The Baby Decision

by Merle Bombardieri

  take your time before signing up for childbirth classes, or furnishing the nursery, even if others are urging you forward.

  receive the support you need from family, friends, counselors, and support group members.

  Your best resources may be friends or women online who can tell you about their experiences. You will typically feel some hope when you realize that these women were as scared and disbelieving as you but wound up with a child. Even if your most frightened voice says, “Yeah, they eventually got lucky, but how do I know it will happen to us?” you may be able to feel somewhat more hopeful.

  Also, talk to your medical team about their plans for monitoring your pregnancy. Are your hormone levels increasing as they should? Will you need any medical treatment to increase the chances that the pregnancy will continue? Are there suggestions for prenatal care?

  Aline Zoldbrod, the author of Men, Women and Infertility: Intervention and Treatment Strategies, recommends a mantra, “So far, so good,” for each day that you are still pregnant.

  This situation is so difficult and so confusing because medical realities and your loved ones’ assumptions that you are on your way to parenthood may be at odds with your feelings. Professional help can provide relief. I recommend seeing a psychotherapist when you first get the results and making follow-up appointments throughout the pregnancy. You and your partner may want to come together for the first visit and then toward the end of the final trimester when your worries about childbirth and about the baby’s health peak. You will probably want some individual sessions as well for extra support and perhaps a chance to speak more freely than you can when your partner is there. The mid-trimester tends to be the easiest because you are can see and feel the pregnancy and you are most likely to be physically comfortable

  When I see clients who are pregnant after infertility, I use guided imagery for relaxation and, for those who wish, for visualizing yourselves as a happy family a few months after the birth. I include affirmations in each session. I record the session right on their smartphones so that they can listen as often as they like. Perhaps your therapist can do this for you, too, or if she lacks this expertise, can refer you to a hypnotherapy/guided meditation expert.

  Later Stage: Thinking About Stopping Treatment

  A time will come when you (and your partner) become more tired than ever of treatment, and less optimistic that the treatment will work. Sometime, when you and your partner are just beginning to consider stopping, your medical team, family or friends may be bringing up the possibility of moving on. If you have been working with your own gametes (eggs and sperm), you may be considering ending the current treatment and turning to donor egg or donor sperm. If there are uterine issues that may be contributing to fertility or to pregnancy losses, you may be considering surrogacy.

  If you have ruled out these alternatives because you are not comfortable with them for psychological or ethical reasons or the medical risks involved, or if you have been told that these treatments are unlikely to work, you may be thinking of stopping altogether. In this case you may be considering adoption or remaining childfree.

  But how do you know when to say “Enough is Enough!” when there may be a new treatment your team has just told you about, or they are proposing a new protocol that might improve your chances?

  First of all, you may be able to reduce your stress in decision-making if you realize that you don’t have to decide to stop and choose an alternative simultaneously. You may need and benefit from some time off from treatment for your bodies and minds to recover. Walking in nature and lounging over brunch and the newspaper, for instance, may refresh you mind for new insights.

  Compassion is key in being able to say, “Enough is enough. My body and I [or my partner and partner’s body] have had about all we/they can take! We start cycles feeling hopeful, but these hopes are dashed every time. It is time to end this suffering.” “We like ourselves too much to continue,” said one couple who went on to adopt their two children.

  Another aspect of compassion, is that when the time comes that continuing to try is harder and less promising than it used to be, that you don’t let the compulsion to succeed at pregnancy override your need for relief and need to get on with your life.

  When we talk about resolve to keep going no matter what, we often associate this with the Puritan ethic. But actually, the Puritans had compassion for their own suffering. They said, “Enough is Enough—enough of religious persecution in England, time to move on to a place where we can practice our religion in peace.” They were looking for religious freedom. When you say enough is enough you are looking for freedom from medical intervention and from riding the monthly roller coaster of uncertainty.

  Here are some of the actions to help you decide when to stop.

  Couple Actions

  Have a conversation about stopping. Tell each other how you feel about recent treatment. Are you optimistic, or feeling exhausted and burned out? Is it possible that one of you has been ready to stop while the other wants to continue? You may have already talked about this, but I have met couples who did more treatment than either wanted because they thought that the other wanted to keep going.

  Do either of you have in mind the number of cycles you are still willing to do, or the number of months after which you would like to stop if you’re not pregnant? It may bring you a sense of relief to even think about stopping.

  Consider a sabbatical. Maybe you aren’t ready to stop, but you might benefit from a break, sometimes referred to as a “vacation from trying.” This could be a month or two with no doctor visits, no ovulation monitoring and no treatment, a month that you will not have to ride the rollercoaster (two weeks of hope and trying, two weeks of waiting with an unbearable mix of hope and dread resulting in the woman’s getting her period).

  During this time, many people literally take a vacation, often going to a favorite spot they enjoyed earlier in their relationship. This is a chance to connect with happy memories of falling in love at a time when you weren’t trying to have a baby. You might even enjoy lovemaking in these circumstances. You may connect with what you like and love about your partner, things that pre-dated infertility and that you will enjoy about each other when you are parents (or have made your peace with being childfree).

  Although you may be terrified that your sabbatical month might be the only month that a successful conception might happen, postponing treatment a month or two down the road is unlikely to decrease your chances of success.

  Medical Actions

  Call your medical team and ask for a longer meeting to discuss your treatment plan including the possibility of stopping soon. Be sure to bring a partner or a friend, obviously your partner if you have one, since you are making the decision together. Your companion can write down the team’s answers to questions you ask, and might record the conversation.

  Your team could be trying to encourage you with new techniques to try if they think you are eager to continue. If they know that you are thinking of stopping, you can take stock of what makes sense if you will only do one or two more cycles.

  Get a second opinion to see if there are other things you haven’t tried yet, or anything has been overlooked. A fresh eye can be useful even if your team is well-regarded. Don’t worry that your regular specialist will be insulted. Most won’t, and as a matter of course, they also give second opinions to their colleague’s patients.

  Make sure your second opinion consultant knows you are leaning toward stopping. You want to focus on what, if anything, it makes sense to continue doing or to do differently if you decide to go forward a little longer. Even if this person recommends continuing a treatment you’re already doing, s/he may have a suggestion for doing it differently, for instance, using a different medication or different dosage of a current medication.

  Now that we have dealt with the medical issues, let’s take a look at the psychological ones.

  Psychological Actions to Help You Consider Stopping />
  Now that the preliminaries are established, it’s time to do some inner work.

  Values Clarification

  1. Is having a child and getting on with parenting becoming more important than how the child arrives in your home, or than whether the child is genetically connected to you?

  2. How much is treatment costing you financially, mentally, and physically? Do you feel too exhausted or reluctant to go to medical appointments?

  3. Would you cheer or would you groan if you found out that new treatments were available for you condition?

  4. Do you have a deadline in mind for stopping? E.g., January 1st, your birthday, in six months.

  5. On a scale of 1 to 10, how confident are you that treatment is going to work?

  6. On a scale of 1 to 10, how willing are you to submit your body (or watch your partner’s body being submitted) to the next treatment?

  7. Consider a tentative deadline for stopping that you could extend if you chose to. This might be easier than setting it in stone.

  8. Each of you can do a chair dialogue between the part of you that wants to keep going no matter what until you finally succeed at pregnancy and the part of you that wants to get on with your life as a parent by some other means (or even make your peace with being childfree).

  Through resolve.org or your own social connections, talk to other people about how they made the decision to stop.

  Grief Work as Preparation to Stop Trying

  There is a Zen proverb, “The way to control a bull is to give it a big pasture.” I use this proverb in every talk I give on grief, because I believe that infertility grief is a kind of freedom from struggle. Imagine that in trying not to feel your grief, you are hanging onto a bull’s horns, getting dragged all over a muddy pasture while those horns are bloodying your hands. Then imagine hopping over the fence and just watching the bull run and charge, bringing an end to your suffering.

  I believe that dealing with grief in this country, where we are ordered to “stuff it down” tosses us right into the bull pen. The task at hand is to allow yourself to let go of all the anger and sadness that you have been trying not to feel about not having a baby or about pregnancy losses.

  But Merle, you may ask, how can you insult me? I’ve been crying and raging for years. Unfortunately, it seems we can let out about 90 percent of our grief and get only 10 percent of the relief we need.

  I am going to give you some ideas that may make your grief more tangible so that you can get more relief. Rather than thinking about these losses in the abstract, you are about to use sensory detail to connect emotionally to these losses.

  Some advice: Don’t do these in public. You will be more comfortable in the privacy of your home. If you have a psychotherapist, you can do these with her/him. Or you might want to start seeing someone for short-term grief work.

  1. What month and year did you started trying for pregnancy? If that had worked, how old would that child be now? For instance, if you have been through five years of infertility, you might have a fouryear-old and a one-year-old.

  2. Make a list of all the family, friends, neighbors and co-workers who have had children since your start date. This is your validation for how many times you have watched others get their dream of parenting, while still waiting for your own dream to come true.

  3. Imagine a child of each sex, perhaps three years apart. What do they look like? What characteristics do they share with you or your partner? Looking at your own baby pictures may help with this.

  4. Collect any baby objects you have in your home, an heirloom baby spoon, your niece’s teddy bear, the rattle you bought at an art fair. Spend some time holding these objects. You might bring them to a therapy session to show your therapist.

  You may find it helps to take a day off from work, or to clear regular activities on a quiet Sunday. Most people say they are surprised that, despite their sadness, it was easier to let these feelings out than to be struggling to keep them in a pressure cooker. Be sure to talk to an understanding person to process this experience.

  Many people who are trying to say, “enough is enough,” are pleased to discover that after grieving, it is easier to make this decision and also decisions about alternatives.

  Although first-time parents usually turn to adoption only after ruling out pregnancy, it has many attractions:

  The chance to provide a loving home to a child whose life might have otherwise been much harder. If you have concerns about population growth, you may feel that adoption of an existing child is better for the planet.

  The chance to be free from the medical and psychological stresses of fertility treatment.

  In the case of those with genetic concerns or whose physical or medical problems would mean risk to the mother and to the child, if pregnancy was chosen, the relief to not have to endure a high-risk pregnancy.

  If you have had a number of miscarriages, you can avoid putting yourselves at risk for another.

  If you are in an educational program, work situation or caring for another child or family member who needs a great deal of care, the possibility of bedrest or having activities restricted is bypassed by adoption.

  The chance to know that your child has already been born healthy (even though some problems don’t show up until later.)

  In some cases, you are given the chance to choose your baby’s sex, for instance in international adoption, where the placement happens after a child is born. With a domestic adoption of an unborn baby, the child’s sex may be known from prenatal tests. Keep in mind that agencies are more likely to work on sex preferences if you have had a miscarriage, stillbirth, or child who died around birth, and would prefer a child of the opposite sex.

  Adoption does also have some disadvantages, however:

  The costs. If you live in a state that pays for fertility treatment, even if you want to move on to adoption, you may stick with the fertility path because it is less expensive.

  The scrutiny. No one likes the idea of having to prove to a stranger that they will make a good parent, when cruel, emotionally clueless or abusive people weren’t subjected to an evaluation. Be aware that states and children’s service organizations have a legal and ethical obligation to get enough information about you in order to conclude that the child will be safe and cared for.

  So why adopt? There are a number of reasons for using adoption to create your family:

  One or both of you are infertile.

  You have one or two biological children and want another child, but you don’t want to contribute to the world population problem. You also want the satisfaction of providing a good home to a child who really needs one. Or maybe you aren’t a parent yet and find the population/environmental concerns compelling, as well as getting matched to an existing child.

  You’re a gay couple who has ruled out pregnancy for medical or personal reasons.

  You have one or more biological children and have tried again but with no luck.

  You are a single woman who wants to become a mother. For various reasons, you prefer this option to pregnancy.

  You’re a single man who wants to become a father without the complications of creating a pregnancy for co-parenting.

  All of these reasons are good ones, and acceptable to adoption agencies.

  Guidelines for Considering Adoption

  1. Do some reality testing. Have you been too caught up in romantic notions to ask and answer realistic questions? Are you fully prepared for the sacrifices as well as the gains?

  2. Talk to successful adoptive parents. Discuss the problems they have faced, and find out how they have coped as well as their joys and satisfactions. Is your level of patience and tolerance equal to theirs? Could you cope with the problems they have had? Although it’s unlikely that your problems would be the same, you will get food for thought for decision-making.

  3. Face disappointment about infertility. If you’re adopting because of fertility problems, make sure you don’t leave any unfinished bus
iness behind. You have to mourn the biological child you will (probably) never have before you can welcome an adopted child into your life. Otherwise, you may consider the child a substitute at best, and you won’t be able to give him the first-rate love he deserves.

  4. Consider the rest of the family. If you have biological off-spring, have you considered their needs as well as your own? If they are old enough, discuss the possibility of adoption with them, after consulting a psychotherapist or adoption worker.

  5. Be realistic about potential problems. If you adopt a mentally, emotionally, or physically-impaired child, are you still planning to work? Will your agency let you work after the child comes to live with you? You may find it even harder to juggle career and child than if you had a biological child.

  Common Forms of Adoption

  Domestic adoption, in which your adoption agency places a child whose birthmother worked through your agency.

  Domestic adoption in which a local agency in your state (if required) works with an out-of-state agency, law practice, or children’s home. This is common if most women with accidental pregnancies in your state keep their babies or terminate the pregnancy. For instance, it is more common for women in the South, West, and rural areas to consider adoption the best solution. This choice may be based on religious or personal beliefs or a clear-eyed understanding that they are not in a life situation to raise a child.

  Independent domestic adoption in which you locate, through networking, advertising, or a law practice, a birthmother interested in relinquishing her child to you. If the child is in another state, you will need a lawyer in your state and another in the other state to coordinate logistics and be sure you follow the requirements of the Interstate Compact regarding adoption across state lines.