DR. LORRAINE M. DORFMAN
CALL DR DORFMAN: 1-610-740-0755
By Lorraine M. Dorfman, Ph.D. © 1996*
The family had finished the evening meal. The kids were watching television. Anne’s husband, Jack, was reading the paper. Anne was rinsing the dishes and stacking them in the dishwasher, whistling a tune from My Fair Lady she heard on the radio earlier and could not get out it out of her head, when she was jostled by the phone ringing. In no danger of anyone else dashing to answer, Anne wrestled a rubber glove from her receiver hand to put an end to the disturbance. It was her sister on the other end of the line.
Some sisters have miles of sibling rivalry between them, but Anne and Michelle had shared all their secrets since the time the cohabited the frothy pink bedroom they plotted together and needled their mother into painting according to their specifications. So, Anne could tell immediately Michelle’s voice held something ominous that she was trying to cloak in a breezy tone.
Evading Anne’s questions at first, finally Michelle allowed that she was being admitted to the hospital. The pregnancy she was so excited about five weeks before was over. Michelle announced her pregnancy to everyone she knew as soon as the test stick turned color. Recipients of the news started counting on their fingers, as it was not long after the honeymoon. Michelle and Anne’s brother-in-law were both blissfully happy. The world was a pearl in an oyster and life was richly complete. Until the oyster expelled the pearl. One day Anne’s sister was pregnant and the next day there was no trace that she ever had been pregnant.
This was not the receptionist at the office or some faceless person to whom this was happening; this was Anne’s dear sister. Anne felt the blood drain from her. Her mouth remained open, but no words would come out. She held her breath and the tears immediately welled up in her eyes, spilling over on her cheeks. Anne still was in shock when she told her husband the emotional devastation that became labeled “the news.”
That was just the beginning. Over the next five years, Michelle had three more miscarriages. Friend turned away from her, unable to face someone else’s pain, lest it hit too close to home. Again and again, she heard, “You’ll get pregnant again.”
To add insult to injury, interaction with the medical establishment was totally dehumanizing. When Anne accompanied Michelle to one of her gynecological visits, Anne saw firsthand the t-shirts, depicting swimming sperm, worn by the office staff. Between pregnancies, Anne’s sister and brother-in-law went to an infertility clinic. Even the label “infertility” was demoralizing. Michelle’s days were punctuated with thermometers and test tubes. Making love, Michelle confided, was transformed into a “must do” prescription from the doctor at specified times, along with temperature readings and urine specimens. When the doctor injected her husband’s sperm into her uterus, her husband held her hand so that he could maintain the sense that he had something to do with the conception process. The synthetic hormones made her sick and irritable, which she described as feeling like she was “bouncing off the walls.” None of her four pregnancies ever had anything to do with the medical treatment she received.
From the sidelines, Anne watched with her heart in her throat as he sister and brother-in-law ran out of money and hope and, finally, energy. In the end, her sister’s marriage died too; Michelle and her husband divorced. By then, she was 39 years old. She never would have a child. Her dreams, and Anne’s for her, were shattered.
Anne’s kid wanted to know what happened to the babies, their cousins. There was no funeral. Michelle’s employer would not give her paid “death” leave. The doctor, whose office always seemed full of happy, pregnant women and offspring, offered Michelle a happy pill. No one wanted to deal with her profound grief. Even Anne was often lost for words. A friend asked Anne about Michelle, “How can you grieve something you never had?” Her baby already had a name. She grieved that she never would hear her child call her “Mommy.” She never would feel the tiny little hand holding onto hers. And, for a while, she though no one would ever look upon her as a whole woman, not even herself.
Anne watched her sister cringe during introductions when asked, “Do you have children?” Anne is grateful most of their friends are too old be having baby showers. Michelle is irritable thorough the Christmas/ Chanukah holiday season, which cannot end soon enough. This puts a strain on the family get-togethers. Then, in the middle of the year is Mother’s Day, a joy for some, a painful reminder for Michelle.
Michelle is not unique. In the United States, 18.5 percent of couples are childless, not by choice. Infertility is a problem faced by 4.9 million women and 4 million men. Infertility problems may be related to inadequate sperm count or sperm motility, making it nearly impossible for a single sperm to fertilize an egg. Female infertility problems may be due to follicles, cervical mucus, immunological antibodies, endometriosis, fallopian tube scarring or blockage, or DES (the drug prescribed to mothers of a generation ago to prevent miscarriage), and hormonal problems. Or infertility may be relegated to none of the above, but comprised of the baffling “unexplained infertility.”
In a single year, three million American couples will spend as much as $100,000 per couple for diagnostic testing and infertility drugs. They will sacrifice their dignity to painful procedures that dehumanize sexuality and love. Of these, only 21.2 percent will conceive. Intrauterine insemination (IUI), suing a catheter to insert sperm, is the most commonly performed and least expensive procedure with the lowest success rate. In vitro fertilization (IVF), combining egg and sperm in a petri dish and transferring the zygote to the uterus, is the second most popular procedure. When the zygote is transferred to a healthy fallopian tube, it is called zygote intrafallopian transfer (ZIFT). Intracytoplasmic sperm injection (ICSI) involves injecting a single sperm into an egg and transferrin the zygote to the uterus. Gamete intrafallopian transfer (GIFT), as the name implies, involves injecting egg and sperm into a healthy fallopian tube. Anything that involves forming a zygote in the laboratory averages upwards of $10,000 per attempt.
Statistical success rates may be misleading when applied to the individual. Successive trial percentages are based upon the pool of subjects so that if one woman in one hundred becomes pregnant with the first try, only 99 women are left for the second try, automatically increasing the percentage rate for one woman becoming pregnant. It is termed “the gambler’s fallacy” to believe that one’s potential for success increases with each successive attempt. The potential rate for any given try for any given woman is 50-50 that she either will or will not become pregnant.
Conception is not the end of the story. An estimated 75 percent of all fertilized eggs never come to term as a mature baby. Approximately 60, 000 women experience the loss of motherhood through ectopic pregnancies and 1.5 million through abortion. The IUD, an abortive contraceptive device, has caused untenable pregnancies. Between 600,000 and 800,000 fertilized eggs that do not divide properly to continue growing into a fetus are spontaneously aborted, a miscarriage, in lay terms. Some women repeatedly miscarry, as was the case with Michelle. Of those that carry to term, 250,000 will experience perinatal death and 15,000 will lose a child to SIDS (Sudden Infant Death Syndrome), the unexpected and sudden death of an apparently normal and healthy infant that occurs during sleep.
There are no statistics for those who have lost the dream of parenthood to life experiences and circumstances, though the grief is no less painful. While medical advances bring others who suffer the loss of motherhood into public awareness, this group goes virtually unnoticed. They are those whose biological alarm has gone off while they were faced with divorce, spending their reproductive years on working for a living, refusing to sleep with anyone with whom they were not in love, or searching for an appropriate mate. Even if they chose not to have a child with the wrong partner or to live celibate until married late in life, they may still be grieving in their hearts for the extension of life they have lost. In answer to Michelle’s sister’s friend, the loss is very real, regardless of how it took place.
On Mother’s Day we pay homage to the institution of motherhood in all its complexity. From a biopsychological perspective, the yearning to have a child may be a primal urge to propagate the species. From a sociological perspective, childbearing may rest with societal pressure to grow up, be mature, be responsible, become a member of the parent club, provide an heir and demonstrate that you are not “selfish.” From a cynical anthropological perspective, the desire for a child may be rampant commercialism and consumerism to have the product that promises parental glow and happiness. Or it may be a deeply spiritual undertaking rhapsodized by poets through the ages.
For women who desperately wanted a child and have none, Mother’s Day tugs at the heart’s strings. On Mother’s Day, especially, they are set apart. They are the women who are not wearing a corsage to the restaurant and who receive no greeting cards. To their great dismay, their hearts are not overflowing with pride at their offspring who are not there.
What happens to people like Anne’s sister who courageously risk their hope to the disappointment of an empty nest? Some become obsessed with succeeding, regardless of the cost in time, money, effort, and relationships. Others shut down and withdraw.
These women and their partners are out loved ones, our neighbors, our coworkers. They need our support to heal. Yet, as a society, we are ill-prepared to offer the consolation and healing needed. Indeed, we feel helpless in the face of such profound loss and grief. We may try to keep a stiff upper lip. We may fall silent. The silence is probably better than some of the awkward reassurances, such as “Life goes on,” “You’ll get over it,” “Give it time,” or “It’s nature’s way.”
The alternative – to turn away altogether – is even less satisfactory. When emotions are denied, relationships suffer. Some relationships will recover and some will be irreparably broken. For the person grieving the loss of parenthood, the loss of existing relationships compounds the recovery time that otherwise would be eighteen to twenty-four moths. They need our compassion and yes, our hope, that they will live through their grief and find happiness.
The loved ones of the bereaved may be bereaved as well. Parents experience the loss of grandchildren, siblings experience the loss of nieces and nephews, and children experience the loss of siblings or cousins. Look for signs of depression such as change in appetite, change in eating patterns, change in sleep patterns, change in activity patterns, change in mood, irritability, tearfulness, loss of pleasure, loss of libido, difficulty concentrating, or ideas of suicide. The bereaved may be more frequently absent from work. They may present to their family doctors with complaints of anxiety, stress, flu, more frequent colds, or psychosomatic illness with prolonged recovery times.
With help and support, the bereaved progress to resolution and acceptance. If you want to help, be patient with the gestation time for healing the grief and reaching acceptance, however long it takes. Rather than imply the loss is trivial or meaningless with hollow words of consolation, tell the truth if you do not know what to say. Ask the person how she feels rather than assuming you know. Include the partner, offering support to both. Patiently listen to talk about the lost child, hopes, and dreams and try to understand from the other person’s perspective. Offer your time and attention. Visit. Show affection. Be sensitive to the person’s sensitivity to Mother’s Day, Father’s Day, the baby’s due date, the anniversary of the loss, or the presence of pregnant women or children. Also be gentle with yourself and accept your own impatience or grief.
Seek community support as it is needed. There are many organizations that offer support and information. RESOLVE, based in Massachusetts, disseminates information about infertility and adoption, including a booklist and doctor referrals. INCID, the International Council on Infertility Information, is on the internet, SHARE, based in Illinois, offers support to women and their families dealing the death of a baby, either before or shortly after birth. The eastern Pennsylvania chapter of SHARE is UNITE. Other support is offered by American Fertility Society in Birmingham, Alabama; Compassionate Friends, Inc. in Oak Brook, Illinois; the Endometriosis Association in Milwaukee, WI; Ferre Institute in Utica, NY; National Infertility Network Exchange in East Meadow, NY; Pregnancy and Infertility Loss Center is Wayzata, MN; and Serono Symposia, U.S.A. in Norwell, MA. There are many adoption societies, including Welcome House: Social Services of the Pearl S. Buck Foundation in Perkasie, PA.
*Presented at the 16th annual “Day For All Women” conference co-sponsored by Bucks County Commissioners’ Advisory Council for Women and Bucks County Community College and underwritten by First National Bank, First Service Bank, First Union Bank, Kumon, U>S>A>, Inc., Merck and Company=any, and Pro-Dent Corporation.