On Pregnancy Loss

Twenty percent of women experience a miscarriage at some point in their lives. Many women take on feelings of blame or guilt for this natural, yet random, event. You try to make sense of what happened, but it is challenging to accept uncertainty. Sometimes there are no answers—we simply just don’t know.

Feelings of sadness and anger may take over. You start to experience obsessive thoughts about what you could have done differently. You throw yourself back into work to avoid addressing your feelings. You feel paralyzed to get out of bed. You feel as if you are going to lose control when pregnancy reminders pop up on social media or you see a pregnant woman. A lot of women report feeling badly about how they handle this loss. Remember these feelings are normal and there is no one way to grieve.

We live in a culture of silence and often hide our grief. In some cases, we try to open up but others respond with hurtful, insensitive responses, unintended or not. The truth is pregnancy loss is a major loss, no matter how far along you are. It takes time to heal, both physically and emotionally. The attachment to the pregnancy can last for some time, and anxiety and fears for future pregnancies can take over. It’s ok to talk about it. Say out loud the unspeakable. Take time to grieve and explore the meaning of this loss in the context of your life plan.

Having a miscarriage is an experience that is difficult to understand if you haven’t gone through it. The loss of a pregnancy after infertility can add to the distress. October 15 is National Pregnancy and Infant Loss Awareness Day, however it takes more than one day to acknowledge this complex loss. Find someone with whom you can share your miscarriage experience and express your feelings and concerns. The more we talk about it, and express the pain of pregnancy loss, the more we help ourselves and others to heal.

Navigating the Beta Test / (2WW)

Waiting to find out if you are pregnant is stressful, especially after IVF or FET. To keep the beta test result wait from completely taking over your life, make a plan of action in advance. While there is no way to not think about becoming pregnant, it is helpful to find comforting distractions and reduce obsessive thoughts. Most beta test days are typically 10-12 days post-transfer, then there is a secondary wait for the actual beta result, which can seem unbearable.

Use mindfulness to help let go of what you can’t control. You can’t control the outcome, but you can control your response. Find a mantra that helps, such as ‘so far, so good’ or ‘my body is ready to be pregnant’ to ground and center yourself.

Try to control obsessive thoughts re pregnancy symptoms, and resist the urge to take a pregnancy test before your beta hcg test. It’s truly too early to tell.

Stay busy: connect with friends; spend time with your partner not focused on pregnancy; practice calming rituals; do creative projects; deep breathe; get outside into nature; clean your house; or distract with reading fiction or watching relaxing media.

If you find yourself obsessing too much in unhealthy ways, give yourself up to 10 mins/day to structure formal worry time to express or write down all of your worries and then let go and move on with your day.

Sitting in uncertainty is challenging; waiting to find out if you are pregnant after a long infertility journey even more so. Make sure to continue to live your life and be hopeful, open and curious to what may happen next.

Should You Freeze Your Eggs?

Are you considering freezing your eggs? The decision to freeze one’s eggs for the possible preservation of future fertility is subjective and full of complexity. Professional reproductive/medical organizations (ASRM and ACOG) have promoted oocyte cryopreservation for medical reasons (e.g. prior to chemotherapy treatment) for decades. However, fertility specialists and private egg banking companies have increasingly been promoting fertility preservation for elective reasons, such as delaying childbearing, making this option readily available to all women. 

The egg freezing process involves: 1) stimulation of the ovaries through hormone self-injections and monitoring follicle growth via ultrasound, 2) the egg retrieval procedure, which is quick and performed under sedation, and 3) the egg freezing procedure done through vitrification and subsequent storage of the frozen eggs. Remember, this is just the egg freezing process. You will later need to undergo the rest of the IVF process (using sperm from your partner or a donor to create embryos, and transferring embryos into the uterus) in order to become pregnant using frozen eggs. 

In making the decision, it is helpful to explore the numerous psychological, emotional, spiritual, financial and medical considerations involved in this process. Also look at success rates based on your age and fertility, as well as possible risks involved. Have an understanding that the procedure is invasive, that egg retrieval / freezing and storage costs are expensive yet separate from later IVF fertilization and transfer expenses, and there is no guarantee of future success. Take time to imagine how you would feel building your family this way, or what it may be like to be an older parent.

You should also consider the research: ACOG/ASRM studies have shown that the age of the oocyte (egg) at retrieval correlates with success rates, with viable studies ’supporting the use of these technologies in well-selected patients aged 35 years and younger,’ while ASRM/SART state that ‘even in younger women (under 38), the chance that one frozen egg will yield a baby in the future is around 2-12%.

There are many pros/cons to consider in making an informed decision. It can be helpful to meet with a reproductive mental health professional to explore feelings and navigate expectations and possible outcomes so you may make the best decision for yourself.

For more information and resources, check out:

Motherhood, Rescheduled: The New Frontier of Egg Freezing & the Women Who Tried It
by Sarah Elizabeth Richards

 

The New Sibling Adjustment

Here are some ideas to help with the second child / big brother or big sister transition.

When you share the baby news with your current child during pregnancy, it can be helpful to frame it as adding to your family. Let your child know how much you and your partner wanted a family, and you were so happy to have him or her. Now you and your partner are excited again to add to your family. Express some of the complex feelings s/he may be experiencing: I imagine you may feel happy, sad, excited, angry, etc. Name whatever emotions s/he seem to be sharing.

  • Talk with your child about the logistics of what will happen when you are in the hospital: who s/he will stay with; when s/he will come visit you and meet the new baby, etc.

  • Make sure to have some solo time with your older child in the hospital when the baby is in someone else’s arms or sleeping in the newborn crib. Have him or her sit or lie with you and check in together.

  • When you get home, you won’t be able to do everything s/he wants you to do during your birth recovery, but you can do slow paced things each day with your older child like reading books or cuddling.

  • Once you are more mobile, have special outings with just your older child. When you are out remind them that only s/he can eat pizza or go on the big slide, etc., not the baby.

  • Tell him how much you love him or her and how grateful you are that s/he will always be your first baby, and how special it is that now s/he is a big sister or brother.

  • Use positive reinforcement for each time s/he does something helpful and kind with the new baby.

  • Expect some regression or acting behaviors. It's natural and this behavior is a young child's way of processing such a big family transition.

Books for kids:

Daniel Tiger: The Baby is Here
by Angela C. Santomero and Jason Fruchter

I am a Big Sister or I am a Big Brother
by Caroline Jayne Church

Books for parents:

Siblings without Rivalry
by Adele Faber and Elaine Mazlish

Understanding Postpartum Anxiety 

Postpartum anxiety is confusing - it can be hard to distinguish from regular new mom worry. What we look for is severity - has worry completely taken over? Are you unable to relax and enjoy your baby? Are you unable to rest at all? Are you having trouble turning off your brain? Are you worrying about everything? Is it difficult to focus on one thing?  Do you have nervous energy? Do you have a relentless to-do list? Are you ‘present’ but really in your head the whole time? Are you having sleep difficulties due to excessive thoughts? Is your appetite non-existent? Did you quickly lose your pregnancy weight? Do you have perfectionist traits? Are you focused on trying to do everything 'right' (when there is no right way to care for a new baby)? Are family members constantly telling you to just relax or calm down but you can’t?

Postpartum anxiety is experienced by approximately 10 percent of new moms. It can be related to having a history of anxiety before or during pregnancy, or from birth trauma or a newborn health concern. It can be impacted by higher levels of cortisol (the stress hormone), which are present during pregnancy and early postpartum. Postpartum anxiety can be challenging to identify – it often gets grouped under the more commonly known postpartum depression, but is its own maternal mental health concern. It is a common concern in SF - I see more moms with postpartum anxiety in my practice than postpartum depression. One of the biggest regrets I hear from moms with postpartum anxiety is they feel they wasted their maternity leave worrying and constantly doing, rather than just slowing down and being with their baby and enjoying this special time. 

It is not always easy to tell others that you are having scary thoughts or excessive amounts of worry. Please know there is much strength in being open with others about feeling this way. If any of this describes your experience, please reach out for support to help manage these thoughts and stabilize your mood.

I’m glad to see that postpartum anxiety has received more media coverage in the past year. Below are links to some helpful articles.

Postpartum Anxiety Is a Thing—Here’s What to Watch Out For
https://greatist.com/live/postpartum-anxiety-symptoms-and-treatments

This is What It's Like to Have Postpartum Anxiety
https://www.scarymommy.com/postpartum-anxiety-exhaustion/

Postpartum Anxiety Affects 1 in 10 Moms
https://www.vogue.com/article/postpartum-anxiety-vogue-april-2018

The Lonely Terror of Postpartum Anxiety
https://www.thecut.com/2017/08/the-lonely-terror-of-postpartum-anxiety.html

Infertility Between Friends

While friendships naturally evolve over time, infertility can really test a friendship. Learning that a friend has become pregnant, while you have not, is unbelievably hard. You are happy to hear about the pregnancy, but the news is painful and naturally may bring up feelings of envy and frustration. You become angry from yet another reminder of your own challenges to conceive. Having these feelings in response to your close friend’s news creates feelings of guilt, so you end up feeling even worse.

How can you handle this situation? It’s important to be honest with your friend. Let her know that you are having a difficult time due to your current infertility experience. You are thrilled for her and would like to be there for her, but it’s simply too much at this time. 

Take some time to consider your history together and determine your needs in this relationship. Also look at your personal limitations on what you can offer your friend during her pregnancy.

•    Has she been supportive during your infertility experience? 
•    How have the two of you handled past friendship concerns? 
•    Are you comfortable offering support and remaining close during her pregnancy?
•    What are your boundaries around her sharing pregnancy details and baby shower planning? 
•    Do you want her to continue to check in with you around your fertility treatments? 
•    Have you considered her experience of being the one who became pregnant? What if it was you?
•    What changes would be needed to keep the friendship intact?

Infertility is a stressful time and requires support from friends who can hold what you’re going through. Remember you’re not always going to feel this way. Identify what works for you and express those needs to your friend. Many women have navigated fertility friendship bumps with grace. Some may decide to let the friendship dissolve, while others are able to reconnect when they are ready. Give yourself time to reflect on the support you need and find resolution that makes sense to you.  

Limits around Trying to Conceive

How do you know when you are ready to stop trying?

The decision to stop fertility treatments and live childfree involves much self-reflection. Some things to consider:

  • Emotional, physical, and financial limits of fertility treatment.
  • Cost to the relationship with yourself and your partner.
  • Readiness to stop keeping life on hold.
  • Finding meaning in the experience of all of that you’ve gone through with pregnancy losses and fertility treatment.
  • How to cultivate letting go of the idealized family and refocus on being a family of two.
  • Existential concerns on finding purpose and connection and an openness to living life on a different path.
  • Finding new ways of looking at personal meaning around femininity and what it means to be a woman.
  • Recreating relationships – finding a new way to fit in with family and friends.
  • Acceptance of the decision and integrating it into a new identity.

All of this self-inquiry essentially encompasses grief work. There is much grief work to do. As you can imagine, the decision to stop trying is subjective - every woman or couple has to decide when they've had enough and reached their limits around trying to build a family. Through infertility research, we know that over time, the pain of infertility lessens but it doesn't completely go away. It is in integrating infertility into your identity, while no longer letting it completely take over, that the healing begins.