I have been successfully pregnant twice. The first time, I conceived fairly quickly, and without intervention. The second viable pregnancy was conceived after cycle, after cycle of failure, doctors, treatments, and several early losses.
Once a viable pregnancy is achieved after infertility, a woman is dumped in the OB world. Having two completely different experiences entering to that obstetrics world, I naively expected my OB experience would be different too.
After all, I am different.
But it wasn’t. My concerns and needs, vastly different the second time, were treated identically to the first time I was pregnant.
They shouldn’t have been.
So, this is what I would recommend OB-GYN and Midwifery practices do when a women is pregnant after dealing with infertility:
Ask about her infertility journey
A woman who is pregnant immediately after beginning treatment is going to be a different patient than one who went through 5 failed IVF attempts before finally conceiving. A woman who had difficulty conceiving will be different than one who could get pregnant, but who repeatedly miscarried. Get to know her story, and where she was in the infertility process when she did conceive this pregnancy.
Ask how she is feeling about this pregnancy
Give her an opportunity to express her fears. After fighting for such a long time to become pregnant, it feels like you are just waiting for the other shoe to drop. Expressing concerns about miscarriage helps. It’s even better if you validate those concerns and address them.
Make sure she knows what her options are if something isn’t quite right.
All practices have an “emergency” line. But what is an “emergency?” And what do I do when what I am dealing with isn’t an emergency, but is causing me a great deal of concern? Should I call the nurse line? Make an appointment for the next day? There is plenty that is “normal” in pregnancy that has caused me to panic- light spotting, mild cramping, a day without morning sickness, etc. Giving a woman who has dealt with infertility security in knowing any concern will be dealt with goes a long way to easing this process for her.
When there is a moment in which a miscarriage may happen, please, please, don’t say the following:
“You are young and healthy, so if you lose this one, you have plenty of time.” So much about this. First, with a history of infertility, this pregnancy was not easy to achieve. Don’t make it sound like it will be easy to achieve again. Also, I am connected to THIS pregnancy. THIS child. And, “plenty of time” ignores my fertility issue, and my family planning goals which may involve child spacing or career planning.
Also, never say this:
“If you do have a miscarriage, there isn’t anything we can do anyway.” No. No. No. First, there is plenty you can do. You can provide information. You can provide support. You can provide options. Also, it will NEVER help to remind me that a miscarriage may be inevitable regardless of how hard I fought to conceive this child.
Provide a familiar face (and a consistent one) during office visits:
OB practices in this area are large, and it is common to rotate a woman through the different doctors or midwives, so she will get to know all of them to ensure she knows the person who ends up delivering her baby. While this makes sense, it is something that has caused a lot of anxiety after infertility. It would be best to see if it would be possible for someone to be a constant point of contact for a woman who has dealt with infertility- the same nurse each time, for example. A familiar face is very reassuring. I know it is hard to do this at a large practice where it is important to move patients through quickly. But it would provide so much support to women who need it.
Recognize a woman who has been through the infertility experience will have different worries, different fears, and different needs at every single point in her pregnancy. Infertility is surprisingly common considering the little it is talked about. OBs see women all the time who have been through infertility, which may skew their perspective some.
Every woman’s experience and reaction will be different, and she needs to be treated as an individual.