Pregnant at Last (Summer 2010)

PREGNANT AT LAST!
The emotional experience of pregnancy after infertility

by Sherry Dale, MSW, RSW

You may have been trying to get pregnant for years. Perhaps you’ve gone through endless fertility tests and treatment. When you finally get a positive pregnancy test, it should feel like victoriously crossing the finish line to the roar of a crowd… right?

Unfortunately, the reality of pregnancy after infertility is quite different for most people. When you finally get the news that you are indeed, pregnant, you will likely be exhilarated, relieved, incredulous… and terrified.

Julie blogged, “You're happy, yes, but you're broken. You'll never be that giddy newlywed plotting a cute way to tell her husband, ‘You're going to be a daddy.’ You may well be a mess, much as you've been since that first crushing negative.”

When you receive the good news, you may not really believe it. Sandra says, “I went through four years of infertility, six rounds of cycle monitoring, two IVFs, countless injections, and tens of thousands of dollars in order to get pregnant. Yet the first thought that went through my head when they called with my positive result was, ‘How did that happen???’ – ridiculous, really, but I guess while I was in the infertility trenches, part of me felt I was never going to get pregnant.”

Some women have learned through their infertility and unsuccessful attempts to conceive that their bodies are not necessarily their friends, and can’t be trusted to deliver a safe and healthy baby. This can make them feel very tentative in their pregnancies. Julie wrote: “If you're infertile, you may have thought that getting pregnant was your only concern. Maybe it was. Maybe, now that you're pregnant, your body will rush effortlessly into cradling the tiny life inside you, keeping it safe and inviolate for the next 36 weeks. Maybe you can begin to love your body again, after hating it for so many countless cycles. Maybe pregnancy will reaffirm what you had begun to doubt: that you are a strong and healthy woman whose body was made for nurturing a child. But maybe not. Maybe your body will disappoint you yet again. Maybe you'll need supplements, infusions, injections to stay pregnant, to keep your baby healthy inside. Maybe you'll spend the next six months flat on your back like an invalid, praying that just this once your body won't betray you.”

Even if her doctor is unconcerned and optimistic, the “pregnant infertile” can be very frightened of miscarrying or of something being wrong with the baby. In the literature on pregnancy after infertility, “Increased anxiety and cautious attachment to the post infertility pregnancy have been a frequent research finding.”

This is especially true for those who have already had a pregnancy loss. The woman may have a very hard time relaxing and enjoying her hard-won pregnancy. When the mother-to-be is feeling very anxious, she can actually start to worry about her worry! She may be afraid that her anxiety might actually make her worst fears come true. The intense worry and focus on her pregnancy can make the mother-to-be wonder if she’s losing her grip on her sanity. A woman pregnant with IVF twins blogged, “Am I crazy? I don't think I will know this is going well until they are out and I can see them, and that's kind of psycho, right?” However, there is no evidence that infertility causes women to develop serious mental health issues during their pregnancies if they did not have them prior to pregnancy. Covington and Burns state, “The most significant factor predictive of psychiatric illness during pregnancy is prior history of mental illness.”

As a coping strategy, the expectant mother may emotionally distance herself from her pregnancy and the growing baby. Heather, who had a (medically) uneventful pregnancy and healthy daughter after five years of infertility, and three miscarriages, said, “The entire time I was pregnant, I couldn’t look at myself from the waist down. I didn’t say the word ‘pregnant’ or buy maternity clothes, just larger sizes and baggy styles. I didn’t get the nursery ready until after I brought the baby home from the hospital. We had to scramble to choose her name because I couldn’t tolerate thinking about it during my pregnancy. I feel sad now that I essentially missed my precious pregnancy because I was so afraid to get attached…just in case.”

Another former infertility patient said, “After trying to get pregnant for seven years, it finally happened. I guess I should be happy but I’m not. All day long I am terrified of losing this baby – which is why I don’t want to get attached. There just isn’t any guarantee that things will work out.”

When the woman disconnects emotionally from the baby in order to protect herself from the loss she fears, she can feel guilty and sorry for the baby that she isn’t “bonding” properly.

While most infertility patients look forward to the day they say goodbye to the fertility clinic, for some, the transition from infertility patient to obstetrics patient is not an easy one. Alison said, “When I was finally pregnant after five years of trying, part of me just wanted to put our years of infertility behind me and be a ‘normal’ pregnant person. But sometimes, part of me seemed to want some validation or recognition of what we’d been through to get there. I felt as if my pregnancy was more precious than anyone else’s!”

Women pregnant through infertility treatments can feel that they truly belong in neither the fertile nor the infertile world. If they have friends who are also experiencing infertility, they can feel awkward with them… and yet not feel like a genuine member of the “mommy club” of friends who conceived easily. One woman said, “I guess I feel a little self-conscious. I feel sorrow. For my fellow infertile sisters that have not yet had the chance to pick out crib bedding. And may never have the chance. Somehow I felt that I was dishonouring my not -yet -knocked -up -or -adoptive -parent infertile sisters by being excited and positive about this pregnancy.”

During your long ordeal to achieve a pregnancy, at some point you have probably thought or said, “If I ever get pregnant, I will be so happy that I won’t care if I throw up every day for the entire nine months, or gain 75 pounds!” The discomforts of a pregnancy seem inconsequential compared to the struggle to achieve it. This can lead women to feel that once they are pregnant, they must not complain about anything about the pregnancy. In fact, other people might say, “Well, this is what you wanted…”

Not everything about pregnancy and childbirth is delightful. But pregnant infertiles do not feel they are entitled to the normal ambivalence that accompanies most pregnancies. If they experience normal but uncomfortable or unpleasant pregnancy symptoms, they may feel they must “grin and bear it” because, after all, this is what they strove for. This lack of entitlement to ambivalence can carry into parenting as well, with new parents not feeling they can complain about sleep deprivation or the stress of a colicky baby. Infertility patients often feel that during their pregnancies, they can only be joyful and grateful.

It’s not uncommon for a couple pregnant through fertility treatments to already be thinking ahead to their next pregnancy. They often worry that since the present pregnancy was so difficult to achieve, they must start trying for another soon after the baby is born. Tamara, pregnant after two years of fertility treatments, said, “Here I am, seven months pregnant, and I feel jealous of other pregnant women! I can’t help but think, ‘You didn’t have to go through what I went through to get pregnant, and if you want another, you can just decide to and it’ll happen’ – I wonder if this will be my only pregnancy and it makes me sad to think about never feeling this again.”

If an egg donor was used to help create the pregnancy, the expectant mother, while delighted to be welcoming her baby soon, sometimes experiences bursts of intense sadness during the pregnancy. These feelings can be unsettling, and make her wonder if she’s attaching properly to her unborn baby. It can be helpful to think of these “grief bombs” as a parallel process – as she is saying “hello” to the baby she will be the mother to, she is also saying “goodbye” to the baby she had hoped to create from her own egg. Even if her head has known for some time that her own eggs would not create her baby, the heart sometimes takes a bit longer to process the loss. Feeling sad about the “dream baby” not coming does not compromise the relationship she will have with her actual child.

If you are pregnant through fertility treatments, congratulations! If you find the experience is more emotionally complex than you’d expected, please know that your feelings are quite normal and understandable. A counsellor trained in working with infertility issues can help you navigate the joyful and sometimes frightening new world you have entered.