Parenting after infertility – do we ever truly move on from fertility trauma?

Going through any kind of fertility struggle, whether that be natural, assisted or baby loss is traumatic and devastating. We look for answers and often feel: Why me? Why us? Why did we deserve this?

We share so many emotions as a community and so many suffer in silence, feeling they’re the only ones. That’s why we are trying to help to end any stigma, give people light at end of the tunnel and connect others who have walked or are walking a similar path.

People assume that once a fertility struggle is ‘over’ all is perfect. But, do infertility scars ever fully heal? What happens if you’re parenting after infertility, and finding things hard? With this in mind, we’ve spoken with expert Julianne Boutaleb – Consultant Perinatal Psychologist, Founder and Clinical Director of  Parenthood in Mind, to get her views on it.

Over to Julianne…

www.parenthoodinmind.co.uk |  @parenthoodinmind

“But I just don’t understand, I mean after all this time? I have my little girl now – so why did her telling me she was pregnant make me feel like I was right back there again?”

These words were spoken recently by Maria, one of the many women I work with therapeutically in my role as a perinatal psychologist who specialises in fertility issues. Like many who go on to conceive successfully via ART, she knows she is one of the lucky ones. So she thought, like many, that once she had finally got pregnant, given birth and become a mum to her daughter, she would leave the pain and trauma of infertility behind her.

Of course she did for a while. Attending antenatal classes, buying clothes for her little one, organising her Christening, making mum friends at the play group were all important steps for Maria on the road to parenthood post-infertility.  These were important milestones away from the feelings of not fitting in, of being a ‘failure’ and of loss that she associated with her struggle to conceive. But recent research carried out in Taiwan (1) suggests that even when women become pregnant via ART, it can be hard to shake off these feelings and to engage wholeheartedly with the joy of being pregnant and becoming a mother. Whilst a study by Fertility Network UK in 2016 highlighted levels of anxiety and depression, fertility trauma and its particular impact on the transition to parenthood and on one’s sense of self as a parent is less recognised.

What is fertility trauma?

Fertility or infertility trauma, also ‘reproductive trauma’, is a term first coined by perinatal psychiatrists Dr Janet Jaffe and Dr Martha Diamond in 2005, to describe the psychological impact of a range of experiences such as infertility diagnosis, recurrent pregnancy loss, reproductive injury and fertility treatment on individuals and couples. Whilst most people associate trauma with soldiers coming back from war, we know that infertility involves surviving repeated traumatic experiences such as those described over a period of many years. 

Research carried out recently into the impact of miscarriage and ectopic pregnancy, for example, estimated 2 in 5 women showed PTSD symptoms up to 3 months afterwards (2). Although only a minority will go on to develop full-blown Post Traumatic Stress Disorder, it is common for individuals and couples to experience some of the following symptoms of PTSD:

• Re-experiencing or intrusion symptoms e.g. constantly thinking about pregnancy or fertility treatment, flashbacks to previous losses or even nightmares about aspects of fertility treatment
• Avoidance e.g. avoiding baby showers or friends who are pregnant again, avoiding places or events connected with families
• Changes in mood and feelings about self and the world eg negative emotions about others who may be pregnant, feelings that the world is divided into those who are pregnant and those who are not, loss of joy, shame, anger, envy
• Hyperarousal and heightened emotional reactions eg insomnia, irritability or anger, concentration difficulties, hypervigilance, panic attacks
• Experiences of fight-flight-freeze

Whilst thankfully studies suggest that these symptoms lessen once couples become parents, we also know that experiences that we may not have had time to process may re-emerge once our brains tell us it is safe.

How might fertility trauma impact us after becoming parents?

In order to survive the fertility rollercoaster, individuals and couples develop a range of coping skills including numbing, dissociation, compartmentalisation, ‘keeping going’ and emotional detachment. Let’s face it the busyness of early parenthood often means there simply isn’t time to process what they have been through to become parents.

Some research suggests that couples who conceive via ART may initially be anxious and overprotective of their baby. Women who become mothers after multiple pregnancy loss also struggle to allow themselves complain or be negative about parenting. However, with the right support those who become parents following ART are just as securely attached as others who conceive spontaneously and express more pleasure and gratitude in their parenting after infertility role. But of course there will also occasionally be reminders of what they have endured and lost, and some of those losses are not obvious.  

They weren’t immediately obvious to Maria either. But she came to realise in therapy that she had been triggered by her sister-in-law’s pregnancy announcement back into unresolved feelings of loss: loss of the experience of falling pregnant spontaneously; back into feelings of loss she used to have when friends would announce pregnancies; back into the loss of failed IVF cycles. She also experienced the same panicked sensations and difficult emotions she used to have then.

Have you been forced into a termination for medical reasons? Read here a personal story about this heartbreaking decision and how no-one talks about TFMR.

Typical triggers for fertility trauma after becoming parents may include:

• Experiences of parenting – not having the family we imagined, not being the parent we thought we would be, conflict with partner, conversations with other parents about experiences of conception, pregnancy and birth that don’t match ours
• Transitions for our children – developmental shifts eg weaning, the firsts and lasts that come with parenting an only child, children starting school, children asking questions about siblings or family formation
• Transitions for us – secondary infertility, subsequent losses, birthdays and due dates, other losses e.g. of a job, of friends connected to our infertility story, menopause
• Transitions for others around us – others ‘falling’ pregnant, having a termination, losing a pregnancy

What can I do if I feel impacted?

1. RAIN. Recognise what you’re feeling. Accept your feelings. Interest – reflect on why you might be feeling this now? Non-identification – letting the feeling go once you have felt it.
2. Find out more about trauma and how it might be impacting you. Grounding and breathing exercises can be very helpful in managing trauma symptoms.
3. Speak to a trusted person or your partner about what has happened.
4. Seek out professional support with a counsellor or therapist with experience of working with fertility trauma.
5. Allow yourself to grieve the losses and perhaps create rituals to commemorate those losses. Create a journal, rewriting and accepting your ‘reproductive story’, its losses and unexpected gifts.

There is no doubt that our ‘reproductive story’ is what makes us the parents we are – perhaps more anxious and more risk averse than others, but also at times more emotionally connected and grateful. More aware too of the incredible privilege of being a parent. Want more on this topic? See below some interesting articles and books.

Articles

• Huang, M et al (2019) First-time mothers’ experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan. Journal of Health, Population and Nutrition, 38 (10).
• Farren, J., Jalmbrant, M., Ameye, L., Joash, K., Mitchell-Jones, N., & Bourne, T. (2016) Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: A prospective cohort study. BMJ Open, 6 (11).

Recommended books

• Haines, S. (2015) Trauma is really strange. Jessica Kingsley Publishers: London.
• Jaffe, J., Diamond, M. & Diamond, D. (2005) Unsung Lullabies: Understanding and Coping with Infertility. St Martins Press: New York.
• Flemons, J. (2018) Infertility and PTSD: The Uncharted Storm.

If you’re experiencing a fertility struggle, read here how an infertility counsellor may be able to help you.