I sat across from her in the exam room. She was there with her partner and the youngest of her two children, a toddler. She had no clue when her last period was, but based on some recent negative pregnancy tests and now positive, I knew she was in early days. I had congratulated her when I entered the room and she welcomed my words with a smile.
“So were you guys trying or was this a surprise?”
I ask pretty much all my patients this, especially at these kind of visits- one we call “confirm pregnancy” appointments. It’s a quick early visit, to establish with our test that a woman is pregnant and to see if they need an early ultrasound. Plus we are able to start some education and answer questions before the typical initial pregnancy appointment at 8-10 weeks. I ask this question because sometimes people come to this visit to discuss options- I’m trying to see if I need to discuss termination or just plow forward with all the excitement of a new pregnancy. I’m also trying to assess her emotional needs- does she have support? What are her worries?
“Oh, it was a surprise!” She said with a laugh.
“So were using any birth control recently then? Pills? Condoms…?” I ask this to help assess her pregnancy dating. Recent pill use can affect timing of ovulation and thus pregnancy due dates.
“No…” A typical answer that always makes me laugh internally. In my world if you’re not contracepting, you are actively trying to get pregnant.
“But you seem happy about things?”
“Oh yes! I’ve always wanted a big family!”
I looked at her, in her twenties now pregnant with her third child. No history of loss. Smiling, happy, accepting and expecting that things of course would work out.
I’ve always wanted a big family. In the beginning of our relationship, Chris and I discussed how many kids we wanted. He wanted two. I wanted five. He came from a family of two kids; I came from a family of five. No wonders there. Because I got married and would be starting a family later in life, I knew that five was unlikely- we sort of agreed on three (though he would sometimes would argue for two still). When Mabel was diagnosed with Down Syndrome, I became firm in my belief I wanted three kids. We needed to ensure she had siblings who would care for her when Chris and I were no longer able to or weren’t around.
I now laugh at myself- even then- at the naivete of those thoughts. As if we have some sort of control of how many kids we get to bring home (I recognize in a way we do- with the medical marvels of birth control and all…). I didn’t realize that when I was wanting three kids I should have been hoping for three living children. Silly me!
I recently posted about grieving parenthood but I’m also grieving the loss of my future family dreams. If I’m lucky enough to get a take home baby- I no there are no guarantees that I’ll be lucky enough to get another. In another world I thought being an only child seemed like a cruel thing. But I wasn’t thinking about the fact that parents might not have had a choice. My childhood was defined by my large family- I want a semblance of that for any future child I might be lucky enough to have. But I feel like asking for more than one living child is greedy. Just give me one, please. In addition to grieving active parenting, I’m grieving parenting a large family- and the innocence in that statement I heard in the office… “I’ve always wanted a big family!”
How have your visions of your future family changed after loss?
I’ve commented on it before but i need to do so again: i am amazed that you are able to care for your patients after what you have been through. (i hope it doesn’t sound too much like a “you’re so strong, i couldn’t do it” comment. It’s meant to be a “your patients are lucky to have you care for them”)
And yes, my family plans have changed since losing Paul. I never imagined having an only child and assumed i would have 2 or 3. Now, with knowing how a healthy pregnancy and newborn doesn’t guarantee anything, and with the the physical and emotional stress of these 2 pregnancies, i think having one child might be all i will be able to manage…
I hope you can have the big family you’ve always wanted if that what you still hope for, even though an important member will always be missing.
FOr now I hope for whatever I can get- a weird hope, yes? but a true hope. and I thank you for your hope.
and I never tire of hearing encouragement or amazement at me simply doing my job. I dont hear it in the day-to-day. I think those around me often take for granted that my baby died and they should simply be amazed I”m back at all (let alone seeing 25 pts a day, listening to complaints and comments that rip my heart a little). So thank you for that acknowledgement.
My husband and I were just talking about this a few weeks ago. It started about when to try for a second, but our terminology was so different from almost three years ago, as we kept in mind your blog, the losses of friends, and the infertility of others. “We *hope* it will happen then.” “Maybe four, if we are lucky.” It delved into conversations about insurance (we have excellent Navy-provided coverage) needs if a child wasn’t healthy. You’re right. Nothing is guaranteed. It’s a sobering thought to remember that we aren’t in control of what our family will look like.
that has been such a huge reality check- realizing we have no control over what our family will look like. We can’t control baby loss. we cant control infertility. We cant control disability. And I used to have such innocence about how big a family I wanted- I thought negotiating with chris and my age would be the only battles. hah!
I always wanted 3 children, ideally 2 boys and then a girl. My partner always wanted just the 2.
When we were blessed with our twin boys he changed his mind since we were having two at once, we might as well go back for one more sometime in the future. And I thought that plan was perfect. I thought I would get my 3. And then we lost our boys right at the end of the pregnancy.
Now I’m pregnant with a little girl and I feel so conflicted about that number I chose so long ago. I have my 3, I got exactly what I wanted – 2 boys and then a girl. But my boys aren’t here, so at the same time I didn’t.
I don’t even know if I want more children after this. 3 was my number. I have my 3, even though I only have 1.
I feel so conflicted about it all!
Thank you for writing this post, it’s brilliant.
what a wonderfully beautiful (and truly sad) thing that you have your 2 boys and a girl. And the emotions that come with it- both having and not having what you have wanted. a weird twist of fate .
I should like to see Kaitlynva’s two cents on this question, since we both lost our marriages at the beginning of our first pregnancies, which ended in baby deaths. I had psychologically prepared myself for becoming a single mom of one (we had nicknamed my daughter ‘Gilmore’- after the TV series ‘Gilmore Girls’ featuring a single urban mom that is best friends with her hip only child teenage daughter). At this point I am totally lost on the “family size” fantasy- back to square one- at 34?
this adds so much more to the thoughts of a future family. When you lose your partner in addition to your child (whether it be loss of a partner during pregnancy or after- as I know grief can tear partners apart sometimes). Adds so much more to the future family image. ugh ugh ugh!
I wanted 3. K wanted 2. We might both get our wish.
right? the numbers game. the numbers dont quite represent in the same way anymore
I hope to have step-grandchildren.
gosh, how the hope changes from “i hope to have XX many of my own children” to what other babies can I love in my life- like step grandchildren. My step-mother-in-law’s daughter just had a baby and she is clearly thrilled. I like to think that she would have been just as thrilled had Mabel lived. I really do think she would. Because step grandbabies can be so loved too. They are not Lily but they can be yours too. I will hope for you too.
I am grieving so many aspects of my (planned) future life. My vision for my family has had to change multiple times, with the deaths of my boys. After Zachary’s death, I no longer have any hope for more (living) children. My three are my three. Two of them dead (I still choke on having to say that), and a living son flanked by dead brothers. It is still extremely difficult to accept, to admit publicly, to string together intelligently for others to absorb.
And, so, so hard to accept the easy, effortless realities of others. I sometimes wonder did we get greedy by wanting C.T. to have a living brother. It took us 5 years to agree to try for a third, after all the grief of having lost B.W.,…. then a miscarriage, then Zachary dead at 2 weeks old.
The innocence lost is tremendously crushing. There was even more innocence to be lost when Zachary died, buried deep in the place where I believed(?), hoped(?), told myself(?) that a once-bereaved mother would certainly not lose another child. I mean, with what probability does that happen? It always makes talking to innocents extremely painful. And it even makes the future (reproductive) hopes and expectations of the once-bereaved so unfathomable and disorienting to me. (I’m sure that’s hard to take in, but it’s the truth.)
I am not quite sure how you smile and congratulate your naïve patients, but I’m glad you are able to unload it a bit, here. I’m sorry it’s not easy and effortless for you too.
right? it feels greedy to want more! It certainly is NOT greedy- I mean look at these people who effortly want (and get) more! We just carry this strange, unreasonable but weirdly necessary guilt that we ask for too much. To get a living child after a loss? shouldnt that be enough? NO. NO WAY. people get kids upon kids after a living child. you deserved to have Zachary come home (and BW for that matter). It’s so wrong that we even have to question if we were greedy to want more!! the non-bereaved dont. the loss of innocence is crushing! (what a great word). THere’s so much loss beyond the loss of our children- sometimes it feels like it will never end.
thank you for your encouragement in dealing with pts. It’s not easy but it’s a whole lot more manageable being able to unload here.
Me too. I have 3 brothers and wanted a big family, while H has one brother and wanted 2 kids. With infertility we knew a big family might not be in the cards. Then I got pregnant with the twins and we felt so lucky. Now we went from having no kids to having 3 in a year, yet only one of them is with us. And we feel incredibly lucky to have this one.
We also have 6 more frozen embryos. And we hope we’ll be lucky enough to get to parent some of them, too. The thought of giving them away is terribly difficult, much more so than when we signed the paperwork. But of course we know that there are no guarantees, in any direction.
going from infertility with no kids to three to one. It’s such a crazy numbers path that so few people could really take in. it just blows my mind!
My husband and I both come from small families and agreed on having a large one (like 5-7 kids–though we always said as many as we could have). Recently, he started saying, “As long as we get to keep one…” and I realise how much more realistic that is now, and how much lonelier than our original plan. We’ll still try for as many as we can, but sometimes I wonder if my visions for the future are just of someone else’s home and not my own.
Also I think it’s funny that YOU think it’s funny that not using contraceptives means trying! 😉 Among most people we know, they are not necessarily “trying” but not necessarily “trying not to” if you get what I mean. So most of us would say we weren’t “trying” but we knew it could happen. That’s what happened with our pregnancies so far.
as long as we get to keep one…. YES! that’s exactly how I feel now! it’s like asking for more feels greedy (like Gretchen mentioned). It is a lonely plan asking for one- and it is dream like- like our whole life- this really happened to us? us? really?
I find it a little funny too about the trying/not trying. When people arrive pregnant and surprised despite not actively contracepting- I have to smirk a little (epseically if they dont want to continue or are very unhappy about continuing). I want to tell them, they had control. By not contracepting, they were making a decision. I have many people in your boat- not preventing, and welcoming if it happens. that’s a different story. The ones who dont want to be pregnant, but find themselves so without any prevention can smart a bit- especially to those who want to badly to be pregnant and temp, pee on sticks, time sex, harvest eggs, etc. the “oops!” ones can smart a bit.
I can’t believe you are able to handle visits like that, discuss options, etc. Recently I’ve been tearing up during even completely unrelated patient visits – discussing the risks of colonoscopy, for example. I truly wouldn’t be able to have a full conversation about another person’s pregnancy, that really does take an incredible amount of strength and grace. I know you’d rather be an average person with your Mabel at home than an “amazing person”, but you really are amazing. We learn and discover so much about ourselves through this – things other people may never have to learn about themselves – and I hope you’re able to give yourself some credit for those beautiful aspects that are shining through.
My plans have changed so dramatically, it is too painful to even think about… I had hoped to be a surrogate, planned for maybe 2-3 kids but hopefully around 6 pregnancies (for friends who are gay). That’s pretty much off the table, and after such a horrifying and traumatic experience of thinking I myself was going to die on the table, only to find out a couple hours later that my son was going to die… Sometimes I don’t even know if I can put myself through another labor & delivery. If I found the right (extremely supportive) person, I might try for one, but I don’t think I’d ever put myself through more than two — try explaining all that on a date, oh man.
I always end up wanting to add something else 🙂 I have a cousin who is an only child. She was delivered prematurely because my aunt had preeclampsia, and she survived after a short NICU stay in the 80s. My aunt and uncle didn’t have any kids after that because it was so scary, and they’ve always felt so lucky to have her. Growing up (in a family of 6 kids), that was one of the saddest things I could imagine – “only” being able to have one child, and having to be around other big families all the time. I was so wrong… That aunt has been one of the slowest and most deliberate to speak, but also the most caring and understanding, throughout this experience.
right? such new perspective only only children. I had never even thought of reasons why before this!
thank you. I dont always feel like that amazing person because even though I smile and give good care, I come home and have these ugly thoughts! I realize there is some credit to merely putting up the face and being a good provider, but in my vision a truly amazing person would be more genuine- the whole idea that I’m not grieving the way I wish I were. I’m really trying to let go of that. writing here helps a lot because I get the validation I dont get at work. I feel like every day my coworkers should be like- you were amazing for simply seeing that pregnant lady. but work gets too busy. maybe they’re thinking it. maybe they forget or are distracted by the crazy schedules and so arent thinking it. maybe it hurts too much to think about how it must be for me. so I thank you for your words- coming from someone who gets it.
and oh what a loss! the loss of all your future pregnancies- the gift you would have given others (on top of the future kids you have lost in a way becasue the future is so uncertain now). it’s a beautiful thing to even consider being a surrogate- the secretary at my chiro office was a surrogate with twins while I was pregnant with mabel. Neither of us came home with babies, but for oh such different reasons. I was so impressed by her. Sometimes when I’m truly daydreaming, I wonder if I could be a surrogate. I did pregnancy well and think I will with any future pregnancies. labored well. I was lucky that I was gifted the body/genetics/circumstance (?) to do so when so many people struggle. I think there is definitely a mindset- being grateful to be still pregnant everyday with Mabel made me poopoo any physical complaints, but I also didnt have to struggle with nausea or vomiting either. In a different world I could surrogate. I LOVED being pregnant. truly loved it. I was sad when labor came on early, for many reasons obviously, but one being I would no longer be pregnant. But I will be selfish now and keep whatever babies I may be lucky enough to gestate. But your dream is truly inspiring.
the dating thing- oh man, yes, I bet! After Mabel died I was talking to a friend who is single and her brother had died. She mentioned how often “tell me about your family” or “do you have siblings?” comes up on a first date, which makes even the most benign seeming small talk so hard. gave me lots of perspective.
I had a lady on my schedule for a fever the other day, but when I looked at her chart it seemed she was breastfeeding and probably had mastitis. I traded patients with someone else, I did not want to go in and talk with someone about her breastfeeding.
I definitely have a baby-making and laboring body, too. I also loved being pregnant and didn’t have any issues, so I was looking forward to doing it again lots of times. Sacha’s head was just too big to come out of anyone’s pelvis, unfortunately my provider didn’t realize that (during the 3 weeks that I was, in retrospect, in obstructed labor, while other OBs and nurses were questioning what was going on and she just kept telling them not to worry about it…). I was on pitocin for 12 hrs with no pain meds, then walked myself to the OR. I was so pissed. I am so pissed!!!
My office is good in the sense they dont book any postpartums with me. but we have such a big staff sometimes new people dont know, or dont realize other non-tradtional or “hidden” postpartums. the ones who come in for a “post op BP check” its not booked as a postpartum, but those are appts for either vaginal births or c/s who need close followup of their BPs. these slip by, and they can be worse! if they bring their baby in, they’re usually a week old. ugh. but luckily I can purely focus on BP and try to ignore the other stuff. or the postpartum IUDs. they are booked simply as IUDs, but are often at 7 or 8 weeks PP and bring their babies. I can sometimes trade, but sometimes there isnt a good opportunity to or I am the only provider. Its very validating to hear you avoid that stuff too. Sometimes the appt is booked per one of the other providers… someone who knows. and that’s where i seem to get the message that I should be seeing these pts no problem. Or if I call the other provider to followup about the pt, they dont mention something like ” oh i’m so sorry I had to book her with you” or “were you ok with that?” and I dont bring it up- so again. I guess this conversation has totally helped pinpoint why I feel ike at work peopel think I”m over it.
having a good pregnancy/laboring body seemingly go to waste just sucks! one of the myriad of secondary losses- but this one is especially dear to me.
I too wanted a large family. I have no idea what is in store for us, but c-sections and potential medical complications do seem to limit things a bit.
aye, c-sections do complicate things more! I hope you get the large family you dreamed of. (and deserve)