For some women, the most painful aspect of motherhood is not becoming a mother. When personal, familial, and social expectations of maternity are unfulfilled, the psychological fallout is often immense. Infertility and pregnancy loss are at odds with the biological, emotional, and spiritual drives that motivate a Jewish woman to birth and nurture her children. Those painful experiences are seldom discussed openly, but they are an aspect of maternity nonetheless.
This
article took shape thanks to a WWW reader who reached out to request a
voice for “struggling would-be mothers” in our community. Although she faced
hurt and disappointment while coping with consecutive miscarriages, her primary concern was for others who
feel marginalized by stigma and
frustrated over the lack of compassion they receive. Her bold sentiment reminds
us that maternal mental health includes the unpredictable journey toward
motherhood, beginning even before conception.
Nobody
deserves to suffer alone, the
least of whom are women who’ve
endured much physical and emotional pain in their attempts to raise a family.
This article is for them, though it can benefit us all.
Miscarriage,
stillbirth, infant death, and infertility are more common than we realize. More
than 15% of known pregnancies end in miscarriage, and 10% of women will
experience fertility issues. The chances are that you know at least one woman
who is or was enduring a reproductive hardship. Each year in the U.S., there
are at least 750,000 miscarriages affecting hundreds of thousands of women. So
much trauma, yet we hear so little about these painful experiences.
Considering
the prevalence of these delicate maternity issues and lack of available social
support, we understand the need for their “voice” as well as empathetic
audiences for their plight. Community awareness can increase our shared ability
to respond to a would-be mother’s needs tactfully. Still, awareness alone
cannot create the needed platforms for supporting their grief. To that end,
let’s briefly explore the most common experiences related to reproductive
grief, taking a small yet significant step toward destigmatizing a subject that
leaves many suffering in silence.
Infertility
There
are numerous causes of infertility and several treatments available to help
couples overcome reproductive setbacks. Couples readily attest to the
overwhelming uncertainty underpinning their testing and treatment process. Life
becomes a blitz of diagnostic tests, medications, and invasive procedures. Each
method involves high stakes, minimal margin for error, uber-precise timing, and
dozens of injections and blood tests. And it’s expensive. Very expensive.
Although community organizations and private insurance can defray treatment’s
financial cost, a woman must endure the pain and physical burdens unaided
– injected, probed, prodded
– daily for weeks. If any
part of the multi-step process fails, then she starts from the beginning.
“I’m
bracing for the worst” and “I hate putting myself and husband through this” are
two of the most commonly expressed sentiments from women reeling fertility-related stressors.
They report persistent worry about the unknown: “What if something goes wrong?”
Having the financial means and willpower to continue after unsuccessful
treatments is a looming burden that gnaws at couples. So is the disgust that a
cold and sterile medical procedure has replaced the intimate joy of organic
conception. So much emotional hedging against disappointment eventually leads
to blunted emotions, hostility, sleep disturbances, muscle tension, and
isolation. Most women go through this process alone, concealing pain from employers and neighbors, even from
family members or their children if they already have them.
Miscarriage
and Neonatal Loss
A positive
pregnancy test often elicits a flash of thoughts and feelings. A burst of
expectations crystalizes in the mind as a vision of baby girl or baby boy,
multiple births, names, sleeping arrangements, upsizing to a minivan or
12-seater, the child’s first steps, and dancing at the wedding. Those thoughts
are complicated, even muddied, by questions about family dynamics, shalom
bayis, finances, living space, carpool schedules, and many other logistics.
Then it’s gone. Days, weeks, or months later, the bounty of dreams and
anticipation of potential life come to an unceremonious end.
For
some, their loss blindsides them during what was supposed to be a routine
ultrasound as the doctor or an unknown technician announces, “There’s no
heartbeat.” Then the dread of breaking the sad news to one’s spouse and loved
ones, followed by a D&C procedure. Even the raw descriptions fail to
contextualize her profound
sorrow.
As
with fertility treatment, women who lose a pregnancy feel pressure to smile and
carry on – a noble
ambition with a lasting emotional toll caused by unhealed wounds. After raising
a large family, some women will return to therapy more than 15 years later to
process the trauma of an earlier loss. These mothers can vividly recall the
fear of facing a world that knew they were pregnant.
Although
80% of pregnancy losses occur during the first trimester, social pressure
compounds for women further along in pregnancy who have already started to
“show.” A stillborn child’s mother reports grief and shattered expectations
common to the mother coping with neonatal loss. Neonatal loss (death of a child
within one year of delivery) leaves many mothers with the nagging suspicion, “I
could have prevented this; this is my fault.” Traumatic loss colors their view
of self, others, and their future, and few can truly relate to their new perspective. When they
carry future pregnancies to full term, these mothers tend to rely heavily on
stress-based parenting practices. Without professional help, many develop hyper-vigilant
reactions to perceived threats and take an overprotective parenting stance
fixated on maintaining control. Mothers who have sat vigil by an incubator in
the NICU (neonatal intensive care unit) can relate to this experience. They are
likely to experience frequent intrusive thoughts about their child’s safety
after discharge from the hospital and
can distort their worldview until they’ve had time to process their NICU
experience.
You Are
Not Alone
When it
comes to supporting women during and after their reproductive struggle, our
role is one of compassion and respect. Many women prefer not to speak about
their experience; that is their choice, and we respect that choice.
Understandably, they may feel uncomfortable discussing such an intimate issue,
especially one laden with complex emotions, including guilt, shame, resentment,
inadequacy, jealousy, frustration, anger, and even conflicting emotions that
can lead to panic.
Still,
many women report that they don’t disclose their loss because they “don’t feel
entitled to grieve” for a pregnancy they hadn’t announced. Also, they fear
off-putting and insensitive comments that make silence more preferable than
risking another awkward – or
offensive – encounter.
Despite
loved ones’ good intentions, we inadvertently stumble over hurtful tropes that
induce future silent suffering. Unfortunately, we subject many women to
minimizing statements, like “My sister-in-law went through the same thing”; and
dismissive comments, including “At least you can get pregnant”; and faith-based
rejections, such as “G-d has a plan.” The speaker’s intention aside, those
statements are easily heard as polite forms of “Quiet down, you’ll be fine.”
Also, guilt-inducing messages – from
“I heard wearing heels can cause miscarriage” to “Maybe you’ve been working too
hard” to “You haven’t been davening enough” – imply that the woman should be
doing a better job staying pregnant or getting pregnant. In fact, genetic
anomalies cause around 50% of first-trimester pregnancy losses; the fetus is
highly susceptible to miscarriage even from conception.
Though
we may be trying our best to comfort them, we must keep in mind that many of the clichés and platitudes we
say are counterproductive. Side note: I’m yet to work with a grieving woman who
needs to be reminded that emuna and tefillos are critical. The
steady chorus of “mazal tov” emanating from our blessed community can easily
drown out the quiet suffering of not-yet mothers. Even among the mourners of the
community, women do not find comfort for their loss.
What
to say when you want to provide support?
At
first, try not saying anything. Silence doesn’t mean ignoring; however,
patience is the best place to start while broaching such a delicate issue.
Suppose you know someone who was showing for a couple of months before losing
her baby bump. In that case, that’s not the time to initiate a conversation
about her loss. These women aren’t looking for advice or a list of segulas or even to create a meal train
(though a meal train may be a welcome gesture). Generally, they seek an empathetic listener, a
respectful confidante, someone emotionally developed enough to be compassionate
and sit with another person’s pain without judgment. We can consider the nature of the relationship and use our good sense to determine what
she (she, not we) would
most likely appreciate. Just being emotionally available, warm, and validating
toward those in need is so much more valuable than anything we can say. By
taking to heart the “voice” of would-be mothers, we’ve already begun the
process of becoming more supportive of their needs and helping to mend years of silent suffering.
Joshua Kleiner is a certified perinatal mental
health professional and licensed therapist practicing in Baltimore, and a
research coordinator at the Johns Hopkins Women’s Mood Disorders
