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George and the dragon and the maiden in distress – an analogy of how couples can deal differently with infertility and miscarriage 

Look at this picture for a moment. To me, this is an iconic image that epitomises the nature of the relationship between a couple when they are facing adversity.

We see a maiden in distress with a dragon breathing fire over her. The dragon can represent infertility, the inability to have a baby due to miscarriages – or in fact any kind of serious challenge faced by the couple.

Worse still – you see the cave in the background – and in the maiden’s mind is the ever-present threat that the dragon could carry her off into his cave and devour her – fulfilling her worst fear that she may never have a baby and may never be a mother – or any other of her worst fears.

The damsel is very distressed and is weeping copiously.

Then George comes into the scene on his trusty white steed.

He has on his armour, his helmet and his breastplate and he carries a shield – all the things to protect him from the emotional difficulties the world may face him with. And in his hand, he wields a sword.

Now there are two things we need to know about George: –

One is that he cannot bear to see his damsel in distress. It pains him enormously to see her like this.

And two, he needs to fix it, to rescue her from the thing that is causing her such heartache, grief and fear (not least because he can’t bear it himself and wants it all to stop).

So, George tries to slay the dragon. But this dragon is invincible. It will not die. He cannot make his wife or partner pregnant or keep the pregnancy going, if she is in danger of miscarrying again. He realises he has absolutely no control over the situation and feels powerless and helpless in the face of this unconquerable foe. He doesn’t know what to do. He’s tried everything. He’s said everything he knows to say many times before and it clearly hasn’t worked – she’s still crying and upset – again and again.

So, what is he to do?

Well, he has several options: –

1.  He can gallop off and leave her to it – go and play on his X box, go to the pub or watch the football.
2.  He can go into the cave himself, shut down and become uncommunicative.
3.  Sometimes he even gets angry with the damsel because she won’t stop crying and it faces him with his own powerlessness and inability to make things better. He waves his sword at her in a threatening way. He just wants her to stop going on about it and stop being so unhappy and miserable (he just wants the return of the bubbly happy-go-lucky, sociable maiden he knew before all this baby-making malarkey started
4.  But the fourth option – and listen up here fellas because this is the one that does the trick – he gets off his horse, he puts down his sword and shield, he takes off his armour and he goes over to the maiden. He takes out a clean white hanky from his pocket and hands it to her, then gives her a hug, laying her head on his shoulder and allowing her to cry and sob until the wave of distress passes, saying “There there, it’s OK. We will be OK; we’ll get through this together, no matter what happens.”

Believe it or not, it can be that simple . . .

Now I grant you, George, that sometimes the maiden may not be weeping, she may be in a bad mood, irritated with you and everything and everyone – and she seems to you like a prickly pear – and the last thing you want to do is give her a hug. But if I were you, I’d give it a go – ask her if she’d like a cuddle – and if she says yes – make it a good one.

 

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The Lion’s Den – An analogy of pregnancy and Miscarriage

Picture this . . . . .

Imagine a large enclosure surrounded by a high chain-link fence. This is the home of a full-grown lion.

The lion spends most of his days at one end of this enclosure – sleeping and eating and generally hanging out. It’s where the park keeper feeds him his daily ration of meat – and where the public can view this big cat going about his daily life.

At the far end of this long enclosure are two gates. The one on the left side is the entrance into the lion’s den and on the opposite side is another gate leading out.

This image represents the nine months of pregnancy.

For most women who get pregnant, all they do (metaphorically speaking) is open the first gate and walk casually and happily across the width of the enclosure, posting photos of their scan pictures on Facebook, deciding on possible names for their baby, arranging their baby shower, buying all the necessary and lovely things for their soon-to-arrive new born – and, when they get to the other side, they simply open the gate and pick up the lovely baby waiting for them there. And off they go to enjoy motherhood.

Then, when these women want another baby, all they do is go back round to the first gate, open it up again, walk blithely and optimistically across the compound and, once again pick up their next baby who is waiting for them on the other side of the far gate.

For some women, however, the journey across this lion’s den is nothing like this.

She too opens the first gate and starts to walk across the enclosure, but, unbeknown to her, the lion has decided to take a stroll around his domain that day, to stretch his legs and see how the land lies. To her horror, she sees the lion notice her in his territory and instantly he attacks.

Mauled and scratched and badly hurt the woman runs towards the first gate and thankfully escapes. But bleeding and maimed and utterly traumatised by this shocking event, she finds herself right back where she started – on the outside of the compound . . . with no baby.

What is more, her husband or partner watches this with horror from the other side of the fence, completely helpless and powerless to do anything to save his loved one from such suffering. This vicarious trauma is as distressing for him as it is for her, but he feels the need to be strong for her – after all, he was not the one who has been clawed and injured, it was not his body this has happened to. But he feels the shock and he feels the loss too.

So, imagine how keen the woman will be to consider entering that lion’s enclosure again. This time she knows a dangerous animal lives there and that he poses a severe risk to her emotional and physical wellbeing. It can take a great deal of courage and strength for a woman who has suffered a miscarriage, an ectopic pregnancy, or a medical termination, to contemplate facing such a threat again.

When, finally, she does feel strong enough to take that risk again, she enters the compound full of fear and trepidation. Gingerly she tiptoes across the vast space – day by interminable knicker-checking day, week by endless week, month by testing month, never being able to relax fully – especially when she gets close to the place where the attack happened previously. And even beyond this point she can never be fully sure the lion will not appear again to maul her.

And what’s more, she realises to her sorrow, that she has been robbed of the joy, the delight, the celebration and the pleasure of pregnancy that other women take so much for granted. Instead, she is nervous and anxious and worries at every little sign, twinge and bodily sensation that alerts her, unbidden, and reminds her of what happened before.

Gradually, as she gets closer and closer to the other side and she can see the exit gate in sight (and no lion in her vision so far), she may begin to allow herself to trust that this baby might just be hers.

Sadly though, some very unfortunate women may have to experience this traumatic event several times before they finally get to leave the compound and attain the baby for which they have been yearning for such a very long time.

Women who have lost a pregnancy, in whatever way, need a huge amount of love, empathy, support and understanding. No amount of saying things like ‘Well at least you know you can get pregnant’ or ‘It will be fine this time, just be positive’ or ‘You mustn’t be so stressed and anxious – it’s not good for the pregnancy’ will make it easier for her. In fact, such comments can be counterproductive as she’ll feel misunderstood or think you think it was her fault that it happened.

Allowing her to be worried, recognising her understandable fears, and acknowledging her sadness at not being able to enjoy her pregnancy as she would have loved, may genuinely help her.

Ask her what she needs. Listen to her. Check out with her what does help. Let her be upset – even weeks or months after it happened. Let her cry. Let her talk – without being afraid that broaching the subject will ‘upset her’. Hold back on the well-meant comments about how she needs to stay positive. In this way, you may be able to ease – if only a little – the distress that such a challenging and dreadful time is bringing her.

 

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Misconceptions about stress, distress, and miscarriage

The NHS Choices website outlines some misconceptions about miscarriage and concludes that “increased risk of miscarriage is not linked to a mother’s emotional state during pregnancy, such as being stressed or depressed”.

I’m sure if you’ve experienced a miscarriage, the nurses and doctors will have reassured you that there was nothing you did to cause it. However, I know that women will almost inevitably blame themselves and scour their memories for what they might have done that could have resulted in their loss. This seems to be a natural and normal response, but it can be extremely painful if you feel you or your body was the cause of it.

Most women I see who have experienced a miscarriage for the first time were not at all stressed or distressed before it happened. In fact, they are usually quite the opposite – very happy and with every expectation that it would continue for the remaining gestation period.  And yet they still, sadly, lost the pregnancy. Equally, I see many women who have suffered multiple losses and who are as distressed and anxious as it’s possible to be – and yet they go on to carry a pregnancy to full term and have their longed-for baby in the end. So, what does this tell us?

It’s an understatement to say that it’s stressful trying for a baby when all around you seem to do it so quickly and effortlessly, but stressing yourself about getting stressed and fearing your stress levels are the cause of your difficulties is soul-destroying and only serves to make women feel responsible and to blame for their lack of a family.

It is of course a good idea to reduce stress in your life if you can – through mindfulness, yoga, relaxation, gentle exercise, counselling or whatever helps you cope with the difficulties you are experiencing – but only because it makes a sometimes long and emotionally difficult journey more bearable. And the better you cope with this challenging and testing life event the more likely you are to be able to keep going until you succeed in the end.

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Misconceptions about stress and natural conception

NHS Choices website analysed a scientific study which claimed that the levels of two stress hormones – cortisol and an enzyme produced in response to adrenaline levels (alpha amylase) – affected the likelihood of getting pregnant.

The researchers did find that women with higher salivary alpha-amylase levels were less likely to fall pregnant, compared with women with lower levels, but this was only of borderline statistical significance, and they concluded that the study failed to prove the effects of stress on natural conception and fertility.

I once asked a PhD student who was doing research into stress and infertility if she believed stress affected a woman’s chances of conceiving. She said, “It’s well known that stress does not affect IVF treatment outcome, but it can affect natural conception.” When I asked her why this was, she said it was because when a couple is very stressed in their lives, perhaps due to financial difficulties, serious problems at work or difficulties in their personal and family lives it has considerable impact on their relationship and quality of life. They may become emotionally and physically exhausted, they may argue a lot and fall out more, and generally be more unhappy. The direct consequence of this is that couples don’t have sex as often or as much as they need to if they are trying to conceive. So, in this way, stress can affect their chances of pregnancy.

I realised then why everyone says “Just relax! You’re too stressed” and that when a couple goes on holiday and they get on better and they have the odd glass of wine, they’re more likely to have sex and therefore more likely to get pregnant.

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My Comment

It is an understatement to say that it’s stressful trying for a baby when all around you seem to do it so quickly and effortlessly, but stressing yourself about getting stressed and fearing your stress levels are the cause of your difficulties is soul-destroying and only serves to make women feel responsible and to blame for their lack of a family.

It is of course a good idea to reduce stress in your life if you can – through mindfulness, yoga, relaxation, gentle exercise, counselling or whatever helps you cope with the difficulties you are experiencing – but only because it makes a sometimes long and emotionally difficult journey more bearable. And the better you cope with this challenging and testing life event the more likely you are to keep going until you succeed in the end.

So the one thing you can do is stop stressing about the stress your difficulties are causing you and tell anyone who says otherwise where to get off!

*J. Boivin, E. Griffiths, C. A. Venetis. Emotional distress in infertile women and failure of assisted reproductive technologies: a meta-analysis of prospective psychosocial studies. BMJ, 2011

** L. A. Pasch, S. E. Gregorich, P. K. Katz, S. G. Millstein, R. D. Nachtigall, M. E. Bleil, and N.E. Adler. Psychological distress and in vitro fertilisation outcome. Fertil Steril, 2012