Do I Need a Specialist After a Miscarriage?

Finding the appropriate care based on your needs

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If you’ve experienced a pregnancy loss, it’s understandable to be concerned if you decide to try again. Your first instinct may be to seek out a specialist "just in case," but is it really necessary?

In truth, there are times when a specialist may be helpful in overcoming obstacles to a pregnancy and times when having one onboard may not make much of a difference. While you should always be under the care of qualified doctor or midwife when pregnant, you need to focus on finding the appropriate care based on the type of loss you experienced.

If You’ve Had One Miscarriage

If you experienced a first-trimester miscarriage or an ectopic pregnancy and have no other chronic health issues and no prior history of pregnancy loss, you probably don't need a specialist.

It is important to remember that 80 percent of miscarriages occur in the first trimester and that anywhere from eight to 20 percent of pregnancies will result in a miscarriage. Moreover, in the majority of cases, a woman will go on to deliver a perfectly healthy baby the next time around.

Most first-trimester miscarriages occur because of a chromosomal abnormality that made the fetus non-viable from the start. Ultimately, the loss was a glitch and one that is unlikely to be repeated.

Under these circumstances, you can continue seeing your midwife, family physician, or OB-GYN, all of whom are more than qualified to see you through the pregnancy.

On the other hand, if you have diabetes, thyroid disease, or any other health condition that may impact a pregnancy, speak with your doctor who can refer you to appropriate specialist for treatment and/or advice.

If You’ve Had Recurrent Miscarriages

If you have had two or more miscarriages, the odds are greater that there is an underlying condition interfering with your ability to carry a baby to term. To identify the cause, you will want to have tests performed to look for some of the more common causes (including uterine abnormalities, clotting problems, or hormonal imbalances).

OB-GYNs are generally familiar with these issues and will know which tests to run. However, if the early examinations reveal nothing, you may be advised to meet with a ​reproductive endocrinology specialist. Endocrinologists are experts in the disorders of the endocrine (hormonal) system and may have the tools and expertise needed to pinpoint the cause.

If You’ve Had Late-Term Pregnancy Loss

If you experienced a pregnancy loss in the second trimester or have any medical condition that can place your pregnancy at risk—including high blood pressure, kidney disease, polycystic ovary syndrome (PCOS), and autoimmune disorders such as lupus—you may want to put together a team to help oversee the pregnancy.

One possible route is to find a specialist in maternal-fetal medicine, known as a perinatologist, who can work alongside your OB-GYN. A perinatologist will usually not be the primary physician but will rather be tasked with managing any possible complications that may arise during the pregnancy.

Generally speaking, a perinatologist will only take the lead if the baby needs neonatal surgery soon after delivery. But, in all other regards, your OB-GYN will be the lead member of your team.

Sources:

American College of Obstetricians and Gynecologists/American College of Nurse-Midwives. "Joint statement of practice relations between Obstetrician-Gynecologists and Certified Nurse-Midwives-Certified Midwives." Washington, D.C.; updated July 2014.

U.S. National Library of Medicine. "Choosing the right health care provider for pregnancy and childbirth." MedlinePlus. Washington, D.C.; updated October 11, 2016.

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