25 April, 2022

Dealing with pregnancy announcements

Last week, Mel wrote about how to tell someone you are pregnant, prompted by a question raised in the Washington Post. I started writing a long (looooong) comment, and realised it would be better as a blog post. Jess beat me to it, and wrote her perspective here. It’s worth reading them both.

The question posed was how to tell someone who has struggled with infertility that you are pregnant. Obviously not a problem we have had, but the lack of understanding* of others has sometimes caused us a problem. The answer suggested giving the person space by telling them by text or email, and telling them it was okay to take time to process. It was really nice to read that advice in such a wide-reaching forum as the WP. I hope a lot of people gained a new understanding of how to announce their pregnancies to their infertile friends and family.

The thing that bothers me with this issue is that so often it is the person on the receiving end of the news (the one struggling with infertility or childlessness) who is criticised and judged for being upset, for potentially being upset, or for simply struggling with the news. People who should know better judge us, even if we react perfectly decently. (See Jess’s post for an example of this.) We judge ourselves too, sometimes even more harshly.

The reality is that pregnancy announcements can be very difficult to hear for anyone who has suffered infertility, loss, or childlessness. They are a reminder that everyone else (or so it seems) manages to do something so easily, and we can't. They bring up all those feelings of "what's wrong with me?" or "maybe I never deserved it" or "maybe I did something wrong" etc. The feelings aren't about the friend who has the good news. We are happy for them. But we want (or wanted) their good news too. And that good news prompts all those feelings of self-worth and failure, which we might still battle with daily (especially in the days of active infertility, or in the first years of childlessness), but usually silently.  We then have to deal with those sad feelings, and on top of that, we feel bad and guilty about having them, even though a) we are happy for our friends, but we are unhappy for ourselves, and b) it's a perfectly natural reaction.

So I agree that, as suggested in the WaPo, having time to process is really important. It gives us time to prepare ourselves for being around/seeing the reaction of others too. Because the outpouring of excitement, ooh-ing and aah-ing, and gushing (there’s no other way to describe it) from others is hard to take. If you want to listen to pronatalism run riot, listen to the comments at a pregnancy announcement! So when a friend told me she was pregnant, and would be announcing it at a small gathering I would be at a week later, I was very grateful. She herself never made me feel bad – but the sometimes over-the-top reactions of others were not as easy to deal with.

It's a two-way issue too. The pregnant person doesn’t always realise this, but inevitably it may signal a change in the relationship, and the potential loss of the relationship too, depending on both parties in the relationship. We see that coming, often from bitter experience. I saw a comment online the other day, when someone with children said that, “motherhood means lost friendships.” She should try it in the other direction, I thought! But it was evidence that both parties hurt over friendship changes. The truth is that frequently friendships change when children arrive, whether infertility is involved or not.

I will say this again though. Struggling with a pregnancy announcement is a normal reaction. We should not beat ourselves up for it. Ideally, our friends will understand and give us a little time to deal with this. If they don’t, it's out of ignorance, not malice. So taking a little time for ourselves is perfectly acceptable, and oftentimes, very important. I don’t recommend ghosting a person, as I read somewhere recently! I think that’s an appalling way to deal with the situation. But sending a card, or email, congratulating them, and then gradually talking to the pregnant person individually, on our own, can sometimes be easier. I would avoid groups if you can! That way we can let them know we’re happy for them, but at the same time might struggle with the news and need time to process. They can understand better that we might struggle, but that we’re still delighted for them and love them. Besides, the reality is that they are going to be surrounded by people congratulating them, and fussing over their announcement. That leaves room for us to take a little more time.

* my worst experience of a pregnancy announcement was, however, by email. "Sorry to hear of your ectopic pregnancy," emailed a (male) friend I'd emailed to tell about it. "But guess what, we're pregnant, and attached is our scan photo!!!"

18 April, 2022

Pros and cons of a childless Easter

First, the pros:

I got to sleep in. 

I didn't have to amuse children, go out in crowds, dread the coming school holidays (which started here on Friday).

I didn't have to buy a lot of chocolate, especially not the cheaper Cadbury's chocolate that flooded our supermarkets but isn't certified from non-child-labour sources.

We bought bakery hot cross buns (my baking attempt failed - I'm blaming the recipe) which probably wouldn't be to the taste of children.

We had an lovely meal on Easter Sunday at our leisure, and a bottle of excellent wine.

We watched adult (not adult-themed!) TV.

It was exceptionally peaceful, especially today, after a disrupted night, a morning when I felt unwell, so I could spend a day on the couch reading.

The weather was gorgeous, and we could do what we want.

But there are cons:

It's often a family time, with people travelling to see their families, or getting together locally. But it's too far to go to see my family in the South island, and my sister in the north visited last year and was spending it with friends and their families this year. So it can be lonely when you're the only ones you know without immediate family nearby.

It's easier to hide the loneliness by staying at home than by going out, so we hibernated, despite the gorgeous weather.

I made my own Easter Eggs (having first made them over the first pandemic lockdown two years ago), and have now mastered the recipe. But there was no-one to share them with. (Okay, to be honest, I could have and would have shared them with the neighbour and his little girl, but there weren't enough to go round!)

But that's life. I'm sure there are people with families who would have liked to have our peaceful, low-calorie weekend! So I'm sticking with the pros.

11 April, 2022

Covid Isolation and Childlessness

My sister-in-law in Perth (Australia) was complaining last night to me about the lengthy isolation periods she and all her friends were going through, as each of their kids get covid (because that's what university/high school age offspring do) in succession, every few weeks. Two of her kids have had covid over the last two months, and she is expecting more time spent in isolation as her youngest, and then she and her husband, inevitably (as far as she is concerned) get covid. (For those who don't know, Western Australia has been much like NZ, covid-free with life as normal for the majority of the pandemic so far, but omicron was their undoing, as it was ours.) She was telling me about all the meals her friends were dropping off to her because she had been sick (not covid this time), and said they had all been doing that for the last few months through these isolations.

I had two reactions. The first was one of, ironically, isolation. We only have a few friends who live close to us, so there wouldn't be a lot of food drop-offs if we get sick, or vice versa. Whereas her network comes from the friends they made through all their children and their various schools, so they are all linked, and centred around a similar location (the schools) too.

My second reaction was smugness. If DH gets covid, I'm very likely to get it, and vice versa. We'll have to isolate then, but that's it. No lengthy or multiple inconveniences brought home by kids. I shared my smugness with her. That's when the conversation ended! 

04 April, 2022

Grief as a disorder and the childless factor

In the US, a new disorder – prolonged grief disorder – has been included in the Diagnostic & Statistical Manual used by medical professionals to diagnose and treat mental disorders. They define it as being “incapacitated, pining and ruminating a year after a loss, and unable to return to previous activities.”

There has been a long debate over this – Loribeth covered this going back to 2012, and includes some interesting links in her post here where you can see some of the historical issues. It seemed particularly crazy, ten years ago, to look at diagnosing grief as a mental illness a mere two weeks after a loss. So they have taken time and research to do this now to “… allow clinicians to aid a part of the population that has, throughout history, withdrawn into isolation after terrible losses.” The NY Times article has received a lot of comment in the No Kidding community, and I took my time to read it and a lot of related articles, before commenting myself. I decided to share my analysis and thoughts today.

What they are addressing is what they will now call prolonged grief disorder. Elsewhere, it has been referred to as complicated grief. I’m not sure I like either definition, because even “normal” grief is complicated. Anyone who has grieved can vouch for that. But in that very name – complicated grief – they are also acknowledging how complicated this can be.

Names are so difficult to get right. In fact, I have a particular problem with the very first sentence of the article, which been the subject of a lot of commentary. It says:

“After more than a decade of argument, psychiatry’s most powerful body in the United States added a new disorder this week to its diagnostic manual: prolonged grief.

This is not my reading of the situation. They have added a disorder called “prolonged grief disorder.” The key word here is disorder, not simply “prolonged grief.”

This definition does not pathologize the “normal” grief that most of us experience. Normal grief is accepted as … well, normal. We grieve, in different ways and at different levels I am sure, but in due course we manage to come out of it and begin to find joy and enthusiasm for our lives. The grief may change us, and stay with us, but at manageable levels, and – as we all know – it may come and go, swell and ebb, at different times. It becomes a part of us, but does not define us or our lives. This is not the grief they are addressing with this categorisation. They’re not talking about acute grief either, that grief in the immediate period after losses – in our case it might be when we first know that we will never have children, or after a pregnancy loss. Acute grief is painful and terrible, and sadly, it is perfectly normal, as they acknowledge.

It is natural to worry about this. After all, maybe we think about our own grief, and reject the idea that it is or was a mental illness, when most likely our form of grief would not be included in this definition that requires help. But there are huge differences between normal or acute grief, and complicated, prolonged, grief, and I don’t think it diminishes our grief, or pathologizes it, by recognising a disorder at the extremes of grief. They are not the same, but one has the power to completely restrict and hinder our lives. I think that this is the level of difference they are describing.

By my interpretation, they are not pathologizing grief, or putting a time limit on it. A comment on the article points out that

“The twelve-month criteria states that the diagnosis of prolonged grief disorder (my edit) in adults CANNOT be made in LESS THAN twelve months, not that it MUST be made at twelve months.”

It does not mean that grief lasting longer than a year automatically becomes a disorder by definition of that time frame. Besides, there are other criteria to the definition, which I will touch on below. Of course, length of grieving varies for an individual. Two weeks or two months (still in the acute grief phase), or even two years of grieving, is very different from 10 years, or a lifetime. In my own experience, and in observing those in the loss and childless community over twenty years, most people seem to be able to fully embrace life after around two years (plus or minus a year or two), and can take joy in people or moments well before that. A woman grieving her child was quoted in the article,

“All of a sudden, you look up,” she said, “and a few years have gone by, and you’re back in the world.”

If I could not have reached this stage, if I had found myself still debilitated by grief five or ten years afterwards, I would hope that someone would diagnose me with a prolonged grief disorder, and then make an effort to help me.

So it isn’t only about the length of time grief lasts. The article notes that it also must take into account that a sufferer is “… incapacitated, pining and ruminating … , and unable to return to previous activities.”

I think that this is key, and it is what I see (and don’t see) in our community. There is a particular emphasis here on “pining and ruminating.” This is a natural form of grief, of course, in the early parts of suffering. But I have found that the only way to move on is to stop wishing for the impossible – wishing that the person or child we have lost, or the baby we lost or never had, is with us, when we know that cannot ever happen. This is acceptance, and includes missing them. We can miss them, and probably will miss them, for the rest of our days. We can even wish things might have been otherwise, but at the same time we can accept that they will not be. We can live with the “missing.” But pining and ruminating (perhaps what I call the more obsessive “what-ifs”) don’t serve us in any way, and may well incapacitate us, which brings me to the other key feature of determining what is PGD. Any grief that incapacitates us, that does not see any improvement, or even management, that isolates us, that consumes us, can in time become a problem – for the person, their lives and their relationships. That is when they need help getting through it.

There are also worries that grief as a disorder will be treated only with medication, or will be lumped in with depression when the two are actually very different, and studies are beginning to show they do not respond to the same treatments. If, by categorising a particular manifestation of grief as a disorder, there will be more studies, development of more treatments (and so far medical treatments appear to be less effective), and enable more people to pull out of their deep, disabling grief and take part in the world again, I am all for this. I choose to be optimistic, and hope that it helps people to get treatment. Especially as this is also related to the US health insurance system, which I don’t quite understand, but it seems it will enable more people to get help.

However, I do think there might be a difference here for the No Kidding. I wonder if that is why we, as a community, have had such a strong reaction to the suggestion that complicated grief is a mental health issue. Included in childless-not-by-choice grief is the issue of disenfranchised grief, a grief that has never been recognised. Many of those who suffer or have suffered it have rarely had anyone acknowledge our grief in the first place, or allowed us to express it and heal naturally. There were no funerals, no acknowledged anniversaries, no public showing of mourning to support us. So it feels as if this recognition of a prolonged grief disorder might once again disenfranchise our own grief, as it suggests that we should “forget about it” and/or “get over it” and move on without anyone ever acknowledging our grief in the first place, or the ongoing losses we feel. If we’re not allowed to recognise our grief, how can we begin to heal, or consider, or manage our grief?

What do you think?