Pregnancy & Birth
Pregnancy After Infertility or Previous Pregnancy Loss
Infertility is about so much more than the inability to conceive. It can rock a woman's very foundations -- her sense of control over her own future, her faith in her own body, and her feelings about herself as a woman. It can result in a loss of innocence, as a woman finds herself on the wrong side of the statistics. Suddenly, bad things don't just happen to other people. Despite all her efforts, she is unable to achieve the experience that many women see as a birthright. Pregnancy likely cannot be achieved except with substantial medical help, and may very well never be achieved at all.
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. The long-desired pregnancy may not be the joyous experience she has dreamed about. 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.
Women who conceive after a loss and/or infertility often have similar experiences during pregnancy. If you have suffered from such a loss, you may experience one or many of the following:
- Feeling different from other pregnant women.
One woman says, “Other than brief spurts, I couldn't get excited until the very end, and even that was guarded. I've had friends who've seemed to go through pregnancies with an air of expectation that everything will work out, and I'm envious of the joy they seem to have had. I felt like all the commercials and cards out there about the joys of pregnancy were written for someone other than me. It made me feel defective a bit, that I couldn't get into fully loving being pregnant, even though my pregnancy was easy.”
- Feeling like you don't belong.
You may feel like the average pregnant woman can’t understand your feelings, yet you may feel uncomfortable talking about your pregnancy with your infertile friends who are still undergoing treatments.
- Obsessing over pregnancy symptoms, symptoms of miscarriage, or preterm labor.
- Finding it difficult to change from a reproductive endocrinologist's care to that of an OB or midwife.
You may feel your pregnancy is more vulnerable and fragile than a fertile woman's, and that a regular provider will provide fewer opportunities for procedures such as ultrasounds that can assure you the baby is ok.
- Desiring more appointments and ultrasounds, or wanting to rent a home Doppler for reassurance that the baby is still alive.
- Distrust of your body's ability to carry a pregnancy.
This may be particularly true if you have a medical condition (such as a blood-clotting disorder, or uterine anomaly) that causes your pregnancy to be high-risk.
You may feel like your body is at fault for a previous loss or for putting the current pregnancy at risk.
- Fear of acknowledging a pregnancy until after the first trimester, or until after the week when you experienced a previous loss, or, for some women, until you have grown big enough that you cannot disguise your pregnancy any more.
- Fear of bonding or becoming attached to a child until you feel sure she or he will remain alive.
- Fear of preparing for a birth, buying maternity clothes, or purchasing baby items so as not to “jinx” a pregnancy.
- Fear of complaining about pregnancy symptoms or discomforts because you might seem ungrateful.
The emotional effects of infertility needn't doom a much-wanted pregnancy to a joyless experience. There are ways to ameliorate the doom and gloom expectations that years of repeated failures have led you to expect.
- Most importantly, get support throughout your pregnancy.
With roughly 10% of couples experiencing infertility in the United States, there are many women who are experiencing the same feelings as you. You may wish to attend a local support group, such as those held by RESOLVE, a nationwide infertility support organization. You can also find support through online at sites such as the Pregnancy After Infertility message board and the Fertile Thoughts forum.
- Find a supportive provider.
A doctor or midwife who has both the time and the willingness to help you work through your anxieties and provide reassurance when you are full of fear can make an enormous difference in your pregnancy experience. If you feel your provider brushes off your concerns, try to switch to a more supportive one.
- Educate yourself about pregnancy and birth. Knowing the common sensations and symptoms of pregnancy may help you from panicking with every twinge -- or lack thereof.
Although some causes of infertility may also automatically place a pregnancy at high-risk, infertility itself does not rule out a low-risk pregnancy. Educating yourself about birth practices that lead to better outcomes for mothers and babies can help you make better choices for the precious cargo you are carrying. One great resource for finding up-to-date evidence-based information and resources on planning for pregnancy, labor and birth is the Childbirth Connection.
Finding a childbirth class that works for you may be challenging. Even at the end of your pregnancy, being around other pregnant women who “had it easy” may be hard. Some types of childbirth education methods, with their focus on fewer medical interventions, may make you feel like an outsider as well. Hearing that birth is a natural, healthy process -- when nothing about getting pregnant has been “natural” and your body hasn’t worked like it is supposed to -- can be less than comforting.
- Be prepared for questions about how you got pregnant.
Relatives, friends and even perfect strangers may ask whether you’ve done IVF or if you used donor eggs. This is particularly true if you are carrying multiples or are an older mother. Remember that how much you want to disclose is a matter of personal choice.
- Don't feel guilty complaining about pregnancy discomforts.
You may feel like you have no right to complain. Even your friends and family may respond to your griping with, “Well, you asked for it....” The truth is, pregnancy can be uncomfortable, but disliking frequent vomiting, pelvic pain, Braxton-Hicks contractions, or heartburn does not mean you cherish the pregnancy any less.
- Don't be afraid to prepare for the baby's arrival.
The vast majority of pregnancies will result in a live baby, and that baby will need at least a few necessities. Basic infant care skills are more easily learned before the sleep-deprived days a newborn can bring. One woman advises, “Infertile women need to be gently reminded that it is important, for the sake of their babies, to look ahead. They may even need guidelines so as to prioritize and break down the task. For example, they can let themselves off the hook when it comes to baby clothes and crib sets they want, but they should definitely learn how to feed and settle their baby in some detail, as much as they can before time."
- If you plan to breastfeed, educate yourself beforehand and identify local sources of support.
The vast majority of women, including women who have struggled with infertility, are able to breastfeed. However, breastfeeding can be challenging, and many women need support and help from a health care provider, lactation support person, or support group such as La Leche League. Lining up support people during pregnancy will ensure that you have help if you need it in the early days after birth.
Even with help, some women are unable to breastfeed. If this happens, it may feel like your body has once again betrayed you. Finding people who will support YOU, no matter what happens, is vital.
- Line up a support team for after the baby is born.
No matter how much you’ve longed for this baby, the early months of mothering can be demanding as your body recovers and you learn to take care of a new baby. Women who become pregnant after infertility treatment may be at increased risk of postpartum depression. Seeking out people who can provide practical help and emotional support can make all the difference.
- Don't feel guilty if you don't feel bonded to your baby during pregnancy or the minute she or he arrives.
For many women – and not just women who have experienced infertility and loss – bonding doesn’t happen instantly but occurs over the days and weeks of caring for the baby.
- Don't feel pressured to gloss over or forget about a previous loss, or the feelings about it that the current pregnancy might dredge up.
Every pregnancy and every child is unique, and one cannot take the place of another. Acknowledging a loss is part of the grieving process. One woman, currently pregnant, who lost another child at 20 weeks, says, “The hardest part for me has been answering the question, 'Is this your first?' Most often, the question has come up in casual conversation and it wouldn't be appropriate to give any answer other than 'yes.' But even now, at 35 weeks, I feel a little like I am betraying my son when I don't tell his story--how at 20 weeks, we found out the devastating news that even though we had waited so long for him, we would still never be able to take him home. How, just when I was beginning to show, I went into the hospital and gave birth to a tiny, stillborn boy. But casual acquaintances would rather focus on the potentially happy future, rather than the unhappy past.”
- Don't be surprised if having a child does not resolve the grief of your infertility.
You may have overcome your medical condition this time and achieved a successful pregnancy. However, grief from years of repeated failures, losses, and invasive, expensive medical treatments has taken its toll and may be felt for years to come. You also may want to have more than one child and may experience secondary infertility. The roller coaster of hope and grief may be something you ride again in the not too distant future.
- Seek professional help if you need it.
For some, anxiety and depression may become severe enough to warrant help. If you find your symptoms of guilt and worthlessness overwhelming, are unable to focus on everyday tasks, sleep way too much or are unable to sleep at all, have severe changes in appetite or have thoughts about harming yourself, it's important to bring this to the attention of your care provider. You worked hard to become a mother and deserve the support you need to be fully present for your child.
Infertility and loss may have unavoidable effects of the experience of pregnancy, but with support and understanding, you may find more moments of peace than fear during your long hoped for and long awaited pregnancy. Good things, after all, may come to those who wait. As one woman succinctly states, “I am thankful beyond belief that we have a child. We came very close to living childfree. I will never take her for granted.”
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Written by: Jen Dozer
Last revised: March 2013
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