A Doula’s Guide to Pregnancy and Birth After Infertility

The struggle with infertility can be one of the most challenging (sad, disappointing, traumatic…you name it!) experiences of someone’s life. In fact, research shows that women experiencing infertility have emotional stress levels similar to cancer patients.

What doulas, and any person working in the maternal health field need to know is that the thoughts/feelings associated with infertility don’t just go away when pregnancy is achieved.

The infertility journey and the impact this road has on a person’s life is often minimized or misunderstood by those outside of the experience. And although this has been changing over the last few years, we are not surprised that many women are expected to go about their pregnancy, and even parenting as if nothing ever happened. In fact, they are expected to be happy at all costs. After all, they got what they wanted, right?

With 1 in 6 couples struggling to conceive, the odds are high that you will be working with clients who have tried for years, or have undergone painful, expensive, time consuming reproductive procedures to become pregnant and have the opportunity to be working with an amazing doula like you!

So, if you have never been on the inside of the infertility journey and hope to have a better understanding of what your clients are going through, we have created this list. We hope it helps!

Your clients may not be happy.

Happy might be one of the feels, but there may be many others and all of them are ok. If you have become accustomed to loss and disappointment month after month, staying positive can be a bit of a stretch. The idea that their body has betrayed them, or is somehow broken or flawed does not go away after a positive pregnancy test. Many women will ‘white knuckle’ their pregnancy until they have a baby safely in their arms and some may feel disconnected from the pregnancy and the baby/ies.

With all of this comes feelings of isolation and guilt. Guilt creeps in when your client is not feeling happiness in the way that they think they should and also for leaving friends and family behind who are still struggling. The isolation part comes in when they feel like they no longer belong to the infertility community or the happy, baby planning, baby shower community – they’re in pregnancy purgatory and it’s as terrible as it sounds.

They may need extra support.

Being transferred out of the care of a Fertility Clinic and into the care of an OB or Midwife can be terrifying. Going from constant monitoring to appointments that last only a few minutes or are few and far between is not easy. All this tends to happen right before the 2nd trimester when the chance of miscarriage goes down, and many pregnancy symptoms that (believe it or not) have be reassuring up until now, start to disappear. If you are lucky enough to have your client this early, expect to have more phone calls, emails and texts. They are going to need more support than you might be used to this early on. Although this is great, and most of us love this aspect of being a doula, please know that this support cannot always be you and could be out of your scope. Make sure you are prepared by knowing what resources are out there, such as counsellors and support groups in their area or online that can help. If this is an area you are really passionate about, consider running a support group, this topic often gets overlooked.

Infertility affects queer families too.

There has been an interesting shift in the modern family in the last decade or two – particularly in the last few years. According to Census Canada same sex marriage almost tripled between 2005 and 2011! The 2011 Census found that there were 64,575 same-sex couple families living in Canada. Now, not to say all of these couples want to go forth and reproduce, and for those that do they will need support, information and care around their reproductive plans. Queer families can use surrogates, donors, adoption, traditional conception, IUI, IVF, and community parenting. Although there can be many options, they can be financially/emotionally draining, and things don’t always go as planned.

Depending on where the family lives, there are legal differences in parentage from province-to-province, state-to-state, and country-to-country. Some areas require the non-birth or non-biological parent to declare parentage or legally adopt the child. Without this step, families may find themselves in situations where one of the parents have no legal rights to the child. Some areas allow for 3 or even 4 parent birth certificates while others do not recognize the parentage of queer families. It is important to know where your state or province stands so that you can inform your clients.

They may not use their B.R.A.I.N.S the same.

Many of us work through B.R.A.I.N.S with our clients. Working through benefits, risks and alternatives to each option presented. When clients have gone through years of trying to conceive, and quite possibly their life savings, they may not be willing to take any risk when it comes to the baby. And when we talk about risk we are also talking about perceived risk. We know that there are risks associated with cesarean birth and induction, and to our clients those are risks that they are willing to take to have a healthy baby.

Remember, some who go through infertility may believe their body does not work. They may feel betrayed by their own body and don’t trust it to do its job. Some women may have actually heard the phrase ‘intervention going in, intervention coming out’ and while this is not based in any truth, it is incredibly harmful.

How can you help? The best thing you can do is to be completely supportive of your clients’ decisions. And that means even if it’s not at all what you would do. Besides, that’s what being a doula is about, right? Remember, your client’s perception of risk will likely be different than yours. Help them build confidence during pregnancy: remind them how their body is growing a baby everyday! Empower them with stress relieving techniques such as yoga, journaling, hypnotherapy (check out circle + bloom) and above all else support their choices.

It helps to know the studies:

Like I said earlier, ‘Intervention going in, intervention going out’ is not based on anything really, although it is catchy! Research shows that women who have undergone fertility treatments should have the opportunity for a vaginal birth. Yes, the rate of cesarean birth is higher after assisted reproduction, it may not be for the reason you think. One study showed a cesarean rate of nearly 50% but when you look closer you see the rate peaks at 38 weeks, indicating elective cesarean. Births after 40 weeks show a cesarean rate closer to average.

The SOGC states that a majority of ART pregnancies are uncomplicated and result in the births of healthy children, however, there is a mild increase in preterm deliveries, low birth weight as well as an increased risk of hypertension, Gestational Diabetes, placenta previa, multiples and more. It is not conclusive if these elevated risks are a result of IVF or because of other contributing factors (i.e. maternal age, smoking, diet). The good news here is that while there seems to be a slight risk, most of these conditions will be screened, monitored, and treated by their healthcare provider during pregnancy.

Clients may be at higher risk for PPD.

Get caught up on your knowledge of postpartum mood disorders and keep your resources on hand, you may need them.

Any major life stressor that occurs around the time of childbearing becomes a risk factor for PPD. A woman parenting after infertility may be dealing with issues of loss, depression, anxiety, relationship problems, or social isolation, which puts her at a higher risk for developing PPD.

We already know that women dealing with infertility have a higher rate of depression during the course of treatment. A successful pregnancy in and of itself does not dissolve or cure the depression.

And then you add in a healthy does of all the pressure to not complain about the stress of new motherhood – I mean, after all isn’t this what she dreamed of for all these years?

Parenting is hard and the expectation that someone who has faced infertility issues should JUST be happy once they have a baby puts them at a greater risk for not letting others know of their struggles, depression symptoms, and general concerns.

Be sure to set your client up with a solid postpartum plan and oodles of support, also be sure that their village knows the signs and symptoms of PPD. These cheat sheets are perfect for that.

. . . 

We are not saying all women/couples feel this way. Some will move into pregnancy and birth with a renewed feeling of confidence in their body… and not all will. We want you to be aware of some issues that can arise so that you feel prepared. As doulas, we are there to help clients through the emotional, physical and informational changes that take place as they move into parenthood. Understanding what your clients have  gone through, or are going through, will allow you to provide non-judgemental support. It is important that we validate feelings and assure our clients that what they feel is normal, and not only normal but common.

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Natasha Marchand is a birth doula trainer, hypnobirthing instructor, prenatal fitness/yoga instructor and business consultant. She is the co-founder of bebo mia and Baby & Me Fitness and is also the proud mother of 6yo Sadie, conceived with ART after a 4 year struggle. She now has another on the way!