When You're Not Expecting Part 8

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Different Dreams: Opening New Doors to Life Opening New Doors to Life "We got all the way through infertility treatment with the support of family and friends. But now that we have ended treatment with no hope of becoming pregnant, I'm really feeling stuck. My parents are encouraging us to pursue adoption, but Jim and I just aren't interested in doing that. We've used up so much time and money on infertility that now we just want some time to catch our breath. My sister suggested that it might be useful for us to talk with a counselor about where we'll go from here. She knows me pretty well, and I guess she can see that I am at a crossroads about how to move into the future without the hope of a birth child. Jim says that a counselor might help to get us talking again about what we want, since the focus for so many years has been on getting pregnant. So I guess that's our next step - maybe a counselor will offer some new ways for us to think about our lives together and ways that we can find happiness without children of our own."

"After we discontinued infertility treatment, we first explored adoption. I remember one of the social workers saying that we needed to think of adoption not as second best best, but as our second choice choice for how to become parents. The more Tom and I talked, the more we became aware that adoption would always be 'second best' for us, and we didn't want to subject an adopted child or ourselves to the feeling of disappointment that adoption was an alternative that we selected out of desperation. So we took some time away from any pursuit of parenthood and tried to think about what could work for us as a second choice. The more months pa.s.sed without the disruption and uncertainty of infertility treatment, the more we came to realize that we were getting our lives back! Not the lives we had before infertility, but lives where we could enjoy choosing how to spend 225 for how to become parents. The more Tom and I talked, the more we became aware that adoption would always be 'second best' for us, and we didn't want to subject an adopted child or ourselves to the feeling of disappointment that adoption was an alternative that we selected out of desperation. So we took some time away from any pursuit of parenthood and tried to think about what could work for us as a second choice. The more months pa.s.sed without the disruption and uncertainty of infertility treatment, the more we came to realize that we were getting our lives back! Not the lives we had before infertility, but lives where we could enjoy choosing how to spend 225our time together, choosing new hobbies to pursue, choosing to plan a trip or take a course that wouldn't be interrupted by tests and treatment. What we began to discover was that we were learning to enjoy life as a twosome. That has opened up a whole new conversation about how parenthood is not the only pathway to happiness for us."

"During our years of infertility we found it was very painful to be around friends who were pregnant or parents of infants and toddlers. So we sought out friends who were not parents or whose children were grown and out of the house. What we discovered, even as we were desperately trying for a pregnancy, is that our friends without children were very content with their decision not to pursue parenthood. We also realized from our older friends that their children, while often the source of joy, had also been the source of considerable heartache. These friends helped us to become aware that society tends to paint a rosy picture of parenthood, but rarely shows us the flaws in that picture. There's an a.s.sumption that parenthood is the way to become personally fulfilled, but now some of our younger friends are deciding not to become parents, and some of our older friends tell us that they felt worried and preoccupied rather than fulfilled as parents. Once our physicians told us that the statistical odds of our becoming pregnant were slim, we found that we did less grieving than we expected, perhaps because even then we were beginning to realize that parenting has its own sets of worries. Also, we are both feeling very fulfilled in our work and in our relationship, and the thought of adding parenting is different from what it was three years earlier when we began our infertility workup. So now we are moving in the direction of building our lives with no birth children and with few regrets. We've even decided to begin 226 Different Dreams: Opening New Doors to Life Opening New Doors to Life using birth control again as a way of confirming our commitment to being child free. The future looks full of possibilities that we're eager to pursue." using birth control again as a way of confirming our commitment to being child free. The future looks full of possibilities that we're eager to pursue."

Therapeutic Tips Most couples have been considering "next steps" before they ultimately decide to end treatment. This gradual process may have been informed by discussion with family, friends, support group members, a therapist, or one's reproductive physician.

And, once you decide to pursue another way of thinking about "family," here are some helpful tips to aid you in that process.

Adoption: * It is important to grieve the losses attached to your earlier hopes for a birth child before moving too far into the adoption process. By resolving these losses, you then have the psychological energy to devote to the process of considering whether adoption would be the right choice for you. It also is important for you to be clear on why you are making the decision to adopt, which will involve both personal and selfish needs. This is the time to discard any savior fantasies of rescuing a child from unfortunate circ.u.mstances.

* Make every effort to speak with adoptive parents in your community, as well as attending conferences, accessing Internet Web sites, reading adoption literature, and attending community events for adoptive families. Not only will this give you a sense of the realities of the adoption experience, it also can introduce you to some helpful sources of support as you proceed through the adoption process.

227.* Your investigations will remind you that there are many routes to adoption, and each one has advantages and disadvantages that you will want to carefully consider.

* Ultimately, you will need to be clear about what kind of relationship, if any, you will want to have with your child's birth parents. You will want to a.s.sess your level of comfort with an anonymous, semi-open, or fully open placement. A fully open relationship typically involves ongoing contact among birth parent(s), adoptive parents, and child. The terms of the placement plan need to be clarified before the adoption is finalized.

* Prior to the placement, it will be important to educate and sensitize family and friends about easily misunderstood adoption issues. Share your own literature with them and help them to use correct adoption terminology. For example, the terms birth birth or or biological biological parent should be used in place of parent should be used in place of real real or or natural natural parent; in reference to the termination of the birth mother's parental rights, rather than using the phrases "give up" "surrender," or "give away," it is far preferable to describe the birth mother as "making an adoption plan" for her child. The term parent; in reference to the termination of the birth mother's parental rights, rather than using the phrases "give up" "surrender," or "give away," it is far preferable to describe the birth mother as "making an adoption plan" for her child. The term illegitimate illegitimate should be replaced by should be replaced by born to single parents. born to single parents.

Surrogacy: The decision to use a gestational carrier often provides the only opportunity for there to be genetic ties between you and/ or your partner and your baby. As stated earlier in this chapter, there are both legal and religious constraints that some couples may face in using a surrogate. The costs are generally likely to be more expensive than adoption, so it is important to research all aspects of gestational surrogacy that may apply in your particular circ.u.mstances.

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Different Dreams: Opening New Doors to Life Opening New Doors to Life The challenges of using a gestational carrier are considerable, and it is important to antic.i.p.ate concerns in advance, as well as to enlist the a.s.sistance of attorneys and mental health professionals to ease your way along this particular path to parenthood. The most common problems fall within two categories: The challenges of using a gestational carrier are considerable, and it is important to antic.i.p.ate concerns in advance, as well as to enlist the a.s.sistance of attorneys and mental health professionals to ease your way along this particular path to parenthood. The most common problems fall within two categories: * Struggles with conception. Simply locating a surrogate is not enough; she will need to surmount the risks facing all pregnant women: miscarriage, high-risk pregnancy, negative prenatal test results, and illness all can occur. Even once there is a successful conception, frequent concerns arise around the difference in perspectives between the carrier, who may feel quite optimistic, and the intended parents, whose history of infertility may have schooled them to be apprehensive and hypervigilant.

* Struggles with the relationship. One area that is likely to present conflict is prenatal and medical care, and the intended parents must communicate early what really matters to them.

They also must decide on which issues of disagreement to be flexible and on which to pursue through careful discussion.

Even though the disagreements may be about medical treatment, it is important that everyone realizes it is not the role of medical caregivers to mediate these differences - this is the time to engage a mental health professional with skills in conflict mediation and expertise in the particular challenges faced by gestational carriers and intended parents.

Child-free Living: As with other post-treatment decisions, even during treatment you may gradually have begun to envision a new way of shaping your family. For various reasons, you may have given special attention to the dilemma of what it might be like to revise your 229perspective from being childless childless to being to being child free child free. These are healthy growing pains to have, since one of the greatest dangers to remaining childless is in not making a thoughtful and conscious decision to live without raising children. Drifting amid ambivalence can lead to feelings of unfulfillment and lack of resolution.

A more conscious approach can promote personal growth on several levels: * Just as prospective adoptive parents need to mourn the losses a.s.sociated with infertility, so do individuals who are considering a child-free future. Painful as it sounds, mourning can also be very therapeutic in helping you to let go of earlier hopes and dreams, changing your focus to new possibilities that can be enriching and challenging. It may be helpful to have some counseling as you do this, since a counselor can provide insightful perspectives for you to consider, as well as validation of you as an emotionally resilient survivor of infertility.

* You and your partner may be reaching your own decisions with different time frames. Keep the lines of communication open, share your struggles and your new hopes as they evolve, and continue to nurture your relationship - remembering how much you both have endured as you faced all the challenges of your shared infertility.

* One aspect of accepting a child-free future is to create and redefine new goals. Doing this can lend a hopefulness to the possibilities you envision for your future, as well as giving you a sense of creativity that may have been lacking during the years you struggled with infertility.

* Even as you may decide to be child free, you also may decide to involve children in your life. Whether through volunteer activities, close relationships with young neighbors or the 230 Different Dreams: Opening New Doors to Life Opening New Doors to Life children of loved ones, or a profession that involves work with children, it is still possible for children to be an integral part of your life. children of loved ones, or a profession that involves work with children, it is still possible for children to be an integral part of your life.

Adoption, surrogacy, and child-free living are all ways of resolving your incapacity to have a birth child. Yet even when you have reached the important decision about whether or how to become a parent, there is still emotional work to be done.

Infertility will continue to be a part of you no matter what decision you reach. You probably began the infertility journey not even thinking of yourself as infertile. You progressed through medical workups, hope, sadness, confusion, medical interventions, loss of control, hormonal side effects, and relationships with a whole cast of people who ranged from insensitive to empathic. You embarked on a journey that changed forever the person you are. It also probably changed your relationships with your partner and with other loved ones. The person you have become has been shaped by your experience with infertility and the indelible mark it has left on you.

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Epilogue: The Legacy of Infertility No one endures infertility, with its many losses, and then forgets. Infertility has stolen your trust in your reproductive capacities, tested your trust in medical authorities, and challenged your trust in the strength of important relationships. However, it has also confirmed your trust in yourself, and that you can emerge resiliently from this anguished journey.

But, even as you move forward to face the new challenges that life holds, do not be surprised if infertility is close at hand.

I continue to think of myself as having "tucked infertility into my heart." Others view infertility as a traveling companion along life's pathways. Still others, like Barbara Eck Menning, founder of RESOLVE, view it as a friend: "My infertility resides in my heart as an old friend. I do not hear from it for weeks at a time, and then, a moment, a thought, a baby announcement or some such thing, and I will feel the Epilogue tug - maybe even be sad or shed a few tears. And I think 'There's my old friend.' It will always be a part of me."1 The Aftermath of Infertility So what are the ways in which infertility is most likely to be felt as you begin your new journey beyond infertility? One is your s.e.xual relationship, which for heteros.e.xual couples has been threatened on several levels. Months or years of timing intercourse to your most fertile time of the month can take a toll on your s.e.xual relationship. You may need to relearn how to move from the emphasis on programmed procreation to the emphasis on s.e.xual spontaneity and pleasure. Another unexpected issue that presents a dilemma is birth control. For infertile couples, the idea of practicing birth control can strike an irrational raw nerve. And yet, for a variety of reasons (perhaps because you are confident in your plans to be child free or maybe because you are readying your home for an adoption or even because you have experienced painful pregnancy losses), an unplanned pregnancy would present its own set of problems. So you, like other couples, decide to practice birth control as a way to end that long period of uncertainty around conception. It represents a way to exert some control over your life in an area that was painfully out of control during the infertility struggle.

Another area that is affected by infertility has to do with how infertility has influenced your thoughts about the number of children you hope to have. Perhaps your infertility has B 1..E. Menning, Infertility:A Guide for the Childless Couple. (Englewood Cliffs, NJ: Prentice Hall, 1977). (Englewood Cliffs, NJ: Prentice Hall, 1977).

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The Legacy of Infertility caused you or your partner to rethink the size of your family. This can be influenced by the sense of how special each child in your family will be; by the extent of complications during your pregnancy or that of a surrogate; by the ease or complexity of any adoption efforts; by wanting your child to have at least one sibling; and by practical considerations such as your age and your income. In considering these issues, you also may ask yourselves if having more children than you had originally planned is really what you want. (Or could it represent something else, such as the need to prove yourselves reproductively, to protect against the fear of losing a child, to demonstrate your capacities as super parents, or to have repeated rea.s.surance that the pain of infertility need never haunt you again?) You, like many infertile women, may be surprised at how health-conscious you have become. The focus may be on your reproductive capacities, either because of ongoing concerns or because the initial experience of body betrayal still haunts you.

If you have had considerable medical intervention, you may at times see yourself more as a patient than as a person, and it may take time to develop more confidence in your health.

Depending on your age, your health, and your energy level, you may worry that you won't be healthy enough or live long enough to offer your children all you hope to give them over a lifetime. Taking life for granted does not come lightly after one has struggled with infertility, and the concern with mortality seems to remain one of the persistent legacies of the infertility experience.

And that preoccupation with mortality extends to your child or children. Perhaps one of the most unspeakable fears that haunt a parent with a history of infertility is the fear of losing the child who is so precious. This sense of psychological vigilance may 235 Epilogue.translate into real-life vigilance about health and safety. On the one hand, you want to ensure your child's health and well-being; on the other hand, you realize that you need to guard against conveying to your child a sense of insecurity or lurking danger.

We want our children to be appropriately watchful, but we do not want to make them wary or suspicious in circ.u.mstances that do not warrant such feelings.

The Challenges of Living Child Free Couples who have decided to resolve their infertility by opting for child-free living have unique issues. It is not unusual for one or both partners to question whether living child free was really the "right" decision. This may be even more likely to be an issue if you and your partner have endured disappointments or tensions in other aspects of your lives - work, family, friends, geographical moves, and finances. The hope that child-free living is the "right" decision does not protect you against other life disappointments any more than it does those couples who bring children into their lives.

Living child free does have some built-in challenges, however.

One of these challenges is how to field insensitive remarks or questions from people who note the absence of children in your immediate family. You probably encountered these unwelcome intrusions during the period that you were trying to resolve your infertility. But now that you have made the conscious choice to remain child free, you probably have been challenged by other people's a.s.sumptions or value judgments about your decision.

Particularly insensitive remarks will suggest that you are being selfish to choose a child-free life. Other remarks, intended to be supportive, may sting as well: a friend who offers to trade in all of her children for a European vacation that you are planning; 236 The Legacy of Infertility a relative who complains that her parenting responsibilities have compromised her career success; or a sibling who says, "You really made the right decision. If I had it to do all over again, I'd never have had kids." Supportive as these remarks may have felt to the speaker, to you they may reverberate as a reminder that the option of giving birth was never yours.

Depending on your extended family and the opportunity for your parents or in-laws to become grandparents, you may find yourself confronting the sadness of prospective grandparents at your decision to be child free. Your parents and in-laws who had held out high hopes for enjoying their roles as grandparents may experience their own mourning period as they let go of this life dream. They may convey their disappointment directly by encouraging you to reconsider your options, or they may be indirect as they offer financial support for you to pursue medical treatment, adoption, or surrogacy "a little longer."

Adult children, even living quite independent lives from their parents, are nevertheless vulnerable to parental messages of disapproval or disappointment. There is the possibility that such messages can cause a serious rift in the relationship. If you find this rift is troubling and is not resolving itself, you might want to consider asking your parents to visit with your counselor, your clergy, or some other mental health professional who is sensitive to unresolved issues of loss and grief.

Re-evaluating Relationships Another legacy of infertility is how to continue to relate to the friends you have made during this intense journey. In the early stages you may have distanced yourself from friends who were card-carrying members of The Club. As time elapsed, you probably sorted out which friends were prepared to stand with 237 you through the heartache and sadness of your struggle. And, very likely, you made new friends with other women and couples who were, like you, trying to resolve their own infertility.

You know by now that all of these friends relate to you as more than your "infertile self." And in many cases the bonds forged during infertility are enduring and mutual.

One of the most perplexing issues for you as a woman who has resolved her infertility is how to continue to relate to your infertile friends. You still can identify with their emotional pain, even as you have moved beyond that struggle yourself. With each friend the situation is likely to be different. If you have chosen to be child free, your family responsibilities are unlikely to interfere with the friendship, and the absence of children in your immediate family will enable infertile friends to feel emotionally safe when they visit with you at home or in telephone conversations. However, if you are visibly pregnant or have a child in your life, you will need to talk quite directly with your infertile friends to see whether, or in what circ.u.mstances, they feel comfortable being in touch with you. You have been there before, so you know how alienating it can be to interact with a friend whose preoccupation with her pregnancy, her child, or with her maternal role is in every conversation. Conversely, during your infertility struggle, you may also have had friends with children who were able to support you emotionally. There is no one answer, but you and your infertile friends need to have a discussion so that the issue is in the open. Ideally you will both acknowledge that you need to be clear with one another about how your resolution of your infertility may present some ongoing challenges to your friendship.

And, if you are a new mother, you now have the potential to become a member of the once scorned Club. You may decide that some of your friends whose pregnancies or parenting roles 238 The Legacy of Infertility were too painful to endure can be a part of your life once again.

This will depend on many factors, but you very likely will find some of these Club members eager to be supportive of you during your pregnancy or adoption, to offer tips on infant care, and even to provide welcome hand-me-downs.

Your Long Journey So, here you are, with your life in a very different place than it was when you first began your infertility journey. Certainly you have learned that you are not alone in the feelings of despair and desperation that come and go. These are normal feelings - not indications that you are "going crazy." You also have learned that some burdens may be too heavy to bear alone, or to share only with your partner. If so, hopefully you have found a support group or a counselor who can help you sort out your emotions and your relationships. You know now that infertility is not simply a medical condition. Infertility touches the very core of who you are and causes you to wonder how you will emerge from this unexpected journey. Even in the midst of your efforts to regain some balance in your life, you find yourself making changes and decisions about your future.