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The Jellyfish Swarm – an analogy for the invisible pain of infertility and miscarriage

This very powerful analogy can apply to any woman who, for whatever reason, is struggling either to conceive a baby or to carry a pregnancy to full term. It describes the pain that those experiencing fertility problems or miscarriages, can start to experience at the prospect of attending any social gatherings.

Fear begins to develop at being confronted at one of these events by something that is certain to upset and distress you – perhaps seeing a pregnant woman with a bump; a couple with their newborn baby; an unexpected announcement of a pregnancy; or questions about when you are going to have children.

As time goes on, and no baby is appearing for you, it seems that everyone you know is getting pregnant quickly and easily around you. This begins to cause you more and more pain as time goes on. You soon find yourself feeling horrible emotions, like jealousy, envy and resentment and anger towards those who are pregnant. It gets to the point where you start to avoid any occasions that might put you at risk, and, in doing so, you become more and more isolated.

It’s hard for those who know you to understand why you’re refusing the invitations and social engagements you once would have jumped at. This can mystify and perplex those around you – and can be misinterpreted by your family and friends – and even partner – as being anti-social or strange.

This idea for this jellyfish analogy was given to me by one of my clients when she was trying to describe what was going on for her in her life. I think it goes a long way to help people understand why socialising can become a difficult and painful experience for women trying unsuccessfully to have a child.

Picture this . . . . .

You and your partner have been invited to the wedding of one of your closest friends. It’s going to be on a beach in an idyllic location. Surfing, body boarding, snorkelling and windsurfing activities have been organised for the following day and you’ve been asked to bring a wetsuit as the sea is going to be rather chilly.

 

The wedding is wonderful, as perfect as the bride and groom could ever wish for to celebrate this special occasion – ideal weather; a stunning location; the most romantic setting; a beautiful ceremony and surrounded by all their closest family and friends.

The next morning the weather is fantastic. You and your partner are getting ready to spend a fun day on the beach with the bride and groom and all the wedding guests, when you suddenly realise you’ve forgotten your wetsuit. Undeterred by the prospect of a very cold sea, you head off, determined to enjoy the surf.

What you didn’t bargain on was that the sea would be full of tiny clear, jellyfish. and, although invisible to the eye, they nonetheless have a nasty sting.

As you, alone, don’t have the protection of a wetsuit, your body is vulnerable to these jellyfish, so you are the only one who feels them. Only you are suffering. Each time you feel the pain of another sting, you cry out, “Ow!” “Ouch” The other guests near you look surprised and you might try to explain that It’s hurting you to be in the water. They are a bit mystified. They all have on a wetsuit and are not being stung at all. They can’t see any jellyfish. They’re all having a great time and are really loving.it. They can’t quite see what your problem is.

Eventually, it gets too much for you. You explain to everyone that you have to get out of the water, that you just can’t bear the pain and that it hurts you too much being there.

So, you walk back to the hotel and sit alone by the pool.

Your partner comes to see you and feels bad that you’re so unhappy, sitting there on your own. He tries to understand, but he has his wetsuit on, and even he doesn’t experience the pain of the jellyfish stings as you do.

He wants to be supportive of you and so he joins you by the pool, but he doesn’t really get it and he’s clearly a bit fed up that he’s missing out on all the fun with his mates. Yet he knows how guilty he would feel if he were to go back and join them.

He may try to imply that it can’t be as bad as all that, and surely it would be better for you to be out there, enjoying being with him and all your friends, than sitting here isolated and miserable by the pool. He doesn’t want to shut these people out of his life and really wants you to find a way to be able to socialise with him and all your friends. He also wants to be with you and would love to be able to enjoy this wonderful time with you. He misses the fun, bubbly outgoing person he used to know and love – and he wants her back.

You don’t want him to leave you to go and be with his friends. You wish he also felt the searing pain of these stings so he would understand what it’s like for you. You may feel you have to give him permission to go and be with the others, but at the same time, you desperately want him to choose you over them.

 

So how can you manage this? First, begin by understanding there’s nothing wrong with you. Your reaction to the sometimes-insensitive things people say; to the pregnancy announcements that come out of the blue; to the scan picture posted on Facebooks; and to the probing questions about your intentions for a family – are almost universal among women who are trying unsuccessfully to have the family they dream of. It is a protective mechanism, a coping strategy that you instinctively employ to shield yourself. To do otherwise would make like insufferable. For many women, avoiding situations that would put them at risk of severe emotional pain is very common.

Try to accept that this behaviour is a normal response for women in your situation. You’ve not gone ‘mad’ or become a ‘bad’ person. It may feel like that to you because these reactions are all very alien to you. We are conditioned to believe that envy and jealousy at other peoples’ good fortune (especially something as ‘wonderful’ as the announcement of a pregnancy) is unacceptable and unpleasant – so we must be bad. We are also social creatures that thrive in the company of our friends and family. So, to find yourself wanting actively to avoid social situations at all costs is abnormal for you and you can feel like you’re going a bit nuts. It is such a strange and difficult time for you and your partner. No one warns you that you may not be able to conceive as easily as you’d always assumed. There’s no manual to help you navigate your way through this unfamiliar terrain. You may easily end up feeling isolated and alone in your pain.

 

The Thwarted Maternal Drive

I have a sense that this behaviour and these feelings are an automatic response to what I call the ‘thwarted maternal drive’ (TMD). ‘Mother Nature’ is a powerful entity. She resides there, deep within you, willing and urging you to procreate. This biological imperative is primal and intrinsic to women.

So, what happens when this drive is frustrated and no baby is happening for you?

In my theory, Mother Nature starts to make herself felt – and felt extremely powerfully. She starts to make this experience as painful and uncomfortable for you as she possibly can. Somehow, she switches on these excruciatingly agonising emotions within you. She knows that the more hurtful and unbearable this is for you, the harder you will try for the baby you are longing for – to make it end. You will do anything to achieve this goal and suffer any amount of physical, medical and financial duress in order to escape this torturous purgatory of no baby. She will make you notice, like never before, bumps and babies and young families everywhere you look.

You will start to contend with numerous losses and fears. Like the loss of having a baby when all your peers are having them and making you feel left out and left behind. Like the loss of being able to have a new-born at the same time as some of your best friends or family – giving you sadness that such a special time will not be shared with those you are closest to. Like experiencing the 3 am fear that, for you, a baby might never materialise and you may never be a mother. These fears and griefs are invisible (like the jellyfish). Perhaps even you can’t fully understand what’s happening to you, let alone your partner, friends and family.

The hardest thing is to accept that what you want is not happening in the way you imagined and envisioned. Even harder is that you have to learn to accept that you don’t have control over procreation. It begins to dawn, gradually, that creating a baby is not in your hands and so your family is not going to be realised in the way and in the timeframe you want. All of this is hard to accept, and can feel utterly unjust and unfair, especially when others are managing to achieve this same goal so effortlessly.

But try to hold onto the hope that, although your family not going to come to fruition as you hoped and expected, one day it will happen, somehow, albeit not necessarily in the way you anticipated. You are having to re-imagine a different way forward, one that will not be the same but will be equally as wonderful and positive.

 

So how can you do this?

I don’t know if this is possible or not, but if you can accept that what you’re going through is a very natural and unavoidable process, designed to help galvanise you to get the baby you so desperately want, perhaps this may help you better tolerate what is going on within you.

Perhaps you can use this understanding to help you accept that you are not mad or bad, that you’re simply responding like any potential mother-in-waiting who is having her powerful desire for a baby thwarted. Perhaps you might be able to allow each jellyfish sting to increase your determination to do whatever it takes you to get there.

Also, you need to realise that there is only one group of people on this whole planet that feels these terrible feelings and react this ‘extreme’ way. Few men express such strong and difficult feelings at other people’s happy news; women who don’t want children are not bothered by pregnancy announcements; women who are not yet interested in starting a family do not feel jealousy or resentment; women who are pregnant, or who have had a baby or who have children do not experience any of these feelings of injustice and unfairness.

It is only women who really want a baby, but for whom this is not happening, who get to experience Mother Nature’s hand in their lives.

So try to understand that your partner may not feel as hurt and distraught as you and learn to accept that it’s OK that he feel quite differently from you. When you’re weeping because two more of your friends or another family members have just announced their pregnancies and he says something like “Why do you feel so much sadness at other people’s happiness?”, it’s not that he doesn’t care or that he doesn’t want a family as much as you do. He does. It’s just that he is not at the mercy of Mother Nature’s powerful primal forces in the same way as you are. Also, he has probably been conditioned not to show or express his feelings and probably feels he has to be strong for you.

 

How to help others get it

Perhaps you can explain this analogy to your partner, to your friends and to your family, to help them understand why you have become so uncharacteristically sensitive and withdrawn. Hopefully, they will then be able to understand why their enthusiastic announcements of their fantastic news; or their endless excited discussion (or complaints) about their pregnancy; or their detailed blow-by-blow account of their birth; or their description of how hard it is to have a newborn; or the grandparents cooing adoringly over the newborn baby; or your family’s innocent and well-meaning enquiries into your fecundity – are perhaps not as welcome as they might imagine.

Try to see that those jellyfish stings are Mother Nature’s way of keeping you fully focussed on the task. Take each of them as evidence that she is alive and kicking within in you. She wants you to have this baby as much as you do. And, although it seems harsh medicine, without that pain driving you forward, you may not have the impetus to keep going on this socially, emotionally, financially and relationally challenging quest.

In the meantime, I wish you well on one of life’s most difficult journeys and I hope, one day, you get the baby you are yearning and striving for.

 

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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

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Misconceptions about the effect of stress on fertility treatment

The notions about stress affecting the outcome of fertility treatment don’t stand up to scientific scrutiny.

In 2011 Professor Jacky Boivin from the Cardiff Fertility Studies Research Group investigated links between stress and the success of fertility treatment. She undertook a large-scale review (known as a ‘meta-analysis’) of all the studies that had been done on the impact of stress and distress on fertility treatment outcome. *

Fourteen studies with a total of 3,583 infertile women were included in the review. The women were assessed before fertility treatment for anxiety and stress. The authors then compared data for women who achieved pregnancy and those who did not.

The results show that emotional distress was not associated with whether a woman became pregnant.

Professor Boivin therefore argues that “these findings should reassure women that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise their chance of becoming pregnant.”

Boivin’s conclusion was supported the following year in another study into the relationship between psychological distress and IVF treatment outcome found that pre-IVF psychological distress does not predict IVF failure.

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Misconceptions about Stress and Pregnancy

We all know that stress affects the ability to get pregnant and remain pregnant, right?

Wrong.

“But surely,” I hear you say, “everyone knows that you need to be stress-free in order to conceive or maintain a pregnancy.”  Indeed, why else would everyone you know be telling you to relax and reduce your stress levels when you explain to them, you’re struggling to conceive, or finding it difficult to stay pregnant?

Many women who are experiencing fertility issues or multiple miscarriages believe that emotional stress and distress, or the tensions arising from difficult life-events, are factors in them not getting pregnant naturally, succeeding with fertility treatment, or maintaining a pregnancy.

This view is largely based on anecdotal evidence and fertility myths such as ‘don’t think about it and you’ll get pregnant’, and “you just need to take a holiday/work less/relax more” etc. Plus, there’s loads of information on the internet that supports these widely held beliefs.

Nonetheless, there is little scientific evidence to support such notions.