this could interact with menopause. Any insights on this in the book?

Thank you for your book (all of them really)! I’m pregnant with my second after an emergency c-section with my first. I appreciate how the book lays out the different risks between repeat c-section and TOLAC (including those associated with a second emergency c-section). Trying for a VBAC is my preference (partly because I’d like to have another child and my mom had a very scary case of placenta accretia so increased risk there scares me). However, my doctors tell me that a repeat c-section is strongly recommended since it was less than 18 months from birth to conception. Two questions: Is there data to support the 18-month cut off? Are placenta complications (accretia or previa) hereditary? Thank you!

I have the book but have only skimmed it so apologies if this is redundant. I’m curious how you think about elective c section after a traumatic birth. With my first birth I had a series of rare, serious complications (severe sulcus tears, peritoneal hematoma, sepsis). Every provider I’ve spoken with says they don’t think a c section is medically necessary but they’d offer it. How do you weigh the overall increased risks of c sections vs the psychological difficulty of another vaginal birth?

I had growth restriction with my first daughter back in 2020 that got diagnosed at 36 weeks due to her femur measurement being under the 10th percentile. Everything else was normal and I was induced just before hitting 39 weeks with a healthy baby. With my 2nd pregnancy in 2023, because of my history, I had a growth scan at 27+4. I was again diagnosed with FGR with abdominal circumference lagging and elevated umbilical dopplers. I had an initial round of steroids and moved to weekly monitoring. At 30+4 we had intermittent absent end diastolic flow that led to a hospitalization for additional monitoring. Then I was discharged for twice-weekly monitoring. At 34+1 we had repeat absent end diastolic flow (50%) with dopplers more than double the 95th percentile for GA. That led to our daughter being born via c-section. After about a month in the NICU, she is our tiny but mighty little one. Neither case of FGR revealed anything in pathology of my placenta so both were unexplained.

In the FGR chapter, it noted that given the randomness of occurrence, it can be likely to have a subsequent pregnancy that is “normal.” Given a repeat occurrence with the additional complications of absent flow, would that change likelihood of recurrence? Does it mean my body just can’t grow a fully healthy placenta?

My water unexpectedly broke at 35 wks and was also diagnosed with severe preeclampsia right after and ended up delivering my baby 12 hours later. Both me and my baby have luckily been totally fine 2+ years later. I would have loved to have read this book prior to getting pregnant again. However, I’m 7 weeks pregnant now and I’m concerned this book could be “triggering” and make me question if I should have gotten pregnant again after I’m already pregnant. Thoughts on this concern?!

Hi Emily, Does the book discuss diastasis recti or hypermobility? What do you believe the ideal postpartum care should look like? For example, should pelvic floor physical therapy be automatically offered by ObGyns? Should pre- and post-natal massage therapy be covered by insurance?

For context, my births 4 years ago and 2.5 years ago both disabled me, and I still haven’t recovered a functional core (or normal exercise generally). The combination of hypermobility and diastasis allowed my spine and hips to “melt”/deform, causing excruciating pain and disability that went undiagnosed for months. Thank you.

After my second pregnancy, I was diagnosed with severe postpartum preeclampsia after delivering via planned c-section at 39 weeks. I’m nervous that this may happen again if I decide to have another child. Would delivering at 37 or 38 weeks decrease my chances of postpartum preeclampsia (assuming it doesn’t occur before then)?

Do you discuss the risks of future pregnancies after having preeclampsia? I had gestational hypertension with my first and preeclampsia with my second birth.

I hemorrhaged about 2-3 hours after giving birth due to retained placenta. It was a serious hemorrhage and an emergency, and they had to manually attempt to remove the retained placenta without anesthetic or pain relief, leaving me with serious trauma from the pain.

Two questions:
1. What is the chance in a second pregnancy that I will retain placenta again?
2. Can they do anything proactive to provide pain relief, were this to happen again? I’m so, so scared of experiencing that again.

I went into birth so calm and excited and had a wonderful, empowering experience, up to that point. I think I want a second child, but I also am fearful that I will be panicking my entire pregnancy.

Hi Emily!
I am currently in my second pregnancy with diet controlled gestational diabetes. In the book, it says there are good outcomes as long as blood sugar is “mostly normal”. What does that mean? How many times can your blood sugar spike before it actually becomes a concern? Trying not to beat myself up when something like an apple pushes me over the limit!

Do you cover chromosomal abnormalities in the book? Last year, I had a pregnancy that ended due to Triscomy 21, noted under “severe Down syndrome” due to my test results and soft markers that noted not carrying to term at 13 weeks.

I am pregnant again (11 weeks) at 36 y/o. Are there increased chances of chromosomal abnormalities since I’ve had one before and/or due to my age?

How does covid affect preeclampsia? Can paxlovid be taken during pregnancy? I had mild preeclampsia, got covid in December 2023, doctors advised against paxlovid and said I should just deal with the covid symptoms, my preeclampsia became severe within days, and I had to deliver at 35 weeks. Curious if this escalation could have been avoided or managed better. Thx!

Hello! I have had two difficult pregnancies that ended in 1) miscarriage at 16 weeks and 2) stillbirth at 21 weeks. In the second, I developed eclampsia – severe liver and kidney failure, extreme blood loss, critically low sodium and seizure. I’m pregnant for the third time and have a wonderful MFM who has me on an immunology protocol to try to prevent my body from rejecting the pregnancy. Do you cover these topics in the book? I’m so interested in reading it but given the PTSD I already carry w/r/t pregnancy, I’m not sure now is the right time. Thank you!

Hi, does your book touch up on postpartum pulmonary embolism (estrogen induced caused by pregnancy)?

Why not give the steroid shot for lung development to all twin pregnancies?

My wife and I had a due date of 4/21 for our b/g twins. They moved us 4/8 since they don’t want twins going 40 weeks.

The doctor mentioned several times that we could do a steroid shot if preeclampsia symptoms appeared. This would help our twins’ lungs develop.

We ended up having preeclampsia set in and delivering on 3/13 (~6 weeks early). It was a relatively easy 20 days in the NICU (which I say because another set of twins born that day was life-flighted elsewhere). They’re home happy and healthy.

The only reason that we got the steroid shot is because we happened to come to the doctor’s on 3/11. One test was a bit high, so we pushed for the steroid shot just in case. We got the first dose that afternoon. It needs two doses and 48 hours to be effective. Early the next morning (3/12), we went to the hospital in labor. They gave us dose two that morning. Then, our twins are born after 24 (long) hours of laboring at the hospital.

We’ve been of two happy and sleep-deprived minds since. On the one hand, is there a chance that the steroid shot worsened preeclampsia? On the other, holding the early labor start constant, surely it would have been better to get the steroid sooner than we did?

So, why not just do the steroid shot for all twin pregnancies?

Twins tend to be small and come early. It seems like an excellent place to have a steroid shot planned for twin mothers. Just like mothers receive maternal vaccinations, they’d receive a steroid shot to help the twins. Or, mothers with signs of preeclampsia could have it. We had high blood pressure throughout our pregnancy, for example. But maybe there are risks we weren’t aware of then?

I’m looking forward to reading The Unexpected–we had plenty of unexpected events in our pregnancy. Your other books helped handle those uncertainties and make our own educated calls.

Is the unexpected a good read for me even though I feel like I’ve processed my labor trauma and I don’t plan to have more kids? I love everything you write, but also am unsure if I should dive back into that world!

Hi! It seems the target audience for folks who have had complicated births. I love your books and was about to get this one, I feel like I need all the information, but then I realized some the content I was seeing on IG etc was actually triggering anxiety for what could happen, people’s stories of late pregnancy loss etc (I am going to be a FTM, currently 31 weeks pregnant, with no complications so far…). Is there any value for a FTM who so far has had a healthy pregnancy, or should I skip for now?

Do you discuss VACTERL syndrome at all in the book? My son was born at 36 weeks with TEF/EA, hypospadias, and a persistent left superior vena cava. He’s mostly thriving now but our first few months were hell — 5 weeks of it spent in the NICU — and also, we weren’t prepared for it really. The only real indicators when I was pregnant (for TEF/EA) was polyhydramnios, which didn’t become excessive until two days before I went into labor. Phew, in all this, my question is, how does having one baby with VACTERL syndrome impact the likelihood of having another?

Thank you for bringing the conversation about pre-eclampsia to light- I had it pre and post-delivery- and am now contemplating baby #2. Both times being treated with magnesium- in your research, did you come across any data about the medical impact of magnesium on mom/ baby or other options? What is the ROI? (personally, it was horrible, impacted bonding and breastfeeding but guess I would feel better knowing there isn’t another option or the pros outweigh the cons)