December 8, 2008

Emotional Effects of Pregnancy After Infertility or Loss: An Interview With Jen Dozer

When a woman becomes pregnant after experiencing infertility, those around her are likely to expect nothing short of complete joy. Pregnancy, after all, is the long-awaited goal.

But as Jen Dozer, a freelance writer and registered nurse, writes in this article published at Our Bodies Ourselves, a woman who has experienced infertility or a pregnancy loss may find it difficult to push aside feelings of worry and concern.

“The long-desired pregnancy may not be the joyous experience she has dreamed about,” writes Dozer. “The experience of infertility brings its own baggage to a pregnancy: grief for previous losses; anxiety; and fear that her body, unable to conceive on its own, may not be able to carry a pregnancy.”

In addition to discussing the emotional effects of infertility that a woman may experience once pregnant, Dozer lists a number of useful ways to “ameliorate the doom and gloom expectations that years of repeated failures have led you to expect.” Links to related resources are also provided.

Dozer writes from experience. She went through almost two years of infertility before giving birth to a boy on Mother’s Day 2008 and blogs about infertility, motherhood and health care at MrsSpock.blogspot.com. She recently spoke with OBOB.

Our Bodies Our Blog: What was your experience with infertility?

Jen Dozer: It took almost two years to conceive our son. I had never had any sign that there could be anything wrong with me reproductively. After 12 months of unsuccessful attempts, my husband and I underwent testing. Other than my progesterone being slightly low, and a mildly misshapen (arcuate) uterus that should not interfere with conception, all the tests were normal. Our official diagnosis was unexplained infertility.

According to our doctor, we had a 3-to-4 percent chance of conceiving on our own. We underwent several cycles of me taking Clomid to stimulate my ovaries to release eggs, and one cycle of Clomid combined with intrauterine insemination. I was set to begin injecting myself with stronger medication when I became pregnant spontaneously. Our doctor could offer no explanation other than the previous medicated cycles may have “jump-started” things. A non-answer, really.

Most infertility patients are able to conceive with relatively low-tech means. In the future, for us, there are no guarantees about how easy or how difficult it might be to have a second child. There is always the possibility that we may need IVF to conceive, or we may never have a successful pregnancy again. There is a lot of uncertainty.

OBOB: In the OBOS article you wrote: “If a pregnancy finally does occur, it can be difficult for a woman who has experienced infertility to view herself as just another pregnant woman.” What was your pregnancy like, and how did you cope with your fears or concerns?

JD: There was definitely a higher level of anxiety, and I have never even had a loss. I can’t imagine the anxiety level I would feel after a stillbirth, or six miscarriages, or seven years of infertility instead of 20 months. I approached my ultrasounds and the heartbeat searches with the Doppler with trepidation: Was my baby still alive? I don’t think that is going through the average woman’s head. Disaster could be around any corner.

I think I called the office nurse in a panic twice a month. My OB was kind and bumped me to appointments every two weeks by the time I was 20 weeks. I needed the extra reassurance. I was successful in not caving in to renting a Doppler to listen to my son’s heartbeat. I really wanted to have faith in my body. It can be almost an impossible task when your body has shown month after month concrete proof of its dysfunction. How could I be sure that it could get the pregnancy and birth part right, too? Those were uncharted waters. After all, there had been no indication that my body would have problems with conception.

To try and cope with the ramped-up anxiety, I chose a provider — an OB who worked with two midwives — who was known for trusting women’s bodies, yet at the same time sensitive to my background of infertility. It’s easy to say, “Get over it,” or, “Trust birth,” but those statements just invalidate the very real experience of having a body that doesn’t function properly.

What I loved about my providers was that no one ever said anything like that to me. They took the stance of “innocent until proven guilty” when it came to my body, yet still were willing to provide extra support in the form of more appointments, and taking the time to address my anxieties and reassure me that my baby was fine. In the end, when there really was a problem with my son, they took it seriously. Perhaps I wasn’t “supposed” to worry or fret over my body’s ability to carry a pregnancy, but, despite my best efforts, I did. The head can only strong-arm the heart so much.

I also did a lot of reading good birth stories. My copy of “Spiritual Midwifery” and “Ina May’s Guide to Childbirth” were well-thumbed. I avoided watching birth shows on TV. They tend to show pregnancies as complicated and births as emergencies, and I had enough fear rolling through my head already. I tried to avoid Googling my symptoms. Dr. Google is notoriously full of misinformation.

I had some small experience as an OB nurse, and I found calling and asking the OB nurse to be more helpful and less likely to send me into a panic. Last, I took a hypnobirthing class. I used my relaxation techniques every night. I admit, this class would probably not be a good match for the average infertility patient, who would likely feel they had nothing in common with their classmates. In our circles, it seems like hubris to desire more from a birth than a living child.

OBOB: How well does the media cover infertility?

JD: Just like with birth stories, drama sells. Although I do know some women who have endured multiple losses, more than 10 IVFs, and over-stimulated ovaries that landed them in the hospital and whatnot, they do not represent the majority of infertile women. Really bad things do happen sometimes — the same with birth. My birth story was not the ideal. It’s not typical for a nuchal cord to almost kill a child. If that’s what you see on TV most of the time, that’s what you’re going to think birth is — fraught with danger.

Most of the time, we resolve our infertility with more low-tech means. We take oral medication or do some inseminations. We take some heparin throughout pregnancy to avoid miscarriage from clotting issues. We have a child after a normal pregnancy. We go for adoption.

IVF, in real life, is the last resort. IVF, however, is more interesting than me popping some Metformin to control PCOS. No one wants to hear about your stomach cramps after using Metformin. Find a surrogate in India, carrying triplets conceived with eggs donated from your sister, all after you’ve already done 7 IVFs yourself, and you have ratings gold. No wonder the public thinks treatments are “out there.”

OBOB: You wrote a wonderful post at your blog about women feeling judged by their childbirth choices, and you include eight smart and practical “wishes” concerning medical care and attitudes toward women. Does your experience as a nurse make it more difficult for you to accept absolutes about what’s “best” for women?

JD: Yes, I would say so. When you’re out on the floor, you can see that although a disease state or body process usually tends to go one way, and the research shows it to be true as well, there will always be outliers. Human beings are so complex. No good practitioner, no matter what model of care they are using, can be said to be doing their job well if they don’t view their patient as a whole. That big picture may very well show you that what is best practice for most women may not be best practice for one particular woman.

For example, best practice shows that a vaginal delivery has better outcomes for both mom and baby. What if mom has a bicornate uterus and the baby does not have sufficient room to turn and get into an optimal position to make it through the birth canal? A good practitioner will be able to expect the best but plan for the worst.

Infertility and loss can change the landscape so much when it comes to pregnancy and birth. I hear over and again that a living child is the number one goal. Ensuring their safety at the expense of ourselves is not uncommon.

OBOB: How long have you been writing Mrs. Spock? What are the most frequently asked questions or concerns that you hear from readers?

JD: I will have been writing Mrs. Spock two years this February. In the ALI blogosphere [adoption/loss/infertility], it’s like a big kaffeeklatsch of women reading and supporting each other. Infertility blogs become adoption blogs, or pregnancy blogs, or life-after-infertility blogs. Sometimes life will throw an extra monkey wrench, and they will become infant loss blogs or cancer blogs. We share our treatments, our successes and failures, our dreams, our family life, and above all, our hopes to share our lives with children.

My blog usually addresses what is going on in our life now. A lot of my regular readers have had a child in the past year as well, and we are all muddling through this new experience of motherhood together.

OBOB: What resources do you recommend for women dealing with infertility?

JD: If they are in the beginning, and have tried to become pregnant and been unsuccessful, I would suggest ignoring the advice of friends and relatives, who mean well, but tend to be misinformed, and seek the consultation of a reproductive endocrinologist. For those women in the throes of it, and who are keeping their infertility a deep, dark, dirty secret, I say, seek support.

I have been very open about our struggles from day one, and was shocked to have no less than four good friends, people I knew well, secretly come out of the closet to me. It’s a shame that women can feel so judged by their own family and friends for seeking answers to their reproductive challenges that they hide the truth.

I think there is nothing shameful in cancer treatments having left you sterile, or endometriosis scarring your tubes, or your ovaries having difficulty releasing an egg, or in your blood clotting too easily and causing miscarriage, or in your partner’s sperm count being quite low. It’s not like you’ve purposely done that to yourself. I think if more couples are brave enough to tell the truth, the level of judgment due to misinformation will decrease.

People seem to have awfully strong opinions about something they know very little about. The internet, I find, is a great place to connect with other women who are undergoing the same kinds of things, and in a more anonymous atmosphere for those who are afraid of revealing their secret to those who know them.


11 Responses to “Emotional Effects of Pregnancy After Infertility or Loss: An Interview With Jen Dozer”

  1. Mrs Spock Says:

    Thanks for the write-up Christine!

  2. cara Says:

    I’ve got to say, Mrs. Spock rocks. Your ability to integrate your infertility experience with parenthood while continually affirming others who are still struggling is inspiring.

  3. Martha Says:

    Thank you for sharing your excellent insight, it’s a wonderful interview. The measures to help cope with the stress of pregnancy after IF are excellent.

  4. Mel Says:

    Excellent advice! Especially about finding a provider who works with you and understands the fears. It is a great provider who can walk the line of respecting your needs while also not giving into whims or fears. If it had been up to me, I would have had an ultrasound every day :-) Luckily, I had a doctor who could respect my fears and give me more support.

  5. Lori in Denver Says:

    I think every woman needs a kaffeklatch like this.

    Thanks, OBOS, for giving a voice to ALI women and men.

  6. Christine C. Says:

    Thanks, Jen! The credit all goes to you!

  7. k77 Says:

    Fantastic. Mrs Spock does indeed rock!

  8. Calliope Says:

    Fantastic interview of a wonderful and inspiring woman. Mrs. Spock’s blog is wonderful and supportive.

  9. WaterBishop Says:

    Wonderful interview. Thank you for the view of the other side. The advice on coping with stress after IF is great.

  10. Artblog Says:

    Great post. Words out of my mouth. Its never easy as it is but after loss and infertility, it changes it all, I certainly had no joy during my last pregnancy and I regret that, quite a bit but my boy seems to be fine, very smiley considering but I still regret not enjoying it as much as I could have and I have barely any photos too!

    Such a shame!

  11. Rebecca Says:

    As a woman that had a difficult time conceiving my second child, it is refreshing to know that I am not alone in the anxiety that I feel with this pregnancy. I live in constant worry that this child that I have tried for so hard to conceive will be taken away easier than she came. It makes it that much harder to bond with your child because of the fear of becoming attached. I appreciate this blog very much.

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