PTSD

This post is kinda a continuation of last post.  "I should be more happy", I keep telling myself.  Don't get me wrong, I AM happy that we are finally able to have a baby.....REALLY REALLY happy.  But a piece of me thinks I should be more happy. Elated.  Shouldn't I be even more happy than the average person who finds out they are going to be a mom for the first time?   Sometimes I got to wonder what was wrong with me.  It prompted me to bring it up with a trusted therapist and even do my own research to see if I'm "normal".  Everyone likes to feel as if what they are feeling is normal and I'm no different in this situation.  Everyone needs to feel as if their feelings are validated and important...and that you're not crazy. Upon my research I found a few interesting medical research articles.  PTSD is what I found. PTSD, I thought?  To me it was weird and impossible.  Isn't PTSD only what soldiers get after horrifying and life alerting experiences?  Surely someone with infertiltiy couldn't be compared to them?  I'm not saying I have PTSD because I'm not self diagnosing myself....I'll leave that to the professionals.  BUT I just want it out there that it can happen and IS real.  I would never dare to compare infertility with being on the battlefield, as the soldiers that have been see more in their lifetime than I luckily ever will.  God Bless them for doing what they do, because I couldn't.  But in a much different way couples that struggle with infertility have lived through their own different and VERY real kind of battle.  I just wanted to share some excerpts of the articles I found and make everyone aware there are other articles of "proof" if you need it.  

Examining PTSD as a Complication of Infertility

, New York Hospital-Cornell Medical Center, New York City, , Manhattan Psychiatric Center, New York City, , New York Hospital-Cornell Medical Center, , Cornell University Medical College, , Advanced Fertility Services, New York City

Disclosures

Medscape General Medicine. 1997;1(2) 

"Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may develop following exposure to threatened or actual injury or death. While commonly associated with war or natural disaster, symptoms of PTSD have been described in patients who are undergoing or who have completed infertility treatment or high-risk pregnancies....."

"Posttraumatic stress disorder (PTSD) is diagnosed in patients with persistent psychiatric distress resulting from events involving actual or threatened death or injury.^[1] Subsequent to the trauma, victims experience feelings of intense fear, helplessness, or horror. The precipitating trauma sets in motion a series of physical and emotional reactions that can have major and long-lasting effects. The characteristic triad of PTSD symptoms include (1) persistent re-experiencing of the event, (2) avoidance of reminders and numbing of responsiveness, and (3) increased arousal. Significant distress and functional impairment may result. Psychologically, PTSD is characterized by a classic triad of intrusive, avoidant, and hyperarousal symptoms."

"Although PTSD commonly occurs in situations such as war or natural disaster, other life-threatening situations like sexual or physical assault, being kidnapped or taken hostage, or being diagnosed with a life-threatening illness^[2] have been cited as precipitants...."

"The inability to conceive can catapult some patients into a state of shock, disbelief, and helplessness.^[3]Infertile couples must grieve 2 losses simultaneously: the loss of their ability to procreate as well as the loss of the hope for children. Women who have difficulty conceiving may react to these dual realizations as simply loss, or alternatively as psychological trauma. Those who experience a loss may subsequently develop major affective or adjustment disorders, but those who experience this loss as a trauma may instead develop PTSD. We have observed the development of PTSD in women who have experienced a variety of reproductive problems, including infertility, miscarriage, complicated pregnancy or delivery, and multiple births."

"When PTSD develops in response to infertility or other adverse reproductive events, patients exhibit the classic triad of symptoms described above. They may re-experience the trauma as nightmares, flashbacks, and intrusive thoughts about distressing procedures or pregnancy loss.^[1] Symptoms may manifest as extreme distress under seemingly innocuous circumstances, such as seeing a pregnant woman, menstruating, or visiting the doctor's office; these types of occurrences may trigger a recollection of the infertility battle or mark an anniversary of events in the struggle to conceive and/or to complete a difficult pregnancy."

"Avoidant symptoms include hesitance to discuss the trauma or to engage in any activities, thoughts, and feelings connected with infertility, pregnancy, or childbirth. The woman may be reluctant to discuss the experience with even her most intimate contacts. Avoidance may result in failure to bond, or a delay in bonding, with a newborn. Some PTSD-afflicted women even experience an aversion to the baby and become anxious just holding the infant. Other symptoms include amnesia regarding certain aspects of the trauma, apathy toward previously cherished pleasures or toward other children at home, hopelessness, feelings of isolation, and a general dulling of emotional responsivity."

"Comment. This case demonstrates the feelings of shock and helplessness associated with infertility itself. Some patients become overly involved in their infertility treatment as a defense against feelings of inadequacy.^[3] Further, the infertility work-up and treatment may be perceived as trauma in that it can be painful, humiliating, and intrusive. The nature of the treatment may lead to estrangement from one's own body and sexuality and a distorted perception of the self as merely a vessel for conception. This case also demonstrates some of the marital and sexual problems typical of patients with infertility.^[9,10]"..... Social withdrawal is common with PTSD and has the effect of depriving the woman of much-needed support of friends and relatives. The stigma of infertility is another barrier to seeking support."

"... It is painfully ironic that many of the patients who win their battle with infertility subsequently develop PTSD or another psychiatric illness during or after the pregnancy. Since the full implications of the relationship between infertility and PTSD have yet to be fully explored, this area remains very worthwhile for future research"

Here is few excerpts from another article:

Allyson Bradow, director of psychological services at Home of the Innocents, a nonprofit organization in Kentucky

"The definition of trauma should be expanded to include expectations of life," said Bradow, who went through fertility treatments herself, and conducted the study as a doctoral student at Spalding University in Louisville. "Having children, expanding your family, carrying on your genetic code — that's an instinctual drive that we have as human beings. And when that is being threatened, it's not necessarily your life being threatened, but your expectation of what your life can be or should be like," she said.

The general diagnosis of infertility, or not being able to have a baby, is kind of this giant earthquake that rocks your world. And then, there's all the aftershocks," of fertility testing and treatment, Bradow said.

Bradow said the symptoms she experienced during fertility treatment went beyond those of depression and grief, conditions previously linked to fertility treatment. Others she spoke with felt the same.
To find out how widespread these feelings were, Bradow and colleagues surveyed 142 people who had undergone fertility treatments, and who visited online support groups for infertility. Survey participants — 97 percent of whom were women — completed an online survey to assess their symptoms of PTSD. They were asked to consider their infertility diagnosis and fertility treatment as their traumatic event...Overall, 46 percent met the criteria for PTSD. Among this group, 75 to 80 percent said they felt upset at reminders of their infertility, such as seeing commercials for baby diapers. Other common symptoms included feeling distant or cut off from people, or feeling irritable. Many also said they felt hopeless, and had changes in their personality."

I'm still not "over it"


As I've posted before, just because our miracle finally happened, doesn't mean I'm cured of infertility and that "I'm over it".  Anyone with something so devastating and life changing would agree that the wounds are always somewhat fresh, especially when a trigger appears.  Why do you think so many cancer survivors are passionate about joining walks and celebrating life?  The hard part is that the infertility folks don't have the support like most other groups.  There's no "infertility survivor" support group.  You'd be hard pressed to find any type of support group readily available, although this is slowly changing.

Sure we will have our child we wanted so badly but I still am traumatized by my experiences the last few years.  I have more anxiety than the average pregnant woman that something will happen to my baby.  It took years to get where we are and unlike them I don't have the luxury of trying again should something horrible happen.  With every new symptom or lack thereof....I'm nervous something is wrong.  
Unlike everyone else I know we had to pay to get pregnant.  We have accrued debt most other couples will never know.  Sure we had a little help, but most of it we did on our own by saving money and working extra jobs.  Hallelujah for friends and family that helped us out.  Like most couples, soon we'll have daycare to pay for.  We both need to work and aren't lucky enough to have family watch our child.  But UNLIKE most couples, we are still "paying the baby off".  Babies are expensive and if we are going to make ends meet, it is essential the debt is paid off before the arrival of our child.  While other couples are enjoying shopping for baby items, I'm frantically figuring out how I'm going to pay for these items AND our debt at the same time.  While I'm lucky to be where I am, it does take alot of the joy away that I was SO looking forward to experiencing.  
As I mentioned in my previous post...most of my friends get to "family plan".  They get to decide how many kids they are having and when.  They get to choose if their child has a sibling and when.  We don't.  We know our child will be an only child and I so desperately want them to have a sibling.  That will never happen.  Before people asked me if and when I had children....now they ask how many I'm going to have and how far apart.  Some even comment I NEED more than one child to avoid "only child syndrome" or a "spoiled" child.  Seriously?  Some people are so naive.  Some people have even commented that we will not be real parents until we have two....for all the fighting and sibling rivalry.  Considering we have fought for this and have been through hell and back, I can say we already are REAL parents because we have been through more than most will ever know or experience.  THAT is what makes a real parent....sacrificing for your child.....not listening to fighting.  We can't afford a baby AND expensive fertility treatments so it WILL be an only child.  But hey.....I am lucky to have at least one.  Many others don't even have that choice.  I wish people would realize that. 
I'm extra sensitive about gender questioning.  My least favorite question is, "what do you hope your having" or "what would you prefer, a boy or girl?"  For most, this is a simple and innocent question.  For me, it sets off a trigger.  After ALL we've been through we are just lucky to have ONE child....we were told we'd likely have none.  Why, after knowing we could have ended up without any, would I be picky enough to want a certain gender?   I'll take anything since we are lucky to have anything at all.  For me it's the equivalent of a starving person turning up their noses at baked chicken....you should be blessed you have what you do.  It makes my blood boil when people who have all boys and are griping that they wanted a girl with this pregnancy.....do they realize some people can't have any.  Any child is a blessing.
I've been warned by a therapist that guilt and subsequent depression are a side effect of those who have children after struggling with infertility.  Seems weird but when she explained it, it made complete sense.  Most would think that after we finally achieved our goal, we'd be happier than most.  The truth is that we have placed high pressure on ourselves for wanting children.  We know firsthand how lucky we are to be blessed with a successful fertility treatment and a child.  Let's face it, most parents have moments when they want to strangle their child and most pregnant women have moments when they wish they weren't pregnant anymore.  It's human nature.  However, we often feel guilty for having these thoughts since we know how lucky we are.  We feel horrible and guilty for having such awful thoughts when we could have ended up with nothing at all.  Sure it's human nature, but often we are harder on ourselves than "normal people" without fertility issues for such negativity.  I've already had moments when I could barely get out of bed from morning sickness and could barely make it through the day.  I was SO hard on myself because all I could keep thinking was "you should be so lucky, you could have nothing" and "this is what you asked for".  It's also funny how at the first moment you let your guard down and complain, people are 10 times quicker to let you know it.  We seem to be held to higher standards when it comes to venting...like you're not allowed.  Sure I'm hard on those that complain about what they have.....but that's usually because they don't follow it with the acknowledgement that they are still blessed and lucky to have what they do.  I don't need to be made to feel guilty when I complain.....I make myself feel that way enough.  And I know how lucky I am, even when I do complain.  Not everyone does.  

What the doctors don't tell you....

The goal of infertility treatments are this:  Step one = to get pregnant. Step two = to stay pregnant.  Some couples that struggle with infertility can easily get pregnant but are plagued with frequent miscarriages.  I think most are like us....we couldn't make it to step one and couldn't get pregnant.  Either way, both are devastating because you never get to bring a baby home and have the family you long for.  

So when we FINALLY made it to step one after several years and procedures later, we didn't realize the uncertainties that could happen after that.  I think the hard part for me is that we've never been pregnant, so how do we know if there's a problem with miscarrying?   It is a big unknown the doctors never really speak of.  It took us years just to make it to the first step and I couldn't imagine trying so hard to get pregnant and then find out we have yet another problem with carrying and keeping the baby.  It was a big blow.  I'll never forget the phone call from Dr. Sobel when he said our beta was positive.  I suspected it was, but hearing it was by far the best words ever spoken to me.  "Honey, I'll clean the house" was the second.  Just kidding.  However, it was followed by news I didn't ever suspect.  "Come in every 3 days to get your blood tested to make sure it's a viable pregnancy." What?!  How could this not be viable after all we've been through?  We were SO focused on getting to step one.....we never even thought about step two.  While I was elated I was also more scared than I've ever been in my life.  For about 2 weeks I went to the office about every third day to  make sure my hormone levels were steadily rising.  Numbers that don't rise means you are losing the baby.  Waiting for those results every three days was painstakingly slow and horrible.  I must have checked my phone a million times.  For fertility doctors, this procedural...for me it felt like life or death.  

The next step is waiting for your first ultrasound....usually done at "5 weeks pregnant".  They kept saying how important it was to hear a heartbeat, but "don't worry, sometimes it's too early".  I've ready blogs and internet articles about women who finally got pregnant, only to never hear a heartbeat.  It made me sick to think that could be me too and the worry got the best of me, even though I was still happy to just have this chance.  I lost a few nights of sleep during this process needless to say.  Having never been pregnant, I didn't realize how important and fragile early pregnancy is.  It's something that wasn't spoken to me...maybe because it would have just fueled my worry.  At week 5, we had our first glimpse of our baby-to-be and we were SO lucky to hear a heartbeat.  THAT was the best sound I've ever heard.  For the next few weeks, I had weekly ultrasound appointments to make sure the baby was developing according to plan.  Although it's pretty obvious, no one ever told me how important this was....mostly because most women don't get 50 million ultrasounds because they are "normal".   I can remember long nights of waiting for the next ultrasound, hoping and praying all would be well.  There's so many things they are looking for in these ultrasounds....which means there are so many things that could be wrong.  Once I knew what they were looking for, I had a check off list in my head each time I went.  With each good ultrasound I grew slightly less anxious, but the feeling never completely goes away.  Most women get one to two ultrasounds their entire pregnancy because they are "normal" and not "high risk", that it's foreign to them when I speak of so many ultrasounds.  While I was dreading the ultrasounds in a way because I might have gotten bad news, they were a needed relief to see that everything was ok.  With each ultrasound the doctor's gave me my "chances of miscarriage"....something I never knew or thought of before....but it was real scary.

My point is that people who don't struggle with infertility will never know how this feels....getting the best news of your life but that black ominous cloud still looms overhead.  Miscarriage sucks no matter who has one or what the circumstances, but unlike my fertile friends I can't "just try again" next month.  This is a once in a lifetime chance the way I see it....a miracle (if I believed in them).  When I first started this journey, I didn't realize that I'd accumulate emotional scars that would never go away.  This is just one example.  While I'm lucky that we are going to have one child, it still kills me that I can't give our baby a sibling, especially when I hear friends say "well we'll likely have more than one".  I want that too...but I can't have that.  I want my baby to grow up with a brother or sister.  I want them to have someone when we are gone...someone to spend holidays with and someone to reminisce about memories.  It kills me to hear people "plan" their future.  How they talk about how they are going to "try" to get pregnant so their kids are only 2 years apart.  Don't talk to me about trying, because you don't know the true meaning.  It must be nice to be able to plan your life the way you want it because your body works the way it was intended....so many people take this for granted.