This Pain Feels Too Great to Bear
"I can't believe this is happening to me." How do couples cope with a loss that is invisible to the rest of the world? When we lose a grandparent or a pet, society has given us rituals of mourning, venues to express our pain, cultural normalizing takes its cue. But not all losses are equal. People who experience infertility and pregnancy losses all too often suffer in silence. Sadness, shame, guilt, loneliness, all experienced in isolation. This article is for all of the families impacted by such losses, and should be shared with the greater community at large to raise awareness of issues that remains under discussed and under studied. October marks another pregnancy and infant loss awareness month. Let's all do our part to raise our society's collective awareness around these issues.
To Miss a Person We Have Never Met
"This was supposed to be easy, what is wrong with me and my body?" "What did I do to deserve this?" "I feel like my body is betraying me." Women who have trouble getting pregnant often blame themselves. As adults going through this, the stories we told to ourselves as children or teenagers of one day becoming a parent, the stories of self and how things were "supposed to go" gets rocked - decorating the nursery, picking out names, parenting, this all needs to get expanded now that the ideal has seemed to go off track. In the context of couples trying to get pregnant, we need to remember that infertility is a relational issue. The relationship can become so focused around the infertility. And each partner's pain can go unnoticed by the other. Those experiencing complications around fertility are at risk for developing depression, anxiety, and in some cases PTSD.
What exactly constitutes as infertility? Infertility is the inability to achieve or maintain pregnancy after 12 months of regular unprotected sexual intercourse. In the U.S., 1 out of 8 couples have trouble getting pregnant. Couples facing this challenge often find that much of the joy and spontaneity around sex gets lost. Being physically intimate has now become "results driven", "we're on the clock", and feeling that pressure can be so difficult. This element in a relationship that is so fundamental to a couple's intimacy is now painful or even absent. The act of sex itself can be a source of grief and emotional pain for the couple for what is represents - "we're not a fertile couple." It is so important for couples who feel like they just need some space and distance from sex to be able to remain physically and emotionally close. If couples take intercourse off the table, they still have affectionate touch, playful touch, and sensual touch available to them.
I Held You in My Dreams
When couples who have been trying to get pregnant for some time are able to achieve pregnancy, they can feel a whole host of mixed emotions. What they have been longing for has finally happened. And, not all pregnancies will be successful. About 1 in 5 clinically diagnosed pregnancies will be lost; Here we're not including those pregnancies lost prior to a medical doctor's confirmation. Perinatal loss includes miscarriage, stillbirth, and neonatal death. This may be new ground for a lot of readers, particularly because our culture doesn't talk about these losses, so let's get our terms defined first before we move ahead.
There are a lot of misconceptions and myths around miscarriage that should be covered here. First, the myth that miscarriages are rare has already been addressed, but it's an important one to dispel since believing it can lead many women to feel shame and isolation. Women may believe that it's their fault, that they did something to cause it, "I drank too much coffee", "I could have prevented it from happening." This is simply untrue. Most miscarriages are caused by a developmental problem with the embryo. The myth that this only happens to women over 35 still has traction. The silence around miscarriage in our culture only serves to perpetuate these misunderstandings and sends an implicit message that we should feel shame. Worse yet, well intentioned friends and family members can end up saying incredibly hurtful things like, "Everything happens for a reason" or "Well, you can always try for another one."
How Old Would They Be Now?
26,000 stillbirths occur every single year in the U.S. That's an unbelievably painful statistic to reckon with. That is 68 stillborn babies every day or 1 in every 160 births. Again, there is scant literature out there that addresses treatment for the couple after suffering this type of loss which further implicates our cultural aversion to the issue. This baby had a heart beat. In many cases, the mother felt it moving. It may have been given a name, which gives him or her even more form, more identity, and gives the partners more emotional pain. The couples that face this loss are grappling with the paradox of wanting to hold on to their loss while at the same time trying to let go of it. There is no birth or death certificate given to the parents of a child that dies in utero. For the couple, their loss is real, and yet they are missing some of the symbols and rituals that others have when they are in mourning. It is very important for these couple to not let themselves or their family narrative be defined by the loss. They will never forget, but they can begin to write the next chapter in their story.
The most frequent cause of neonatal death is premature birth. Parents have the choice of holding their baby after death, and for different people, for different reasons, this can help the grieving process or it can stunt it. All of these losses can be traumatizing. Loss triggers previous loss. It is not uncommon for partners to be out of sync in their own grieving process. People go in and out of grief, and this back and forth can feel like an emotional rollercoaster, especially when one partner feels ready to try again for a baby and the other partner is nowhere near being ready, or may even resolve to not try again because the thought of going through this again is unbearable. There is an incredibly powerful article about one mother's story and the death of her infant in the New Yorker written by Ariel Levy called Thanksgiving in Mongolia. Please get your tissues ready before reading.
What Can Couples Do When They're in Hell?
One of the more effective treatment models in psychotherapy for couples or families who have suffered through infertility, miscarriage, stillbirth, and/or infant loss is Narrative Therapy. In this framework, couples are encouraged to externalize the loss. This loss is not "who you are", it does not define the couple, rather it is a challenge that you both are going through. This is not the woman's problem, the couple is sharing this struggle. Often times partners lose parts of themselves when they're in hell. It is important the be able to reclaim these parts of self. Again, you do not have to stay in this chapter. Remember the previous chapters of your life, and get back to who you are fundamentally as a person. Get back to those intrinsic things that define you. Acceptance does not mean that you are forgetting about your child. Couples recovering from this kind of loss are encouraged to expand their ideas around pregnancy, parenting, and identity. How will the couple integrate this chapter with their larger family story. If becoming a parent is still a part of that story, then perhaps adoption is looked at as one option.
This article is only a surface visit to these issues. If you are struggling with any of these types of loss, you are not alone. You do not have to remain alone. Professional help is one phone call away. If you know someone who is going through, or who has gone through a version of this unimaginable pain, please share this article with them.
"I carry your heart with me (I carry it in my heart) I am never without it."
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
Robin S. Smith is a psychotherapist practicing in Bethesda, MD. Robin created The Couple and Family Clinic Blog to provide useful articles on issues related to mental health as well as articles on local, national, and international news stories. Learn more about Robin on the About Page.