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Special Topics

Robin J. Roberts, LCSW, PhD

After dealing with the heart breaking disappointments of infertility, many women and couples anticipate that they will be able to relax and feel good again once pregnant. I hope that you will have such a healthy and fulfilling pregnancy experience.

However, while becoming pregnant is certainly a huge milestone on the path to parenthood, it is not always the "Go Ahead" sign that couples anticipate. Once pregnant, there may still be many bumps, turning points, and reversals on way to the delivery room before bringing home a healthy newborn. If this sounds like you, look below for help with some of the challenges.

Emotional Challenges During Pregnancy:

Pregnancy Ambivalence: Because they have already experienced loss, often multiple times, newly pregnant infertility patients are often very ambivalent about a positive pregnancy test. They may still feel the pain and trauma of earlier losses and try to protect themselves from more pain; restricting positive emotions or withholding the "good news" from others are ways of keeping their guard up against possible injury. Some women feel numb or even more anxious when they reach this stage.

Many women and couples are surprised by this initial reaction of ambivalence. In fact, they are probably a bit in shock; even good news elicits the internal alarm response when it is associated with prior trauma or loss. This lack of excitement does not mean that they do not want to become parents or feel indifferent to approaching parenthood. Even women and couples who have not experienced infertility may go through this stage. If this is you, it simply means that you need more time to feel secure and identify with your pregnancy experience.

Anxiety: Women and couples who have experienced prior miscarriages are especially prone to feeling more anxious with the good news of a positive pregnancy test. This anxiety may be associated with the early weeks of pregnancy or the date of an earlier loss. Consciously or unconsciously, these women may be saying to themselves, "I can't relax and feel good about this pregnancy until I get beyond the stage of my latest miscarriage." Even then, they may not fully relax and feel confident until they hold their newborn in their arms. In this case, rather than get lost in anxiety about the road ahead it can be helpful to focus on the safety and security of the present moment.

Grief And Loss: Women who experienced prior miscarriages or pregnancy terminations may be surprised to find themselves grieving during their current pregnancy. It is quite natural to compare one pregnancy to another, and the associated feelings may arise whether we like them or not. In this case, it can be helpful to write letters to the unborn child(ren) or meet with an experienced therapist to alleviate any feelings of grief or guilt.

Guilt: Yes, newly pregnant infertility patients may even feel guilty about their good fortune. Why? Because along the way they have probably made friends with many other women and couples dealing with similar problems. Their good news now puts them "on the other side." They may hesitate to tell their Resolve friends or others, and now monitor themselves for how much good news they can share without feeling guilty. In this case, it's important to remember that happiness is not a zero sum game: there is enough happiness for everyone, and your good feelings alone will not hurt others. Chances are that your Resolve friends are genuinely happy for you. Your best strategy for maintaining these friendships is to ask about their feelings and experience, and to let them take the lead in your relationship for a while.

Depression: If these negative feelings are left unchecked and unresolved, they can lead to depression during pregnancy. This is especially true for women who were already depressed during their infertility treatment period, or who have a history of depression for other reasons. Women with Bipolar Disorder are vulnerable to negative effects from increased estrogen, which gives other pregnant women that "healthy inner glow" of joy. All of these women should consult a mental health care provider for treatment and monitoring during pregnancy.

Post-Partum Depression: For most women, the hormones of pregnancy protect them from depression. However, the decrease in estrogen immediately after childbirth is largest and fastest hormonal drop that will occur in a woman's lifetime. Women with a prior history of depression are especially vulnerable to mood changes during this period. When we combine these internal biological changes with the lack of sleep and adequate rest, along with the demands of responding to a newborn, we can appreciate the risks for post-partum depression.

Your Ob-GYN is a good resource for information and monitoring for this mood disorder. If you already have a mental health care provider, it is a good idea to have some post delivery check-ups. If you discontinued your antidepressant or other medication during pregnancy, you will want to discuss nursing and medications with your doctor if you are nursing.

Post Traumatic Stress Disorder: As much as childbirth is planned for, unfortunate medical events can occur. When the circumstances around delivery constitute an emergency or exceed a woman's capacity feel safe and fully present, she may be left feeling traumatized by the experience and develop PTSD.

Medical Challenges During Pregnancy

Multiples: Many infertility patients fantasize about having twins. Not only are the odds of twins increased by ART procedures, but the arrival of two (or more) babies at the same time may complete a family without further treatment efforts. Twins are also seen as a wonderful compensation for years of suffering. However, whenever a woman carries more than one fetus, she is in a higher risk group for medical complications and emergencies. If this you, you will also need to make special preparations for delivery and childcare.

Fetal Reduction: As often as multiples are greeted with joy, they are sometimes met with apprehension and fear. When a woman cannot carry more than one child for health reasons, or she is carrying three or more fetuses, the couple may be faced with the heart-wrenching decision of reducing the number of fetuses for the sake of mother and child. Complicated grieving can result. Sometimes only a few people or mental health care provider can be trusted for nonjudgmental help.

Miscarriage: The loss of an unborn child is emotionally devastating. Unfortunately, this loss is often unrecognized by others, especially if it occurs in the early weeks or first trimester. A woman can be left wondering if her feelings or grief are warranted or legitimate, and may be surprised by how long they last. A couple who experiences several such losses may isolate further as they feel "our story is old" already. It can be hard for others to understand that each loss is a unique event. Here the couple may be helped by support groups or counseling to complete the grieving process before moving on too quickly, or to maintain the resilience keep up their efforts.

Stillbirth: The arrival of a stillborn child after a normal and healthy pregnancy is a devastating shock. The couple, their family and friends, need to recognize this loss fully and not hasten the process by moving too quickly. This includes time holding the child and even taking photos for keepsakes. This is a time for guidance and containment by others, including clergy, doctors, and mental health providers. The couple may also be supported by perinatal loss groups, available at some hospitals.

Bed Rest: When a woman is carrying multiples or has other medical complications that threaten her with preterm labor, she may be put on bed rest for several weeks to months before delivery. She may feel anxious about her pregnancy, restless and isolated, and even impatient as she cannot go through the usual preparations for childbirth and homecoming. This is a good time for using mind/body techniques to maximize the body's healthy Relaxation Response.

You deserve to enjoy this time of your life! The mother/child bonding process is already beginning, and can be enhanced by positive emotions and mindfulness during pregnancy.

    Consider Consulting a Mental Health Provider if:
  • Your feelings of ambivalence, grief, anxiety, or guilt persist beyond a few weeks and do not subside as your pregnancy progresses.
  • You continue to feel inhibited in your positive emotions and are not communicating with your developing child.
  • You find that you cannot think about, imagine, or plan for your child's birth, homecoming, etc.
  • Test results for genetic abnormalities are positive and you need you need guidance, education, reassurance, or a neutral ear for decision-making.
  • You have a history of depression or have taken antidepressants up to your pregnancy and now need monitoring.
  • You experience sudden loss, either by miscarriage or still birth.
  • You have feelings of paranoia or hear voices in your head; can't get negative thoughts out of your head; have thoughts of hurting your child or yourself; nightmares or flashbacks to emergency procedures; panic attacks.
  • You require in-home support during bed rest.
  • Marital tension has increased, or you have a limited support system.


    Mind/Body techniques have many applications during pregnancy, including:
  • Hypnosis for preterm labor contractions, anxiety, or anticipated delivery stress.
  • Guided Visualizations for anxiety & bonding.
  • Mindfulness Meditation for bonding.
  • Journaling for grief or anxiety
  • Art Therapy for changing body image & bonding
  • PMR, Breathing Techniques, & visualizations for bed rest periods.
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