All it takes is Faith and Trust, Part 2.

I had a patient I was taking care of early on in my own journey.  I had many infertility patients before.  We, in obstetrics, know what to expect when we take care of patients who have had infertility.  We call it anxiety, but knowing what I know now, that’s not exactly the right word.  This patient did not seem anxious the whole time I knew her.  She had a history of infertility, and got pregnant with her second IUI, which I thought wasn’t too bad on the infertility spectrum.  She always came for her appointments, never asked a lot of questions, and never called in between her appointments.  When she was around 7 months, I had a conversation I typically have from time to time, asking her had she had a baby shower, and how was she decorating the nursery, etc.  She said, “I haven’t bought anything”.  I was still allowing myself to look at baby furniture and think about how I would decorate.  I thought then, that as soon as I knew I was pregnant, I would buy out the baby store.  I hadn’t gotten to that stage yet where you avoid the baby section of any store at all costs.  When I continued talking to this patient, she said “I’ll believe there’s a baby when I see one”.  

As I comb the medical literature for psychological issues in women having ART pregnancies, the results are all over the place.  Some showed women were more anxious during pregnancy compared to women having spontaneous pregnancies, some less.  Some showed women were more likely to have problems with depression, some less.  There were several theories about why the research results were so varied:  the studies were done in different countries; they used different methods for measuring emotional states.  I think there is a fatal flaw in research like this in general, which is that we in the medical field try to take an experience and “medicalize” it, or pigeon hole it into our diagnoses.  I believe that having been through infertility affects the experience of pregnancy.  Every woman will express that experience differently, some through symptoms of depression or anxiety, and some may look no different at all to the outside observer, like the woman I just mentioned.  Some may actually make the trek to Babies-R-Us, have a baby shower, and decorate the room.  But for most, there’s a small gut feeling that doesn’t quite believe that after so many false starts, you’re actually going to cross the finish line. 

So what’s wrong with that little feeling?  Absolutely nothing, which if you get nothing else out of this blog, I hope you hear this.  If you want to buy a million baby booties the minute after the positive pregnancy test, be my guest.  If the worst happens, it’s going to feel horrible, it doesn’t matter how much you bought or planned.  If you don’t want to see one diaper enter your house until the baby is born, that’s fine too.  Despite what the baby registry brochure tells you, you really don’t need much right away.  The big problem with that little feeling, is that for many women it feels “wrong," which in turn causes more distress.  It’s kind of like the snowball effect that happens with postpartum depression:

1. I should be happy
2. I don’t feel happy
3. There’s something wrong with me — which in turn makes you worried and less happy.

There’s another factor that can cause you to feel distressed — in general, everyone else.  Pregnancy, like most of life, does not happen in a bubble.  There are grandparents and aunts and uncles who have also been waiting for this baby.  Everyone else is celebrating, and you’re still waiting for the other shoe to drop.  You may get told, like I did, to “think positive” if you’re not ready to join in the party.  As someone who truly believes in the power of positive thinking, comments like this hurt.  Let me reassure you:  you do not have a negative attitude if you don’t feel ready to prepare for a baby.  You will feel connected to your baby in your own time.  For some women, its after the first ultrasound, after the first trimester, after the second trimester ultrasound, and for some, it’s literally after the baby is born.  So how do you deal with the rest of the crowd?  Well, you’ve had experience dealing with friends and family during your infertility journey.  There are some to whom you can explain how you feel, there are some you will smile at and avoid.  I often say to my patients who are having physically difficult pregnancies that the best thing about pregnancy is that it always ends!  Unlike infertility, there is a finite amount of time you have to negotiate that voice in the back of your head.  

Next post - more concrete suggestions for stress relief in pregnancy.