So, you did IVF and it worked. What now? (preg ment)

This post is an expanded version of a previous blog post on The Stirrup Queen Ballroom.

I can’t say I am really an expert on this topic, since until now I have never managed to make it past the 7th week.  But I do have a few small suggestions.

1. Some of the scarey things that could happen to you don’t actually mean a thing with regards to the health of your pregnancy.

The first and most important suggestion, which you really must follow, especially if you are spotting or your symptoms are going away and you are afraid you are miscarrying, is to race right over to  A Beautiful Day and read her classic and extremely informative post: When IVF Works: What the RE Doesn’t Tell You.  Go ahead, go do it, this post can wait.

Now wasn’t that exceptionally informative and reassuring?

2. You might not feel 100% happy, and that’s OK.

So, now that you’re back, let’s sit down and have a heart-to-heart about how you are feeling.  Giddy?  Excited?  Elated?  If so, good for you!!

But if you have a lengthy infertility battle behind you, and especially if that battle involves prior losses, here are some words that might also describe you: terrified, numb, freaked out, anxious, sad, angry… unfortunately, these emotions, too, are par for the course for the post-infertility pregnancy.

In my recent 2ww, I had accepted my infertility and was OK with whatever would happen.  As I said to my friends after the transfer, “60% chance I start building my family with DE, 40% chance I start building my family through adoption.”  When I POAS’d the day before the beta, while I was waiting for the test I sat with my eyes shut, imagining a blank result and chanting mentally “We are going to adopt!” But within 30 seconds my husband said “There’s a second line!”

My first reaction: incredulity.  My second: shock.  My third: numbness.  I sat with that numbness for a day or so, poked at it a bit to try to find out what was going on, and unearthed a deep, smoking pit of terror.

I was OK with a BFN.  I was OK with moving on to adoption.  I am not OK with losing a baby once it has shown signs of preferring to stick around.  The stakes are now much, much higher.

And so I wake up at 3 AM and stare at the ceiling and wonder whether there will be a heartbeat at the 7w ultrasound.  Whether we are enjoying the first short weeks of a very long acquaintance.  Or whether we are already getting ready to say good-bye to the little life that we created.  Dr. Google says insomnia is a common early pregnancy symptom, according to What You’re Not Expecting When You’re Trying to Expect.  Maybe Mr. Nishkanu is pregnant too because most nights when I am awake, he is lying awake right next to me.  He is normally a pretty resilient, unworrying kind of guy but now he is looking drawn and tired.

And after 2 or more years of finally being OK being around pregnant women and young families, I find myself again reverting to that earlier heated jealousy of pregnant women.  Yes, I am ashamed to admit it, but I am jealous of pregnant women who are farther along than me, who can be more sure than I am that their baby will live.  Today I saw a woman in her 4th or 5th month, wearing a tight shirt that showed off her mini-bump, looking happy and energetic, and I thought to myself, “She has probably never had a miscarriage. She probably thinks everything will be fine.  And everything probably will be fine… for her.”  Yeah, ok, I know it is time to get a grip.

But my point is,  if you are feeling negative emotions instead of the sense of elation you expected to feel, this is totally normal for post-loss (including post-infertility) pregnancy.  If there’s one thing a person learns from infertility, it is that the dice don’t always roll in your favor, and there are no guarantees now, either.   To be honest, I think to some degree the post-infertility pregnancy attitude is simply more realistic than the naive innocent person’s.  Yes, it could go wrong.  And it could break your heart.  Life is like that.

3. There are things you can do that can help to make you feel a bit less anxious, if that is a problem for you.

Nevertheless, after some initial hyperventilating panic, I started to find some things that made differences for me – small differences, but important ones.

I found this article on dealing with fear in post-loss pregnancy incredibly helpful, especially this piece:

“When a fear is a remnant of past experience, it isn’t necessarily a predictor of future events. Your worries are not foolproof evidence that something terrible is actually going to happen. How can you tell? Try to separate out which fears are arising from your imagination and memories of what happened before, and which fears are arising from cues you are actually observing or tuned into. If a fear is coming out of imagination or memory, discount it. It’s not real.”

When I read this, it really helped me to make a mental separation between the fear and trauma from past pregnancies and the current one.  This pregnancy isn’t necessarily doomed, just because the last ones were.

I also remembered that one characteristic of anxiety is that it is often based on desperate attempts to run away from the frightening emotions that are driving the anxiety. Sometimes it helps to stop running, face your fears and clarify them, and find out what you’re really afraid of, rather than leaving them as a big, foreboding, unclear mass.

When I actually sat still and let myself really feel the bad feelings that were welling up instead of covering them up with numbness and racing thoughts, I realized that part of the issue was that I am still really traumatized by the awful D&C that I had after my last miscarriage. It was a collision course of incompetent and uncompassionate care – even Mr. Nishkanu is still traumatized from watching me cry while a bumbling nurse tried over and over again to place an IV in my hand, until I started passing out from the pain (at which point she started complaining about me being a bad patient). I promised myself that if I have a miscarriage this time, I will find compassionate, competent caregivers, and if any of my health care providers start causing me unnecessary pain or treating me rudely I will insist on getting treatment from someone else. Once I had done that, I felt a lot better.

As Katie suggested to me, some women find it helpful to repeat positive  affirmations to themselves, such as “No matter what happens, I am pregnant today,”  “My baby has a good chance to live,” or “My body is taking care of my baby’s needs.”  They work best if they are things that you can really believe – if you are scared of a miscarriage “I won’t have a miscarriage” probably won’t do much for you, but “I will find peace, whatever happens” might.  You should note when constructing an affirmation for yourself that your subconscious doesn’t understand “not”, so something like “I will not let fear destroy my pregnancy” might get turned subconsciously into “I will let fear destroy my pregnancy.”  It’s therefore best to formulate your affirmations as positive statements, eg. “It’s safe to enjoy my pregnancy.”

A lot of women who have worries about their pregnancy get comfort from living one day at a time, reminding themselves that no matter what happens, they are pregnant today.   It can also help to break the pregnancy up into smaller goals – make it to the second beta, make it to the 7w ultrasound, make it to the end of the first trimester… and celebrate every small victory you make it through.  From my experience with miscarriage I can say that I never regretted the time I was happy and I thought the pregnancy would work.  If anything, I wished that time had lasted longer.  So I don’t think you need to feel that if you are enjoying your pregnancy now that you will regret it later if something goes wrong.

I find The Anxiety + Phobia Workbook a good source of longer-term coping strategies. I am working on the strategies suggested there for consciously blocking obsessive worrying but I’m not particularly good at that yet…

Being kind of a research geek, I also found it comforting to read about Denise Cote-Arsenault’s research on how women who feel when they are pregnant after loss in an attempt to educate health-care providers about how they should treat these women. Her article “One Foot In, One Foot Out” explains the coping mechanisms that women use to deal with post-loss pregnancy. My favorite part of the article was this:

“Although the metaphor, One Foot In – One Foot Out [i.e., that women do not fully commit to the pregnancy], seemed ubiquitously applicable, each woman’s response and situation were quite unique. These differences were easily shared and accepted by the other participants, sending the message that getting through the pregnancy was so difficult that no one would pass judgement on how it was managed. How to ‘do’ pregnancy was certainly individual and each woman, not others, knew what was best for herself.”

And that really matters here.  In the end, each of us has to find her own way through – there is no one “right” way for anyone to approach pregnancy.

You might find some comfort out of some of the other measures I mention in my post on Anxiety and Infertility.

If anyone has additional suggestions I would love to hear them – please add in the comments (lord knows I can use some more suggestions myself).

4. You don’t have to read the dreaded pregnancy books to find out what you should be doing, just this next section.

I don’t know about you, but I can’t stand to read regular pregnancy books because they are all so dang happy and positive.  In fact, they seem to presume that you actually will have a baby at the end.  What a crock!   I therefore asked a less infertile friend of mine to report back what you are / aren’t supposed to be doing while you are pregnant.  Let this tide you over until you can stand to look in those books.

  1. Don’t eat: raw or undercooked: fish, meat, eggs (including homemade mayo or soft-boiled eggs), cold meat (including luncheon meat) unless you heat to steaming before popping it in your mouth, raw milk products, moldy cheese (e.g. brie, blue cheese), artificial sweeteners, alcohol.
  2. Take your prenatal vitamins with 800 mcg folic acid.  Also take a calcium supplement, or your teeth and bones will start to suffer while your baby is making his/her teeth and bones.  Most prenatals do not provide enough calcium by themselves.
  3. Do not get overheated (whirlpools, saunas, exercising in hot weather, etc.).
  4. Avoid all your favorite illegal drugs.  Check with your doctor before taking over-the-counter medications. If you are smoking, try to stop.
  5. It’s probably a good idea to take fish oil capsules, but check that they have been tested for mercury first.  In general, fish would be good for your baby’s developing brains if it were not full of toxins; you need to be careful what you eat and it is a bit complicated.  The guidelines for which fish are OK to eat are here.
  6. Reduce caffeine consumption to the equivalent of 1 cup of coffee per day.  And I don’t mean one of those Starbucks Grande cups either.  Be very careful with herbal teas, because many ordinary herbal teas such as chamomile or lemongrass are bad news to drink while you are pregnant.
  7. A healthy diet with lots of fruits and vegetables, low-fat protein sources, and unrefined carbs is always a good idea.
  8. If you are feeling nauseous, frequent small meals are a good idea.  If you are feeling really really nauseous then just focus on getting in enough calories and don’t worry about general nutrition.  “Enough” calories is generally about 300 more calories than you would usually eat.  But it’s not unusual, if you have severe morning sickness, not to gain weight or even to lose some in the first trimester.  Your baby won’t starve, it gets first dibs on the nutrients.  But definitely talk to your doctor if you have any concerns or if you’re having trouble keeping food down.
  9. It is generally OK to exercise when you are pregnant, in fact it is a good idea.  Check with your doctor about the limitations they would have for you.  Chicklet has a great post on what generally is/isn’t a good idea when it comes to exercising during pregnancy.

5. It is OK to complain.

If you have been infertile for any period of time you have probably gone through a period of severe annoyance at women who complain about their pregnancies, and thought to yourself “I would gladly trade my infertile state for your nausea, lady” or even “God, if you let me get pregnant, I will not complain about anything.”  Now a miracle has happened, you have your nausea, and you know what?  It kind of s*cks.   Granted, it doesn’t s*ck anywhere near as much as not getting pregnant does, but that doesn’ t make it a walk in the park either.  It is extremely common for infertile women to feel that they should not complain about their pregnancy, that they have to be happy about all the weird things that happen to their bodies and all the discomforts and anxieties that come with it.  This is not my attitude.  Yes, you should probably not expect much sympathy from people who are suffering from infertility, and it would probably be kind to take your complaints elsewhere.  But I don’t see any reason why, just because you got the short stick and had to walk a trail through hell to get to pregnancy, you now also have to draw the short stick and don’t even get to complain.  Complain away, just be sensitive about who you complain to.

p.s. If you don’t believe me, then please ask A Beautiful Day.

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5 Comments »

  1. This is one fabby post. THANK YOU for that article on symptoms, etc. Yesterday, waiting for my 2nd beta phone call, I wasn’t feeling much ‘down there’, compared to the days/weeks previous and yes, I was really scared. Will keep that in mind for future reference.

    I personally have been repeating the mantra that this is out of my control and that worrying is not good for me… or the baby! (babies?!) That 2nd beta sure has me on a high that should last for at least a few days.

    Man, I also had a Clutz disguised as a Nurse at my D&C, also attempting to get that sucker into my frickin’ hand. WTF? An Angel disguised as Another Nurse showed up after her 5th failed attempt, got it in my arm so fast I didn’t even know she was done. Who trains these people….?!?!

    • nishkanu said

      Yeah, I figured this might be a good day to post this for you :).

      The way the nurse that I had was talking, I figured that maybe she didn’t have a lot of experience and I got to be a guinea pig. Which would have been kind of OK if she hadn’t then started to say she couldn’t get it in because there was something wrong with *me*. My angel was the anesthesiologist who also got it in instantly with no pain.

      Later on in the Adventure in Bad D&C’s I was in the ER with insane pain, begging for pain meds. The doctor refused to give me any since he figured I was a junkie. Then another angel came in the form of a nurse who went and kicked his butt and got him to write me a prescription. I sure wish I knew her name because 2 years later I still think back to her with insane gratitude in my heart. If only these angels knew how much they mean to us!

  2. […] sort of way.   I especially wanted to mention, Nishkanu, and her post link she gave me that holds within it yet ANOTHER helpful post.  Reading those posts was like salve to […]

  3. Hannah P said

    Fabulous post! I know I’m 2 years behind, but I’m glad you’ve left your archives up. I’m just starting down the “fertility/infertility” path and I’ve really struggled with anger, sadness regarding being on this path and anxiety regarding the future. The future seems dim and I go to the worst place to “protect my heart” from being broken by hope.
    Anyway, thanks so much. This post was great.

  4. Anonymous said

    Thank you for these kind words. I’m 8 weeks pregnant after IVf and am struggling with some really difficult emotions and of course sickness. It really to see someone be able to articulate my feelings so well when I haven’t really been able to at all

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