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Tuesday, March 10, 2009

Bonus Barren Advice: Thirty-Four

This is the 34th installment of Barren Advice. You can ask questions that are fertility or non-fertility related.

Barren Advice is posted each Tuesday-ish. If you have your own question for Barren Advice, click here to learn how to submit. Please weigh in with your own thoughts in the comment section and indicate which question you're addressing if there are multiple questions in the post.

Dear Mel:

I need your barren advice. After two D&Cs, the last of which was last week, I am trying to decide if I even WANT a second baby. My last two pregnancies, before their eventual terminations, were each awful in their own ways. The first, a blighted ovum, never felt right, which, it turned out, was correct. The second was great, and I was so excited and happy until I started to cramp and bleed heavily at six weeks. A huge bleed was discovered, and I was told to take it easy, not lift or exercise, not have sex, and not have orgasms. That was in place for four weeks until I went in for a routine check-up, and found out that there was no heartbeat, and not only was this one dead, I have a clotting disorder that killed this one and probably was behind my severe preecampsia with my son. It sounds like knowing this, it won't be hard to fix... baby aspirin and maybe a monthly shot. But I don't know, I am so burnt at this point.

My husband, who would be fine with our son being an only child, thinks we should have another, because he thinks it's something I really want, and have for a long time, and heck, he’s agreed twice before. And that's true: I love babies and children, and I don't want my son to go through life with no siblings or cousins, which looks very likely at this point. My husband also thinks that it would be silly to quit now, when we have figured out the problem. And also, up until the end, my pregnancy with DS was fantastic, so I know it’s possible.

The problem is, I don't have a lot of time to figure this out. I'm 38, and while I seem to be really good at getting pregnant, I don't have forever. I also don't know if I'm willing to make sacrifices to have another baby. I realize they are short-term, but still. And, my confidence is shaken. I was sure that I could have a sunny, uncomplicated pregnancy, then could breeze my way through working full time, having a marriage, having an infant, and raising a kindergartner. Now I don't know... I could potentially ruin everything. Or, I could forever regret chickening out at this point.

Do you have any advice on how to make this decision?


This isn't going to be the answer you want to hear, but this is such a personal decision, the only person who can make it is you. Not your husband, not a friend, and not a therapist or doctor. This doesn't mean that we can't help you by walking with you up to the edge, but you are the one who ultimately needs to make the decision to jump or fly. And only you know which decision represents falling and which one represents flying.

And that is where I would start. I placed you at the edge and used these two words: fall or fly. When you thought about yourself falling, which side of the decision (trying or stopping) did you picture? When you considered yourself flying, what were you flying toward?

I think you already know the answer of what you want to do--it is merely the work of finding it buried under all of those emotions.

Sometimes, when I'm looking for something in a drawer and I know that it has to be in there but I'm overlooking it, I take everything out of the drawer and place it on the floor and then put it all back in the drawer neatly, usually finding the missing item along the way. I think the same thing can work with difficult decisions. Take everything out of your head and lay it on the page and then look at it from the outside, seeing how it looks from a different view. And these are the pieces of paper that you will take to your husband to explain your decision because your choice involves him as well.

Begin with looking at continuing to try for a second child. Write that inside a circle you draw in the center of the paper.

Now make lines coming off it and start writing out every what if you're carrying in your heart about this decision. Follow each what if to its possible end. I included a few I could imagine myself just as an example, but you need to personalize this and make it the what ifs that are suffocating you about this decision.

There will be many more what ifs, all tied to your personal situation, including what happened after the birth of your first child, the feelings of your husband, and your age. Your paper may have five major what ifs, or you may need to pull out the poster board in order to have enough space to get down all of your thoughts.

Once you finish with this choice, you're going to set aside the page, turn it upside down, and honestly fill out another decision web using the other choice--stopping now--and all of the what ifs that stem from that (good or bad what ifs).

When you're doing this exercise, you need to be brutally honest with yourself. You can choose whether you want to redraw the webs to show another person, keeping the brutal honesty solely with yourself, but that is my only caveat. You cannot hold back any of the yucky thoughts, the embarrassing thoughts, the regretful thoughts from yourself. Putting them down on paper, admitting them to yourself, is the only way you'll make this decision without regrets.

Without regrets does not mean joyfully. You may still cry or be angry or frustrated or resigned. But you won't have regrets, and that is truly the only weight others can help you remove before you decide the way to exit the cliff.

Before I send you off to find a quiet space and work through your decision, I want you to know that all of the points you discussed in the note were all valid reasons to keep trying or stop. None should be swept under the rug. Just because you now know about the clotting disorder doesn't dismiss the enormous feelings you have about trying after multiple losses. Not putting yourself through that again, even if it means that you have to change the way you saw your life in the future, should not be undertaken just because. Just because you don't want to disappoint someone or just because you were already on this path. It is equally valid to say no. To stop. To know your limits and respect them.

I don't think we need to continue with everything we start, especially when new information is learned that would have kept us off the path in the first place. Quitters do win--especially those who know their own heart and listen to its wisdom. Winning is not only having everything turn out how we wanted in the end--winning is about how we live our life, the choices we make, the happiness we grab, the sanity we preserve. I have a deep respect for people who can say no. Who can take a step back and ask themselves what is lost as they try to gain and weigh out the two sides so that they don't come out at a deficit just for the sake of doing what is easy vs. doing what is best.

Stopping is neither good nor bad--truly, the only thing that matters about stopping is knowing why you are doing it so you can come to a place of closure. I think a lack of closure comes from not understanding what brought you to a stopping point or having the choice taken away from you and made by someone else or circumstances.

And, at the same time, I have a deep respect for those who continue on, even knowing that they could possibly lose a lot by taking the next step, but doing it anyway because it is the strongest impulse within.

Go find your quiet space. Remove all the thoughts from your head and place them in front of you to examine. Come to a place of peace and know your own heart and then share it with others--your husband, namely, who may surprise you in agreeing wholeheartedly with whatever decision you make when he hears the reasons that brought you to that place.

No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely.

Leave a comment in the reaction box below--only keep in mind that conflicting advice is embraced and rudeness is not. Want to ask your own question? Click here to see what you need to send in order to be included in a future Tuesday's installment of Barren Advice


Mrs. Spit said...

I think that quitting, whatever you are quitting, is not quitting when you make a decision to not try. Quitting is more about failure to show up, failure to make the decision, and then allowing other forces, other people, the situation to make the decision for you.

We have regrets when we quit because we didn't take our life into our own hands. We can't say, right or wrong, it's the decision I made, with what I knew at the time.

I don't have anything to say about which decision to make, other than to say, your friends and your family, the true ones, will be happy with the decision when you are happy with the decision.

infertilityrocks said...

Mel, what wise advice.

I'm really sorry for your losses, and can't completely identify with those, but I can with so wanting to have a sibling for my son in the face of infertility, advanced maternal age, and a probable complicated pregnancy.

Wouldn't it be great if we could peep, just for a moment, into the future? I wish so.

We have decided to keep trying for now, with the knowledge the we may have to stop for my health reasons. Recently my hubby and I also began discussing the adoption option as well.

You may need to act more quickly than others, but you don't need to make the decision TODAY.

Unfortunately, there will ALWAYS be whatifs, no matter what path you choose. And sometimes neither choice is perfect or leads to 'inner peace'. Sometimes its just the lessor of two evils.


serenity said...

I also do not like the connotation that we have with "quitting" when it relates to children. There seems to be this implicit assumption that, as a woman, if you stop trying, you've given up or weren't willing to do EVERYTHING POSSIBLE for your family.

And it's BS, in my opinion. We are so quick to blame ourselves for failing, for refusing to sacrifice everything in the pursuit of that ideal situation, whatever it is. It's unfair to ourselves and to our families, too.

Stopping is NOT admitting weakness. In fact, I agree with Mel here - it is one of the strongest things you can do.

Your story makes my heart contract with empathy; I want to reach out and give you a hug. I hope you find the answer that gives you peace soon.


Anonymous said...

There are so many reasons to talk yourself out of parenting ... or out of parenting again ... that it really is a wonder anyone does it.

You have to sort out ~where~ your ambivalence is coming from. Is it exclusively the burn-out talking? ... And if so, is it something that might ease, after you've had a little time (which I understand you feel you don't have -- the expiration date does nothing to help your clarity, I know) to heal and to rest?

Or is it deeper than that? Is there more to your ambivalence? That's the million dollar question.

In the "Yes, try again" column (just the ones you've mentioned):

- My husband thinks we should have another

- I love babies and children

- I don't want my son to go through life with no siblings or cousins

- We have figured out the problem

In the "No" column:

-I don't know if I'm willing to make sacrifices to have another baby

That's a huge objection. The question is ... Is it a ~real~ objection or are you trying to talk yourself out of this out of fear?

If so, is fear a good reason to avoid trying again?

Self preservation is a powerful instinct. ... Are you afraid because:

- Deep down you know another bad outcome means risking more than you can afford to lose? Will it break you for good?

- Or is the fear more primitive and less rational? Assuming that, just because bad things happened ~before~ bad things will happen again is not rational (unless you have a medical opinion that supports that line of reasoning). Especially now that you know the cause of the trouble.

You have to cross examine your fear. It's either a sound instinct or else it's a bully pushing you around.

In the "Not Relevant" Column:

- I don't have a lot of time to figure this out.

- I could forever regret chickening out at this point.

Those are reasons to fight like hell for clarity promptly and to get to a choice you can live with -- now ~and~ later. These points just mean the issue is urgent and important. But don't let the urgency fluster you. (Easier said than done.)

BTW ... how's your FSH? If it's good and you only want one more child... talk to your RE and see if he can help you understand how much time you can take ... to heal and to think. Yes, age is the 800 pound gorilla and it trumps even FSH #'s. But you might be able to make a small trade off and get away with it. And educated opinion about that would be invaluable.

- My confidence is shaken.

That is only rational. But confidence issues are also separate from whether to go forward or quit, unless they are combined with a lot of other factors.

Check out for some great guided meditations to help with trauma and confidence and peace.

You say that you imagined breezing through ... but nobody breezes through these things ... not IF, not having children, not being married, not life.

You have to weigh your desire for the ~child~ against your desire for ~ease~. Yes, not having another will be easier in some significant ways. But easy is not always the best driving criteria behind big life choices. And you are not guaranteed ease even if you don't have the child.

Both choices have their upsides and downsides. It's what you can live with.

Good Luck.

Kristin said...

Mel gave you some great advice.

I just want to add some info from someone who has gone through a pregnancy on lovenox. Lovenox shots are not that bad. The needles are small. The bruising can be funky but never hurt me at all. For me, it was a small price to pay for another child. However, lovenox is by no means risk free. Educate yourself about the ins and outs of this drug while you make your decision.

Becoming a Family of Four said...

I am living your life. I had my second d&c (3rd loss) in November and was shortly thereafter diagnosed with a clotting disorder as well. I want nothing more than a sibling for my 4 year-old, but am terrified of another loss. It has taken its toll for sure - on me, on my husband, and on our marriage. We have decided to take a break for the next year and try to re-focus on lives on everything else that has been put on hold for the last 3+ years that we've been in babymaking mode. This is proving very hard for me to do (not try...what?!?!), but I'm committed to taking back my life.
Best of luck to you and in your decision. And know that you are not alone!

Bea said...

Anon has given quite a comprehensive answer, as has Mel. I was just going to pop in and say, hon, it was LAST WEEK you had the D&C. I know you don't have time to stuff around but you have a little more time than that. It sounds to me like you're describing completely normal reactions at this stage.

You probably have a good month before you can actually enact your decision anyway - give yourself a couple more weeks, at least. And my sympathies.


Tash said...

I could've written this post. Well, with a change or two, but really, i could've written this question.

Mel, your answer was stunning. And Mrs. Spit is right -- right now I'm in "quit" mode, and I need to make a decision. honestly, I keep hoping my age or a phone call from a doctor will make the decision for me.

I like your idea, and I'm going to do it. Possibly tomorrow at therapy. One of my "regrets" is actually that my husband will regret my decision, or he mine. And I often feel that one small kernel that's possibly driving me is "taking one for the team." Much food for thought here, thank you so much.

loribeth said...

As someone who decided to walk away from treatment -- without a living child -- when it all became much too much, I think you've given some excellent advice, Mel. And thank you for your respect. : )

There will always be regrets & repercussions, no matter which choice you make. There will always be new carrots that drs can dangle in front of you. Only you can decide whether they are worth pursuing, and how long to keep at it.

I've been on boards with lots of women who announced they were "done," only to see them back cycling again a few months down the road, or (I hate to admit it) pregnant out of the blue, or deciding they're interested in adoption after all. When you're younger, you do have the option of changing your plan. Your options start to become alot narrower once you reach your late 30s & 40s.

That said, as Bea pointed out, you don't have to make a decision RIGHT AWAY. I was 40 when I decided, & that was after a summer hiatus away from anything to do with ttc (well, as much as I could make myself, lol). Maybe a defined break for a few months will help clear your head & help you make a decision one way or another. (((hugs)))

Alexicographer said...

I'm so sorry about your losses and that you find yourself in this difficult place.

Mel gives great advice here, but I have a system that's a lot quicker and works for me provided a decision is binary (yes/no) ... flip a coin, live with what it tells you to do for 24 hours (i.e. make that your real, committed plan). If you are miserable during that time, the coin was wrong and you should do the opposite of what it "decided." I find I usually know what the right answer is for me and that the coin helps me realize it without needing to do all the writing out, etc. You may not find the same thing, but it's a small investment to know whether this works for you.

I don't take everything out of drawers, either. I just follow my mother's advice: If something isn't where you know it is, look where you know it isn't. It's annoying how often this works.

BagMomma said...

Mel, you gave wonderful advice and curiously I've done the same analysis along the way in my own battle with SIF and pregnancy loss.

For me, the decisions came easier when I broke them down into smaller parts. It made it so much easier than the blanket statement "should I continue TCC for my second child"?

I am in a very similar position to the person who asked this question. I was 38 years old, with two losses when I came to a crossroad. I decided to move forward. I am now 41, and reaching my own personal End Game. I haven't succeeded in my quest for child #2, (I have a DE cycle in progress), but those years finally brought me to a place where I can be comfortable to walk away if it doesn't work out.

For each person the decisions are so different, but I will say this... failure does not a person make.

Making a well informed decision is really the best you can do.

Io said...

Damnit, I never have anything to comment on with Barren Advice because you are SO SMART Mel. And then all these commenters are SO SMART. I need to come up with a good problem so I can have you all hand me your brilliance!

Chickenpig said...

Ooooh I wish I had this post in front of me 3 years ago. Mel, you should writer your own advice column or something. And the comments are great too.

I was 35 when I had this decision in front of me. I had a miscarriage at 8 weeks, and after 4 years of trying that pregnancy had been the only break my husband and I ever had. I had 4 embryos in storage, and I didn't want to try again, but I couldn't walk away. My husband convinced me that I would be pissed at myself if I turned away from those embryos and "quit" , and that the frozen cycle would be our last if it didn't work. I hated that cycle. I resented every shot, every blood draw, and every re visit. I didn't have any hope that it would work, and I was so afraid it would work, only to lose the pregnancy, that I couldn't breathe sometimes.

Well, it worked. I was afraid for 9 months, but it worked. Somewhere in an alternate universe I gave up, or adopted, but in this one, I've got twin boys. I'm very glad I swallowed that bitter pill.

Sara said...

Thank you, Mel, and thank you commentors (comment-writers? Commentators? What's the term?). Very few people in real life know ANYTHING of this part of my life, and the support and understanding from you is much-needed and much appreciated. Your comments and suggestions have made feel feel less crazy and more clarified. So, again, thank you!!!

By the way, I was thinking, after my pregnancy with our son, I told everyone that I LOVED being pregnant, would do it again and again if I could. Perhaps I should have been more specific...

Anonymous said...

I've had 3 miscarriages and have a clotting disorder myself. I know you're going through some really tough stuff.

Other ladies have left wonderful advice for you. I'd suggest you print it out, put it in a folder and PUT IT AWAY for several weeks.

One week after a D&C probably isn't the best time to be making big decisions. Let yourself heal from the last miscarriage and deal with all of that FIRST. THEN let the decision making process begin.

Whatever you choose, I wish you better times ahead.

hairyfarmerfamily said...

Mel, you're just so very, very wise. Envious of your smarts!

Anjali said...

Wow. This advice is so heartfelt (from Mel and everyone else). I could have really used it myself a couple of years ago.

I had two miscarriages, then a chemical pregnancy. I had two children already, but had really wanted a third. After the third miscarriage in a row, I asked myself this question: What would I regret more -- not ever trying again, or trying again and having another miscarriage?

Hugs to you. And best of luck.